Prevention is Better Than Cure

The public health departments must be prepared for the possibility of a biological terrorist event. Inclination means not only making security adequate and vigilant, but to rapidly identify and investigate and take control of the cosequences of terrorist events.

Biological weapons have recently captivated the attention and the resources of the nation. Discriminating the nature of the threat of bioweapons as well as appropriate responses to them requires greater attention to the biological characteristics of these instruments of war and terror. The dominant example of a weapon as a nuclear device that explodes or a chemical cloud that is set mooring leaves us ill-equipped conceptually and practically to assess and thus to prevent the potentially ravaging effects of bioterrorism. Strengthening the public health and infectious disease infrastructure is an effective step toward averting the suffering that could be wrought by a terrorist's use of a biological agent.

Even with the technologic sophistication available in the world today, effectiveness in dealing with a bioterrorist event is limited. Current supervision systems may be inadequate to detect attacks. Because the onset of illness after exposure to an agent is delayed, even the time and location of the attack may be obscure. In addition, most of the medical community is unfamiliar with many of the high-threat diseases, so identification of the problem may be further delayed. Many of us who are involved in studying the many aspects of bioterrorism believe that it is not a question of if such an event will occur but rather when, as well as which agent will be used and how extensive the damage will be. Given the enormity of what is possible, we must prepare for a potential nightmare.

The recent occurrence of a series of anthrax-related hoaxes demonstrates the need to educate emergency services personnel about how to best ensure patient and worker safety in the case of suspected exposure to biological threat agents. There are very few data to support the methods being used or the variation in current care. Emergency physicians, first responders, and hazardous materials response teams need a standardized approach to the management of patients who may have been exposed to biological threat agents. Currently recommended hospital infection control procedures seem appropriate for the level of risk involved with aerosolized biological threat agents. Such recommendations include standard and transmission-based precautions. These groups need a working knowledge of the isolation and infection control measures recommended for the treatment of patients exposed to those biological threat agents as outlined in the Centers for Disease Control and Prevention Guideline for Isolation Precautions in Hospitals.