Managing the Consequences of a Bioterrorist Attack
Role-playing victims run under water
spray during BW attack simulation
exercise in Washington, D.C., 1998
 ecause strategies
for the prevention of bioterrorism are not foolproof, they must be backed
up with plans to control the damages of an incident, should it occur.
Medical practitioners and emergency planners should prepare for a wide
range of contingencies. It is important not to focus exclusively on
worst-case scenarios but to consider a range of smaller-scale incidents,
which are not only more likely but may require different types of emergency
response.
Types of bioterrorist
attacks for which the technical hurdles are fairly low include:
- The sending
of biological agents through the mail;
- Aerosol releases
in an enclosed space such as a subway station or shopping mall;
- The contamination
of food and beverages.
U.S. military personnel taking
part in WMD response training
Unlike incidents
of chemical terrorism, which would probably produce immediate casualties, the fact that biological
agents have an incubation period of days or even weeks means that the
initial exposed population could disperse widely before the first consequences
of the attack were detected. For this reason, an incident of bioterrorism
will most likely resemble a natural disease outbreak, but with a different
pattern of incidence because a large number of victims will become sick
at about the same time.
Efficient disease-surveillance
systems are therefore required to detect the outbreak at an early stage,
when the disease is most treatable. In the case of a contagious agent,
early detection can make it possible to prevent an epidemic from spreading
by isolating the infected individuals and vaccinating others.
For most bioterrorism
incidents, the first line of defense will be at the local and state
levels. If a release of a biological agent is done in secret, the attack
may go undetected until the first exposed individuals become ill. In
this case, the "first responders" to a biological attack would not be
police and firefighters, but rather healthcare providers working in
hospitals, clinics, and medical offices.
Accordingly, it
is essential that physicians learn to diagnose exotic infectious diseases
such as anthrax or smallpox at an early stage. For example, because
the initial appearance of a smallpox rash closely resembles that of
chickenpox, a relatively benign disease, health practitioners must be
trained to recognize the differences between them.
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