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An innovative and sophisticated computer simulation model can help public health officials and emergency planners to prepare a public health response in case of bioterrorist attack, a study by scientists in the Department of Public Health at Weill Cornell Medical College has demonstrated. The simulation model, which predicts staffing requirements for antibiotic or vaccine dispensing centers, should help remedy a potential gap in current local, state, and national bioterrorism preparedness.

The study, authored by Dr. Nathaniel Hupert, Dr. Alvin I. Mushlin and Dr. Mark A. Callahan, first appeared in the current issue of the journal Medical Decision Making.

Dr. Hupert, Assistant Professor of Public Health and Medicine and the study's lead author, said, "In the event of a widespread bioterrorist attack on a major metropolitan area, a successful public health response requires carefully planned triage and drug-dispensing centers with specific staffing requirements. While the Department of Health and Human Services mandates that every state provide a detailed plan, the states have been delayed by a lack of research on how the centers should be designed and operated. The use of computer simulation modeling may remedy this situation."

The Weill Cornell Medical College research team, led by Dr. Hupert, is under contract with the Agency for Healthcare Research and Quality of the Department of Health and Human Services to apply their computer modeling techniques to develop national guidelines for drug and vaccine dispensing in the event of a bioterrorist attack.

Using a computer technique called discrete event simulation, the researchers identified the optimal number of staff to place at patient triage and drug-delivery stations in order to avoid long lines and delay in treatment for a variety of hypothetical bioterrorist attack scenarios. The number of staff required to efficiently operate each dispensing center in these scenarios ranged from 93 individuals for a smaller attack to 111 individuals for a larger attack involving a disease like anthrax. At these staffing levels, the average predicted patient wait-time would be only 4.2 minutes for a center processing nearly 1,000 patients per hour.

Dr. Hupert and his colleagues intend to use the study's insights and simulation techniques to model other components of the medical and public health response to bioterrorism (e.g., logistics of distributing drugs from central storage facilities to dispensing sites, smallpox vaccination clinics).

The study's computer simulations use discrete event simulation modeling, a software technique widely employed in industrial design and logistics planning, to represent complex, real-world situations. The research team used a commercially available program called Arena©. Dr. Hupert has adapted the simulation model to run on standard spreadsheet programs (e.g., Microsoft Excel©) to speed the dissemination of this work to state and local public health and emergency planners.

Weill Cornell's Public Health Contribution

Dr. Hupert and the Weill Cornell Medical College's Department of Public Health have been among the nation's leading researchers in planning a public health response to bioterrorism. Since 2000 (well before the September 11 attacks), the Department of Public Health, along with the Weill Cornell Department of Emergency Medicine, has pioneered the use of sophisticated computer models to study the public health response to large-scale bioterrorist attacks. In addition to research on antibiotic and vaccine dispensing, they have studied hospital capacity to treat mass casualties for a bioterrorist event and have engaged in extensive educational activities for medical students, residents, and practicing physicians.

With over a half-million dollars in research funding for this effort, faculty from Weill Cornell have been working with the Centers for Disease Control and Prevention (CDC), and the Agency for Healthcare Research and Quality (AHRQ) of the Department of Health and Human Services to educate emergency management and public health officers around the country about the design and operation of antibiotic and vaccine prophylaxis centers. This past summer, Dr. Hupert gave a keynote lecture at the CDC's inaugural course on the National Pharmaceutical Stockpile at Ft. McClellan, Alabama. Additionally, Weill Cornell has provided technical support to the New York City Office of Emergency Management on bioterrorism-related planning.

Faculty from the Department of Public Health and the Division of International Medicine and Infectious Diseases have designed a two-hour-long session on bioterrorism for the second-year Weill Cornell medical students in their "Basis of Disease" course. Agents discussed include anthrax, smallpox, botulism, tularemia, ebola, and others. Since the September 11 attacks, there have been numerous panel discussions and presentations for medical students and residents covering everything from the microbiology of bioterrorist agents to the psychological sequelae of bioterrorist attacks.

Additionally, Weill Cornell Medical College's chief clinical affiliate, NewYork-Presbyterian Hospital, and the Hospital's Emergency Medical Departments, led by Dr. Neal Flomenbaum, have carried out extensive preparations for bioterrorism, and cooperate closely with city, state and regional authorities in planning for disasters and emergencies.