New ventilation units blast curtains of purified air between patients and nurses in Washington Hospital Center's emergency room. Outside, yellow tarpaulins and water taps can decontaminate people on the sidewalk.
Nearby, a 2,400-square-foot "ready room" has 110 portable beds and cots, three "decon" showers and 1,000 prepackaged "undress/redress" kits for victims, complete with rubber sandals.
Chris Wuerker, left, head of emergency preparations at Washington Hospital Center, talks to Joe Nadzady as he puts on a biological personal protection suit at the center's bioterrorism decontamination and treatment facility.
(Lucian Perkins -- The Washington Post)
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The new equipment at Washington's busiest emergency room, trauma and burn center was made possible with $10 million in federal funds -- a fraction of what has poured into localities and first responders after the Sept. 11, 2001, terror attacks.
Since the attacks, the United States has allocated more than $250 million to improve emergency preparedness at public health agencies, hospitals and laboratories in Virginia, Maryland and the District. About one-third has gone to the capital region, including more than $60 million into the District and $20 million to the immediate suburbs.
But three years into a multibillion-dollar national buildup, a review of where the local money has been spent and interviews with two dozen local and national experts reveal gains in technology and personnel but little reassurance that a biological outbreak of the kind officials fear would be contained around the nation's capital.
Emergency rooms remain overloaded, public health offices are understaffed and Washington area doctors, health directors, lab technicians and hospital officials say despite all the activity, there is no coherent plan.
"What we really haven't connected is a system," said Susan Allan, health director of Arlington County and a member of the bioterrorism committee of the National Association of County and City Health Officials. "We're putting together a lot of individual pieces, some of which may be strong . . . and some may be very weak. But if you've got a chain, and one link is fragile, you might as well just not have bothered."
As funding has increased, its impact has been blunted and diluted by changing federal priorities, lack of consensus on goals, overlapping bureaucracies in the region and the sheer difficulty of hiring hundreds of medical specialists in such a short period, officials said.
As Daniel Ein, head of the Medical Society of the District of Columbia's emergency preparedness committee, put it: "What do we need? How do we best achieve it? How do we coordinate it? If you find out, would you let me know?"
William Pierce, a spokesman for the federal Department of Health and Human Services, declined to comment for this article.
To be sure, the money has brought successes. Virginia has spent the lion's share of its federal public health aid, about 60 percent of $68 million, on staff -- rebuilding an almost nonexistent public health corps, according to a breakdown of funds received since 2001 from the Centers for Disease Control and Prevention.
"The whole idea of emergency planning in public health didn't really exist before 9/11," said Lisa G. Kaplowitz, Virginia's deputy commissioner of health. The grants have paid for 100 field workers, including about 20 epidemiologists, planners, trainers, medical consultants and nurses in Northern Virginia.
Maryland also channeled two-thirds of its CDC grants -- $12.4 million -- to counties in 2003, the only year for which it could provide a breakdown, said Dianne L. Matuszak, director of Maryland's Community Health Administration. Much of the remainder has gone to hardware: information networks, laboratory equipment and pagers, laptops, wireless networks, e-mail and backup communication systems.
State health labs also have made big gains. Virginia's $40 million facility is a national showcase. Maryland has tripled its secure lab capacity and quadrupled the number of its technicians to 27. Even the District Department of Health, which almost shut its facility five years ago, will seek this year to meet federal standards for handling such substances as ricin, smallpox and plague.