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The health care community must take action along several fronts to become better prepared for biological terrorism from anthrax, smallpox, and other agents. Over time, the United States will move away from a HAZMAT/first responder model of bioterrorism to an emergency department/hospital provider model. There will be less emphasis on decontamination and more emphasis on diagnosis, according to Jessica Jones, M.D., of the University of Alabama at Birmingham.
In a recent article, Dr. Jones and her colleagues at UAB, The Southern Research Institute, and the U.S. Army Medical Research Institute of Infectious Diseases describe our current state of readiness for biological terrorism, as well as some of the challenges that lie ahead. Their work was supported by the Agency for Healthcare Research and Quality (contract 290-00-0022).
For instance, surveillance will be improved with development of nationally computerized databases such as LEADERS (Lightweight Epidemiological Advanced Detection Emergency Response System). LEADERS collects data via the Internet or a faxed sheet listing the types of syndromes seen in U.S. emergency departments (EDs). Results are compiled every 12 hours and distributed to ED workers and public health authorities who generate alerts when unusual patterns appear.
Handheld, lightweight, fully automated devices that can detect biological agents in the environment in less than half an hour are now in the final stages of development. However, the technical difficulty of environmental detection of biological agents makes early clinical recognition more effective at present. That will require savvy laboratory workers and clinicians, who are trained to recognize laboratory or clinical indications of bioterrorism-related illness.
A national Laboratory Response Network is being developed by the Centers for Disease Control and Prevention to provide reagents and training, along with a system of rapid regional laboratory referral of suspicious specimens. Various medical groups are developing programs to train physicians and emergency medical personnel for bioterrorism crises.
Also being studied are new classes of broad spectrum antibiotics to treat bioterrorism-related illness and ways to diagnose such infections before symptoms develop. For example, gene "chips" are being developed that might make it possible to conduct a broad range of diagnostic tests from a single blood sample. In 1999, $51 million was appropriated by Congress to the Department of Health and Human Services to develop vaccine and drug stockpiles.
For more information, see "Future challenges in preparing for and responding to bioterrorism events," by Dr. Jones, Thomas E. Terndrup, M.D., F.A.C.E.P., David R. Franz, D.V.M., Ph.D., and Edward M. Eitzen Jr., M.D., M.P.H., F.A.C.E.P., in the May 2002 Emergency Medicine Clinics of North America 20, pp. 501-524.
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