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INTRODUCTION
The importance and the challenge of being prepared to respond to terrorist attacks within the United States have been repeatedly reinforced. The release of the Report of the 9/11 Commission provided a graphic and compelling statement of the exposure of Americans to the dangers of such attacks, the distance that we traveled since September 11, and the gap that remained.
More than 5,000 persons came into New Jersey after the attack on the World Trade Center. There were 60 New Jersey hospitals involved in the treatment of 1,019 patients from the World Trade Center catastrophe. Even those facilities that received no casualties provided support with offers of volunteers, supplies, blood, and medications. All New Jersey hospitals were placed on full alert and postponed elective surgeries.
State emergency officials determined that about 1,500 victims and refugees were ferried across New York Harbor for triage at Liberty State Park. A majority of those patients were treated at the scene and released; others were transported to hospitals for additional care. About three miles north on the Hudson River waterfront, a second triage area was set up in Hoboken. Roughly 3,500 victims and refugees from lower Manhattan were evaluated at that site, with 195 of them transported to nearby hospitals. The bulk of the injuries were respiratory problems caused by the thick smoke and debris permeating the disaster area and burns, chest pains and injuries sustained in the escape from the scene. A few hospitals reported more seriously injured patients.
The spectre of bioterrorism surfaced the next month. Envelopes containing anthrax were processed at a postal facility in Hamilton, New Jersey on September 18, 2001. In October victims of anthrax exposure were identified in several locations around the country. When cutaneous anthrax was confirmed in a Trenton postal worker, the facility was closed and underwent decontamination. An investigation in New Jersey was also initiated to determine the extent of the anthrax outbreak in the state, assess potential sources of the anthrax exposure, and prevent additional cases by developing and implementing control measures. 2
Committed physicians, nurses, paramedics, emergency medical technicians, social workers and other health care professionals responded, many spontaneously, and showed how well the state could cope in the face of a previously inconceivable attack on our nation. But potential shortfalls were also evident.
Overview of Governmental Actions since September 11
In response to the events of September 11, 2001, the State of New Jersey acted to improve the capability to respond to potential bioterrorism acts. On October 4, 2001, the New Jersey Domestic Security Preparedness Act was signed into law.3 This act created the New Jersey Domestic Security Preparedness Task Force, which was given responsibility for preserving, protecting, and maintaining the domestic security of the state and for developing, implementing and managing comprehensive responses to possible terrorist attacks or other technological disasters. There are two major subgroups of the Task Force to assist it in fulfilling its responsibilities: the Infrastructure Advisory Committee and the Domestic Security Preparedness Planning Group.
The members of the Planning Group include the Commissioner of the Department Health and Senior Services (DHSS) or his designee, the State Medical Examiner, and a representative of the University of Medicine and Dentistry of New Jersey. Its duties include the identification and assessment of potential risks to “the delivery and availability of essential health care services, and the potential impact of terroristic chemical, biological and nuclear attacks or sabotage.” 4
In November 2001, then Governor-elect McGreevey directed the establishment of a multidisciplinary panel of health care experts known as the Medical Emergency and Disaster Prevention and Response Expert Panel (MEDPREP).5 Chaired by the Commissioner of DHSS, MEDPREP issued the Terrorism and Public Health Emergency Preparedness and Response Plan in October 2002.6 This plan was intended to help aid state, county, and local public health agencies, hospitals, and other health care providers prepare for and respond to acts of chemical, biological, radiological, nuclear, or explosive/incendiary terrorism.
Based on a recommendation in the Preparedness and Response Plan, DHSS created a Rapid Response On Call Team made up of infectious disease physicians from around the State. This On Call Team was to assist in the rapid diagnosis of illness that may be associated with acts of terrorism. DHSS also developed a Smallpox Preparedness Vaccination Plan that addressed preparedness for, and response to, an outbreak of smallpox. It included a monitoring and surveillance system for adverse events following vaccination. From January 2003 to July 2003, nearly 700 volunteers were vaccinated at 23 clinics around the State. While there were nine reports of vaccination-related adverse events, there were no hospitalizations. None of the adverse events was considered life threatening.7
In 2003, New Jersey developed a plan to obtain medications and ancillary medical supplies from the Strategic National Stockpile (SNS). Originally known as the National Pharmaceutical Stockpile Program, the SNS was created in 1999. Its mission is to provide large quantities of essential medical items in a timely fashion to states and communities during an emergency. DHSS has also developed a plan to make potassium iodide available to persons living, working, or attending school within a 10-mile zone of the nuclear generating stations in New Jersey. If taken in a timely manner, potassium iodide blocks uptake by the thyroid gland of radioactive iodine during an uncontrolled release of radioactive material from a nuclear power plant.8
There have also been improvements in the response infrastructure by enhancing communications capabilities. New Jersey became the first state in the country to implement a radio communications network connecting all acute care hospitals, the Level I trauma centers, Mobile Intensive Care Unit dispatch centers, and other operational and command centers. Future plans include expansion of the system to neighboring states.9
These steps were taken under the auspices of the Domestic Security Preparedness Task Force. In September 2005, the New Jersey Emergency Health Powers Act (NJEHPA) became law.10 This legislation expanded the responsibility and authority of the Commissioner of DHSS for the development of a public health emergency response plan because of the Commissioner’s more focused expertise with respect to health-related emergencies. Nonetheless, the Commissioner works with and consults with other agencies in addressing potential terrorist-related scenarios in the plan. |
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