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The TNA also has a bank of 15 phones that can be converted to toll-free numbers to enable the organization to process calls from would-be volunteers from out of state who want to cross state lines to help in a time of crisis. The organization will help them quickly convert their licenses so they can work in Texas. “We learned that from New York,” Jordan said. “They had so many spontaneous volunteers after Sept. 11.”

Health officials also have learned other lessons from previous incidents, including the 1995 sarin gas attack on the Tokyo subway system that left 12 people dead and sent more than 5,000 in search of medical care. “When we looked at Tokyo, a lot of these people were simply going to the nearest hospital,” said Ron Hilliard, RN, coordinator of the Texas Department of Health Bioterrorism Hospital Preparedness Program. “They were pretty scattered.”

Texas and Louisiana are using a regional approach as the basis for their disaster planning, with Texas forming 22 cooperative “regional” hospital planning groups and Louisiana forming nine. The groups were created during the first year of bioterrorism-training funding.

Hilliard said the TDH has looked at every licensed hospital facility in Texas, whether it was acute care, specialty, military, VA, or psychiatric. “Every hospital is going to be a resource and is going to have some level of preparedness,” he said. “People will go to what is most familiar to them.”

The groups, which use a national Centers for Disease Control and Prevention model for guidance, are asked to meet at least once a quarter to develop and maintain plans and coordinate preparedness activities.

“Every hospital is set up to handle contagious disease outbreak,” Hilliard said. “The question is, can they handle one? For crowd control involving hundreds of people, we even thought in terms of a lockdown. But one hospital in Texas didn’t even have locks on its doors.”

In preparation, Memorial Hermann Hospital in Houston has installed a standing decontamination unit with three showerheads, which drains into an independent holding tank, said Richard Bradley, MD, medical director of the Emergency Center at Memorial Hermann and an associate professor of emergency medicine at UTHSC-Houston.

The unit, which has already been used for petrochemical decontamination, has a mask plugged into the wall so caregivers can breathe clean air while they are decontaminating.

Some hospitals, such as Parkland Health & Hospital System in Dallas, also have outdoor showerheads for decontamination.

In part as an offshoot of the Canadian SARS outbreak, Memorial Hermann and other hospitals throughout the state are stressing “cough etiquette,” where patients are asked to cough into tissues and dispose of them in no-touch containers, Bradley said.

Another adjunct concern, Bradley said, is the Occupational Safety and Health Administration’s Hazardous Waste Operations and Emergency Response standard, which requires that hospital workers be trained at first-responder level if they are expected to provide even limited decontamination. Such training determinations should be based on worst-case scenarios, according to OSHA.

“Every hospital has to have a team available to comply with this unfunded federal mandate,” Bradley said.

New training

To meet qualifications for licensure, RNs and LVNs in Texas must complete at least two hours of bioterrorism training. The classes are required by all Texas nurses seeking licensure after June 1 and for all nurses who will seek licensing renewal in the state after that.

“We have 200,000 RNs and LVNs in the state of Texas and this whole issue of bioterrorism has come about since most have graduated,” said Deanna Grimes, RN, DRPH, FAAN, an associate nursing professor at the UTHSC-Houston School of Nursing.

UTHSC-Houston leads an alliance of five UT system schools that are training nurses for disasters through the Texas Statewide Bioterrorism Continuing Education program, which was funded by a two-year, $3.6 million federal grant awarded late last year.

UT officials say they hope to train 20,000 health care workers in the next two years at five campus locales statewide. Some training also will take place at remote sites, including hospitals.

The mandatory two-hour courses, which cost just $15, cover identification of patients infected by biological agents and viral agents such as inhalation/subcutaneous anthrax, botulism, smallpox, monkey pox, ricin, and SARS, as well as decontamination, personal protective equipment, and reporting protocol.

“For example, each facility has a contact person who, if she runs into botulism, should contact the epidemiologist who will contact the TDH and then the CDC,” said Candiance Duplessis, site coordinator for continuing education classes for the UTHSC-Houston School of Nursing.

More than $60 million is filtering down from the U.S. Health Resources and Services Administration to the Texas Department of Health over three years, in addition to other smaller state and federal grants. Louisiana received about $10 million from HRSA for its first two years and is awaiting word of its third-year grant denomination.