Observations from the Top Off exercise.

Abstract

Thomas V. Inglesby, MDa For a number of reasons, an analysis of the May 2000 Top Off exercise is an appropriate place to begin this examination of the most important issues surrounding the containment of contagious disease. First, the Top Off exercise provided the most comprehensive test to date of our medical and public health systems' ability to respond to a bioweapons attack. It revealed valuable lessons as to how the United States might deal with future epidemics. By this measure alone, the exercise must be considered a success. Second, the issues presented by our panelists are all very much a part of what happened at Top Off, and a discussion of Top Off will put them in context with each other. Last, Top Off provides a good context for the scenario that will follow. My remarks are taken from an article written by my colleagues Rita Grossman and Tara O'Toole and myself. That article, in turn, was derived from the observations of 11 senior participating officials who were observers, partici pants, or controllers in the Top Off exercise, to whom we are very grateful. We also should note that this exercise brought out the best in medicine and public health at the state and federal levels in Denver, and many people worked tirelessly for days and nights on end during the exercise. In an effort to assess the nation's crisis and consequence management capacity under extraordinary conditions, the US Congress directed the Depart ment of Justice to conduct an exercise engaging key personnel in a response to large-scale terrorist attacks. The resulting exercise took place in May 2000 and was called Top Off, so named for its engagement of top officials of the US government. It was the largest exercise of its kind to date, involving $3 million in direct costs and much more in indirect costs.