Emergency rooms unprepared for bio-attacks.

Of all the safety nets designed to cope with a biological attack in U.S. cities, emergency rooms are among the least prepared, lacking diagnostic tools and trained personnel, experts told a Senate panel.

"Emergency rooms are overcrowded, understaffed and have almost no surge capacity to handle a mass casualties," Harvey Meislin, head of the University of Arizona's Department of Medicine, told the Senate's subcommittee on terrorism, technology and homeland security.

Among the technologies that would help fill the gaps is a diagnostic tool that would identify exposure to a biological agent definitively, with a simple blood test, researchers and proponents said. Armed with such a device, emergency room personnel could identify those infected from the "walking worried" and alert higher authorities to the presence of a natural or manmade outbreak.

Current pathogen identification tests require growing cultures or testing against antibodies, which take 24 to 48 hours.

The equipment proposed by the Arizona researchers would use the reactions of individual genes to biological agents to identify them, giving an ER doctor or nurse the power to make conclusive diagnoses in five minutes. The technology, however, still remains several years away.

"The problem is getting the device to a level of sensitivity and specificity," Meislin said.

Sen. Jon Kyl and Rep. J.D. Hayworth, both Arizona Republicans, requested $25 million for medical research for biological preparedness as part of the Department of Defense appropriations. "Rather than attempting, at great cost, to set up sensors across the nation," said Kyl, who chairs the subcommittee, this project "would quickly determine whether symptoms of patients presenting themselves to emergency rooms were the result of normal diseases or biological agents."

However, other politicians expressed skepticism about the technology. "I don't understand how a clinical response is very helpful. By then, it's too late," said Sen. Diane Feinstein, D-Calif.

The experts were quick to say the hypothetical diagnostic tool would be best used in conjunction with point detectors.

"These are not mutually exclusive," said Paul Keim, director of pathogen genomics at TGen Inc. and forensics expert who analyzed DNA evidence from the 2001 anthrax attack on the Senate. "How much coverage do you want, and how much do you want to pay for it?"

Keim pointed out that emergency rooms are the catch-all for the sick, making them a logical place to screen for agents. Furthermore, diagnostic tools would be used daily to treat patients, reducing strains on limited emergency care resources.