Emergency medical services have seen relatively few changes in the way they operate since the 9-11 attacks. Coordinator Dan Birch says the kinds of responses and the preparation needed are similar to the kinds of emergencies EMS was originally designed for. The biggest change has been in the area of disease recognition and reporting. The possibility of bio terrorism has increased the number of diseases, some of which had been eradicated through vaccines, that must be prepared for. Birch and his crews have also been checking many suspicious letters and packages since the Anthrax scare that followed closely on the World Trade Center and Pentagon attacks. Birch the possibility of deliberate acts of bio terrorism had not been a priority before 9-11. While the number of suspicious packages reported to his office has diminished gradually over the course of the year, Birch says his office is still prepared and available to check them out.