Report 4 of the Council on Scientific Affairs (A-99)
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Organized Medicine's Role in the National Response to Terrorism (A-99)

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At its February 1999 meeting, the Council on Scientific Affairs (CSA) held a briefing seminar to learn about national planning for responding to mass casualty events resulting from acts of nuclear, chemical and biological terrorism. The Council’s interest was prompted by Federal planning efforts (including those announced by President Clinton) and by recent well-publicized events involving suspected anthrax exposures. The Council was addressed by Major General John Parker, MD, Commander, US Army Medical Research and Materiel Command; Scott Lillibridge, MD, bioterrorism coordinator at the Centers for Disease Control and Prevention; and Joseph Waeckerle, MD, representing the American College of Emergency Physicians. 

These speakers briefed the Council on current issues including: events that have already occurred; the known potential for a terrorist attack involving chemical or biological weapons in the United States; and current efforts by the US Departments of Defense, Health and Human Services, and Justice to develop systems to anticipate and respond to these incidents. 

At the 1999 American Medical Association (AMA) Annual Meeting, the House of Delegates will be offered similar information at a seminar on Saturday afternoon, June 19, 1999. This seminar is being jointly presented by the Federal and Military Section and the CSA. The CSA encourages the House of Delegates to attend this seminar in order to learn about this very important topic.

In the event of a mass casualty event involving chemical or biological terrorism, physicians of all specialties in the affected area and surrounding communities will be called upon to care for victims. In addition to physicians, physician organizations, hospitals and health systems should be part of the national and local response planning that is now being defined. To date, however, it appears that the involvement of medicine in these efforts has been limited to a few physicians and specialty societies.

National Response to Terrorism

Terrorist attacks cause adverse health consequences. Thus there are important aspects of the national response to terrorism that require the involvement of organized medicine. These include:

• Military, law enforcement, and public health agencies must develop community response plans involving first responders, hospitals, and medical providers. Organized medicine should be involved in developing and rehearsing these plans.

• If a biological warfare agent is spread without warning, the event will be recognized only when cases of unusual illnesses are reported to public health agencies. The same is true of "natural" threats such as newly emerging infectious diseases, diseases with changing geographic distribution (e.g., dengue fever), or newly emerging strains or serotypes (e.g., an influenza pandemic). Physicians will play a crucial role as sentinels detecting and reporting these cases, and systems must be developed to allow physicians to recognize and easily report these cases to public health surveillance.

• Depending on the exposure, victims of biological or chemical terrorism may require specific care with specific treatments. Physicians and hospital personnel will require training and education in caring for victims of biological or chemical warfare agents. 

• Victims of chemical agents will require decontamination as part of their care. Physicians caring for chemical terrorism victims will require skills and resources needed to provide this care without becoming victims due to contamination from their patients. Personal protective equipment and decontamination systems are needed, raising questions about who should stockpile them, and how can they be deployed when needed.

• Some vaccines against potential biological terror agents are considered experimental by regulatory agencies, and might never undergo human trials because of ethical constraints. Similarly, some antibiotic or antiviral treatments are "off -label" uses because, in the absence of specific human trials, they have not been approved by the Food and Drug Administration. Scientific and ethical issues will confront individual physicians, as well as officials making policy for the health of populations, in determining whether to use or approve experimental vaccines or off-label treatments.

• The Federal government will stockpile essential vaccines and antibiotics to be used in case of a confirmed terrorism-related exposure. These stockpiles must be distributed to the physicians who will be administering them in such an event. Systems must be developed to follow the treated patients in order to provide needed care as well as to learn essential lessons about treatment efficacy. The role of treating physicians and local hospitals in this follow-up must be defined.

Conclusion

Based on information that was presented at its February 1999, meeting, the CSA concludes that there are significant issues confronting physicians and the United States health system in the effort to prepare for nuclear, chemical, or biological terrorism. The AMA and organized medicine must define their role in this effort, and work to ensure that the unique perspectives of physicians are represented in plans to prevent or respond to this crucial threat to health.

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1999 AMA Annual Meeting.

1. The AMA and the Federation of Medicine will work with appropriate public health, law enforcement, hospital, and emergency response agencies and associations, as well as the pharmaceutical industry and media to develop coordinated plans and strategies that identify the specific needs, roles, contributions, and participation of organized medicine and individual physicians in disaster planning and emergency response to terrorist attacks and identify procedures for the rapid detection, early reporting , and medical management of affected individuals.
2. The AMA and the Federation of Medicine will sponsor a planning conference on this topic immediately preceding the Interim 1999 AMA Meeting and invite all interested parties to help develop such plans and strategies, and that the plans developed from these efforts be reported back to the House of Delegates at the Annual 2000 AMA Meeting.
3. The AMA urges medical schools and residency programs to develop curricula and training programs for medical students and residents regarding medical and public health aspects of biological and chemical terrorism, as well as community disaster planning and emergency response procedures in the event of such terrorism.

Also see Featured Report:  Medical Preparedness for Terrorism and Other Disasters (I-00)

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