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At the top of the task force's to-do list was a resource assessment. The medical center increased its supplies of protective equipment and antibiotics such as ciprofloxacin and doxycycline, which can treat anthrax as well as some of the other high-risk agents. Additional breathing tubes and mechanical ventilator bags will enable the hospital to, if necessary, triage and manually treat patients with respiratory failure if there were a sudden influx that exceeded the capacity of the intensive-care units.

"It would take some work, but we've now developed contingencies to allow us to bend without breaking, at least in the short term, if we saw 100 people with respiratory failure," says Pegues. "When you get much more than that, it reaches beyond the individual institution and you need a coordinated county or statewide response."

Among UCLA's richest resources are its microbiology laboratories. The campus is capable of testing several thousand specimens a day. Still, a few letters containing anthrax spores generated the need for tens of thousands of laboratory tests on the East Coast, both for possibly infected individuals and for environmental sampling to ensure that buildings were safe. At a certain point, whether due to the quantity or the nature of the pathogen in question, UCLA would refer to the county health department's reference laboratory, which is investing in high-throughput machines for rapid diagnosis.

Then there are the human resources. UCLA is educating its primary-care providers to recognize and report when patients present with symptoms that raise red flags — a particularly severe respiratory illness, an acute gastrointestinal illness with internal bleeding or hemorrhaging, a severe rash-like illness with fever that might suggest smallpox, a spike in out-of-season cases of flu.

"In traditional disaster planning, first responders are the firefighters and paramedics who arrive on the scene or the physicians in the emergency room," notes Ridlehoover. "In an unfolding bioterrorist event, the first responder might be a primary-care doctor or nurse practitioner in a clinic."

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