shortage contributes to this lack of excess patient care capacity. Further, if we have a concurrent overseas conflict and U.S. disaster, reservists will be mobilized further draining the health care system. While we currently count beds to assess capacity, beds are no longer a good surrogate marker. We need to develop methods to assess patient care capacity and explore creative solutions to the lack of surge capacity.


VA is the largest national integrated healthcare system with facilities and personnel across the country. The initial response to any disaster is local—it will take some time before state and federal resources can be mobilized. Therefore, VA is uniquely positioned to assist with both local and federal counterterrorism efforts. While our primary focus remains protection of our ability to care for veterans, VA also provides the federal medical presence in the local community since we are “in and of that community.”


Mary J. R. Gilchrist, Ph.D.

Director, University of Iowa Hygienic Laboratory

President, Association of Public Health Laboratories

The Laboratory Response Network (LRN) was instituted in 1999 in preparation for the U.S. response to bioterrorism. The LRN consists of public health laboratories that form linkages to the private hospital, clinical, and referral laboratories, which refer isolates to the public health laboratories for confirmation of identity of suspect microorganisms. The system was not fully operational when the October anthrax events began but, even so, it functioned relatively well. One can only guess at the difficulties that would have occurred without the embryonic phase of the LRN. Human illness was limited so the system was not fully tested for dealing with a large outbreak of disease. However, it did appear to work even though training had not been widely and intensively administered to the local laboratories. In several cases the isolates of Bacillus anthracis were presumptively identified at the local laboratory and referred to the state lab for full identification. It is apparent that without widespread knowledge of the diagnosis of illness, some of these cases might have been missed completely.

Because the event played out over several weeks in the form of envelopes being delivered to offices, the primary challenge to the public health laboratories was to rule out other suspect powders. At the peak, the public health laboratories in the LRN were testing over 1,200 powders per day. These were those powders that were deemed a credible threat by the law enforcement community so it is likely that some ten-fold or greater numbers were evaluated and rejected as non-

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