By: Lauren Middleton, Captain, 2016-2017
According to the Centers for Disease Control and Prevention (CDC), bioterrorism is defined as “the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants…” These agents are classified into three categories based on their potential risk. Category A contains the highest priority agents that are easily transmissible, result in high mortality, and would cause major systemic disturbances (1). Category A includes anthrax, botulinum, Ebola virus, and plague (2). Since these agents are found in the environment, it can be difficult to distinguish accidents and natural causes from harmful intent.
Bioterrorism is not a new threat. One of the earliest recordings of a major bioterrorist attack was in the 1346 Siege of Caffa in which the Mongols threw bodies infected with plague over the city walls (3). In more recent history, there have been attacks using botulinum, salmonella, and anthrax. Although the 2001 anthrax attack was a relatively small scale event with only 22 cases, 35,000 people were vaccinated against anthrax and smallpox and the government was in turmoil. The stock of smallpox vaccine had been almost depleted because it was considered eradicated in 1980. Since then, larger amounts of the vaccine have been stored (4). Plans have also been put into place on how to respond to bioterrorism and highly infectious diseases such as Ebola and Zika (5).
Rapid identification and response are important elements in limiting the severity of a natural outbreak or attack. Healthcare workers, including first responders, play an important role in minimizing the disease spread. Starting on October 4, 2014, dispatchers asked about any recent travel to Ebola-affected countries for patients complaining of fever. If the patient had travelled to West Africa, a specially trained Haz-Tac team was dispatched rather than the nearest EMS. From December 2014 to February 2015, 3090 EMS responders were trained in putting on and using the appropriate personal protective equipment (PPE). They were also trained in asking about travel to West African countries for patients with symptoms suggestive of Ebola (6). In June 2016, New York implemented training programs for first responders to protect themselves and safely treat patients infected with high risk diseases such as Ebola and Zika (7). Emergency responders can help by identifying potentially infected patients by knowing which symptoms to look for. Training such as in these examples could be used to minimize illnesses and deaths following a bioterrorist attack.