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This case presents a simulated scenario of a bioterrorism attack involving the deliberate release of Francisella tularensis (tularemia) in rural farming communities. The scenario challenges participants to manage an overwhelming influx of patients presenting to a rural hospital’s emergency department with varying symptoms of tularemia, including ulceroglandular disease, pneumonia, and sepsis. The hospital faces severe limitations in critical care resources, such as ventilators and ICU beds, requiring a transition from conventional to crisis-level care. Participants are tasked with diagnosing tularemia without on-site diagnostic tools, stabilizing patients, and utilizing emergency management resources, such as the hospital incident command system (HICS). The scenario also emphasizes the need for effective communication with public health agencies, the recognition of a bioterrorism event, and ethical decision-making in allocating scarce resources. Additionally, participants must navigate the complexities of national emergency preparedness and response systems to mitigate the impact of the attack on healthcare operations.
This case presents a medical scenario involving a 55-year-old woman in critical condition after a suspected bioterrorism attack involving pneumonic plague. The patient arrives at the emergency department intubated and in septic shock, with a history of severe respiratory distress, high fever, and coughing up blood. EMS reports possible exposure to a plague bioterrorism attack in a subway, raising concerns about the patient’s condition and potential public health risks. The case focuses on recognizing bioterrorism-related illnesses, using appropriate personal protective equipment (PPE), and isolating the patient. Key management steps include advanced airway management, fluid resuscitation, vasopressor support, and initiating appropriate antibiotics for pneumonic plague. The scenario also highlights the need for coordination with infection control, notification of public health authorities, and postexposure prophylaxis for healthcare providers exposed to the patient’s secretions. This exercise emphasizes quick, coordinated care in the face of a potential biological disaster involving a highly contagious pathogen.
This case presents a scenario involving a 45-year-old postal worker with inhalational anthrax following a suspected bioterrorism attack. The patient arrives at the emergency department in critical condition, presenting with shortness of breath, altered mental status, and a widened mediastinum on chest X-ray. His wife reports flulike symptoms over the past few days, and both she and the patient work in a mailroom at a government office. The scenario focuses on recognizing and managing inhalational anthrax, a rare but life-threatening condition. Key teaching points include securing the airway, fluid resuscitation for septic shock, and appropriate antibiotic therapy. Additionally, it emphasizes the importance of notifying public health and law enforcement authorities to manage the potential bioterrorism threat. The case highlights the critical need for timely intervention, proper use of personal protective equipment, and coordination with infection control and public health authorities during a bioterrorism event.
This case presents a scenario involving a botulism bioterrorism attack targeting a small rural community, where restaurant salad bars were intentionally contaminated with botulinum neurotoxin (BoNT). The local emergency department of a 45-bed hospital is overwhelmed with multiple patients exhibiting progressive neurological deficits and respiratory distress after consuming contaminated food. With limited critical care resources, including only four ventilators, the hospital faces the challenge of managing a rapidly escalating crisis. Key teaching points include the diagnosis and management of botulism, advanced airway support in severe cases, and coordination with national emergency preparedness resources for procuring antitoxins. The scenario emphasizes the transition from conventional to contingency and crisis operations, triggering the hospital’s incident command system (HICS) and raising ethical questions about critical care resource allocation. It highlights the importance of disaster preparedness, collaboration with public health authorities, and effective crisis management in responding to a mass casualty bioterrorism event.
Global public health is now seen as a security issue by many nations across the globe. Aside from naturally occurring outbreaks of infectious disease, deliberate attacks involving biological agents have emerged as a major security concern and a source of public anxiety in recent decades. Though many public health and security experts now recognize that effective prevention and response to these threats depend on building resilient public health systems around the world and international cooperation in maintaining them, it is unclear that the kind of sustained political will and economic resources exist to address such a massive undertaking that would need to take a holistic approach to human security and incorporate measures addressing: poverty; food insecurity; environmental degradation; lack of access to basic health-care services; adequate education; housing; sanitation and clean water; as well as more conventional aspects of security.
The development of technologies for the biopreservation of infectious organisms requires careful analysis of benefits and risks. This article reviews the regulatory landscape and oversight responsibilities in the United States in respect to pathogen biopreservation. Focused on two globally significant pathogens, Cryptosporidium and Plasmodium, the article explores advantages and potential risks of biopreservation concerning biosafety, biosecurity and biocontainment.
Industrial disasters can have a myriad of repercussions ranging from deaths, injuries, and long-term adverse health impacts on nearby populations, to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health-care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.
Methods:
Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.
Results:
A total of 1054 industrial disasters were recorded from 1995 to 2021. Most of these disasters occurred in Asia (720; 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533; 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.
Conclusions:
A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters, and they remain a significant contributor to the health-care risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve health-care responses in the future.
The objective of this study was to describe and compare almost all the components of disaster preparedness between private and government hospitals in the Eastern Province of the Kingdom of Saudi Arabia, using the World Health Organization’s (WHO) checklist.
Methods:
We assessed and compared the disaster preparedness between government and private hospitals in Province, using the 10-key component WHO checklist in a descriptive cross-sectional study. Of 72 hospitals in the region, 63 responded to the survey.
Results:
All 63 hospitals had an HDP plan and reported having a multidisciplinary HDP committee. In all responding hospitals, HDP was acceptable in most indicators of preparedness; however, some hospitals to some extent fell short of preparedness in surge capacity, equipment and logistic services, and post-disaster recovery. Government and private hospitals were generally comparable in disaster preparedness. However, government hospitals were more likely to have HDP plans that cover WHO’s “all-hazard” approach, both internal and external disasters, compared to private hospitals.
Conclusion:
HDP was acceptable, however, preparedness in surge capacity, equipment and logistic services, and post-disaster recovery fell short. Government and private hospitals were comparable in preparedness with regards to all indicators except surge capacity, post-disaster recovery, and availability of some equipment.
Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the coronavirus disease (COVID-19) pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats.
Methods:
This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey.
Results:
Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. The provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment.
Conclusion:
To effectively prepare for and respond to a bioterrorist attack, all levels of the health care system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.
Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats must be comprehensively reviewed to create a preparedness plan to recognize outbreaks, to educate the public, and to offer vaccinations and/or treatment options, if available. A scoping review using PRISMA guidelines was performed to categorize current information on Category A biological agents as well as understand their potential for future threats. The results used 34 articles and found that while botulin neurotoxins were the most lethal, anthrax posed the most likely threat for use as a bioweapon. Most research was conducted on plague, though it is not the most likely threat. Smallpox is the most likely agent to vaccinate against as there is already a working vaccine that has proven effective and the issue at hand is the need for a larger stockpile. Ultimately, preparedness efforts should include vaccinations and continued research and development of them. Category A agents are a serious public health concern; updated and reformed bioterrorism preparedness plans could greatly minimize panic and mortality.
Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond.
Aim:
The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events.
Methods:
An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool.
Results:
A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.
Conclusions:
By comprehensively identifying the facilitators and barriers to HCWs’ WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.
Biological weapons are one of the oldest weapons of mass destruction used by man. Their use has not only determined the outcome of battles, but also influenced the fate of entire civilizations. Although the use of biological weapons agents in a terrorist attack is currently unlikely, all services responsible for the surveillance and removal of epidemiological threats must have clear guidelines and emergency response plans.
Methods:
In the face of the numerous threats appearing in the world, it has become necessary to put the main emphasis on modernizing, securing, and maintaining structures in the field of medicine which are prepared for unforeseen crises and situations related to the use of biological agents.
Results:
This article presents Poland’s current preparation to take action in the event of a bioterrorist threat. The study presents both the military aspect and procedures for dealing with contamination.
Conclusions:
In Poland, as in other European Union countries fighting terrorism, preparations should be made to defend against biological attacks, improve the flow of information on the European security system, strengthen research centers, train staff, create observation units and vaccination centers, as well as prepare hospitals for the hospitalization of patients—potential victims of bioterrorist attacks.
Anthrax is a potential biological weapon and can be used in an air-borne or mail attack, such as in the attack in the United States in 2001. Planning for such an event requires the best available science. Since large-scale experiments are not feasible, mathematical modelling is a crucial tool to inform planning. The aim of this study is to systematically review and evaluate the approaches to mathematical modelling of inhalational anthrax attack to support public health decision making and response.
Methods:
A systematic review of inhalational anthrax attack models was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The models were reviewed based on a set of defined criteria, including the inclusion of atmospheric dispersion component and capacity for real-time decision support.
Results:
Of 13 mathematical modelling studies of human inhalational anthrax attacks, there were six studies that took atmospheric dispersion of anthrax spores into account. Further, only two modelling studies had potential utility for real-time decision support, and only one model was validated using real data.
Conclusion:
The limited modelling studies available use widely varying methods, assumptions, and data. Estimation of attack size using different models may be quite different, and is likely to be under-estimated by models which do not consider weather conditions. Validation with available data is crucial and may improve models. Further, there is a need for both complex models that can provide accurate atmospheric dispersion modelling, as well as for simpler modelling tools that provide real-time decision support for epidemic response.
The goal of this study is to test an implementation and examine users’ perceptions about the usefulness of telemedicine in mass casualty and disaster settings and to provide recommendations for using telemedicine in these settings.
Methods:
Ninety-two US Army Forward Surgical Team (FST) members participated in a high-fidelity mass casualty simulation at the Army Trauma Training Center (ATTC). Telemedicine was implemented into this simulation.
Results:
Only 10.9% of participants chose to use telemedicine. The most common users were surgeons and nurses. Participants believed it somewhat improved patient care, attainment of expert resources, decision-making, and adaptation, but not the timeliness of patient care. Participants reported several barriers to using telemedicine in the mass casualty setting, including (1) confusion around team roles, (2) time constraints, and (3) difficultly using in the mass casualty setting (eg, due to noise and other conditions).
Conclusions:
There appear to be barriers to the use and usefulness of telemedicine in mass casualty and disaster contexts. Recommendations include designating a member to lead the use of telemedicine, providing telemedical resources whose benefits outweigh the perceived cost in lost time, and ensuring telemedicine systems are designed for the conditions inherent to mass casualty and disaster settings.
Following chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons.
Objectives
This study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill.
Methods
Postdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics.
Results
The sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms.
Conclusions
Given the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness. 2019;13:555-560)
This article analyzes a specter that has haunted bioethics almost since its inception, namely the specter of the misuse of biotechnology by maleficent agents bent on mass destruction, or the complete eradication of human kind and life as we know it. The article provides a general account of why bioethicists cry “catastrophic bioterrorism potential” when new biotechnologies emerge, and an analysis of the arguments that flow from the prediction, especially in relation to synthetic biology.