Am Fam Physician. 2003 May 1;67(9):1877-1878.
The article in this issue of American Family Physician by O'Brien and colleagues1 on the recognition and management of biologic agents points out that family physicians may be well positioned to recognize bioterrorist attacks and expedite response. In the event that these agents are used, family physicians' clinical knowledge and skills can make the difference between a localized outbreak and widespread disease transmission, between lower and higher rates of morbidity and mortality, and between panic and an effective community response.
Family physicians and other primary care clinicians have a critical responsibility to the community in terms of prevention, detection, treatment, and education before, during, and after a terrorist event. To fulfill their responsibilities, family physicians should cooperate with local health departments to ensure a proper medical response to such outbreaks.
The following actions will help physicians prepare for a bioterror event2:
Know how to contact local and state health departments (www.statepublichealth.org), and contact them immediately when suspicious cases arrive.
Maintain contacts with local health officials so the latter can call on community physicians when necessary.
Maintain reference materials on the diagnosis and treatment of chemical, biologic, and radiologic agents, including syndrome-based criteria and epidemiologic features consistent with these agents. The article by O'Brien and colleagues1 includes a list of Internet resources for bioterrorism preparedness and response (see Table 5 on page 1933).
Develop a bioterrorism response plan for your office. Be prepared to use infection control practices for patient management (i.e., handwashing, gloves, masks/eye protection, gowns), patient placement and transport, and cleaning, disinfection, and sterilization of equipment and environment.
Know the requirements for laboratory support and confirmation, including obtaining diagnostic samples, laboratory criteria for processing potential bioterrorism agents, transportation requirements, and sending samples for testing when necessary.
Be aware of proper postexposure management, including decontamination of patients and environment, prophylaxis and postexposure immunization, triage and management of large-scale exposure, and psychologic aspects for patients and health care staff.
Develop skills in and resources for counseling patients to minimize the psychologic consequences of terrorist attacks and resultant infections.
However, preparation is not enough. State and local health departments must provide an information infrastructure that facilitates a two-way exchange of information on bioterrorism preparedness and response between the public health department and the family physician. This information ranges from medical alerts issued by public health departments to reports of suspicious cases from family physicians to health departments.
Although some physician offices and health departments may not have access to the Internet or maintain electronic medical records,3 the situation may improve as a result of new federal biodefense funding.4 The Health Information Portability and Accountability Act facilitates the sharing of health information with the public health department in the context of public health emergencies and activities to identify and contain the spread of contagious diseases. Ensuring that physician offices and public health departments have access to this information infrastructure is important in the effort to address terrorism and support the delivery of health care.
Policy makers should review public health policies at the local, state, and federal levels, and address important questions. For example, the following questions may occur to the family physician in a cost-constrained environment: “What is the most effective way to rule out a rare event when a patient presents with nonspecific symptoms (e.g., inhalation anthrax)?” “Who pays the physician to perform these services?” “Who will be held liable for compensating persons who received the smallpox vaccine for the sake of the public good but suffered adverse events?”
Family physicians, along with other primary care clinicians, play an essential role in the nation's preparation for and response to bioterrorism. It is the responsibility of the public health system to provide physicians with the support and infrastructure necessary to prepare for and respond to such an event effectively. To meet this need, local, state, and federal policy makers must provide necessary resources.
Helga E. Rippen, M.D., Ph.D., is director of the RAND Science and Technology Policy Institute, Arlington, Va. Dr. Rippen received a doctor of philosophy degree in biomedical engineering from Duke University, Durham, N.C. She completed a preventive medicine residency at Johns Hopkins University School of Medicine, Baltimore, and is board certified in public health and general preventive medicine. She has led the work of the Summit group on a national information technology infrastructure for bioterrorism and has built disease management software systems.
Elin Gursky, Sc.D., is a senior fellow for biodefense and public health programs at the ANSER Institute for Homeland Security, Arlington, Va. Dr. Gursky received her public health and epidemiology training at the Johns Hopkins Bloomberg School of Public Health, Baltimore. She has held senior level positions in government and the private sector, addressing population health and infectious diseases. Previously, she was a senior fellow at the Johns Hopkins Center for Civilian Biodefense Strategies, Baltimore.
Michael A. Stoto, Ph.D., is a statistician and epidemiologist who serves as the associate director for public health of the RAND Center for Domestic and International Health Security, Arlington, Va. He is also an adjunct professor of biostatistics at Harvard School of Public Health, Boston. He is currently engaged in research on smallpox immunization policy, syndromic surveillance, and measurement of public health preparedness.
Address correspondence to Helga E. Rippen, M.D., Ph.D., RAND Science and Technology Policy Institute, 1200 Hayes St., Arlington, VA 22202 ( firstname.lastname@example.org). Reprints are not available from the authors.
1. O'Brien KK, Higdon ML, Halverson JJ. Recognition and management of bioterrorism infections. Am Fam Physician. 2003;67:1927–34.
2. APIC Bioterrorism Task Force. A bioterrorism readiness plan: a template for healthcare facilities. Retrieved March 2003 at: www.apic.org/educ/bioplan.doc.
3. Chin T. Making connections: hooking up for health. Am Med News February 25, 2002. Retrieved February 27, 2003 from: www.ama-assn.org/sci-pubs/amnews/pick_02/tesa0225.htm.
4. HHS: Highlights of 2002 [press release]. United States Department of Health and Human Services; December 27, 2002. Retrieved February 27, 2003 from: www.hhs.gov/news/press/2002pres/20021227.html.
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