Table of contents(19 chapters)
A Note from the Editors of Bioterrorism, Preparedness, Attack and Response This thematic volume on preparing for bioterrorism, bioterrorist attacks, and the response to such attacks is, in part, the collective response of both the authors of specific chapters as well as that of the three editors to the events of September 11, 2001.
This paper presents an overview of the articles used in this edition of Advances in Health Care Management. The beginning of the article gives the reader a history of bioterrorist activity within the United States, and how these events have led to current situations. It also provides a model for health care leaders to follow when looking at a bioterrorist attack. The model includes descriptions of how the articles within this book relate to an overall bioterrorist formula. Through this, the reader shall be able to deduce which individual article fits into the vastness of healthcare research pertaining to bioterrorism.
The following article looks at the biological weapons problem from different perspectives to evaluate the international threat of biological weapons from both a legal perspective and a regulatory perspective. Biological weapons fall into a category all their own with unique characteristics as weapons of mass destruction in which suggestions for new directions should be explored with respect to historical failures. Biological weapons regulation is currently predicated on a certain legal framework, and through that a presentation is shown by a synthesized approach to biological weapons control.
Terrorists’ threats pose a grave danger to the health care environment in which we live. In the following paper, we look at how bioterrorist plots can effect a given population and show ways to dissect terrorist actions. We look at variables that use various cause and effect relationships, and lead the reader down a path of being able to use information presented in a real life or fictitious bioterrorist attacks. We seek to inform the reader reasons why preparedness is essential in dealing with the likelihood of the following scenarios.
When modeling environmental jolts from terrorist attacks, various aspects should be analyzed in order to properly present an accurate configuration. The following article discusses how asymmetrical warfare has an impact on the outcomes of a terrorist attack. The several dimensions of terrorist attacks can be extracted to deduce the ways that asymmetrical warfare can damage the health care system. The article will relate real life terrorist attacks and hypothetical scenarios to better inform the reader about the weak attacking the strong, and then explain how this relates to health care providers.
Preparing for a potential bioterroism is a difficult task for health care leaders because of the fundamental unpredictability of bioterroist acts. Complexity science thinking is presented as an approach that can help in this task. Basic concepts from complexity science, especially the role of relationships, are presented. Specific recommendations for action including sensemaking, learning, and improvisation are made. A case study is used to illustrate the power of complexity science thinking in assisting health care leaders addressing potential bioterroism. Questions for further research are presented.
Health care organizations are accustomed to rapid and often discontinuous environmental change. Even when contemplating large scale change including the decisions to merge or integrate operations, health care managers can draw upon the expertise and advise of peers who have gone through similar experiences. However a bioterror event is a class of change that represents something totally unplanned and for which the industry has little or no experience in confronting. The objective for health care organizations is to mitigate the effects of this type of an event. Specific ideas for taking systems oriented, network-centric approach to disaster planning are provided.
The threat of bioterrorism presents an opportunity for health care organizations to transform into more resilient, learning organizations. Rather than focusing solely on preparing for what is known or expected in a bioterrorist attack, organizations should strengthen their infrastructures to better manage surprises of all types. We advocate a combination of guidelines derived from conventional and complexity science perspectives on organizational change, including the need for leadership commitment, self-organization, culture change, and interorganizational connections.
The possibility of a bioterrorism event haunts all healthcare organizations. We believe a bioterrorism event is more likely in an urban area, and that urban multiprovider systems will be the “first line healthcare responders.” Due to the lack of empirical research on this topic and firsthand experience with a bioterrorism event, this paper will provide the theoretical underpinnings to support the rationale for multiprovider systems as “first responders.” This chapter outlines the nature and challenges of bioterrorism for a healthcare organization, the likely “state of the art” preparations for such events on the part of the four categories of healthcare organizations, and finally, the implications for the structuring of multiprovider systems to enhance their ability to plan for, and respond to bioterrorism events. Potential future research issues are also addressed.
As a key component of the American health care system, the physician office could be the front line in a bioterrorist attack. Nationally and locally, the primary focus on this subject appears to be from a hospital preparedness and public health agency perspective, with little attention devoted to primary physician providers in their own offices, and those specialists to whom patients may be referred. While unrelated to bioterrorism, the recent SARS outbreak also brings to the forefront the need for physicians offices to be able to clinically, operationally, and managerially respond to illnesses that mirror the symptoms of known illnesses, but may be more virulent new organisms or hybrids of existing organisms. If the face of bioterrorism is subtle and slow in its presentation, physicians, in their own offices, could be the first providers of care. Will they be prepared, or will they be among the first fatalities in a bioterrorist attack?
Although we have yet to experience a major bioterrorism event in the U.S., we are nevertheless preparing for such an event. In this paper, we consider the nature of bioterrorism and the threats and challenges it brings to managing health care organizations. Because existing managerial theory may be inadequate in responding to bioterrorism events, management scholars are advised to approach their research with a great deal of humility and openness. Inasmuch as emerging theoretical frameworks based on complexity science and chaos theory are not fully developed, we propose that stakeholder management theory may be the best approach at this juncture.
The threat of future biological attacks within the United States forces the additional responsibility of preparedness and response onto health care managers. An endless amount of information on this topic can be readily obtained from a variety of sources. The purpose of this resource guide is to provide health care managers with a well-organized, up-to-date listing of credible sources that can be accessed electronically. This resource guide is designed to facilitate the retrieval of relevant information that is crucial in the process of health care managers designing a bioterrorism preparedness and response plan.
The implications of a bioterrorist attack within the United States were well observed in the 2001 anthrax attacks. The effects of these attacks were not only felt by the primary victims but also reached into communities and health care organizations that treated patients. The concerns for future attacks have spurred an enormous amount of interest and forced health care administrators to implement safety measures and develop plans encompassing preparedness and response. With respect to this topic, a major problem facing health care managers is the ability to obtain relevant, up-to-date, reliable information.
Many health care managers are aware of the endless amount of resources that are available pertaining to preparedness and response planning. It should also be noted that the information concerning bioterrorism rapidly changes and the available information can be overwhelming. To that end, the authors have compiled an array of selected websites that provide excellent, up-to-date, and unique resources in attempts to facilitate the gathering of knowledge and make that experience more efficient.
The objective of the following resource guide is to provide a comprehensive list of topics in a “user-friendly” format that can be obtained electronically. To facilitate information retrieval, electronic resources have been categorized according to topic. For example, up-to-date information concerning the multitude of biological agents can be obtained by using the links contained within the biological agents category. Under this topic heading you will find a listing of important resources. Each listing contains a heading that identifies the sponsoring organization, a short explanation of information and materials that can be expected, and a web address identifying its location.
The authors’ compilation was not intended to be exhaustive nor do the authors necessarily endorse or warrant the reliability of the information/products. Websites may change regularly; please visit email@example.com to obtain an electronic version of this resource guide and for updates to web addresses.
The purpose of this chapter is to describe the role of the Reserve Components of the Armed Forces of the United States during the September 2001 terror attacks and the role they play in the war on terror, both in the United States and in foreign nations. Reserve Component forces will operate with the Department of Homeland Security to provide security within the United States. Reserve Component units possess many unique skills and knowledge of local conditions that will contribute greatly to maintaining homeland security. Reserve Component forces also participate in major military operations overseas.
CIVIL-MILITARY RELATIONS IN AN ERA OF BIOTERRORISM: CRIME AND WAR IN THE MAKING OF MODERN CIVIL-MILITARY RELATIONS
The United States of America is on the verge of a possible revolution in civil-military relations in an era marked by increased defensive alertness stemming from the attacks of 11 September 2001. As we anticipate the normalization of terror as a way of life, we are witnessing a paradigmatic shift from the use of violence towards some political end to the use of violence as an end in itself (Jenkins, 2001). 1 It is tempting to frame our analysis in terms of the broader notion of asymmetric warfare, since the arguments we make in this paper may be applied to a wide range of settings, including those in which vastly unequal forces are pitted against one another and one side may make use of irregular fighters employing unconventional tactics. However, this would serve only to shift the emphasis away from our central argument. Terrorism may be a form of asymmetric warfare, but what distinguishes it is the fact that it intentionally targets civilians, and that among civilians, it is indiscriminate in the devastation it wreaks. Terrorism is important because of the way in which it socializes danger, breaking down the barriers between combatant and noncombatant and subjecting all to the worst of harrowing and potentially lethal attacks. It is this socialization of danger produced by terrorism, in turn, that is critical in assessing whether and how civilian and military authorities elect to treat its use against their own societies not as a crime, but as an act of war. Bioterrorism in turn, as we argue below, has unique attributes that distinguish it from other forms of terrorism.1 And where, for most nations, homeland defense is the primary mission of the armed forces, the United States had to establish a new cabinet-level Department of Homeland Security due to the primarily expeditionary nature of American armed forces for the past half-century. The military has been a unique institution in modern societies. It has acted as the agent for the state’s possession of a monopoly on the means of large-scale organized violence and war-making. The establishment of a second executive agency responsible for homeland security makes the equation more complex. As a result, ever greater attention must be given to the balance of civil-military relations in American society.
INTEGRATION OR DISINTEGRATION? AN EXAMINATION OF THE CORE ORGANIZATIONAL AND MANAGEMENT CHALLENGES AT THE DEPARTMENT OF HOMELAND SECURITY
The attacks of September 11th transformed homeland security into a central policy task for governments in the U.S., culminating in the creation of the Department of Homeland Security. Planning and preparation for counter terrorism were no longer secondary priorities. This article seeks to examine some of the salient organizational and management issues that could potentially facilitate or impair DHS’s successful integration of its varied 22 agencies, and its subsequent execution of its critical tasks associated with countering terrorism and bioterrorism. Characterizing this change as a type of punctuated equilibrium, this article closes by suggesting that a differentiated network structure offers a potentially powerful mechanism by which the DHS could proactively and effectively address many of these leadership, management and organizational challenges.