December 2001 • Volume 7 • Number 12
Family practice residency meets challenge of bioterrorism scare
In a matter of hours on Oct. 26, family practice residents in Harpers Ferry, W. Va., were shaken from their usual Friday routine to respond to a public health threat raised by an anthrax scare.
When an anthrax scare threatened local postal workers, Rosemarie Cannarella, M.D., M.P.H., standing at left, associate program director for the West Virginia University Rural Family Medicine Residency Program, and Konrad Nau, M.D., standing at right, residency director, organized their residents and staff to screen nearly 400 workers. The events were set in motion when Rosemarie Cannarella, M.D., M.P.H., associate program director for the West Virginia University Rural Family Medicine Residency Program in Harpers Ferry, received a call for help. Workers at a nearby mail-sorting facility had just learned that most of their mail had passed through the anthrax-contaminated Brentwood mail facility in Washington, D.C. Fortunately for the postal workers, the family practice residents had taken grand rounds on bioterrorism via teleconference the week before.
"These events shine a bright light on the ability of small rural communities to respond to the public health demands of a true bioterrorist event," said residency director Konrad Nau, M.D., who quickly assembled 10 residents and four faculty members to answer the call for help. Nurses from nearby Jefferson Memorial Hospital also joined the effort.
And although the CDC and the state health department recommended that employees with potential mail contact be prophylactically treated with antibiotics, the Harpers Ferry physicians learned that they would not have access to government stores of ciprofloxacin. Calls made by Cannarella to local pharmacies revealed that there were only 1,200 doses of the drug in the county. But the pharmacies had 4,000 doses of doxycycline -- so doxycycline it was.
The residency's nurses drew on their experience conducting group immunization clinics and school physicals to organize the effort, said Nau. They set up distribution and examination areas at a nearby fire hall and individually bagged and labeled the pills into three-day supplies.
A West Virginia state trooper later drove through the fall's first snow to bring another 6,800 doses of doxycycline, procured from the state health department. The group cheered, said Nau, and then set to work packaging enough individual dose packs to complete the needed 10-day course.
And then the patients began coming. By midnight, the staff had screened 180 mail facility employees. Dozens more streamed in over the next two days. Ninety-two of the patients had symptoms that warranted blood cultures, chest X-rays and further examination by a doctor, said Nau. Within four days, 353 employees were put on prophylactic antibiotics, and 121 employees were examined by physicians.
And although none of the patients tested positive for anthrax, Nau said he was most heartened by seeing his residents spring to action in a time of crisis.
"There was no handbook to follow here," he said. "Everyone contributed what they could in a spirit of cooperation."
Cannarella concurred. "The ability to gather so much talent so quickly, and to know that all of the resident and faculty doctors were updated in this disease and able to provide consistent exams and recommendations, was a wondrous thing to see," she said.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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