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Community of Caring

Library Response to Terrorism

The following excerpts of Medlib-l discussion revolved around the library immediate response to the threat of future terrorism. This discussion led to the development of terrorism bibliographies and resources and identification of roles for libraries in addressing these issues.

Library Response to the Threat of Future Terrorism

Date: Thu, 20 Sep 2001 13:24:42 -0400
Sender: Medical Libraries Discussion List
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From: "Gluck, Jeannine
(jgluck@MMHOSP.CHIME.ORG
Subject: Library response to threat of further terrorism

We are all aware that the trend in libraries has been moving away from the model of warehousing of data in case it is needed, to the just-in-time model of retrieval of information. In general, this is appropriate. However, we have a big fat exception staring us in the face--response to biological warfare.

I think that my belief that we have not seen the last of terrorism, and that the next attack will not likely be of the airplane-as-weapon model, is shared by many. If / when there is a biological attack, will the members of our hospitals' emergency dept staffs know exactly what to do to treat the patients, WITHOUT relying on remote electronic sources? As we saw on Sept. 11, communication systems often are not functioning, or at least functioning well, at the time they are most needed. Even if not physically damaged, they are overloaded. Many emergency physicians have been trained as to response to this kind of disaster--but not all of them. Very few non-emergency MD's (who we can easily imagine could be recruited to help) have been trained.

What we need to do is have high-quality, current info available, especially pertaining to treatment, but uncoupled from a reliance on communication technology at the time of use.

Those of you whose institutions are legitimate subscribers to the INTERnet version of Micromedex* may want to print out the Poisindex section entitled "warfare agents," and other files to which it refers, (for your institution's own internal use, of course, due to copyright.) I have spoken to my contact at Micromedex, and strongly suggested that they put this file on mobileMicromedex, the version of the database which is downloadable to a PDA. He told me he will address this with the powers that be at his company. I'll let you know what I hear-- it was only this morning that I called. (*INTRAnet or CD users of MDX, or other systems, shouldn't have this problem, as long as it sits on a server internal to your organization.)

I'm well aware that many hospitals do not use Micromedex, and that there are other good sources out there. Perhaps we could tap our collective wisdom to put together a brief list of the most pertinent current resources specific to diagnosis & treatment of the various agents. Our views of what clinical information is "likely" to be needed changed pretty quickly last week, and we cannot predict which of our hospitals will be in the unfortunate position of having to actually use this info. Many thanks to Donna Beales and Alice Hadley, whose postings re: recent terrorism really made me think about this.

Jeannine Cyr Gluck
Director of the Medical Library
Eastern Connecticut Health Network
jgluck@mmhosp.chime.org
860-647-6853
413-383-7803 fax

Date: Thu, 20 Sep 2001 12:41:36 -0500
Sender: Medical Libraries Discussion List
(MEDLIB-LLISTSERV.ACSU.BUFFALO.EDU
From: "Jones, Dixie"
(DJones@LSUHSC.EDU)
Subject: Re: Library response to threat of further terrorism Comments:

Jeannine makes a good point about having inhouse material ready in case of emergency for treating victims of bioterrorism or chemical terrorism. It is true that remote electronic services might not be available during an emergency. We hope that such information will not be needed, but it is better to be prepared for it than to ignore the possibility.

Ten years ago, I was working in a VA Medical Center Library when Desert Shield began and subsequently turned into Desert Storm. The government tried very hard to disseminate information in advance to each individual VA library, providing inhouse materials on chemicals, biological products, and diseases that our servicemen might be exposed to, as well as materials on treatment of various types of injuries and PTSD. I was impressed with the amount of material delivered to my library in the attempt to prepare medical personnel for every eventuality. Unfortunately, Gulf War Syndrome was not anticipated and it turned out to be the major medical malady of that conflict.

Dixie A. Jones, MLS, AHIP Head, Reference Section
Associate Professor, Medical Library Science
LSUHSC Library
P O Box 33932
Shreveport, LA 71130-3932
tel: 318/675-5447 fax: 318/675-5442

Date: Thu, 20 Sep 2001 13:46:11 -0700
Sender: Medical Libraries Discussion List
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From: Lora Thompson
(Librarylora@YAHOO.COM)
Subject: Re: Library response to threat of further terrorism

Jeannine, Your post is very interesting. Just yesterday I compiled a bibliography and reserve binder of articles on bioterrorism. I am sending memos to all the key departments at the hospital to let them know it is available. I have received a number of article requests internally and through interlibrary loan. It is definitely a hot topic.

This is just another area where medical librarians can be proactive and promote their skills while keeping their patrons informed on timely topics.

Thanks, Lora :-)

Date: Fri, 21 Sep 2001 08:43:04 -0400
Sender: Medical Libraries Discussion List
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From: Grace Godell
(GODELLG@TRINITY-HEALTH.ORG
Subject: Re: Library response to threat of further terrorism

I too have conducted several researches on the terrorism issue.

One of them was a request to find out how much Anthrax was available to physicians in the community or from our state (Michigan). I found several articles on "getting ready in the hospital, training physicians, nurses etc. Nothing on how much is available.

Will check the CDC.

Grace E. Godell
Trinity Health Care (Mercy Hospital)
Cadillac, MI

Date: Thu, 20 Sep 2001 4:46 PM
Sender: Medical Libraries Discussion List
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From: Lora Thompson
(Librarylora@YAHOO.COM)
Subject: Re: Library response to threat of further terrorism

Jeannine,

Your post is very interesting. Just yesterday I compiled a bibliography and reserve binder of articles on bioterrorism. I am sending memos to all the key departments at the hospital to let them know it is available. I have received a number of article requests internally and through interlibrary loan. It is definitely a hot topic.

This is just another area where medical librarians can be proactive and promote their skills while keeping their patrons informed on timely topics.

Thanks, Lora :-)

Lora L. Thompson, MLIS
Director of Library Services
Frank J. D'Agostino M.D. Medical Library
Easton Hospital
250 S. 21st. St.
Easton, PA 18042

Date: Wed, 26 Sep 2001 11:31:57 -0400
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From: "Gluck, Jeannine"
(jgluck@MMHOSP.CHIME.ORG)
Subject: Re: Library response to threat of further terrorism

I told the list members that I would post a compilation of the responses I received to my request for resources on terrorism, (biological, chemical, or physical). I was looking specifically for current items concerning management of patients who have been exposed. The short list is as follows. Thanks to all of you who responded. Also see listing from RI Dept of Health, mentioned further down in this e-mail, for more links.

... [Resources for Healthcare Providers] includes a listing of resources provided in this message]

What I did in my own institution was to print out and organize the most pertinent sections from Micromedex, and place one in each emergency dept. They were very happy with that.

In terms of both treatment and the larger question of disaster planning, Deborah Porrazzo of the RI Department of Health Library has posted a far more comprehensive list than any I could compile. She wrote to MEDLIB, earlier today:

I've been following the thread on bioterrorism and wanted to let you know that we have a nationally known authority on this subject here at the RI Department of Health, Greg Banner. Greg is the Emergency Response Preparedness Coordinator and has compiled an extensive/comprehensive list of Internet sites for emergency planning and in particular Weapons of Mass Destruction (WMD) and medical emergency planning. As his list is over 30 pages long, people may download this file by going to the RI Dept. of Health's Bioterrorism Preparedness Program Web site [MSWord] . Greg also invites any inquiries by contacting him directly at gregoryb@doh.state.ri.us, 401-222-6868 (voice); 401-222-6953 (fax).

Deborah Porrazzo, MLIS
RI Department of Health - Library
Room 103 - Cannon Building
3 Capitol Hill
Providence, Rl 02908
Phone:(401) 222-2068 Fax: (401) 222-6683
Email: DeborahP@doh.state.ri.us

Again, thanks to all. --Jeannine

Jeannine Cyr Gluck
Director of the Medical Library Eastern Connecticut Health Network jgluck@mmhosp.chime.org
860-647-6853 413-383-7803 fax

Date: Mon, 24 Sep 2001 08:45:55 -0400
Sender: Medical Libraries Discussion List
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From: Donna Beales
DBeales@LOWELLGENERAL.ORG
Subject: Re: Bioterrorism-- Answer STAT

A report shown on WBZ 4 Boston this AM reveals that terrorists may have approached a crop duster recently. For those who do not know, these planes are routinely used to spray pesticides in agricultural areas. The pilot alleges that one of the hijackers came to his airport with other men and asked questions about how his plane operates. If this report does not raise awareness of the grave situation we face, I do not know what does.

Here is what I have been able to put together for my hospital, based on information I received from my state DPH. I recommend that you find and PRINT these sources-considering how communication can be disrupted during emergency conditions, why take the chance?

First: contact your state Department of Public Health and locate the correct emergency number for reporting suspected cases of biological agent use. Have it readily available to all appropriate personnel.

JAMA has several articles on bioterrorism agents-search under 'consensus statement' or 'as a biological weapon[title].'

The US Army Medical Research Institute of Chemical Defense put out a publication entitled "Medical Response to Chemical Warfare and Terrorism" that is quite useful in identification & treatment of various chemical substances used in warfare. Mine came out of the Veteran's Administration, Office of Emergency Medical Preparedness. Try them at (413) 582-3024.

The CDC website has good information on Ebola, Marburg, and other exotic potential agents. www.cdc.gov.

Mary Sheryl Horine of the Massachusetts DPH provided me with these three sites, of which the top site has excellent information on symptomology and therapy for many biological agents:

http://www.usamriid.army.mil/education/bluebook.html http://www.ndpo.gov/ http://www.ahapolicyforum.org/policyresources/MOdisaster.asp

Valerie Rankow provided me with many emergency preparedness sites (thank you, ListMom!). However, since they are copyrighted, perhaps she would share with us...?

This book is written by the former top USSR official for biological warfare research. It is readily understandable by anyone, and was recommended to my by our immunology specialist as a good introduction to various agents: Author Alibek, Ken. Title Biohazard : the chilling true story of the largest covert biological weapons program in the world, told from the inside by the man who ran it / Ken Alibek with Stephen Handelman. Edition 1st ed. Publisher New York : Random House, c1999. Description xi, 319 p., map : ill. ; 25 cm. Bibliography Includes bibliographical references and index. Subjects Biological weapons -- Soviet Union. Add Author Handelman, Stephen. ISBN 0375502319 (alk. paper) : LCCN 98056454

Donna Beales
Lowell General Hospital
Health Science Library
Lowell, MA
(978) 937-6247 FAX (978) 937-6855 dbeales@lowellgeneral.org

Resources on Library Record Confidentiality

Date: Tue, 25 Sep 2001 14:26:26 -0500
Sender: Medical Libraries Discussion List
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From: Michelynn McKnight
(michelynn_mcknight@HOTMAIL.COM
Subject: Fwd: Resources on library record confidentiality

Below are 2 items that have been developed by ALA in response to the events of September 11, 2001. They may be of interest to your students. Please feel free to distribute these documents.

Item 1 - In light of recent events, the American Library Association has drafted ... Q&A to assist librarians with questions that might arise. Our proactive efforts now will help ensure we can expedite information requests within the framework of state confidentiality laws.

Also attached for your information is a shared statement [Freedom of Speech and Access to Information] [PDF] from the ALA, the American Association of Law Libraries, the Association of Research Libraries, [and MLA].

Please forward these documents to all appropriate library listserves. If you have questions or need further information, please do not hesitate to contact staff from the Office for Intellectual Freedom, the Washington Office or the Public Information Office.

Thank you.

Larra Clark
Public Information Office
American Library Association
Chicago, IL 60611-2795

Note: The ALA's Office for Intellectual Freedom keeps reference copies of state confidentiality laws on file, which may be requested by calling the office at 800-545-2433 x4223 or emailing oif@ala.org.

Web Links for International Students

Date: Thu, 27 Sep 2001 11:29:33 -0400
Sender: Medical Libraries Discussion List
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From: Nancy Curtis
(Nancy_Curtis@UMIT.MAINE.EDU
Subject: LONG summary: Web links about 9/11 for international students

Many. many thanks to all of you for your suggestions, which are listed at the end of this message.

As for the University of Maine's response:

The University President assumed responsibility for issuing a general statement of sympathy and support. The home page of the University was temporarily modified to prominently list a link to the statement, as well.

The library compiled a page of links (http://www.library.umaine.edu/Tuesdaysite.htm), which could also be reached from the University's home page. The library staff worked with staff from the campus office for international programs to find resources for international students.

What we learned (in case something like this ever happens again):

If you can't guarantee that you will cover *all* the nations of the world, it's best not to post *any* information for specific countries (outside your own). While there may be valid reasons for omissions--a minimal presence on the Web, or no translator to help select appropriate Web pages--some people will interpret omissions as deliberately offensive acts.

Posting information only for those countries represented on your campus is also risky, because it might appear that the library is posting a "target" list.

A complication is the existence of multiple sites with unique information. In some cases, we found that a country's embassy in Washington, its consulate in New York, its national department that deals with foreign affairs, AND one of its major newspapers all provided different information, and all the information was potentially useful.

We ended up listing 2 sites for our international students: ...
[link includes a listing of all the sites listed in this message).

Thanks again, everybody

Nancy Curtis
University of Maine
nancy.curtis@umit.maine.edu