- In a way, Sept. 11, 2001, was a kind of dry run for the
country's medical examiners and coroners. While thousands of people died,
their bodies didn't pose a major risk to rescuers. And the final disposal
of the remains has gone smoothly. Next time, the dead may be a huge threat
to the living. Alarmed by the prospect of serious dangers, officials are
paying more attention than ever to the medical risks posed by the aftermath
of a terrorist attack. Just last month, the Centers for Disease Control
and Prevention issued an alert to coroners and medical examiners about
how to protect themselves while still doing their jobs.
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- "Not only are people thinking about it, they're
thinking about it in a formal way," said Dr. Michael Graham, chief
medical examiner of the city of St. Louis and president of the National
Association of Medical Examiners.
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- Disaster preparation, of course, is nothing new. Cities
and counties routinely plan how to handle events like airplane crashes,
hurricanes and tornadoes. But now, for the first time, the disposal of
the dead is getting attention from officials who usually focus on the living.
Before, "it was not a mainstream issue in disaster management the
way the medical management of victims would have been," said Dennis
McGowan, a former Atlanta coroner's investigator who advises government
officials on how to handle mass fatalities.
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- For coroners and medical examiners, the most immediate
hurdle after a terrorist attack would be removing dead bodies from the
scene while protecting the health of investigators, rescue workers and
themselves. While they're usually fairly harmless, corpses can spread disease,
as warriors realized in the Middle Ages as they committed what may be the
first acts of bioterrorism in history. According to historians, they used
a unique delivery system -- catapults -- to fling plague victims over walls
into enemy territory.
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- In more modern times, the bodies of the victims of the
Tokyo sarin attacks in 1995 sickened many of the doctors assigned to take
care of the injured. Fortunately, many chemicals that can be used as terrorist
weapons are easy to remove, McGowan said. "Soap and water will go
a long way in some cases, and sometimes you have to add something to it.
The problem for medical examiners and coroners comes when you have large
numbers of bodies that need to be decontaminated. Then it becomes a logistical
problem."
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- Biological weapons -- germs -- are a different story.
Some infectious diseases, such as plague, can be spread in aerosol form,
especially if bodies are sprayed by water. In a June 11 report, the CDC
warned that people can become infected if they're exposed to bodies of
people who died from hemorrhagic fevers (like the Ebola virus) or smallpox.
The CDC said workers who do autopsies are at risk of getting infected by
organisms that cause diseases -- including Q fever and tularemia -- that
could potentially be spread by a terrorist attack.
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- The next challenge will be finding storage for bodies.
They must remain refrigerated; otherwise they "could just serve as
a culture medium for anything that's out there," said Dr. Dean Blumberg,
an associate professor of pediatric infectious diseases at the University
of California at Davis who studies fatality preparedness. "This is
the kind of thing you read about all the time with big disasters like earthquakes
or floods."
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- Then, finally, the bodies must be buried or cremated.
Officials have talked about some worst-case scenarios that involve crude
methods of body disposal, such as mass graves or mandatory cremation, but
they're considered "unnecessary options," Blumberg said.
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- Experts differ on how well-prepared the country is to
handle the risk in the hours and days after a terrorist attack, but Graham,
the St. Louis medical examiner, is hopeful. "I don't think you can
ever be perfectly ready and prepared. But if you have a framework in place
and have thought about these issues, you can usually work through them."
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