Proposals to combat terrorism would change Americans' ways

As traders returned to the New York Stock Exchange this week, they passed through metal detectors and checkpoints, and were sniffed by trained dogs. Aviation authorities are now examining previously rejected proposals for armed marshals on flights and bulletproof cockpit doors. Security officials in public buildings are starting to look at face-recognition technology that is currently in service at some Las Vegas casinos. The use of racial and ethnic profiling is getting a second look. The Bush Administration is circulating a wish list of ways to expand law enforcement powers, calling it the Mobilization Against Terrorism Act.

Dozens of steps can be taken domestically to reduce--but not eliminate--the risk of terrorism. "Terrorists exist to obviate and overcome all the physical barriers put in their place," said Bruce Hoffman, a former adviser to the National Commission on Terrorism and the vice president for external affairs at the Rand Corp. "That's not to say we shouldn't do anything. It is to say we should have realistic expectations. You can't create a riskless society."

The challenges for counter-terrorism efforts inside U.S. borders will largely be ones of balance: cost versus benefit; freedom versus security. Some of the proposals that could conceivably do the most to stave off terrorist attacks will also be the most controversial and will prompt objections, on moral and civil liberties grounds. Warns Laura Donohue, a fellow at Stanford University: "Anything we do now, we're going to be stuck with it." Rolling back such measures--even if they don't work-- will be difficult without appearing to be soft on terrorism. What follows is a look at more than 30 proposals being talked about in the wake of the September 11 attacks.

At the Borders

Improve technology

Most experts agree that it is unnecessary for federal agents to scour every vehicle that crosses our borders, because doing so would cause massive economic disruptions. The question, then, is how to ferret out the potentially dangerous vehicles, without interrupting the flow of those that don't pose a risk. It isn't easy, but technology can help.

Already, commercial-freight shipments can be encased in tamper-proof packaging at their factories of origin and tagged with codes that are then scanned. Information about the shipment can be relayed ahead of time to border officials, who then need only to check the codes and the seal's integrity before waving the shipment through. This process is in use to a certain extent already, but it could be expanded, experts say.

Shipments that aren't pre-tagged--especially those that strike inspectors as suspicious--can be scanned by large X-ray machines. Officials have recently used this technology to unearth illicit drug shipments at some border-crossing points.

Federal officials could also implement "speedpass" technology--a variation on the kind commonly used by commuters on toll roads. Some frequent crossers of the Canada-U.S. border can already sign up for such passes, which require a modicum of background checking before they are issued. The "Cadillac version" of this technology could one day include face-recognition software, which ensures that the driver is indeed the pass holder, said Christopher Sands, the director of the Canada Project at the Center for Strategic and International Studies. "Many of the small crossings are just a shack," Sands says. "We have to make sure these tools are everywhere."

None of this would prevent determined terrorists from smuggling something into the United States. Indeed, the September 11 hijackers needed to smuggle very little into the United States. But by speeding up the flow of goods known to be safe, border officials would be able to focus their energies on vehicles and people that strike them as suspicious. Previously, cost has been a barrier to using new technologies at the border, but "this may well be the event" to change people's minds, said Demetrios Papademetriou, co-director of the Migration Policy Institute in Washington.

End visa waivers

Visitors from some 30 countries now enjoy visa waivers for tourist visits: All they have to do is fly here, fill out some paperwork on the plane, and--assuming no hitches during the cursory checks by passport officers--go on their way. Foreign countries, businesses, and citizens love it; so do Americans, who enjoy reciprocal visa-free passage to cooperating countries. But any terrorist who manages to get a passport from a waivered country--say, Germany--will likely breeze through security, as long as he is not already known by the United States to be a terrorist. "I have to wonder if the whole program is at risk now," said one immigration expert.

There are downsides to imposing new requirements on foreign nationals, beyond inconvenience. Consular officials--already considered overworked--would face additional strain. Typically, foreign applicants for nontourist visas must show a valid passport, a sponsor's letter (from a university or an employer, for instance), and evidence of a reason to return home at the end of the stay (such as a bank statement or a letter from government officials). Creative terrorists can always get around such investigations by creating sham employers or sponsors.

Require passports

Currently, visitors from Canada are not required to carry passports--a cherished perk of America's long, friendly relationship with Canada. But with evidence that terrorists have made their way into the United States on ferryboats from Canada--first in a foiled plan to bomb Seattle's Space Needle, and then in the attacks on the World Trade Center--some say that luxury may be nearing its end.

In the meantime, some analysts suggest that the United States should upgrade its technology for producing passports. Already, newly renewed U.S. passports are being sent with a built-in, computer-readable strip that immigration control officers can swipe through a scanner. That strip not only speeds analysis of incoming American travelers, but could also serve as a foundation for better-integrated data collection about travelers. Some experts suggest accelerating the passport switchover, even to the point of recalling and exchanging all outstanding U.S. passports.

Pressure countries

Historically, the United States has been reluctant to get tough with foreign countries that have lax emigration controls. That's understandable, given the diplomatic sensitivities involved. But some critics say it's time for a change. "We could put pressure on other countries that are known to be a disproportionate source of troublesome visitors to the U.S., telling them that we won't be processing their nationals' visas in as timely a fashion if they don't exercise more control," said Dan Griswold, associate director of the Cato Institute's Center for Trade Policy Studies. One immigration expert notes: "Some people in Congress have been after the State Department on this point for years."

Travel Security

Use air marshals

In the 1970s, with hijackers forcing U.S. planes to fly to Cuba, the federal government began to place armed undercover agents aboard selected passenger flights. And even before September 11, air marshals accompanied a few international and domestic flights that were considered the likeliest targets of hijackers and terrorists. The government refuses to identify which flights--or even their exact number.

In the past, some aviation observers advocated expanding the number of air marshals as a way to deter hijackers and terrorist attacks, but the idea was ignored because of cost concerns and the airlines' reluctance to alarm passengers. Now, the Bush Administration has begun to press for an expanded marshal program, and some members of Congress have proposed adding a $1 surcharge per flight segment to pay for it. Experts warn that the United States will never be able to patrol every plane, however. "We can't do a sky marshal on every flight," said Michael J. Boyd, a Colorado-based aviation consultant. "We would need a force the size of the U.S. Marine Corps to do that."

Fortify cockpit doors

Installing heavily fortified, bulletproof cockpit doors might prevent hijackers from getting control of an aircraft. According to The Wall Street Journal, Boeing Co. developed stronger cockpit doors years ago, but they were never required. Fortified doors could make it more difficult for pilots to escape from plane crashes and could pose air-pressure problems (unless air is able to circulate freely throughout the cabin, pressure can build up at certain points and cause structural damage to the plane). In addition, an impenetrable door could prevent pilots from coming to the defense of passengers threatened by terrorists.

But airline consultant Michael J. Boyd says attitudes have changed since September 11. "We don't crash all that often. Every pilot I've spoken with, they say they'll take that chance." And Boyd isn't alone: The Federal Aviation Administration has made stronger cockpit doors a top regulatory goal.

Centralize security

Responsibility for airport security is currently shared by the FAA (which sets guidelines, establishes procedures, and shares intelligence), the U.S. airlines (which screen passengers, baggage, and cargo), and the airports (which provide security inside airport facilities). Perhaps the biggest security problem lies within the airlines, which pay their security screeners little more than minimum wage. The airlines, explained Robert W. Poole, the founder of the Reason Foundation, a conservative think tank, have always seen security "as an extra cost that they'd like to minimize."

Some observers are calling for a more centralized security system run by the federal government. But critics are wary of turning over the security duties to the FAA--because, they say, the agency has a history of mismanagement.

Require background checks

The next terrorist attack could target a different segment of the transportation system, such as buses, subways, commuter rail, or Amtrak. Conducting thorough background checks for transportation operators could help prevent terrorists--serving as bus drivers, subway operators, and train engineers--from turning their vehicles into lethal weapons.

Amy Coggin, the communications director at the American Public Transportation Association, says that instituting widespread background checks is warranted. "I certainly don't think anyone would be opposed to that."

Use face-recognition technology

At some Las Vegas casinos, security officials use face-recognition software systems to try to identify known cheats. Law enforcement officials provide photos of suspicious people to security personnel. The software then takes as many as 128 measurements of each face--such as the distance between the eyes, the size of the nose, and the slope of the cheeks. Simple disguises such as a new hair color or a fake mustache can't hide such basic characteristics. The system was used at last season's Super Bowl, where government security officials spotted 19 people who were on their "watch list."

Tom Colatosti, president and CEO of Viisage Inc., which developed the software, says he has already talked with airport executives about setting up face-recognition systems at airport entry points. The software could also be used at bus terminals and subway stations. But it isn't cheap: Colatosti says his company could introduce the software at Boston's Logan International Airport for about $500,000.

Ground Security

Protect public places

Bag checks and metal detectors have been standard in countries such as Israel for years. In Israel, going to the shopping mall involves extensive questioning at the entrance to the parking garage, along with a search of your car's trunk. If you forget your bag on an Israeli bus, it will be checked for bombs and then destroyed.

But such measures are of limited value in open areas, such as New York's Times Square. And metal detectors are only as good as the people monitoring them, so raising the skill level of security personnel is crucial.

Counter-terrorism experts are now nervously eyeing as potential terrorist targets everything from packed sports stadiums to rush-hour subways. "A subway tunnel fire, that's the scariest thing in mass transit," said one congressional source: Smoke inhalation on a trapped train could kill "1,000 to 1,500 people." But searching every transit passenger or sports fan would slow life to a crawl. Instead, expect to see more security cameras like those already in place in Washington, D.C. Metrorail stations. In the future, security equipment might include hidden detectors for poison gases and germ weapons, now in development at Energy Department laboratories.

Barricade vulnerable areas

After terrorist bombings by Irish Republican Army members in 1993, London barricaded its financial district for about five years. Entry into the so-called "Ring of Steel" was monitored by armed guards, and surveillance cameras with face-recognition capabilities monitored people and license plate numbers. The license numbers were checked against a database on stolen vehicles. Changing the district's streets to one-way also facilitated monitoring.

But critics say that although the effort reduced crime in the designated area, terrorists just shifted to other targets, such as London suburbs and Heathrow Airport.

Seal trash cans

Trash cans are a tempting repository for a bomb. In Israel, it's hard to find a trash can in most public places. In Paris and London, sealed trash cans abound, and are often piled high with trash. But while sealing public trash cans prevents trash-can bombs, many experts argue that it just displaces the problem. "It's not that it has a practical effect as much as it's a psychological assurance," said Bruce Hoffman, a former adviser to the National Commission on Terrorism who is vice president for external affairs at Rand Corp. "Like a lot of physical security, it's more feel-good. Terrorists aren't stupid. If they can't put a bomb in a trash can, they'll find something else to put it in."

Patrol the skies

One of the responses to last week's attacks was easy to notice: For several days after September 11, the only sound in the otherwise silent skies was the occasional roar of a fighter jet, as commercial air traffic was grounded and military aircraft scrambled to put a "CAP" (combat air patrol) over major U.S. cities. Patrols, in some form, are likely to continue. Expect the number of jet fighters on ready alert to increase dramatically, imposing increased costs in both money and personnel on the Air National Guard, the primary defenders of U.S. airspace.

Surveillance

Track foreign nationals

Current methods for tracking foreign nationals in the United States are both piecemeal and antiquated. There is no single electronic database that includes basic information on all visiting foreign nationals. "The INS has no, N-O, idea how many people came into the country legally and never left," says Mark Krikorian, executive director of the Center for Immigration Studies. In 1996, Congress passed a plan--Section 110 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996--that required the INS to begin collecting and organizing data on individuals who crossed into the United States by land. Such information is already collected from visitors arriving by air and sea. However, business interests--especially those in border communities--objected to Section 110 and lobbied Congress to delay implementation. Congress agreed.

Lobbying also stifled attempts to more effectively track the recipients of student visas. In the 1990s, efforts to create a database were crippled after universities complained. They argued that such record-keeping was burdensome and intrusive. "We have 7,200 Iranian students here in the United States," says Raphael Perl, a Congressional Research Service expert in international terrorism. "For most of them, we don't know what they're doing. They can leave the university, and we don't know what happens to them."

Analysts say the government needs to create a database that includes, at a minimum, basic passport information for every foreign national entering the country, plus the entry date and expected exit date. With such a database, officials would find it easy to determine which visitors have overstayed their welcome. Those cases could be flagged and pursued as needed. The database could also be linked to existing electronic systems maintained by federal, state, and local authorities, especially those that detail terrorist links. "Practically speaking, it's quite a task, but it's not like putting a man on the moon or building the nuclear bomb," Krikorian said.

A database of foreign nationals could even be linked to scans of fingerprints or eyeballs. Some civil libertarians would cringe, but supporters note that foreigners have always received fewer rights than American citizens. (Krikorian, for one, suggests that such data be destroyed once a foreign national becomes an American citizen.)

Require registration with police

Registration was actually required of foreign nationals until 1981, and it is mandatory in some other countries, including the United Kingdom, but analysts are divided over the value of this measure. Spot-checking address information could lead police to suspicious visitors. On the other hand, the earlier experience with the requirement suggests that, after a while, it was widely ignored.

Monitor renters

At the height of their internal battles against terrorism, Italy and Germany required landlords to notify police of the identity of their tenants, said Yonah Alexander, director of the International Center for Terrorism Studies at the Potomac Institute for Policy Studies. He added that some areas of France currently require such reporting. The goal is to monitor people who have transient lifestyles. But instituting such a system in the United States would require a very high level of coordination--and would raise significant civil liberties concerns. "If you have a large city, it's more difficult," Alexander said. "In a small environment, you can do more than in a larger city like New York." For a while, Germany and Italy also monitored people who paid their bills in cash.

Hire more translators

Intelligence and law enforcement agencies admit that they don't have enough translators to properly review Arab-language electronic intercepts, TV broadcasts, and newspapers for useful information. At a September 17 press conference, FBI Director Robert S. Mueller launched a recruitment campaign for such translators, with a proviso that all applicants would undergo a background check. The unspoken worry is that such applicants could include terrorists seeking to penetrate the intelligence agencies.

Greater capability to translate available information could provide vital intelligence without expanding wiretap rules, say advocates who are worried about the federal government's police powers. "Existing legal authorities are adequate," said David Sobel, general counsel at the Washington-based Electronic Privacy Information Center. "I suspect they are drowning in so much information that there is not an effective means to analyze the information."

Law Enforcement

Share intelligence

Much of the government's intelligence information is on paper or in computer files that cannot be quickly searched by law enforcement agencies in pursuit of suspects or clues. For example, the FBI cannot track the location, studies, or employment of a foreigner admitted on a temporary visa, unless it can persuade a court that surveillance is warranted. Similarly, people whom FBI agents suspect of being allied with terrorist groups may be issued visas, because of poor coordination with the State Department. Similarly, an airline can unknowingly issue reservations to a suspected terrorist because its computers cannot access the FBI's watch list.

Although the FBI and various state and local police forces are stepping up their sharing of criminal data, the government could automate other sources of information, including: pilot license files, school enrollment rosters, workplace personnel lists, firearms license files, and utilities' customer records. Much, if not all, of this information could be gathered without a court order. But many civil liberties advocates on both the right and the left deplore such integration of information and databases.

Use racial/ethnic profiling

According to a September 13 Harris Interactive poll for Time/CNN, 57 percent of those surveyed "support using profiling by age, race, and gender to identify potentially suspicious passengers" on airlines. Even liberals have not ruled out this possibility, which they would have denounced before the attacks. When asked whether beefed-up airline security measures might include profiling, Sen. Hillary Rodham Clinton, D-N.Y., said, "Well, I think we have to do whatever it takes." The September 11 attacks, she said, "changed everything."

The legal issues are ambiguous, says Northeastern University law professor Deborah Ramirez, who conducted a racial profiling study for the Justice Department last year. "I don't think every use of race or ethnicity constitutes profiling," she says, but adds: "It's problematic when it's more predictive, and is based on racial and ethnic stereotypes."

Some civil libertarians are wary. "Efforts to combat racial profiling remain important, and there's nothing that has happened that negates those concerns," said one civil liberties lawyer who requested anonymity. Immigration policy analyst Demetrios Papademetriou suggests that the use of racial or ethnic factors in profiling to combat terrorism might be justifiable, but he says that America's tradition of civil liberties demands exacting public oversight of such actions. "You may have to create bodies like citizen advisory groups," he says. Changes of this magnitude "have to be negotiated within our society."

Expand criminal files

A Justice Department regulation dating from the post-Watergate period largely bars U.S. security agencies from collecting data on nonviolent groups that may have ties to violent groups. This rule needs to be changed, some officials say, because finding, identifying, and monitoring suspects is very difficult if they gather at centers, such as mosques, that are not visibly linked to any crimes. "If you can't have a file that says [for example]: `Detroit Mosque' and an organization that puts all the pieces together ... of course it gets in the way" of an investigation, a former FBI official said.

But this type of monitoring is very controversial, largely because it could sweep in many peaceful groups. During the mid-1990s, for example, anti-abortion groups accused the Justice Department of violating the regulation when it launched a task force to broadly track violence against abortion clinics. One way around this problem would be to rewrite anti-terrorism laws to criminalize a broader range of activities, such as the collection of funds for terrorist groups, thus providing law enforcement agencies with a basis on which to seek court-ordered surveillance of such groups.

Rewrite terrorism laws

Attorney General John D. Ashcroft and FBI Director Mueller want to rewrite federal terrorism laws and ease restrictions on the FBI's process of gathering information about terrorist plots. They propose revising current laws to broaden the definition of a terrorist to a state, or nonstate, actor who causes mass destruction; allow courts to mete out severe penalties to those who harbor or finance terrorists; to remove the statute of limitations, or court deadlines, for prosecuting terrorists; to accelerate the process for deporting immigrants suspected of having terrorist links; to make contributing to terrorist groups a crime; and to seize terrorist assets in this country.

Ashcroft has also asked Congress to allow the FBI to seek a single wiretapping order authorizing it to eavesdrop on a particular suspect--instead of just to monitor a specific telephone. The government also wants authority to bypass the courts to wiretap a suspected terrorist.

A Clinton-era internal guideline that bars the FBI from sharing with other intelligence agencies information it obtains about terrorists from criminal and grand jury investigations and court-approved wiretaps is sure to be dropped. The Justice Department also hopes to expand its power to detain immigrants suspected of crimes.

Criminalize leaks

Last year, with backing from Sen. Richard C. Shelby, R-Ala., then-chairman of the Senate Select Committee on Intelligence, Congress passed a law criminalizing the leaking of classified information but exempting members of Congress and judges from penalties. President Clinton vetoed the measure. Civil libertarians, and even some intelligence officials, are opposed to reviving the measure, largely because of concerns that government officials might use it to prevent public discussion of agencies' activities.

Citing the importance of secrecy during wartime, retired CBS anchorman Walter Cronkite has called for the appointment of a censorship board, made up of journalists and historians, to help prevent the media from disclosing sensitive information that could hinder investigations and help terrorists.

Crack down on hacking

Computer hackers often weave and dodge through a variety of corporate and university computers to avoid detection before and after they attack their targets. Terrorists, so far, have done little except harass a few Web sites that carry their enemies' messages. However, security officials fear they may try to disable critical nodes in the telephone networks, the Internet, or critical utilities, such as electrical power.

Federal officials are sharing information about hackers' attacks, supporting a draft international anti-hacker treaty, and urging companies, utilities, and local governments to toughen their computer networks. One controversial way to accelerate these computer-defense efforts would be to allow the victims of hacker attacks to sue for damages the owners of any unsecured computers exploited by the hackers.

Bureaucracy

Create a new agency

Turf wars and structural hurdles have been widely blamed for weak American interagency cooperation. Ray Sadler, former chairman of the New Mexico Border Commission, calls the existence of scattered government fiefdoms "the most serious problem the U.S. government faces" in fighting terrorism at its borders. Information sharing is one crucial area where progress has been slow to develop, officials say. In recent years, agencies involved in drug interdiction on the U.S.-Mexico border have taken steps toward interagency cooperation by building joint command centers. But some officials, including Rep. Mac Thornberry, R-Texas, suggest something bigger: creating a single agency responsible for homeland defense. This agency would embrace some combination of the Border Patrol, the Immigration and Naturalization Service, the Drug Enforcement Administration, the Customs Service, the Coast Guard, the Federal Emergency Management Agency, and possibly others. Earlier this year, Thornberry introduced legislation to create such an agency.

Given the new kind of war now being envisioned, young Americans might be recruited for government efforts to handle security, surveillance, intelligence gathering, and cyberinvestigation--and perhaps even security at airports.

Energy

Protect nuclear plants

Nuclear industry watchdog groups say that the government should dramatically tighten security at the nation's nuclear power plants and research facilities. Activists also say that federal regulators should drop an ongoing pilot program that gives 20 power-plant owners more responsibility for the security at their facilities. Industry officials counter that the pilot program increases safety at the nuclear power plants, because it requires companies to test their internal security every three years; the federal government conducts its tests every eight years.

Across the nation, there are 103 commercial nuclear power plants and 37 research reactors. Nuclear power industry officials say their plants are inherently safe because they're built to withstand hurricanes and other natural disasters, and the plants are protected by ground-surveillance equipment and security personnel. The facilities have been operating under stricter security since the September 11 attacks.

However, U.S. nuclear power plants have no air surveillance. And at a September 17 meeting, International Atomic Energy Agency officials conceded that the nuclear facilities were not built to withstand attacks from today's massive aircraft or from missiles. The recent terrorist attacks have also put the spotlight on security tests the government conducts at nuclear power plants. Those mock attacks have found "significant deficiencies" in security at 40 percent of the facilities, according to a Nuclear Regulatory Commission spokeswoman. She added that those problems were later corrected.

Tighten pipeline security

Federal regulators are urging energy companies to upgrade their security along the nation's electric transmission lines, and along oil and natural gas pipelines. On September 14, the Federal Energy Regulatory Commission issued a statement promising to quickly process requests from energy companies that are seeking to pass the costs of their security improvements on to their retail customers. As a result, U.S. consumers could begin to see higher energy rates.

Officials at the North American Electric Reliability Council are working with the FBI and other federal agencies to coordinate security at the nation's electric-generating facilities and along the electric-transmission lines crisscrossing the nation. Security has been particularly important along the massive oil pipeline that stretches across Alaska and the natural gas pipelines that carry fuel from Canada. Environmental groups have long argued for stricter federal control of the oil and natural gas pipeline companies, which critics say have been lax in monitoring for leaks and other environmental problems. They also note that the federal government doesn't know the locations of all the natural gas and oil pipelines in the United States. The Transportation Department's official maps include only 49 percent of the natural gas pipelines and 87 percent of the oil pipelines.

Safeguard toxic chemicals

We now know how ingenious terrorists can be in turning the everyday means of modern industrial life against us. Ordinary airliners hit the World Trade Center with the estimated power of up to 400,000 pounds of TNT--equal to a small "tactical" nuclear bomb. And to improvise a different dreaded weapon of mass destruction--poison gas--terrorists would only have to seize or sabotage a chemical plant or intercept any of the thousands of shipments of toxic industrial chemicals that travel America's roads and rails every day. Some of today's commonplace chemicals, such as the chlorine we use in disinfectants or the phosgene we use in food processing, were actually developed for use as weapons in World War I.

The good news is that local authorities and industry have been responding to spills of such chemicals for years. Most fire departments, and many large factories, have their own hazardous materials ("hazmat") teams with extensive experience handling industrial chemicals. The industry's American Chemistry Council Inc. operates a Chemical Transportation Emergency Center with a 24-hour hot line for technical advice on particular toxins.

"In the wake of September 11," said council spokesman Terry Yosie, "the industry is further tightening access to its facilities," intensifying coordination with local governments, and generally reassessing security. Specific steps--such as more background checks and more guards--remain unsettled, as do the costs. Expect tighter regulation of the industry and more funding for hazmat teams. And all concerned will have to make a crucial mental shift-from guarding against accidents to stopping mass murder.

Preparedness

Establish response plans

For good reason, Israel has one of the most detailed local plans for responding to terrorist attacks--especially one that is biochemical. The government has issued every citizen a "protective kit," distributed through local centers. The kits contain fitted gas masks, plastic sheeting to seal off rooms, and antibiotics. And a military official answers a hot line that citizens can call for help.

Israelis receive mailings with maintenance reminders such as when to change their gas-mask filters. In the event of an attack, the government is ready to give ciizens step-by-step instructions over the radio (including details such as the need for men to shave their beards in preparation for putting on gas masks). The Israel Defense Forces list local distribution centers, how-to information, and answers to frequently asked questions on its Web site at: www.idf.il/english/organization/homefront/index.stm.

"They have a coordinated response," said David Siegrist, a counter-terrorism expert at the Potomac Institute for Policy Studies. "They have a plan. They have a strategy. The United States has fragmented efforts."

Watch for symptoms

The Centers for Disease Control and Prevention has requested heightened watchfulness for "any unusual disease occurrence or increased numbers of illnesses that might be associated with [last week's] events." The alert went to state health departments, which, in turn, were directed to notify epidemiologists, laboratories, local public health units, hospital emergency departments, and 911 dispatchers.

Medical professionals are always supposed to be on the lookout for deadly diseases, such as anthrax, that can masquerade (initially) as less harmful illnesses. Procedures are already in place for notifying the CDC about illnesses that behave unexpectedly and don't respond to accepted treatments.

Stephen D. Prior, research director for the National Security Health Policy Center, which is a part of the Potomac Institute for Policy Studies, says that evidence of bioterrorism will show up first at pharmacies. New York City and Los Angeles already monitor the purchase of over-the-counter relief medications, such as anti-diarrhea drugs, and Prior is hoping that other cities will follow suit. But this will take time, and each state makes its own rules.

Stockpile vaccines

Bioterrorism experts have for years urged the federal government to increase its stockpile of vaccines and antibiotics to combat such deadly infectious diseases as anthrax and smallpox. Stockpiles now are considered to be highly inadequate. More smallpox vaccines are in production, but they won't be available for several years.

Increase hospital staffing

On the very day of the terrorist attacks, the House Education and the Workforce Committee was scheduled to hold a hearing to examine the nation's severe shortage of nurses and other hospital staff. A bill by Reps. Sue W. Kelly, R-N.Y., and Carolyn McCarthy, D-N.Y., would publicize the need for nurses and provide scholarships and subsidies for nursing school. The consensus is that hospitals responded well to last week's crisis, but had there been additional wounded people, the health care system would have been greatly strained.

Train medical personnel

Some health care groups that have been examining ways to enhance disaster response have suggested more training for hospital personnel. For example, California is considering requiring that hospitals there train staff members to respond to earthquakes.

The American Medical Association is calling for the creation of a public-private entity that would develop medical education curricula on disaster medicine; develop information resources for civilian health care workers; provide model plans for a community medical response to disasters, including terrorism; and speed up community physicians' reports of dangerous diseases to public health authorities.

Improve coordination

Washington's experience on September 11 could serve as a wake-up call to cities nationwide about the need for readiness. D.C. officials admit that the nation's capital was caught unprepared to respond to the attacks and their aftermath. The emergency broadcast system was not activated, the city's health department couldn't monitor hospitals' radio network to learn about bed availability, and federal officials did not notify metropolitan police about building evacuations and closures.

Gia Fenoglio, Elisabeth Frater, Sydney Freedberg, Jr., Siobhan Gorman, Erin Heath, Louis Jacobson, Margaret Kriz, Neil Munro, Mark Murray, and Marilyn Werber Serafini contributed to this report.

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