6 C olumbia U niversity RECORD February 6, 2004 Preparing for the Unthinkable: NCDP’s Irwin Redlener rwin Redlener, director of the Redlener: We’ve been working Mailman School’s National continuously on the concerns of ICenter for Disaster Prepared- children and special populations ness (NCDP), which he founded in preparedness planning. The last May, has seen his share of challenge is that a lot of the disasters. He’s helped with earth- answers are not known about quake relief in Guatemala and managing children exposed to served as medical director for weapons of mass destruction. So USA for Africa and Hands Across we held a national conference in America, when he treated famine Washington last year, with 65 or victims in Sudan in the 1980s. 70 pediatric experts, and came More recently the Brooklyn up with a consensus report about native has been working closer to how, given what we currently home, having served as president know, children should be man- of Montefiore’s Children’s Hos- aged under many of these cir- pital before joining Columbia. He cumstances. The report was pub- and his medical teams responded lished last May and is currently with direct assistance in the in the hands of disaster planners immediate aftermath of 9/11, and in every state. We’re also look- he’s been involved in disaster ing into suggested standard pro- planning ever since. He also tocols for school disaster plan- cofounded the Children’s Health ning, as well as developing Fund (CHF) with Paul Simon in guidelines for how to establish 1987. preparedness plans for hospitals So with New York City more or PHOTO BY EILEEN BARROSO and communities. less permanently on Orange Alert, Irwin Redlener, director of the Mailman’s School’s National Center for Disaster Preparedness. Redlener certainly seems like the The Record: Going forward, right man for the job. The Record ability, or willingness, of people been expended or appropriated to 9/11, and found that 76 percent what would you like to see the recently sat down with him to talk to come to work after a major date for this purpose. of Americans are still concerned NCDP doing? about the NCDP’s accomplish- catastrophe, or during a bioter- In general, we are advocating about the threat of terrorism.Yet, ments and role, its current and rorism crisis? One of our senior for a much more clarified, com- less than one out of four people Redlener: We are focused on forthcoming projects, and how researchers, Robyn Gershon, is prehensive preparedness plan for had made any kind of personal or continued development in all prepared the community and the learning a great deal of critical the country. To this end, we want family emergency plan. There’s a areas of the center. There is a country really are in the event of information in this area. For to be a resource for the public major disconnect between the tremendous need to help establish another attack. —Peter Kobel instance, a hospital may create and for government, to help public level of awareness of the some of the critical definitions an emergency response plan to a frame the questions and provide threat, on the one hand, and actu- and benchmarks with respect to The Record: Between federal terrorist attack anticipating that, some directional input on how to ally doing something about it, on preparedness, and I believe we’ll groups such as the Centers for say, 80 percent of the workers respond to the possibility of con- the other hand. We are trying to have a lot to offer in this arena. I Disease Control and the first will report for duty. But research tinuing, major terror attacks on get to the bottom of this. also see a major role for us in responders in the trenches, what may show that only a small frac- the United States. monitoring the impact of pre- is the role of the NCDP? tion of that number will actually The Record: You seem to have paredness planning on the core show up, making the emergency The Record: So, there’s no over- focused a lot on pediatric pre- public health agenda. In other Redlener: The national center plan essentially inoperable. arching plan. Safe means pre- paredness. What’s different about words, there is considerable con- has three general categories of The third area of our work has pared, basically, but there’s no children? cern that intense focus on disaster work. The first consists of a to do with the development of a such thing as total safety… response will divert attention and number of direct services, such dynamic “think tank” that pro- Redlener: If you’re going to funds from traditional needs like as training health care workers vides policy analysis in many Redlener: Here’s the reality: have a functional community tuberculosis control, HIV/AIDS and public health officials in var- aspects of terrorism and disaster We’re dealing with a continuum disaster plan for terrorism, there programs and getting routine ious aspects of disaster manage- response planning, including how here—from complete compla- are a number of things that are immunizations for children. ment, including how to deal with this planning and associated cency at one end of the spectrum extraordinarily important, in- In addition, we are establishing the victims of weapons of mass resource allocation impacts the to a profound paranoia at the cluding paying attention to a new program called the destruction. We’re also develop- larger public health agenda. other extreme. We need to be unique needs of special popula- “Emerging Public Health Crisis ing curricula in these areas for There are many fundamental somewhere in the middle, but it tions who may require focused Working Group.” This will be a students in medicine, dentistry, questions that have not yet been is so hard to pin down exactly attention in the event of a major group of experts from a wide nursing and public health. All of answered and, in my opinion, our what that means or how much we catastrophic event. array of relevant fields who will this is emphasized in a world capacity to respond to terrorism should spend to get there. Consider, for instance, a terri- be charged with the task of rapid- very much changed by the in the U.S. is not much better than Preparedness benchmarks or ble situation where a thousand ly absorbing and analyzing infor- events of 9/11. We also provide it was in the fall of 2001. We real- guidelines need to be set and that schoolchildren are affected— mation about any kind of major mental health services and sup- ly lack a national vision for what hasn’t happened yet for hospi- purposely or otherwise—by a public health crisis, whether it’s port for people still affected psy- we mean by “prepared” with tals, government agencies or nerve gas agent. This kind of terrorism, SARS or anything else, chologically by 9/11. respect to potential terrorist public health facilities. On the event would require a very spe- in order to provide insight and The second general category attacks, especially with weapons other hand, guidance for person- cial approach in the response guidance to media, government of our work includes a series of of mass destruction. There is no al or family emergency planning phase of disaster management. agencies or the public. projects under the umbrella of directive that defines or describes has been proposed by a variety of The fact is that children, physio- The other large-scale project “applied research.” What, for what we’re aiming toward, even governmental and nongovern- logically and medically, may we’re developing is an initiative instance, do we know about the though more than $5 billion has mental agencies, like the Ameri- respond very differently to a lot called “Model Prepared Commu- can Red Cross and the Federal of these agents or “weapons of nities.” The plan is to select three Emergency Management Agen- mass destruction.” For instance, disparate communities: urban cy. The basic idea is that people small children and infants will (probably Washington Heights), should keep three days of food become very sick much more rural and either a small town or and water, a battery-operated rapidly than an adult might. A suburban community where we radio and other materials in their particular exposure to a bioterror will develop templates for getting homes, as well as supplies that agent might require “decontami- the public much more engaged in can be taken with you if evacua- nation” by immediate showering. preparedness planning. We want tion is necessary. A family com- A small infant may not tolerate to close the gap between the pub- munication plan is also essential this procedure in a device lic anxiety about terrorism and to make sure that people can find designed for adults. Similarly, actually getting people to do one another in an emergency. antidote or antibiotic dosages something about their own plan- Interestingly, there is no equiva- have to be significantly adjusted ning. We believe that the key to lent of this kind of guidance to the age and weight of a solving this is “ground-up” orga- available for institutions or the younger victim. Indeed, our cen- nizing of emergency planning whole health care infrastructure. ter is focusing on recommenda- and public safety agencies, along There is another important tions to emergency planners on with families, schools, faith- problem that we are quite con- understanding the special needs based and community organiza- cerned about and are attempting of very young victims in such tions—all working together. It to study in more depth: even circumstances. In fact, we are means building the confidence though individual emergency also working on protocols for and resiliency of individuals and planning is available and widely other special needs populations families, enabling them to have a discussed, there is very little including elderly or disabled vic- balanced, prudent approach to uptake of the “preparedness mes- tims of bioterror agents. emergency preparedness that sage” by people. Actually, this is doesn’t interfere with normal true even for many of my col- The Record: Are there new ini- family life. PHOTO BY BARD MARTIN leagues. We did a survey last tiatives that you’re working on August, roughly two years after that deal with this specifically? Redlener in the South Bronx with patients from a CHF clinic. (Continued on Page 8)