Bioterrorism threats: Are we ready? Or not?

Physicians have a special role in meeting the demands of an anxious time.

Editorial. March 24/31, 2003.

Biological threats. Dirty bombs. Duct tape.

Who would have thought these phrases would become such a integral part of our everyday conversation? But that's what happened when the nation's Dept. of Homeland Security raised for 20 days last month the terrorism advisory to orange -- the second highest level of alert.

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Since then, it's been increasingly hard to turn on the evening news or read the morning headlines without hearing the chilling warnings. Clearly, Americans are nervous, as evidenced by the way plastic sheeting and bottled water flew off store shelves.

The threat index has since been reduced, but the experience still holds an important lesson that applies in medical practice: Readiness is a crucial element to overall emergency preparedness.

To date, medicine has made significant progress in moving toward this goal. In the almost 19 months since the World Trade Center attacks and the anthrax outbreaks, the AMA has played a valuable role in providing physicians with scientific education and support to deal with these previously unthinkable situations. Now, however, the stakes seem to get higher everyday. What does this mean for physicians in this age of color-coded alerts and homeland security worries? The straightforward answer is that it means many things.

It's been said before -- primary care physicians are the early detection system in the event of a terrorist attack involving biological agents. That means that doctors should continue to be vigilant in raising a red flag when they see unusual medical conditions or out-of-the-ordinary patterns of symptoms.

But this is only the first step.

The physician's ability to communicate news of a suspicious case is critical, too. Today's troubled times are a reminder to physicians to take a moment to confirm that they have in place the appropriate links to local public health departments. Traditionally, the mechanisms used to alert public health officials have been a weak spot. If an infectious agent is involved, time will be of the essence. It is when information is collected and analyzed at the public health level that important patterns take shape.

Sensitivity, and communication of another kind, must not get lost in the shuffle. There is definitely increased uneasiness about safety and well-being in light of the threat of war and terrorism. Physicians need to be in tune with this anxiety and respond to patients' mental health needs accordingly.

These worries may also sometimes lead patients to ask for additional doses of prescription medications. This is a request that should be carefully considered. Homeland Security advises patients to check with their doctors about whether they should store prescription medications such as heart or blood pressure medicine or insulin. However, it is unwise for patients to stockpile medications beyond their regular treatment regimens. It is not a good idea, for instance, to give in to a demand for a personal stash of antibiotics by a patient fearful of a biological attack.

Overall, much of what is suggested in response to heightened alerts are the same kinds of precautions recommended for any emergency. Physicians may want to take this as an opportunity to consider questions of overall disaster preparedness. Those in solo or small practices may want to review emergency plans for their offices and employees. They may also want to double-check their record-keeping and backup systems. In the hospital setting, physicians may want to review response plans and preparations for the possibility of mass casualties.

In the midst of it all, the AMA's Center for Disaster Preparedness and Emergency Response continues to be a resource, providing physicians with know-how, tools and resources to help them confront these challenges. The center is currently involved in producing additional educational and training materials targeted to physicians, other health care professionals and communities at large.

Preparation is the best insurance that we'll get through this as safely and calmly as possible. It is something that medicine understands well and has practiced long before duct tape became a hot topic of conversation.

ADDITIONAL INFORMATION:

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AMA disaster preparedness page, with a range of links to government and scientific information sources on bioterrorism and related topics (http://www.ama-assn.org/go/disasterpreparedness)

U.S. Dept. of Homeland Security readiness recommendations (http://www.ready.gov/)