Reviewing the problems encountered in Idaho and how they were addressed may improve the public health response in all states. A centralized communications center is critical for reducing the impact of a large-scale outbreak on a public health emergency response system and for providing timely and consistent response to citizens. In Idaho, the preexisting communications system enabled communication between multiple agencies. The rapid development of triage protocols is important for consistent response to a crisis. While basic response protocols must be outlined for each event, a rapid mechanism for protocol development and agreement by participants must be part of any flexible response plan. Local health departments should be included in biohazard response protocols to minimize confusion during the management and follow-up of each public health event. Initially, StateComm calls included only state health department officials because local health officials did not carry pagers. Local health officials in Idaho are now equipped with pagers and are part of the response protocol. Immediate reporting of laboratory test results to a central communications center reduces the burden on laboratory staff. The volume of callers seeking results was decreased because health and law officials were aware that results could be obtained from the communications center directly. Extra effort and time attempting to reach first responders, citizens, and health officials with test results were also eliminated.
In responding to suspected bioterrorist events, treating each event as a possible crime requires cooperation and planning. Transport of samples by law enforcement required cooperation with multiple county law enforcement officials. Alternative transportation plans would have been useful in Idaho should a local law enforcement agency have refused to transport a specimen. In addition, the establishment of a proper chain of custody and proper packaging procedures would have allowed more streamlined processing of samples for both laboratory safety and chain-of-custody requirements. Education of state communications personnel in communicable disease topics, such as anthrax, is required if communications personnel are used to initiate and coordinate response protocols to biohazard events. A basic understanding of the terminology and the general principles of epidemiologic response would minimize the chance that a potentially serious situation is overlooked. Trust between the decision-makers in multiple state, local, and federal agencies is essential for coordinating responses effectively. In small states, fewer people are usually involved in each response, and the same participants tend to be on each call, simplifying coordination. Planning meetings with other responding agencies are essential in order to establish protocols and to foster trust.
States with small, rural populations often have fewer resources to deal with the increasing stress on their emergency response systems. Despite the lack of anthrax infections in the western United States during the fall of 2001, citizens in Idaho were fearful of being exposed to anthrax, and the public health emergency response system was tested. A well-coordinated response was required from agencies with little experience in working together. Idaho was fortunate to have a statewide communications network in place; however, even with this response system, modifications were required to ensure smooth relationships between first responders and public health officials.