December 27, 2004—The emergence of bioterrorism as a threat is creating new responsibilities for the medical community and, for the first time in history, is putting physicians at the forefront of managing disaster, according to an article by Saint Louis University researchers in The Lancet.
“Unlike other forms of terrorism, in which an acute exposure or traumatic injury is rapidly inflicted and quickly recognized, such as the 9/11 attacks, bioterrorism may involve an incubation period of days or even weeks,” says Bruce W. Clements, MPH, associate director of the Institute for Bio-Security at Saint Louis University School of Public Health, and the lead author of the article.
Clements presents his argument in an article published in the Dec. 18 issue of the medical journal. Clements, and his co-author R. Gregory Evans, Ph.D., MPH, director of the Institute for Bio-Security at Saint Louis University, argue that this transfer of first-responder status puts greater responsibility on doctors, a responsibility that they currently are not prepared to shoulder.
“They will be in the driver’s seat deciding how an outbreak will be managed so they must be trained for it,” Clements says. “The challenge lies in finding the balance between suspicion and hysteria.”
Clements says it is a delicate balance because most potential bioterrorism agents listed by the Centers for Disease Control and Prevention (CDC)—such as those that cause smallpox, anthrax, botulism, plague, tularemia—initially present in patients as flu-like symptoms.
Clements and Evans urged medical schools to incorporate more information about bioterrorism into their curriculums to prepare doctors to meet the diagnostic challenge.
In addition, continuing medical education programs and community drills (such as a simulated smallpox scenario Evans and Clements developed for the CDC for use by state and local health departments) are critical in preparing doctors, they said. The exercises are designed to help physicians see how things may unfold in an atypical outbreak of smallpox and how different their work environment might be.
While physicians stand at the forefront of preparing for bioterrorism threats, Clements and Evans point out in their article that physicians have contributed to the creation and proliferation of these weapons—both wittingly and unwittingly.
The Institute for Bio-Security at Saint Louis University School of Public Health was established in 2000 with funding from the CDC.
