The magazine of the UW School of Public Health

Letter to the Editor

Lessons from TOPOFF 2

Dear Editor:

After reading the article on TOPOFF 2 [Fall/Winter 2003], I would like to provide the perspective of a metropolitan health department, Public Health — Seattle & King County, that may offer lessons for other health jurisdictions.

During a week in early May 2003, more than 100 local, state, and national players took part in TOPOFF 2, a full-scale exercise that assessed how responders and leaders would react to a simulated "dirty bomb" scenario in Seattle and King County and a biological agent attack in Chicago, Illinois. With these two major health emergencies, this federally mandated exercise was proof of how public health is now front and center in national emergency preparedness.

Some of Public Health — Seattle & King County's main responsibilities during the exercise were to coordinate the response for health issues and radiological contamination and to provide accurate and timely health and radiological hazard information to the community. In addition, our department was the primary health and safety advisor to the local elected officials, King County Executive Ron Sims and Seattle Mayor Greg Nickels, who had the final word on deciding protective actions for the population and other measures directly affecting the community's well-being.

In terms of lessons learned, the Department of Homeland Security stated in its after-action report that "coordination of on-site and off-site data collection by multiple agencies at federal, state, and local levels of government need improvement." Indeed, the radiation data guiding our decisions during TOPOFF 2 were piecemeal and often were late in arriving. Nonetheless, as the local health jurisdiction responsible for the health of a metropolitan area, we had to work through these and other challenges, make the hard choices with the information at our hands, and advance the plans to protect the health of our communities.

During the exercise, we were able to test systems with hospitals and other partners, building on our continued effort to have coordinated responses to health emergencies. We also identified some needs, such as in the areas of technology, staffing, and training. Additionally, we were reminded of how in any emergency, whether it is an earthquake or a dirty bomb, a competent workforce with resourcefulness and good judgment is key.

This experience came at a time when we already had our plate full with a host of real-world issues, including a pertussis outbreak, SARS, and smallpox vaccinations. For Public Health — Seattle & King County and our partners, this exercise was a new demonstration that in preparing the nation for biological, radiological, and other emergencies, the rubber hits the road at the local level.

Dr. Alonzo Plough, Director and Health Officer
Public Health — Seattle & King County