Mr. HORN. Thank you. I particularly appreciate that formula situation. We now have Dr. Ian David Jones, Vanderbilt University Medical Center. Dr. JONES. Mr. Chairman, members of the subcommittee. I would like to give you a flavor of how these issues are being addressed at our hospital and on a local level. And to do that, I will divide my testimony into three parts. I want to talk about a situation we faced 6 months ago, the present situation and a description of the Vanderbilt bioterrorism subplan. And I would also like to identify some problems that I have identified within our current system. Our lack of preparedness to deal with a bioterrorist attack was made very clear on the morning of October 4, 2001 when an individual who was initially described to us as a terrorist slit the throat of a Greyhound bus driver near Manchester, TN. The bus ran off the road, flipped, there were a number of patients who were killed, a number of patients were brought back to Vanderbilt via Lifeflight. While the helicopter was en route to Vanderbilt with these injured patients, we received further information from what at the time we thought was a credible source that these patients had been contaminated with a biological agent. Nothing that we had experienced up to that point had prepared us to deal with the threat and many of the staff frankly in the ER were very frightened. On the very same day, the first case of inhalational anthrax was described by the CDC in Florida. As further cases of anthrax were reported in other cities, it became clear that the institution was not prepared to handle the large number of patients who might present in the event of a bioterrorist attack. As a result, at Vanderbilt, a committee was formed to draft a subplan to our Hospital Disaster Plan, which dealt exclusively with bioterrorism. The goals of this plan were twofold. We wanted to expedite the rapid evaluation and treatment of a large number of individuals who may have been exposed to biological agents and our goal was arbitrarily 1500 patients per day. And the other part of our goal was to educate patients, families and staff about biological agents, their risks of exposure and the potential signs and symptoms connected to that exposure. As a part of the plan, Vanderbilt created a hospital pharmaceutical stockpile at considerable expense to the hospital, that was coordinated and dispensed by our hospital pharmacist. We assembled first-line antibiotics enough to treat 5,000 people for 3 days in the event of an exposure. We assembled stock preparations which were available on an immediate pre-mixing dosage appropriate for children and we increased our hospital supply of antidotes, IV antibiotics and IV fluids. In addition, Vanderbilt has constructed a mass decontamination facility which is immediately adjacent to our emergency room. This was actually the first mass decontamination facility in the region and it was constructed about a year before the events of September 11th. Subsequently, our Veterans Administration Hospital has actually used our plans to construct an identical facility on their cam Our Environmental Health and Safety Office here is also providing ongoing training for emergency room nurses, physicians and other staff and the appropriate methods for decontamination in the event of a nuclear, biological or chemical event. We have concentrated heavily on education here at Vanderbilt. There are a number of our staff members who were very concerned and frightened obviously when all this occurred, so as a result, our Learning Center developed both videotape and written materials on nuclear, biological and chemical agents that have been taught to over 5,000 Vanderbilt staff members. In addition, all staff members who participate in our bioterrorism drill at Vanderbilt have received advanced training on agents of bioterrorism and critical stress debriefing techniques. In the past 2 years at Vanderbilt, we have participated in five separate drills that have dealt with either biological or chemical agents. Most recently, in January of this year, we had an internal drill involving 165 people who were simulated to have been exposed to anthrax at Nashville Predators hockey game. We have also participated locally, the city's 10 major hospitals have been coordinating disaster management efforts for over 15 years. As Mr. Thacker has told us, this is administered by the Office of Emergency Management and supplemented by our MMRS grant which is an integrated program between EMS, police, hospitals and the Nashville Health Department. This has given us resources for training and implementation at the EMS level as well as hospital resources for PPES, decontamination equipment and antibiotics. I will tell you from what we have received, it is not enough. My testimony will conclude actually with identifying problems that I see within our current system. The No. 1 problem that I see we are facing today is emergency department over-crowding. There are times when our emergency department has 15 or 20 patients waiting in our waiting room and it is absolutely filled to capacity. The reasons for this are multi-factorial. We are serving as a safety net for uninsured patients in Tennessee without doctors; we are serving as a primary care resource because we do not have adequate primary care resources within the public healthcare system; there is an older, sicker population as the baby boomer generation ages and there is generally a breakdown in the mental healthcare system. We also see a number of patients coming in requesting alcohol and drug rehabilitation. Services that we are not used to providing in emergency rooms we are being forced to provide. We have a huge problem with citywide surge capacity. Right now, as Dr. Schaffner mentioned, a minor epidemic such as the flu that we have had this month has closed a number of hospitals in town. It does not take a lot of imagination to understand what might happen if 1,000 critically ill patients requiring ICU care were dumped on the system at the same, as might happen in a bioterrorism event. We also need to improve our regional communications. This broke down during the Greyhound bus event and we did not know what was going on. We have a number of EMS services with their own communication systems but there is no coordination in the State for that. We need to upgrade our laboratory facilities, as Dr. Craig_has spoken about, and frankly our level of rural preparedness in Tennessee is still very low. It is not possible for the smaller hospitals to do what we have been able to do at Vanderbilt, because they do not have the expertise and they do not have the funding. This has cost Vanderbilt several hundred thousand dollars to put together and it is impossible for smaller hospitals to do that. I appreciate the time you have given me this morning. Thank you very much. [The prepared statement of Dr. Jones follows:] Bioterrorism The Current State of Preparedness at Vanderbilt University Medical Center Ian D. Jones MD Operations Director Vanderbilt Emergency Dept. Assistant Medical Director Metro Nashville EMS Ian David Jones, M.D. Vanderbilt University Prepared Remarks Introduction Early on the morning of October 4, 2001, a Greyhound bus crashed on the interstate east of Nashville. Initial reports indicated that the perpetrator was an Arabic male, possibly a terrorist, who had slit the throat of the driver. A number of patients were known to be dead. As Vanderbilt's helicopter service, Lifeflight, was en route with patients from the scene back to Vanderbilt, it was reported that the incoming patients may have been contaminated with a biological agent. The fear amongst the staff in the ER that morning was palpable. On the very same day, the CDC reported a case of inhalational Anthrax in Florida that was quickly determined to be from an act of Bioterrorism. In the ensuing weeks as the epidemic grew, it became clear how unprepared the hospital had been to deal with a large scale bioterrorism event both with regard to the very large numbers of patients presenting for evaluation and treatment of possible anthrax exposure. Based on the concerns, a subcommittee of the hospital disaster committee was formed to draft a plan aimed at dealing with the unique situation of large numbers of well individuals with the possibility of an exposure to a potentially life-threatening infectious agent. This plan would serve to activate the main hospital disaster plan thus preparing the hospital for the potential influx of critically ill patients as well as to create an site, adjacent to the main hospital, where a large number of individuals who may have been exposed to a biological agent could be evaluated, educated, and treated. The Vanderbilt University Medical Center Bioterrorism Sub plan Goals To expedite the evaluation of a large (1000 per day) number of individuals who may have been exposed to a biological agent - To screen for patients manifesting symptoms of a biological exposure |