In the emergency department at CommonSpirit Penrose Hospital on Wednesday, a woman lay in bed, struggling to breathe as she described her symptoms to a nurse. In the hallway, another staff member checked vital signs on a young mother and her baby. All three patients had similar symptoms, including slurred speech and partial facial paralysis.
As public health and law enforcement personnel conducted interviews, they began to suspect that the patients were victims of botulism poisoning — and that they may have been infected on purpose.
On Wednesday, three CommonSpirit hospitals — Penrose, St. Francis, and St. Francis-Interquest — conducted a full-scale, unannounced bioterrorism disaster exercise. Held simultaneously in all three hospitals, the drills were designed to test hospital, public health and law enforcement response to a bioterrorism attack. In this case, the terrorism agent was botulinum toxin — one of the most poisonous known naturally-occurring substances — placed in the local milk supply.
“When you look at biological threats, botulinum toxin is one of the most difficult to identify,” said FBI Special Agent David Autrey. “It can’t just be identified in the field. Samples need to be taken, and laboratory analysis needs to be done.”
FBI WMD coordinator David Autrey was on hand to observe the handing of a biological disaster drill at Penrose Hospital on Wednesday, February. 21, 2024. (Photo by Jerilee Bennett, The Gazette)
Botulinum toxin can be found in water, certain soils, plants and milk, Autrey said. The levels found in nature are not typically harmful to people, so when multiple patients show up at emergency rooms complaining of the same symptoms — which can include blurred vision, facial weakness, trouble swallowing or speaking — it’s up to the hospital to recognize that something unusual is taking place, and notify the proper authorities.
“Our goal is to be ready to respond appropriately and have good recovery,” said Andrew Ritz, vice president of operations for all three hospitals. “We need to understand how (botulinum toxin) presents, how to identify the signs and symptoms, and then get the right parties involved.”
“We work in partnership with the hospitals,” said Autrey, a weapons of mass destruction investigator. “When they identify something of concern, they notify the state (Department of Public Health and Environment), and Public Health notifies the FBI.”
Together, the agencies conduct interviews and analyze samples in an effort to determine if the patients got sick as the result of a planned attack.
“We try to do the interviews together because (Public Health) may ask different questions than I do,” Autrey said. “They are epidemiologists, so they’ll ask questions I might not think of. I’m an investigator, so I’ll ask questions they might not think of.”
Wednesday’s exercise was one of several drills the hospital system conducts throughout the year, including simulated plane crashes, large-scale fires and multi-vehicle crashes, officials said.
A nurse cares for a mother and "baby" during Wednesday's bioterrorism exercise at CommonSpirit Penrose Hospital.
“Drills like these help us focus on three areas: readiness, response and recovery,” said emergency preparedness manager Sara Baird. “Our goal is to observe how the emergency departments communicate with one another, activate incident command, report to infection prevention and the Public Health.”
“We want to do better, all the time,” said assistant nurse manager Alex Nuttall. “We want to respond as best we can, we want to evolve and grow. That’s why these drills are so important.”
The exercises are designed to deal with every aspect of a casualty scenario, including the death of a patient. In Wednesday’s drill, two of the Penrose emergency patients “died.”
“Unfortunately, that’s one of the things that can happen in these situations,” Nuttall said. “Sometimes you lose a patient, and it’s important to know what to do when that happens, including how to handle the body, and how to properly inform family members.”
Keeping real-world casualties to a minimum is the ultimate goal of these drills, officials said. Seeing a commonality of symptoms, recognizing what they might mean, and getting the right agencies involved can keep a bad situation from growing into a large-scale tragedy.
“There’s a host of issues that could come up at any hospital,” Ritz said. “So it’s really about being ready for these scenarios, and having the processes in place so we can be responsive to them, in the right way, and as fast as we can.”
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