FOCUSING PREPAREDNESS ACTIVITIES | Terrorism and Disaster Management

Preparedness for terrorist-caused outbreaks and injuries is an essential component of the U.S. public health system, which is designed to protect the population against any unusual public health event (e.g., influenza pandemics; contaminated municipal water supplies; intentional dissemination of Yersinia pestis, the causative agent of plague) (Janofsky 1995).

Early detection of and response to biological or chemical terrorism are just as crucial for state and local organizations. Without special preparation at these levels, a large-scale attack with variola virus, aerosolized anthrax spores, a nerve gas, or a food-borne biological or chemical agent could overwhelm the local, and then perhaps the national, public health infrastructure. Large numbers of patients, including both infected persons and the “worried well,” would seek medical attention, with a corresponding need for medical supplies, diagnostic tests, and hospital beds. Emergency responders, healthcare workers, and public health officials could be at special risk.

Prepare for Unique Attacks

The epidemiologic skills, surveillance methods, diagnostic techniques, and physical resources required to detect and investigate unusual or unknown diseases, as well as syndromes or injuries caused by chemical accidents, are similar to those needed to identify and respond to an attack with a biological or chemical agent. However, public health agencies must also prepare for the special features a terrorist attack probably would have, including mass casualties or the use of rare agents.

Terrorists might use combinations of chemical and biological agents, attack in more than one location simultaneously, use new agents, or use organisms that are not on the critical list (e.g., common, drug-resistant, or genetically engineered pathogens).

Focus on Agents of Greatest Impact

Potential biological and chemical agents are numerous, and the public health, hospital, and healthcare organization infrastructure must be equipped to quickly resolve crises that would arise from a biological or chemical attack. Because of the hundreds of new chemicals introduced internationally each month, treating exposed persons by clinical syndrome rather than by specific agent is more useful for public health planning and emergency medical response purposes. Public health agencies and first responders might render the most aggressive, timely, and clinically relevant treatment possible by using treatment modalities based on syndromic categories (e.g., burns and trauma, cardiorespiratory failure, neurologic damage, and shock). These activities must be linked with authorities responsible for environmental sampling and decontamination.

To best protect the public, preparedness efforts must be focused on agents that might have the greatest impact on U.S. health and security, especially agents that are highly contagious or that can be engineered for widespread dissemination via small-particle aerosols (as we are planning now for mass smallpox vaccination of the U.S. population). Preparing the nation to address these dangers is a major challenge to U.S. public health systems and healthcare providers.

Focus on Early Detection

Early detection requires increased biological and chemical terrorism awareness among frontline healthcare providers because they are in the best position to report suspicious illnesses and injuries. Also, early detection will require improved communications systems between those providers and public health officials. State and local healthcare agencies must have enhanced capability to investigate unusual events and unexplained illnesses, and diagnostic laboratories must be equipped to identify biological and chemical agents that are rarely seen in the United States.

Fundamental to these efforts is comprehensive, integrated training designed to ensure core competency in public health preparedness and the highest levels of scientific expertise among local, state, and federal partners.