Northeast, the city described in the anthrax scenario (Inglesby, this issue, pp. 556-60) is actually Baltimore, a metropolitan area of 2 million population, with a football stadium that holds 74,000. Route 95 would be where the anthrax dispersion took place. This author's test case anthrax scenario started on February 13 at 6 a.m. when he went to the emergency room at Johns Hopkins University Hospital and asked to see the physician in charge. He described the typical case and asked what the procedure would be if a patient came down with these symptoms. The physician in charge had actually taken the specialized 8-hour training course on bioterrorism (one of five physicians in Maryland to have completed this course entitled "Train the Trainer"). Nevertheless, she confessed that the typical early case of inhalation anthrax would have a presumed diagnosis of flu, and the patient would probably be sent home. Despite the emphasis on emergency room physicians as the early response team, the actual diagnosis would be made after hospitalization. Many seriously ill patients arriving at the same time might arouse suspicion, but the initial cases would likely be isolated events or would be dispersed in multiple emergency rooms. The author discovers that when this scenario, which coincides with a flu epidemic, is presented, the hospital cannot handle the stress load of anthrax patients. Also, many of the physicians do not even diagnose anthrax when presented with x-rays and other information. No one on staff seems to know the proper numbers to call for an alert, and the number that is called to alert the state and local area is a recording. That phone call was not returned until three days later. The author discusses these results in terms of what needs to be done to better prepare for an anthrax influx.
Emerging Infectious Diseases, v.5, no.4 (July-August 1999) p. 561-563