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Institute for Crisis, Disaster, and Risk Management Crisis and Emergency Management Newsletter Website |
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October
2008
Volume
15
- Number 1 |
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Awareness of the Biological
Weapons Threat in the Medical Community By Dale Yeatts Every day, medical care providers and pharmacists see patients who complain of the following symptoms: fevers, chills, muscle aches, mild breathlessness, and night sweats. For medical providers attempting to figure out how to target their treatment to a particular ailment, these symptoms are considered “non-specific” because they are commonly associated with a multitude of illnesses, including the common cold and flu, and their presence alone is not sufficient to determine the likelihood that a patient is suffering from a particular disease. After evaluation by their physician, the patient is often encouraged to return home, rest and drink plenty of fluids.
From October
4th to November 2, 2001, the first ten cases of inhalational
anthrax
to their primary care providers or
local
emergency department complaining of fevers and chills, sweats, fatigue,
and a
cough. In a tragic unfolding of events
over the following several days, four of these individuals died. It was later realized that most of them were
postal
employees in One of the most concerning pieces of information about this story is that the first time that three of these individuals sought medical attention, the severity of their illness went unrecognized and they were sent home with reassurance. One patient, a postal worker, went to his primary care physician on October 18th after two days of feeling poorly. After evaluation, he was sent home with the diagnosis of probable viral illness. He continued to feel worse, sought medical attention again, and was finally admitted to the hospital where he later died. On October 24th another postal worker was seen in a local emergency department with the same complaints as the first individual. His blood analysis was not diagnostic for an acute infection, and his chest x-ray was normal. As with the first patient, he was reassured and sent home, but later admitted to the hospital when anthrax bacteria grew from a sample of his blood that was being incubated in the laboratory. The third patient, also a postal employee, visited her primary care physician on October 16th with the same “non-specific” medical symptoms as the first two patients, and was sent home after an unremarkable exam, but admitted to the hospital several days later after her condition deteriorated. Given what we now know about this outbreak of inhalation anthrax, is our medical system more vigilant to signs and symptoms consistent with another similar bioterrorism attack? Specifically, if the three cases that were initially unrecognized in 2001 presented to their emergency department or primary care physician today, would they be managed differently? As “frontlines” in the medical care system, the emergency department and community doctor’s office are both integral components of a community’s strategic response to a bioterrorism event. However, while the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 has allocated more than US$6 billion to preparing the medical system to respond to bioterrorism events, much of the money has gone to surveillance infrastructure, medicine stockpiles, and emergency response capabilities rather than encouraging and financing bioterrorism awareness among the people who will truly be the “first-responders” in the event of an outbreak, particularly one as insidious as inhalational anthrax. As we approach the seven-year anniversary of the intentional release of anthrax in the United States, it is worth reflecting on the current readiness of the healthcare system to manage an event such as the anthrax attack, and consider directing more resources to training medical workers to know about, care about, and have a high index of suspicion for finding the next bioterrorist agent masquerading as the common cold. BIBLIOGRAPHY Jernigan JA,
Stephens DS, Ashford DS, et al. Bioterroism-related
inhalational
anthrax: the first 10 cases reported in the Niska RW, Burt CW. Terrorism-preparedness: have office-based physicians been trained? Fam Med. 2007;39(5):357-65.
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