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Sick Feeling

The deputy chief yells "Fire!"

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Dominec Serrone was pissed. He'd begun his slow boil a few years earlier, but the Kansas City Fire Department's deputy chief of special operations was still simmering on October 15. That was when he dressed down Missouri congresswoman Karen McCarthy and Kansas congressman Dennis Moore at a bioterrorism confab at KU Med Center.

If a terrorist really wanted to torture Kansas City, this would have been the time to do it. A couple hundred politicians, fire and police chiefs, paramedics, ER workers and public-health bureaucrats all were sitting in an auditorium at 39th and Rainbow. The meeting wasn't public, but it wasn't any big secret, either. Nobody'd had to pass through metal detectors. A bomb in a backpack could have wiped out Kansas City's entire emergency infrastructure -- that is to say, the people who treat the victims.

Serrone decided to torture Moore and McCarthy instead. The two had called the meeting to gauge the metro area's readiness to handle a major attack.

"I don't see either of you writing any of this down, so I'd like you both to get out a pencil and paper," Serrone told the reps. Then he fired off a litany of Kansas City's preparedness woes, all of which came down to a lack of money for planning and training.

The chastised McCarthy assured everyone that her staff had been taking notes; a few questions later, she mimed a big "write this down" to a woman with a notepad standing off to the side.

Serrone has been trying to get the feds to listen since 1997. That was when Kansas City was among 25 cities chosen by the U.S. government to develop responses to biological or chemical attacks. Since then, firefighters from Fort Osage to Leavenworth, cops from Spring Hill to Liberty, ambulance companies, the National Guards of Kansas and Missouri and staffers at 26 hospitals have been figuring out what to do in a worst-case scenario that now could be worse than anyone imagined. The same efforts have been going on in cities like Baltimore, Milwaukee, Dallas and Honolulu.

Long before September 11, 2001 -- and long before Tom Ridge was named head of homeland security -- Serrone and his colleagues from other cities went to Washington, D.C., to ask for a single agency to lead the national effort. The Department of Justice set up the National Disaster Preparedness Office in 1998, but, says Serrone, "I don't really hear from the NDPO anymore." The local agencies kept planning anyway, knowing they already had the basic skills -- they fight germs and pull people out of wreckage every day. But nobody is prepared for thousands of victims at once.

Say, for example, that last month's trifling anthrax had been the thing everyone's most scared of: smallpox. Someone here would have dialed up the Centers for Disease Control in Atlanta. Within twelve hours, a "push package" would have arrived somewhere in town. Each push pack actually is a $3 million cache containing thousands of cases of drugs, chemical antidotes, IV catheters and other supplies. One such package consists of a hundred cargo containers, each weighing fifty tons.

"More or less, the government says, 'We will dump this in your lap under a time of duress'-- and believe me, we'll be under duress if we have to call for that," Serrone complains. Once the shipmment gets here, somebody has to unwrap it. And this is where it starts to get tricky. Simply opening one of the CDC's care packages requires a 5,000-square-foot space -- one preferably climate-controlled and stocked with generators, toilets, portable lighting, food and "adequate numbers of tables and chairs for working and resting personnel."

Then someone -- lots of people, actually, who had better not get stuck in traffic on the way -- must mete out all the little pills in proper doses. Accordingly, each push pack contains "tablet-counting machines, electrical cords and power strips, safety-cap- and cotton-removal devices." It even stocks Zip-Loc bags.

"You can tell the people you have so many drugs available and calm the fear of the masses," Serrone says, "but the logistics are where we're having a snag."

And when it comes to matters of life and death in a crisis, logistics are everything. If a smallpox outbreak quarantines everyone in their homes, Serrone wonders, "who's going to go door-to-door to hand out the drugs?" In an attack during which people have to go somewhere to get their drugs, how will the emergency workers know who has received the meds and who hasn't? "Say the Smith family says, 'We have two mothers-in-law and a father-in-law at home, and we need three more packages,'" says Serrone. "What stops them from going to the next distribution center and getting more drugs? Short of marking people's foreheads with indelible ink, how are we going to know?"

City officials have publicly admitted that they aren't ready to handle a catastrophe. But, they keep saying, they're making progress. Knowing how much is left to be done, though, is about as comforting as knowing your baggage will be screened correctly -- a year from now.

Congress is finally poised to toss out a bone, presumably after having to listen to a Serrone in every city. The U.S. House has assembled a $7 billion Bioterrorism Protection Act, which begins to fund the efforts Serrone's talking about. McCarthy, one of the bill's cosponsors, says it's gaining support; she hopes it will get a hearing after Thanksgiving. On November 15, the Senate made a counteroffer to spend $3 billion on the same effort. McCarthy says that's not nearly enough, but it's a start. "Hopefully what will emerge is a consensus that both houses and both sides of the aisle can agree to," she says.

Apparently, McCarthy's aide really was writing things down on October 15. "Domenic was very good at identifying those needs," McCarthy says, "and I took them back to the task force that created this BioPAct bill. I went over those high points, and everybody nodded, and I believe we addressed them all in the bill."

But Serrone is still as frustrated as he was a month ago. Seven billion bucks to protect the entire, wide-open country? Just for a little perspective, that's less than the U.S. spends on four B-2 bombers. Serrone doesn't know how much money it would take to prepare for the worst, but $7 billion makes him laugh -- sort of. He thinks everyone should start yelling before there's really something to cry about.

"Elected officials need to hear from the public," he says. "We can get enough money if everyone starts screaming."

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