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According to a study in a special issue of Medical Decision Making, a large-scale, covert anthrax attack on a large city would overwhelm hospital resources even with an extremely effective public health response, primarily because of expected delays in detecting the attack and initiating a response to it.

The article "Predicting Hospital Surge after a Large-Scale Anthrax Attack: A Model-Based Analysis of CDC's Cities Readiness Initiative Prophylaxis Recommendations," examines one of the CDC's principal bioterrorism-response programs, the Cities Readiness Initiative (CRI), a program that recommends the medical countermeasures necessary to minimise the hospital surge resulting from anthrax-related illness and response in the first two days after a major bioterrorism attack.

The researchers found that a CRI-compliant prophylaxis campaign starting two days after exposure would protect as many as 86% of exposed individuals from illness. However, each additional day needed to complete the campaign would result in as much as 3% more hospitalisations in the exposed population. Unsustainable levels of hospitalisations would result from delays in detecting and initiating response to large-scale, covert aerosol anthrax releases in a major city, even with highly effective mass prophylaxis campaigns.

The article, written by Nathaniel Hupert, incorporates some of the latest type of modelling techniques scientists use in the disaster preparedness.field. Such models have become increasingly important to public health officials and hospital administrators. To improve the consistency and quality of these models, the Society for Medical Decision Making convened experts to recommend best practises for modelling the public health response to a terror attack. Their article, also published in the current issue of Medical Decision Making, is entitled

• "Recommendations for Modeling Disaster Responses in Public Health and Medicine: A Position Paper of the Society for Medical Decision Making"

  The authors examined a large selection of published mathematical and simulation health sector disaster response models to generate a set of best practise guidelines. They made several recommendations, including striking the appropriate balance between simplicity and complexity, designing a plan to evaluate the many uncertainties inherent in disaster response, and good model reporting of the disaster response.

• "Evaluating the Capability and Cost of a Mass Influenza and Pneumococcal Vaccination Clinic via Computer Simulation"

  This research set out to determine the best way a clinic could vaccinate as many as 15,000 clients in 17 hours, including such factors as how to best configure the personnel to maximise the number of clients vaccinated; and to estimate the costs and revenue of such an undertaking. The researchers found that it was possible for the clinic to reach its target and that using a computer simulation could help them determine the most efficient use of staff, machinery, supplies, and time.

"How hospitals and public health agencies are prepared for an attack--and how they respond to the surge in patients seeking care—will determine our success in containing an attack if one happens."" said Mark Helfand, editor of Medical Decision Making.