This Is Only an Exercise…

Outside Baltimore’s Northern High School, nine police officers wearing masks and riot helmets block the entrance. Dozens of smallpox cases have been reported in the city. The crowd waiting outside the school for emergency vaccinations is growing impatient. Several people try to push past the police. The officers push back, and two men are handcuffed.

But both men are soon released, and many in the crowd are wearing schoolbus-yellow T-shirts reading, “This is only an exercise.”

The exercise is the Harbor Biological Attack-Simulated Event (BASE), a bioterrorism preparedness drill held July 9 and 10 in Baltimore. School faculty, staff, and students joined the 1,000-plus people who participated in the exercise, which simulated an outbreak of smallpox and botulism to test the city’s response. After the outbreaks were announced, fake patients showed up at hospitals, and city agencies responded as they would to an actual attack.

“Baltimore is one of the first cities to launch anything like this of this scale,” says Margaret Edmunds, PhD, adjunct associate professor of Health Policy and Management at the School and a member of the School’s Center for Public Health Preparedness (CPHP), which helped guide the evaluation of the exercise. “The data will be used to improve the rapid-response capabilities of the city, health department, and hospitals.” (A final report is due out this fall.)

The School’s Center for Civilian Biodefense Strategies helped design the drill. “We provided the Center’s expertise to make sure the drill was as realistic as possible as it was playing out,” says Lewis Rubinson, MD, a fellow at the Center. Planners had to be careful not to overscript the event and remove the element of surprise. When the first mock smallpox case came through St. Agnes Hospital, for instance, the diagnosis came too quickly, says Rubinson. So, to keep health care workers guessing, planners changed the patient’s medical history to make it look like the patient could also have disseminated varicella, a form of chickenpox.

The School also responded as it would to a real attack. On the morning of July 9, a Crisis Response Team set up a command center in the School’s boardroom, and Facilities Management posted signs stating that the water supply had been turned off. Cafeterias and kiosks closed. The Anna Baetjer Room was designated as a casualty area.

School students and staff were involved at the grassroots level as well. Jacqueline Sims, an administrative assistant at CPHP, took on various personae (media rep, average citizen) and called the health department with questions about vaccinations. Sims says she was reassured to find that the health department professionals were prepared for every contingency she could throw at them (“My mother’s an invalid,” or “My car is in the shop”). “Their answers were clean and clear and decisive,” she says.

Chris Toscano, a PhD student in Environmental Health Sciences, volunteered at the mock inoculation site at Northern High School.

“I normally do lab work,” he says. “It was nice to actually see applied public health.”