Bioterrorism: Preparing for the impossible or the improbable

Abstract

There are few instances of a successful large-scale biological weapons attack in history. Weaponization of biological agents for aerosol dispersal is difficult and has often proved to be the rate-limiting step for a successful attack. Although a successful biological attack is currently unlikely, it is still feasible. More importantly, the threat of one is likely to cause much panic in the public, while a successful attack would overburden the current healthcare infrastructure. Intensivists will need to have specific knowledge of identifying and managing casualties from various biological agents. In addition, they will need to play an integral part in the preparedness of their institutions and communities for managing a bioterrorist event.

Cutaneous manifestations of category A bioweapons

“…9,34,39 Approximately 24 hours later, erythematous macules appear on the face, hands, and forearms. 36,38,39 By days 4 to 7, skin lesions progress to papules and vesicles. By the eighth day, pustules are formed.…”

“…Two to 3 days later, the temperature decreases and the patient feels somewhat better, at which time the characteristic rash appears. 36,38 Lesions first appear on the mucous membranes of the nose and mouth that quickly ulcerate, shedding large amounts of virus into the saliva. 9,34,39 Approximately 24 hours later, erythematous macules appear on the face, hands, and forearms.…”

“…9 The ordinary or classic form of variola major is the most common form of smallpox, accounting for approximately 90% of patients with smallpox and carrying a 30% mortality. 9,38 This form of the disease begins acutely with a prodromal syndrome of fever, malaise, headache, prostration, and back pain. Two to 3 days later, the temperature decreases and the patient feels somewhat better, at which time the characteristic rash appears.…”

“…When compared with chickenpox, the rash of smallpox is more homogeneous in stage, is typically more distally distributed, occurs on the palms and soles, and is less superficial. [34][35][36]38 Prodromal fever is less common in chickenpox, the fever is not as high, and other constitutional symptoms are not as prominent. 39 The hemorrhagic and flat presentations of variola major are rare, accounting for 3% and 4% of cases, J AM ACAD DERMATOL VOLUME 65,NUMBER 6 respectively.…”

Organization-based Incident Management: Developing a Disaster Volunteer Role on a University Campus

“…There is a growing body of literature documenting the desire of individuals to provide meaningful services during disasters. 3,4 Evidence exists that volunteers can play an important role in the development and achievement of emergency management: goals related to mitigation, preparedness, response, and recovery. 5,6 Given that volunteers seek meaningful roles in disasters and that those who are appropriately deployed can be extremely valuable in such events, optimal outcomes can best be achieved when their roles and responsibilities are defined and clearly communicated in advance of disasters.…”