Bioterrorism: A Guide for Hospital Preparedness PDF

Preface

Biological agents have played a potent but often overlooked role in the annals of warfare. Smallpox, plague, syphilis, and other devastating infectious diseases - intentionally or unintentionally introduced into susceptible populations - have dramatically influenced the course of human history. Despite many examples over the centuries in which military advantage was gained more through infection than arms and strategy, the potential use of biological agents as instruments of terror in peacetime has only recently been recognized and exploited.

The most dramatic example of such bioterrorism occurred in the U.S. in the autumn of 2001, only weeks after the terrorist assaults on the World Trade Center and the Pentagon, when spores of the highly infectious and lethal disease anthrax were intentionally spread through the mail. Although only 22 people were infected, including 5 who died, thousands sought medical attention. More than 250,000 prescriptions were written for prophylactic antibiotics, numerous post offices and the Hart Senate Office Building were shut down, and mail delivery to Congress was stopped for 6 weeks. The broad impact of this very limited attack revealed a potential for much greater devastation if a wider and more sustained effort at bioterrorism were to occur.

It also revealed vulnerabilities in several key areas. The hospital systems in the cities that experienced the attacks, New York, Washington, D.C., and Boca Raton, FL, were called upon to respond to a fearful population and inquisitive media while evaluating their own systems of triage and care for potential victims of the attack. Even far from the epicenters of the attacks, hospitals and laboratories faced extraordinary demands. In Illinois, for example, laboratories processed more than 1500 samples for anthrax between October 8 and December 31, 2001; none was positive.

The national public health apparatus, which traditionally guides the medical profession and the hospital system in handling epidemics, was thrown into a confusing maelstrom: It was required simultaneously to monitor the extent of the attack, investigate individual cases, provide laboratory assistance, coordinate efforts with political and law enforcement agencies, and inform and reassure the public. The effort consumed the services of more than 90% of the CDC's epidemiological investigation officers and much of its laboratory capacity. Only the limited scope of that attack, which stopped as enigmatically as it began, prevented a crippling crisis for America's health care system.

In the aftermath of the anthrax and 9/11 attacks, concerns about the vulnerability of our health care and public health systems rose quickly. To the surprise of many, this vulnerability had been recognized in surveys and national exercises in the years leading up to the 2001 attacks, spurring attempts to improve preparedness at the national level.