Disaster preparedness and the risky future. (Learning from Experience).

As we have been harshly reminded, it is part of our jobs as environmental health professionals to be prepared for any attacks that might put American citizens' health and safety at risk. We are not living in a safe world anymore, and, needless to say, our national security more than ever needs continuous attention. The timing of this column, one year and one month after the attacks on the World Trade Center and the Pentagon, is appropriate, given public confusion, fear, and uncertainty about the safety of living and work arrangements.

The Message Is Safety at Any Price

NEHA, at its 66th Annual Educational Conference in Minneapolis last June, addressed the threat of bioterrorism and possible unpleasant outcomes. It was noted that "Terrorist experts fear the probability of a surprise biological attack on any city is higher today than ever before." Biological invasion in the form of a nerve gas attack similar to the one that happened on the Tokyo subway, anthrax, smallpox, plague, and the like are on the weapons list of terrorists. The national-security message that environmental health ambassadors have taken with them to their local communities will, it is hoped, provide a ground for useful planning and precautionary measurements. In cooperation with other health professionals, public- and environmental health officials have the opportunity as well as the duty to mobilize themselves to the level of alertness and vigilance associated with necessary education and training. Doing so will increase our ability to minimize public fear and maximize public trust. Americans have an un derstanding that public-health services are a social obligation that embraces us all.

The Mission of Environmental Health Professionals

For many decades, since the genesis of public-health services, those who have dealt with public- and environmental health and safety have demonstrated an ability to ensure that our water, food, air, land, sea, and other vital living circumstances are hazard-free and conducive to the continuity of life. This challenge has been going on for decades with continuous progress enriched with scientific advances and technical development.

As we bid farewell to the twentieth century and celebrate the beginning of a new millennium--with the media pronouncing, "Move forward and be happy"--we must be reminded that the tranquility we experienced when the milkman stopped at our door at dawn is not here any more. Now more than ever, we need to protect ourselves and our freedom by being more vigilant and watchful so that we can survive and continue to raise our children in a safe society Our food and water supplies need to be protected from bioterrorism. This need is an extremely serious one since any attack on us is likely to be a matter of mass destruction. Previous tragedies here in the United States and around the world have made it clear that no time can be wasted in cracking down on any bioterrorism activity. In cooperation with other health professionals, environmental health practitioners must be organized and establish a campaign against biological and biochemical invasion. We need to start planning strategies and guidelines on how to approac h and respond immediately. Health departments should look seriously at this issue and provide training so that all environmental health specialists have the opportunity to receive adequate knowledge about terrorism and its consequences.

Emergency Response Management

Environmental health professionals should closely cooperate with the emergency response management (ERM) personnel of their organization or in their local communities. The timing is right for those public-health agencies with no ERM division to establish one and seek assistance from the Homeland Security Department. I have learned from my past experience working for a county health department that associating with the ERM division has a great impact on anyone responding at the time of a disaster. The combination of environmental health knowledge and the expertise of ERM professionals will expedite the delivery of response and your usefulness to victims.

A decade ago, you could hardly find any detailed literature on bioterrorism in scientific journals, on the Internet, or in daily newspapers. Today we can find many resources, including Web sites that profile information on the new threats, known as "biological attacks," to our health, safety and freedom.

Special Assignment

Along with performing our daily routine and regular duties, we environmental health professionals ought to be wholeheartedly willing to protect our homeland according to our expertise and the services we provide. Many bioterrorism experts agree that public- and environmental health officials should act immediately and provide comprehensive planning for disaster preparedness, with which to confront the aftermath of a variety of biological attacks.

If environmental health professionals are to collaborate effectively with other health care professionals, each organization should have adequate practice in the following activities:

* CPR. First things first. Environmental health professionals need to have basic training in cardiopulmonary resuscitation (CPR). The Red Cross is a good organization for training civil-service individuals and the public.

* Being watchful. We need to watch over two most important resources: food and water supplies. These are the most vulnerable targets for bioterrorism. This warning is not guesswork; terrorists already have threatened us on this subject.

* Be vigilant. While on duty, whether inspecting water supply or food supply in a public or private facility or a school, we need to be extremely cautious for abnormalities and report any found to the appropriate authorities immediately.

* Educate yourself about bioterrorism. Besides consulting the information available in articles and presentations on the NEHA Web site, you may wish to check the Newscientist home page at <http://www.newscientist.com> and look for several reports on bioterrorism.

* Do not exclude domestic terrorists from your list. Any individual or group who for some reason does not approve of the government or has animosity toward governing criteria may turn on American life. The bombing of an Oklahoma City government building should have given us a good wakeup call, but apparently it didn't. We did not adequately increase our security in sensitive buildings, or in airports, nor were we watchful for deadly conspiracies. Still, Timothy McVey's disaster did prove to many Americans that terrorism does not only come from outside America. The anthrax mailer, the mailbox bomber, and other such idiots can be found anywhere.

* Take special courses on risk assessment. This is a broad yet important subject on which every health professional should have some knowledge. In short, I should point out that a variety of uncertainties are in the way of assessing the risk of disasters, especially pertaining to some catastrophic accidents whose like may never have happened. In a publication titled Improving Risk Communication, the National Research Council makes the following statement about assessing the probability of catastrophic accidents:

Risk analysts sometimes address this problem with "fault free" analysis, a technique that uses experience to estimate the probabilities of various events that might contribute to a disaster and then combines the probabilities to estimate the likelihood that enough contributing factors will occur at once to trigger the disaster.

Until now, this kind of analysis is usually used in the nuclear-power industries.

Unfortunately, in our risky future, we as environmental health professionals should include "disaster preparedness" in our agenda if we haven't yet done so and should offer lectures in local communities, particularly in school environments. Students nationwide need to learn how to be vigilant, alert, and able to cope with any attack. Looking at things optimistically, as we have always done in this open society, we may not experience a biological attack or anything again like the events of September 11, 2001. Still, we can't afford to be optimistic all of the time since there is evidence that the enemy is at large and wishes to jeopardize our health, safety, and peace of mind.

Dr Leo F. Parvis researched environmental health science as a graduate student in the Mediterranean region for three years in the late 1980s. In 1998, he received a Ph.D. in health services with specialization in public health from Walden University in Minneapolis, Minnesota. Dr. Parvis has spent many years working in both the public and the private sectors on issues related to environmental health and education research. Currently, he is writing a book for parents--and professionals who work with parents--about protecting children from environmental health problems. He contributes material for the "Learning from Experience" column in every other issue of the Journal. Questions and/or comments for Dr. Parvis can be sent to <[e-mail]>.