ED will be first to notice a biological attack
ED will be first to notice a biological attack
With chemical and nuclear incidents, it may be obvious there has been an attack, but biological incidents are more insidious, notes Robert Suter, DO, MHA, FACEP, regional medical director for the North Texas region at Questcare Emergency Services in Plano.
"These incidents will require more vigilance on the part of the ED, because the ED will be the first place that a biological attack will be noticed," Suter says. The biggest problem is at the beginning, he says. "You don’t recognize you have a problem."
A bioterrorist attack is different from other types of terrorist attacks, stresses Christopher Richards, MD, chairman of the disaster committee and an attending physician at the department of emergency medicine at Brigham and Women’s Hospital in Boston. "There will be no scene, no explosion, no collapsed building footage on CNN — just a ton of sick people in the ED," he says.
The key is early recognition and early communication of a possible attack, says Richards. "Once it is clear, it is too late."
Many of the biological agents, including anthrax, are highly treatable if discovered early. "But if you discover it late, the mortality rates approach 100%," Suter says. Look for patterns of illness when trying to determine whether a biological attack has occurred, he advises. "When it hits full force and everybody is sick, by that time you’re dealing with huge numbers of patients," Suter says.
When there was an E. coli outbreak at a county fair in New York state earlier this year, it took time for clinicians to realize why people were getting sick, Suter notes. "They assumed it was virus or flu. By the time they realized what was going on, people were in renal failure and died."
In that case, the culprit was the cow manure, but could have as easily been a terrorist attack, says Suter. Someone could intentionally put that strain of E. coli in the water supply, he says. The common initial presentation of biologic terrorism is a flu-like syndrome. "So if you disburse a deadly biologic agent during a flu season, there would be a lot of dead people before doctors figured out what was going on," he notes.
Be aware of significant patterns in your patient population, Suter says. During the flu season, it might be difficult to detect, he acknowledges. "But if you have what looks like a huge flu outbreak in July, that doesn’t make any sense," Suter says. "So after three or four patients, somebody needs to think about calling the public health department."
Communicate with the hospital lab, infectious disease and infection control departments, state public health agencies, and the Centers for Disease Control and Prevention (CDC) in Atlanta, Richards advises. Local entities such as emergency medical services, public safety, and emergency management agencies also are key in the communication process, he says.
For example, if you see unusual pneumonias and call the hospital’s infectious disease department, that alone can set a chain reaction in motion, he explains. "Per their policy, notify the infection control department, who notify the department of public health, who then make a call to hospital B just as a guy walks through the door with a cough and hemoptysis. Meanwhile, public health will have notified CDC, the Federal Bureau of Investigation, and public safety."
Most cities already have this "chain" set up, you just need to activate it, he says.
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