By Alex Schmidt
Since the terrorist attack of 9/11, the Community Health Care Association of New York State and the city’s Department of Health and Mental Hygiene have been training doctors and nurses at community health centers in emergency preparedness — on how to deal with people streaming into clinics with all manner of wounds and injuries from bomb blasts, anthrax attacks and other possible dire events.
The next community center in line for a training session is the Charles B. Wang Community Health Center on Canal St. in Chinatown. But this time the emergency they’ll be preparing for isn’t terrorism, but a natural threat: a potential avian flu pandemic.
At a tabletop conference this Thursday, representatives from CHCANYS and the Department of Health will work with Charles B. Wang healthcare providers in a role-playing exercise that will attempt to identify and fill gaps in the center’s knowledge of avian flu before an emergency situation occurs.
Mock patients will walk in presenting flulike symptoms. The facilitators will keep the health providers on their toes by throwing in other possible conditions such as, for example, a flood, chemical leak or a car crashing into the building. The facilitators could not reveal the details of the scenario of this Thursday’s tabletop session, since the goal is to present the medical personnel with a surprise scenario and see how they react.
Some of the potential pitfalls that such tabletop sessions attempt to address include language barriers, communication with outside organizations, such as media outlets, major hospitals and federal organizations, and triage practices for large numbers of patients.
Alyssa Scala, hospital-preparedness trainer for D.O.H.M.H. and one of the session’s moderators, emphasized that there is no “pass-fail” grade at the tabletop conferences. “We’re just encouraging people to be as flexible in their planning as possible,” she said.
Scala and the other moderators — Dr. Jonathan Weinstein, the emergency preparedness clinical director for CHCANYS, and Dr. Elsie Lee, the Department of Health’s medical epidemiologist — said that they chose the avian flu emergency because it is a “hot issue” that has received a significant amount of press, and that community members may want to know more.
Avian flu originated in Asia and has spread as far west as Germany, but so far no incidents have been identified in the Americas. In terms of how great the risk of the disease spreading to New York actually is, Scala said, “We can’t quantify that.” But Dr. Thomas Tsang, medical director at Charles B. Wang, said that assuming the disease would not spread to the U.S. would be a dangerous prospect. “If it does come, we need to be prepared,” he said. Additionally, the measures necessary to prepare for an avian flu pandemic — a “worst-case scenario” — cover standard flu preparedness and preparedness for other illnesses as well. Dr. Lee reminded that the most important measures for preventing spread of disease start with patients. “Cover your cough and hand hygiene,” she told the participants.
The symptoms of avian flu — high fever, body aches — are similar to those of standard flu, but are more severe, and the disease is diagnosed with a blood test. Different from the standard flu is the fact that, at this moment, avian flu is not transmitted from human to human but rather only from bird to human. Dr. Lee emphasized, however, that “Avian flu is a new thing, and as people get infected we learn more.”
One of the things that city and state emergency preparedness programs have learned since 9/11 is the important role that community centers like Charles B. Wang play in the health of populations on a local level. These centers act as safety nets for largely uninsured immigrant groups that historically do not use traditional media outlets and who are often distrustful of healthcare systems at which their languages are not spoken. As Dr. Tsang put it, “In addition to being providers, we are educators too.”
In the event of an emergency, the Charles B. Wang Community Health Center would work not only to provide healthcare, but to transmit information to Chinese-language radio stations, social organizations and local churches on where to seek help and for what symptoms. This was the role the center played when anxiety about the SARS epidemic flared in Chinatown three years ago, while also acting as the official Chinese translator for the Health Department.
Focusing their efforts on centers like Charles B. Wang, which Dr. Weinstein called “a pillar of the community,” rather than only on hospitals, is a powerful tactic for bringing the best emergency care to local populations as quickly as possible.
But the tabletop scenario sessions at local health clinics are only one aspect of the larger emergency preparedness that the city and state have undertaken in recent years. Dr. Weinstein says things have improved vastly, citing the difference in preparedness between “Anthrax 2001 and Anthrax 2006.”
In 2001, an unidentified person or persons mailed anthrax powder to U.S. senators and some news organizations, resulting in 22 infections and five deaths. The sender was never caught. More recently, last month, Vado Diomande, an African drummer and dancer who lives in the West Village, was stricken with natural inhalation anthrax he contracted from raw goatskins he used to make drums. He’s still recovering in a Pennsylvania hospital, though his condition recently worsened. Hazmat teams sprung into action to check Diomande’s Downing St. apartment, the Brooklyn warehouse where he worked and some other locations.
“We’re a lot more prepared even than we as healthcare providers think we are,” Scala added. “When we get in a situation, we’re like, ‘Wow, we can handle this, because we’ve seen it before.’” And that, of course, is exactly the point of the tabletop exercises.
