For years a handful of healthcare and emergency response professionals have expressed concern over the nationwide lack of preparedness to address the mass release of biological pathogens in a terrorist attack.  The results of such an attack and the response needs that accompany them would be very different from what we would see with a chemical or bomb attack.  The first responders to a biological attack would be the healthcare community.  However, the capacity for healthcare professionals to respond is limited.  Until the events of September 11th, the policymakers of this country largely ignored the hue and cry of those concerned about this lack of preparedness.  Consequently, a lack of funding and infrastructure support made it extremely impractical and uninteresting for the healthcare community to provide the necessary training and equipment.  Not only did the healthcare community not seek the help of those proclaiming the dangers and potential devastation of such an attack, but they generally turned these proselytes away when offered assistance.  Since September 11th, the attention given to the special needs associated with bioterrorism preparedness and response has grown significantly.  

     An important aspect of preparedness for bioterrorism is the ability to quickly detect that an attack has taken place and identify what pathogens may be involved.  Early detection can minimize the effects by stemming the contagion as quickly as possible.  The problems faced by the healthcare community in achieving early detection include:

•    Lack of training for healthcare professionals.  They must be able to recognize the symptoms associated with the pathogens likely to be used in bioterroism.  Many physicians have had no experience with diseases such as anthrax, smallpox, or bubonic plague.

•    Inadequate reporting due to complexity of system and lack of incentives.

•    Lack of involvement of healthcare professionals in determining procedures.  Until recently bioterrorism preparedness and response programs addressed those problems seen in chemical or bomb attack in which first response is law enforcement and emergency medical.  These actors would not be the first to come into contact with the results of bioterrorism.

•    Inadequate laboratory capacity.

•    Lack of communication and cooperation among different healthcare professionals, agencies and organizations.

•    Lack of a comprehensive incident management system.

•    Slowness of traditional laboratory-based surveillance.

Solutions:

•    Establish training and education programs to ensure that those responsible for identifying the symptoms of a possible biological attack are able to do so.  

•    Make reporting more user-friendly and make sure physicians have feedback.

•    Involve the healthcare community in preparedness and response planning.

•    Train lab workers and improve facilities and communication among facilities.

•    Institute a hierarchical system for communication and coordination.

•    Institute a comprehensive incident management system such as is found in MaHIM.

•    In addition to traditional laboratory-based surveillance, have in place a standardized system of electronic syndrome-based surveillance.

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