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Dr. John Brown is the medical director of San Francisco's paramedics. A thin, busy, thoughtful man, he'd be in a serious pickle if suddenly faced with the 75,000 emergency patients the federal government says he should be capable of treating. And Brown knows it.
"We can't take care of more than a few hundred CBRN patients for very long, not on our own," he says. "A car bomb might be 10 or 20 casualties. A building collapse could be in the thousands."
Brown says since medical authorities have no way of knowing what germ agent might be used in an attack, they must try to prepare for a variety of possibilities. But, he says, "One of our basic vulnerabilities is lack of an ability to detect a disease rapidly. By the time people start showing up at the emergency room, it is too late."
In the event of a terror attack involving chemical or radioactive agents, the first problem is decontaminating victims as much as possible.
The Fire Department recently practiced decontamination techniques by herding a group of "victims" into an underground garage and turning the sprinkler system on them, says Robert Navarro, who commands the SFFD's special operations division. But what if the victims were panicking and trying to run away from, say, a shopping center where nerve gas had been released? Pamela Katz, an operations manager for the city's Emergency Communications Department, says firefighters would use hoses to force them back inside.
"We learned that if contaminated people come out of a mall, hose them back," says Katz, who recently attended a federal government course in responding to weapons of mass destruction. "We do not want to contaminate the hospitals! But we also do not want the public to know that."
Decontamination is best done, experts say, with portable shower units complete with dressing gowns and towels. But the city has exactly one of these, according to the civil grand jury. So instead, firefighters would have to flush victims from a distance with massive amounts of cold water. Sponges dipped in cleaning solvents and warm water would be made available so victims could self-decontaminate. Victims would then be transported to "casualty collection points" at Fort Mason, Pacific Bell Park, Crissy Field, and McLaren Park for medical treatment.
But, reflecting a view common among first responders, Linehan says there's simply no way to decontaminate and treat large numbers of CBRN victims.
"The emergency planners at the Department of Health know they can't do it," he says. "But they can't say it publicly, because their bosses do not want them to say it."
Brown recently told a meeting of his colleagues that a CBRN attack would overwhelm his medical response system in six to 12 hours. Without massive help from the federal government and from nearby counties, he wouldn't be able to treat more than a few hundred casualties before he ran out of supplies, equipment, and personnel. That could be a real problem if San Franciscans have to be prepared to be on their own for a week, as the Office of Emergency Services advises.
Brown says he has less than $100,000 a year to spend on emergency planning, training, and maintaining the Metropolitan Medical Task Force, an interagency team that will rush to the scene of an attack. The task force needs more ambulances, modular hospital wards, and microbe detectors. It needs dozens of same-frequency radios to hand out to paramedics from Alameda, Marin, San Mateo, and Contra Costa counties who might be able to help. Brown also needs to buy fresh drugs to treat diseases like Ebola, plague, and botulism, and new antidotes for nerve agents such as sarin or VX.
"We need to replace stockpiles of medications that we bought in 1998, because they expire in three to five years," he says.
In the final analysis, though, Brown does not believe that buying a lot of high-tech equipment will end the threat of anti-American terrorism. "We need to work more on terrorist prevention," he says. "We could help [Third World] people improve their standard of living, and not just do a police function."
Over the last year, government officials identified critical city infrastructures that they believe are vulnerable to attack. They decline to make the specific weaknesses public, but the Fire Department's Navarro is willing to talk about them in general terms.
San Francisco's most likely terrorist targets are high-profile corporate buildings like the Bank of America headquarters, factories that use toxic chemicals, fuel storage depots, and biological labs such as those in Mission Bay, says Navarro, whose special unit deals with hazardous material releases and weapons of mass destruction. High-risk targets also include diplomatic compounds, government and military installations, and Pac Bell Park.
It's also clear from interviews and public records that major targets like the port, BART, Muni, government buildings, and telecommunication and utility facilities remain basically unprotected, due mostly to the tremendous cost of "hardening" them against attack.
The civil grand jury reported that San Francisco's water supply is seriously at risk, since terrorists could easily blow up parts of Hetch Hetchy's 165 miles of unprotected reservoirs and pipelines. The city Public Utilities Commission does not have a plan to secure the water delivery system, nor one to provide drinking water to millions of Bay Area customers should Hetch Hetchy fail.