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.