Ambulatory Care Quarterly: Learn how bioterrorism bill will affect your facility

National surveillance network to be established

If you’re like most health care managers, you’re eager to find out how the newly enacted Public Health Security and Bioterrorism Response Act will impact your facility. Most experts agree that the new law will result in better preparedness.

"Legislation that encompasses the entire health care system, with public health as the foundation, is a welcome event," says Ann Stangby, RN, CEM, emergency response planner for San Francisco General Hospital. Stangby adds that the resources allocated will benefit your emergency department (ED) operations in general, not just in terms of preparation for terrorism. "It looks like much of what is being recommended is going to enhance the health care system overall," she says.

Here are key components of the legislation, along with reactions from experts in ED management and disaster planning:

A national bioterrorism surveillance network will be established. The newly created Emergency Public Information and Communications Advisory Committee will track outbreaks of infectious diseases. Stangby says this early warning system will benefit you not just in cases of terrorism but also during disease outbreaks, such as her ED’s annual struggles to meet the demands of the flu season.

Training will be provided. ED physicians and other health care providers will be trained to recognize and treat victims of biologic agents and other weapons of mass destruction. However, she says a key concern is lack of standardized training for all health care providers, including those in large and small hospitals, rural health centers, freestanding clinics, and urgent care sites. "I think there needs to be one approved curriculum for health care providers. It can be customized, but the basic content should be consistent," Stangby adds.

Standardized disaster training should be in the curriculum for students in medicine, nursing, pharmacy, and respiratory care, she says, and refresher training should be given periodically. "Providing certification is an excellent foundation, as it will help to maintain competencies," she says.

Funding will be allocated. The legislation allocates $1.6 billion in grants to states for hospital preparedness. "It’s certain that this will translate into a large amount of funds for ED preparedness," predicts Rich Klasco, MD, chief medical officer for Micromedex in Greenwood Village, CO, and an ED physician at Swedish Medical Center in Englewood, CO. Micromedex is a provider of databases and integrated support tools covering information on drugs, diseases, patient education, toxicology, alternative medicine, and regulatory matters.

Klasco argues that you should take a proactive stance regarding funding. "Instead of just waiting to see what comes to you from the federal government, have a plan in your mind for what constitutes bioterrorism preparedness in your setting." He recommends going to hospital administrators armed with a list of needed resources. "Everyone is waiting to be handed their tool kit,’ so to speak. We all need to make some decisions about our needs," he says.

Betty Karas Bartolini, RN, emergency preparedness coordinator at Waterbury (CT) Hospital, takes that philosophy a step further, recommending that you meet with local or national politicians to lobby for your ED’s needs. She reports that representatives from her hospital recently met with Sen. Joseph Lieberman (D-CT) to discuss the bioterrorism law. "We expressed that we would like to see ongoing training available to staff members in the ED, and a disaster medical assistance team available to respond quickly in the event of a hazard," she says.

Klasco underscores the need to use hand-held computers to put information into the hands of first responders. "It’s necessary to have the full spectrum of information technology available, because we don’t know where the target is going to be in our information chain," he argues.

Bartolini says funding is needed to improve the ability of EDs to decontaminate patients. "We see many patients leaving the scene of a potential hazardous materials incident and making their way to the ED before they are decontaminated," she says.

[For more information about the implications of the bioterrorism law, contact:

  • Betty Karas Bartolini, RN, Department of Surgery, Waterbury Hospital, 64 Robbins St., Waterbury, CT 06721. Telephone: (203) 573-7577. Fax: (203) 573-6073. E-mail:
  • Rich Klasco, MD, Chief Medical Officer, Micromedex, 6200 S. Syracuse Way, Suite 300, Greenwood Village, CO 80111. Telephone: (303) 486-6645. Fax: (303) 486-6464. E-mail:
  • Ann Stangby, RN, CEM, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110. Telephone: (415) 206-3397. Fax: (415) 206-4411. E-mail:]