The history of modern terrorism can be viewed as a competition between psychopaths, a game of one-upmanship in which each act seeks to outdo the next.
In the 1990s, the first World Trade Center bombing gave way to the Oklahoma City bombing, which laid the groundwork for 9-11, which in turn raised the threshold for mass murder to strategic new heights.
That's what scares many health officials, who fear that the next major attack may be an act of bioterrorism: the dispersal of a deadly pathogen that kills swiftly before authorities even realize what they're dealing with. This was the alarming scenario discussed at a seminar last month on terrorism at Columbia University's School of Journalism. The gathering included health experts, current and former government officials, and security experts.
The unmistakable message coming out of the conference was that the United States is still ill prepared to deal with a major terrorist event that would involve chemicals or germs. Much has been accomplished in the last two years, with hundreds of millions in state and federal funds spent on anti-terrorism programs throughout the nation. But many national, state and local plans are poorly coordinated, and the training of doctors, police and firemen to recognize and deal with something like smallpox or bubonic plague is haphazard at best, in many places.
The result is something that looks more like the nation's education system -- with different goals, programs and curriculums stretched out over hundreds of jurisdictions -- than a unified plan of emergency preparedness.
"We all know that this country is not ready to manage a major bio-terrorism incident,'' said Jerome M. Hauer, a former federal assistant secretary for public health who now heads an institute at George Washington University. Among other things, many hospitals are not equipped to handle huge patient loads, and vaccines are not being sufficiently stockpiled, he said.
Where there has been improvement, it's been in emergency training involving single and multiple casualties, but not mass casualties. Of particular concern, said several experts, is what's known as a hospital's surge capacity -- the sheer number of emergency cases it can handle at one time.
"We're very, very far from having any confidence that any place in the United States can handle mass casualties,'' said Irwin Redlener, an expert on emergency preparedness at Columbia University's Mailman School of Public Health. Evacuation procedures are often poorly thought out, the question of quarantine is legally complex, and local health districts cross city and county boundaries in many states. All are formulas for confusion during an emergency.
What is alarmingly clear is the apocalyptic rhetoric of al-Qaida and other terrorist groups. With each success -- a car bombing, a suicide bomber in a crowded caf
