Bioterrorism Readiness

For more information on bioterrorism, visit the DCMS Bioterrorism Resource Center.

Learn More About Bioterrrorism
The University of Alabama School of Medicine developed a program in August 2001 called "Bioterrorism and Emerging Infectious Diseases" that provides 1 hour of Category 1 credit toward the AMA Physician's Recognition Award. Objectives for this free course include identifying potential bioterrorist micro-organisms and syndromes associated with relatively rare infectious diseases or bioterrorist agents.

CMEweb offers two courses that cover topics related to bioterrorism. Both courses are for 1.5 hours of credit and cost $15. They are: "Bioterrorism: What the Primary Care Physician Needs to Know," and "Infection Control," which includes information about potential bioterror agents.

Participate in Disaster Medical Assistance
Physicians should contribute to local planning activities for medical response to disaster relief. To do so, contact your hospital disaster committee or department of safety and security. On a larger scale, the National Disaster Medical System, through the US Public Health Service, fosters the development of Disaster Medical Assistance Teams. A DMAT is a group of professional and paraprofessional medical personnel designed to provide supplemental emergency medical care during a disaster or other event.

Attend a conference in 2002
The NDMS Conference in Atlanta, April 13-17, is designed for physicians and other healthcare professionals to promote interaction among local, state, and federal public health practitioners and policy makers. Seminars will focus on weapons of mass effect and the latest in emergency response and coordination capabilities.

Donate funds to physician-based efforts
The Medical Society of the State of New York has established a tax-deductible disaster fund to assist the physician effort to develop plans to respond to disasters such as the World Trade Center attack. For more information call Diane Eichhorn, Secretary to the Foundation, at 516-488-6100, ext. 306. Checks should be sent to: The Medical, Educational and Scientific Foundation of New York, Inc/Disaster Fund, 420 Lakeville Road, Lake Success, NY 11042.

How to Contact the Dallas County Health Department

As with any notifiable condition, quick and prompt action must occur. Be suspicious of any unusual symptoms and err on the side of caution. Report suspected outbreaks to the Dallas County Health Department at 214-819-2004 for communicable diseases. After hours, page Dallas County Epidemiologist Assefa Nega Tulu, MD, at 214-528-6125.

For more information about surveillance contact the Texas Department of Health.

Useful Web Resources

• JAMA has published a series of articles by the Working Group on Civilian Biodefense that outlined recommendations following the use of five biological weapons: small pox, anthrax, plague, botulinum toxin, and tularemia.
• John Hopkins University - Center for Civilian Biodefense Studies
• Centers for Disease Control
• Texas Medical Association Bioterrorism Resource Center

Ready to Strike - The Dallas Medical Response Team and Domestic Preparedness Program

More Help is on the Way - Preparing for a Biological Attack

What Physicians Can Do

Parkland's 5-Part Training Curriculum for a Weapons-of-Mass-Destruction Event

Laboratory Tests to Verify a Diagnosis

Since the early 1990s, the federal government has devoted resources-funding, military training, and equipment-to prepare its 120 largest metropolitan areas for a terrorist event. Dallas, as the eighth largest city in the nation, is taking such a possibility seriously.

Nuclear, biological, and chemical agents are considered "unconventional weapons" because in the past their use was less common and our ability to detect and prevent their use by employing countermeasures is nascent. Because their intent is to create illness and injury in large populations, these weapons often are collectively referred to as weapons of mass destruction.

Ready to Strike
In September 1997 the development team for the Dallas Medical Response Team, representing police, fire, EMS, FBI, public health and hospital personnel, met for the first time and continues to meet regularly to implement our city's Domestic Preparedness Program (DPP).

The DPP is designed to mitigate nuclear, biologic, and chemical attacks. Although the training is generic, the equipment cache addresses only chemical agents. For now, the equipment the federal military provides is limited to the realm of a chemical response, but planning is underway to provide resources to address a biologic response.

The Response Team is responsible for teaching first responders and medical personnel how to minimize the impact of a terrorist attack, limiting morbidity and mortality.

To date, the Response Team has performed a needs analysis, formulated a disaster plan and tested it with a "dry exercise," or mock scenario in February 1998, and conducted a train-the-trainer session. In September 1999, the team performed a "wet exercise," or functional chemical exercise to clarify strengths, practice on weak areas, and prove we are ready to mitigate a chemical event. The team has received most of the necessary deliverables (sensors/detectors, protective equipment) and half of the pharmaceuticals to treat a chemical agent exposure.

The next step in domestic preparedness for a weapons-of-mass-destruction event is sustainment training. The team has collaborated with the Dallas-Fort Worth Hospital Council to include hospitals in the DPP. The primary concern: decontamination. It takes only one contaminated victim walking into a hospital waiting room to render the hospital unusable to provide further care. When such an attack occurs, the city can't afford to have contaminated or closed facilities-all medical resources will be needed.

Parkland Health & Hospital System is the only metroplex hospital with a model for such an attack. In 1998 employees underwent training to increase their level of suspicion and learn how to report suspicious events. Parkland shared its model with other hospitals' personnel and physicians during three training sessions in the fall of 1999 to emphasize hospital operations, decontamination, safety and security issues, and communications. For more information call the DFWHC at 972-719-4900.

More Help is on the Way
One weakness in the federal government's DPP is preparing for a biologic event, which is less "visible." A chemical or nuclear attack has immediate effects on the population. First responders will be fire fighters, police officers, and paramedics. The diagnosis and treatment will be easily made. But a biologic event will unfold and first responders undoubtedly will be physicians. Dallas has applied for federal grant money to further develop our response for a biological attack. This piece of the program will include public health physicians, epidemiologists, hospital personnel, and practicing physicians.

Another federal initiative for domestic preparedness comes in the form of a grant to the American College of Emergency Physicians, which has assembled paramedics, nurses, and physicians to evaluate educational opportunities to create better training programs.

What Physicians Can Do
Physicians must recognize a threat exists. The threat is real and there will be an event in a major city in the next 5 years. Patients will seek their doctors' help, and when they do, it will be important for every physician to have a rudimentary understanding of the signs and symptoms of biologic agents.

Study. Most biological agents represent disease states that are novel and difficult to diagnose. Although it is impossible to know which bacterium terrorists will use, it is important to familiarize yourself with the most likely "ammunition."

Suspect. When a patient comes to your office complaining of typical symptoms, allow yourself to consider atypical diagnoses. If you suspect something odd-report it to the health department. Reporting is second nature when you diagnose a communicable disease. So should it be with a biological agent. Signs that should peak your interest and suspicion that you are not seeing a garden-variety flu include:

1. Increase in number of patients with similar symptoms
2. Symptoms that won't go away
3. Symptoms that worsen
4. Increase in mortality

Surveillance. One way public health officials will be alerted to the possibility of a biological attack is through the increase of certain laboratory tests.

The next step is to provide training in every medical and nursing school and in paramedic training programs. Diseases of the past are back and rare diagnoses could become mainstream. Physicians must be taught that weapons of mass destruction are a reality and their practice could end up in the war zone.

Back to Top

Parkland Health & Hospital System 5-Part Training Curriculum for a Weapons-of-Mass-Destruction Event

 

Back to "Preparing for a Terrorist Attack in Dallas County"

Most Likely Agents Used in a Biologic Attack

 

 

Sources: US Army Medical Research Institute of Infectious Diseases, US Army Center for Health Promotion and Preventive Medicine.

Back to Top

Laboratory Tests to Verify a Diagnosis

 

Agent	Test
Smallpox	Culture
Botulinum toxin	Blood and urine samples
Plague	ELISA: enzyme-linked immuno-sorbent assay
Anthrax	Culture or ELISA

Home | Who We Are | Membership | DCMS In Action | Communications | Community Service
Products & Services | Business of Medicine | Legislative Issues | Physician Finder | DMJ On-Line

Copyright © 1997-2004, Dallas County Medical Society. Information contained in this site does not constitute legal or medical advice. Links are provided within this site as an added benefit to our visitors. The content of other sites is not monitored by DCMS.