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In 2002, President Bush promised $3.5 billion in disaster preparedness training funds to state and local governments. Most first responders, including firefighters, police officers and emergency medical technicians haven't seen a penny of that money, yet they are being asked to prepare for every conceivable threat — and to calm rising concern amidst heightened terror alerts.

Among the hardest hit by this dearth of federal funding are the nation's hospitals. While local health departments have shared some of the $1 billion in federal funds directed at medical response training, much of that money will be spent on mandatory smallpox vaccinations beginning next winter. The American Hospital Association reports it is waiting anxiously for delivery on $500 million in federal aid that was promised last year.

That leaves many hospital administrations, already hemmed in by drastic budget cuts, struggling to find ways to prepare their staffs for the unthinkable: large-scale biological and chemical attacks. Speed and calm, both critical in a state of emergency, can be taught without special gear, but training in certain techniques and life-saving equipment, like $25,000 protective suits, doesn't come cheap. That means most of America's hospitals are ill-prepared to face a major disaster.

"I would say that U.S. hospitals are aggressively pursuing readiness," says Dr. Howard Levitin, an emergency physician and hosptial disaster preparedness specialist at St. Francis Hospital in Indianapolis. "They're prepared for situations we've seen before: two or three patients involved in a chemical accident. The doctors and nurses know how to decontaminate patients." Does that level of readiness extend to a theoretical large-scale attack, in which tens or even hundreds of people are affected? "I'd have to say, if you're looking at that situation, the answer is no," says Levitin.

That's not because hospital administrators aren't interested in being prepared; it's simply the result of myriad obstacles, says Levitin. Those problems include: a lack of funding; lack of national standards on what "preparedness" actually means; and a lack of experience on a local level — most people simply don't have the qualifications to know what to do in case of a major attack.

And while some of the equipment and training required to correct these problems are contingent on improved cash flow, some of the solutions are nearly free. Levitin advises local governments to "share as much information with surrounding communities as possible." We don't need to re-invent the wheel in every town hall across the country, he says. Instead, the feds need to do a better job of disseminating their valuable information into the localities. That sort of intelligence sharing, of course, depends on cooperation and selflessness — two conditions even less likely these days than solvency.

• Jessica Reaves
• If the worst happens, American hospitals will be the first line of defense against a biochemical attack