Topeka ? Long before Sept. 11, 2001, the threat of bioterrorism existed in the United States. But before the attacks on the World Trade Center and the Pentagon, an attack on the public’s health wasn’t on most folks’ radar.

That is changing. While the system in Kansas is far from perfect, officials from public health agencies, hospitals and first responders — the people who would be marshaled to respond to an outbreak of smallpox, plague or any other nasty organism — are at least beyond the point of introductions and exchanging business cards.

The trick now is making their individual bioterrorism plans fit cohesively.

Training

Kansas is in the throes of six regional exercises dubbed Oktoberfest 2003, which tests the communication and compatibility of existing bioterrorism response plans. Hospitals, which often have been excluded from such plans, are a key player in the exercise.

Each exercise covers two days, with the first day devoted to sharing information.

On day two, the players — often several hundred people, as in a recent Topeka exercise — work through a bioterrorism “event” in a large conference room. For security reasons — and to avoid tipping off participants of future exercises — the scenarios aren’t being publicized.

Salina and Topeka had exercises last week, with “events” scheduled this week in Hays and Garden City and next week in Wichita and Parsons.

“The whole purpose of what we are doing today is ensuring the safety of Kansans,” said Kansas Department of Health and Environment spokesman Mike Heideman, “so that all agencies are prepared to work together to protect Kansans no matter where they are.”

Shifting priorities

One of the first documented incidents of bioterrorism in the United States occurred in the 1980s in Oregon, when members of a religious sect cultivated salmonella and infected hundreds of residents by spraying the disease on salad bars. The goal was to disrupt local elections by affecting voter turnout.

In the past two years, Kansas has made large strides in overall preparedness for bioterrorism incidents, said Mindee Reece, KDHE’s bioterrorism program director.

Those strides include interagency collaboration and development of bioterrorism plans in all 105 counties. The more the plans are tested and revised, Reece said, the stronger they are.

Cindy Samuelson, with the Kansas Hospital Assn., said in some cases hospitals and local agencies were discussing common issues for the first time.

“There’s overlap (of duties) and they’re finding out who’s better to do that job,” Samuelson said. “It should make the public feel good that people are talking.”

Cooperation

Charlie Grimwood, vice president of regional development at Salina Regional Health Center, said hospitals were required to test their capabilities to handle any disaster as part of annual accreditation.

“Too often, that planning is done in isolation without coordination,” Grimwood said. “This is a great opportunity to test our capability to work together.”

Dr. Gianfranco Pezzino, state epidemiologist, added that along with planning, medical surveillance is paying off through the state’s Public Health Information Exchange, or PHIX. The secure network has more than 400 participating health officials and agencies, which provides near real-time exchange of health information.

Grants available to hospitals have put them ahead on preparedness, Samuelson said, and the regional approach Kansas is taking helps foster coordination. Lessons learned from Oktoberfest will be applied to a statewide exercise in spring 2004.

Reece said more than half of the bioterrorism funding received from the federal government has been passed on to local agencies, including a $12 million grant this year. Agencies then use the money for big ticket items that they wouldn’t otherwise be able to afford.

“We’re trying to be very smart and judicious in how we spend the money,” Reece said. “We’re trying to set up a core infrastructure that’s been lacking in our state and nationwide.”

The goal is to create a system that’s sustainable should federal funds be reduced. Later this fall, a special legislative committee will conduct hearings to determine whether the grants are buying essential equipment and not padding payrolls.

Gary Middleton, emergency management director in Shawnee County, said most local resources would be strained in any bioterrorism event, making it good to know what neighboring agencies can bring to the fight.

“We don’t often have the time to work with neighboring counties and state agencies in the same room,” Middleton said, calling Oktoberfest unique.

Rick Sable, agent with the Kansas Bureau of Investigation, said events like Oktoberfest 2003 were valuable for law enforcement.

“This isn’t a waste of time. Because every one of these training exercises you get a little more acclimated to when you step into the batter’s box,” Sable said.