When it comes to an emergency response to a bioterrorism attack, San Diego is doing its part to be prepared.
On the county level, there have been 10 bioterrorism exercises during the past year. Marisa Balmer, emergency services coordinator for the County of San Diego Office of Emergency Services, said exercises range from full-scale action to table-top exercises.
On the city level, San Diego practices its response plans on a regular basis, said Alex Roth, spokesman for the mayor.
In a terrorist attack, the FBI would take the lead and notify public agencies in the region.
A health alert would be given to hospitals and public health officials indicating the nature of the attack, and would initiate an appropriate response.
"For populations potentially exposed, the best treatment is prophylaxis," Balmer said.
Medical professionals would establish points of dispensing to administer medication or vaccines to affected populations to treat or mitigate the effects of the attack.
In 2007, the region conducted a full-scale bioterrorism exercise that included a field component to activate points of dispensing.
Balmer could not provide specific numbers, but estimated that the number of cities able to support a point of dispensing has tripled since the 2007 exercise.
Local hospitals have plans for emergency situations including a bioterrorism attack. Scripps Health, for example, participates in drills at least every six months, said Patricia Skolund, administrative director of emergency preparedness for Scripps.
"In addition, we offer and participate in numerous ongoing table-top exercises, communication drills, training courses and skills training on equipment," she said in an e-mail response.
The hospitals will activate their Hospital Incident Command Structure when alerted of an attack. Skolund said the incident commander and staff would determine the necessary level of response to a particular incident.
"A mass casualty event would most likely trigger a Code Triage to be called," she said. "Hospitals would lock down their facilities and closely control access in and out of the facility.
"Depending on the event, treatment caches would be mobilized to predetermined triage and treatment areas. If contaminated patients are expected, the decontamination teams would be paged/activated."
With a large number of incoming patients, staff will take stock of the available beds inside the hospital and discharge patients who could leave to free up additional beds, she said. When needed, alternate care areas could be established.
Depending on the target of a bioterrorism attack, the scope of affected people and need for a reaction, among other variables, local military commands could be asked to help.
Naval Medical Center San Diego has three required drills each year to prepare for a disaster response situation. When appropriate, they would step in to help with civilian response to a crisis situation, said public affairs officer Sonja Hanson.
Similarly, if the attack were centered on military bases and personnel, Navy personnel would take the lead for the medical response, relying on civilian counterparts when necessary.
NMCSD's next disaster preparedness drill will be Nov. 10, when they practice responding to a mass casualty situation. Depending on the nature of a bioterrorism attack, mass casualties could be a part of the situation.
But beyond drills, first responders, emergency medical personnel and government agencies in the San Diego area have real-life experience to rely on in the event of a bioterrorism situation.
Hanson said Navy medical personnel already know how to communicate and work with their counterparts in the civilian world through their combined relief efforts during wildfires or their current work to combat the H1N1 virus and seasonal flu.
That real-world training can be the best practice to improve for the next emergency, Balmer said. She said the natural disasters and public health threats to which key players in San Diego already have responded serve as a chance to test the response plans practiced during the year.
"A plan is only as good as its practice," Balmer said.
As with any skill and coordinated exercise, the more one practices, the more comfortable and confident one becomes in executing the plan.
The public's experience with emergency situations also can be a benefit to emergency response teams.
Residents know that wildfires are a fact of life in Southern California. They know that an earthquake could strike at any moment. As a result, they are more inclined to take steps to prepare themselves and their families for an emergency.
"Because San Diego County residents have, unfortunately, had to deal with tragedies, they are more receptive of the need to prepare," Balmer said.
While San Diego residents likely have not needed to react to a bioterrorism attack, they might have experience evacuating ahead of a fire or seeking shelter after an earthquake.
Those same preparedness skills will be required in a bioterrorism situation.
"Bioterrorism is a huge, scary threat," Balmer said. "The education is there, but we also want to impress upon people the importance of being ready for any event."