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Emergency room to contact fbi { May 9 2003 }

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A first line of strategic defense

By Karen Roebuck
Friday, May 9, 2003

A blown-off finger, a skin burn or a respiratory illness were not normally reasons for an emergency room doctor to call the FBI. But now, with the threat of terrorism, they could be.

The FBI's Pittsburgh office wants to know about health problems that could signal the outbreak of a terrorist attack or the release of a biological agent, and now it has a way of culling that information quickly.

The Strategic Medical Intelligence unit, formed in the wake of the Sept. 11 terrorist attacks, is a pilot program begun in the FBI's Pittsburgh office that quietly has forged an alliance between the agency and a small group of doctors.

Special Agent in Charge Ken McCabe calls it "an early warning system."

Dr. Michael Allswede, SMI director, national bioterrorism expert and UPMC section chief for special emergency medical response, describes the unit as "a new way to approach bioterrorism."

"The way to attack America is not by lining up your tanks in the desert; it's by attacking our securities and sense of freedoms at home, and bioterrorism is the way to do that," Allswede, 41, said.

SMI's mission is to anticipate and prevent bioterrorist attacks, rather than reacting to events as the FBI traditionally has done, he said.

"In that way, it makes it more like the CIA," Allswede said. "It's a fundamental shift."

"The early detection concept will put us way ahead of the game," said FBI Special Agent Phil Smith, the agency's weapons of mass destruction coordinator.

SMI also takes advantage of another relatively new practice of the FBI, the blending of the private sector with federal agents.

Allswede said he hopes SMI will be copied at each of the FBI's 56 field offices nationwide. While the FBI's top officials are aware of the project, it needs time to prove itself locally before it can be rolled out nationally, McCabe said.

SMI's six doctors in western Pennsylvania and three in West Virginia are not just informants. Extensive background checks have been done on each, and they now hold government security clearances.

The FBI regularly provides the unit with classified intelligence briefings.

For example, should the FBI learn that abortion doctors might be the targets of anthrax-by-mail attacks, Allswede and the other SMI doctors could ask gynecologists who perform the procedures to let them know if they get sick enough to miss a day of work. The potential targets might or might not be told why, according to Allswede.

Should the doctors get sick, SMI will investigate and, if it appears to be something out of the ordinary, alert the FBI, he said.

Both Allswede and Smith emphasize that the public always would be told of any evidence that would threaten public safety, regardless of its effect on prosecution or evidence gathering.

"We're learning about what they're doing; it helps us do our jobs better," Smith said. "And they're learning what we do; it helps them do their jobs better. And together, it helps us combat nuclear, chemical, biological and explosive terrorism."

"The great problem in bioterrorism is that it starts with sick people who go to doctors -- and more than likely get the wrong diagnosis," Allswede said. "What we're really good at in America is diagnosing things after death."

Before the anthrax-by-mail attacks in 2001, no doctor would have thought of pulmonary anthrax as a possible diagnosis, he said. Most now might consider that, but it is only one of 200 potential bioterrorism-related illnesses, he said.

Allswede acknowledges that if he had seen a case of botulism in his emergency room at UPMC Presbyterian, "because of the competitiveness among hospitals," it previously would not have occurred to him to consult with other area emergency doctors to see whether any other cases had surfaced.

A pattern or spate of such diseases would be important, he said.

"You cannot in bioterrorism response underestimate the importance of the first case in getting it right," Allswede said.

So far, SMI has ruled out a bioterrorism link with hundreds of suspicious cases, Allswede said.

He has not been able to rule it out or prove it in three cases, including one fatality, although the victims' illnesses cannot be explained naturally, Allswede said. He declined to provide details except to say that two are in western Pennsylvania, but not in metropolitan Pittsburgh.

What SMI is looking for are suspicious cases. Not everyone who accidentally chops off his fingers will be reported.

But if someone clearly has had a finger blown off, yet claims it was sliced by a lawnmower blade, the FBI could conduct a background check on the victim and perhaps investigate more extensively to see whether he might be making bombs, Allswede and Smith said.

Similarly, certain skin infections or burns could suggest someone was exposed to biological or chemical agents -- either unknowingly or through working with them, they said.

The doctors are specialists in infectious diseases, radiation health physics, environmental toxicology, medical toxicology, surgery and flight medicine, the specialities that would be needed in a bioterrorist attack, Allswede said. Four also have tactical emergency medical experience, such as responding with SWAT teams.

Allswede declined to identify the members, but he said they are the leading bioterrorism experts at UPMC, Carnegie Mellon University, West Penn-Allegheny Hospital System, Hahnemann University Hospital in Philadelphia, West Virginia University and Marshall University in West Virginia. Representatives of the Allegheny County and state health departments meet with the unit.

Patient privacy will be protected as much as possible, they said. However, Allswede added: "Privacy and anonymity are often confused by the general public."

For example, financial information is considered private, but still accessible by those with a need to know, such as lending companies, he said. Law enforcement gets access to medical records when police need to know, he said, as already is done in cases of suspected child abuse.

That approach, Allswede acknowledges, sometimes raises issues with the constitutional right of being presumed innocent until proven guilty.

"That was in the days of our founding fathers when the worst thing that could happen to you was your horse was stolen," he said. "We were willing to give up a few horses in order to prevent innocent people from going to jail. But in the era of bioterrorism, when you could lose a city, the threshold has changed."

Privacy rights must be weighed against the level of the potential threat to security, he said. For example, if the FBI learned someone had brought smallpox into the country, "Those are the sorts of cases we're more interested in being aggressive in."

Karen Roebuck can be reached at or (412) 320-7939.

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