More than 16 months after the horrific attack on the Pentagon and the dissemination of a lethal bioterrorism agent through the mail, Northern Virginia hospitals, despite their best efforts, remain underfunded to deal with a terrorist attack. Although D.C. hospitals were recently promised $8 million for emergency preparedness, Northern Virginia's 13 acute-care hospitals, which serve an area with more than 2 million residents, have not yet benefited from such financial support.

After Sept. 11, 2001, Northern Virginia's hospitals -- which serve an area that ranges from Fauquier County to Fredericksburg and includes the city of Alexandria and Arlington, Fairfax, Prince William and Loudoun counties -- formed the Northern Virginia Emergency Response Coalition. This coalition has been working with agencies involved in emergency response, including those in public health and safety and emergency management. Its member hospitals have spent hundreds of hours and millions of dollars developing decontamination capabilities, outfitting staff with protective equipment and preparing to vaccinate health care providers against smallpox.

During the past 17 months, the Inova Health System has increased its emergency preparedness at significant cost. Its efforts include building mass decontamination facilities at all its hospitals. However, significant federal funds are needed for additional improvements to the coalition's readiness capability, including the radio link for hospitals to communicate during a disaster, effective disease surveillance and the surge capacity to serve hundreds or even thousands of casualties. Hospitals alone can no longer be expected to shoulder the financial burden of health care preparedness for terrorist attacks.

The federal money in the homeland security grant to Virginia will amount to no more than $380,000, to be divided among the 13 hospitals. This lack of funding is worrisome, especially when compared with the federal money going to hospitals on the other side of the Potomac.

Sixteen months ago, Northern Virginia's hospitals were filled with victims of the Pentagon attack; three of the five anthrax victims also first received care at Northern Virginia hospitals. If a catastrophe hit Washington, rendering the city's health care capacity unusable, acute care would be shifted outside the city. Northern Virginia hospitals again could be on the front line of an emergency medical response.

The protection, support and operation of our nation's defense and intelligence establishments, all located in Northern Virginia, are vital to the nation. In addition, a large component of the federal workforce, as well as many of the nation's lawmakers and political leaders, live in Northern Virginia.

At this point in our history, support for health care institutions must be viewed in the same context as other national security imperatives, especially in the capital region. Hospitals must be recognized as part of the country's critical infrastructure and supported for the public safety efforts now expected of them.

-- Dan Hanfling

is director of emergency management and

disaster medicine for Inova Health System.