Bioterrorism Response by Healthcare Organizations

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Introduction

Bioterrorism is a type of terrorism that usually involves the intentional release of micro-organisms and toxins in a community in order to produce disease or even deaths of people, livestock, or crops (Mehrotra et al., 2016). The toxins could be chemical and biological and lead to the development of different diseases which could be hardly controlled by ordinary people.

One of the first steps in any preparedness plan or response to bioterrorism is the necessity to give clear definitions and explanations. Bioterrorism is a frequently used term that proves human responsibility on the development of its outcomes and effects on people and other living beings on Earth.

Facts that Make You Think about Bioterrorism

• 1984 – 751 people were infected with Salmonella intentionally.
• 1985 – an offensive biological weapons program developed by Iraq to produce anthrax, aflatoxin, and botulinum toxin (Mishra & Trikamji, 2014).
• 2001 – five Americans died because of anthrax delivered by mail.
• 2004 – three US governmental buildings were closed because of the toxin ricin discovered there.

These cases of bioterrorism proves the urgency of the problem and the necessity to find the solutions and make sure that people are aware of its threats and possible outcomes.

Types of Bioterrorism Attacks

• Biological weapons can be spread in a variety of ways (Mehrotra et al., 2016):
  • aerosol sprays,
  • explosives,
  • food contamination,
  • water contamination.
• The peculiar characteristics of attacks are:
  • suddenness,
  • unpredictability,
  • inabilities to control their development.
• There are three categories of bioterrorism attacks: A, B, and C. They lead to:
  • panic,
  • contamination of the environment,
  • pressure on healthcare services.

Category A

• Tularemia:
  • also known as rabbit fever;
  • caused by Francisella tularensis bacterium;
  • transmitted through contact with infected animals and insect bites;
  • characterized by fever, headache, diarrhea, joint pain, and weakness.
• Anthrax:
  • also known as Siberian plague;
  • caused by Bacillus anthracis bacterium;
  • transmitted through infected animals or contaminated meat;
  • characterized by flu-like symptoms, chest discomfort, and shortness of breath.
• Smallpox:
  • is an ancient disease with no other names offered;
  • caused by the variola virus;
  • transmitted directly by people, contaminated items, and weapons;
  • characterized by fever, headache, vomiting, back pain, and spots on all body.

These bioterrorism agents could put national security at risk because of its transmittance and high results of mortality. There are many types of agents in this group. The most common and the most dangerous among them are tularemia, anthrax, and smallpox.

Category B

• Ricin:
  • This poison could be found in castor beans. Its inflammation process could last from 4 to 24 hours. Difficulties in breathing, vomiting, bloody diarrhea, eyes’ and skin redness are observed. Death could occur in the next 36-72 hours.
• Typhus:
  • Typhus is the infection that cannot be transmitted between people. Headache, fever, chills, and rash are the main symptoms. Lice could transmit the disease. 60% of cases end with death.
• Brucellosis:
  • This infection is usually transmitted by animals to humans. People with a Brucella bacterium in their organisms could suffer from fever, sweating, and joint pain. Their bodies seem to be covered by ash. Complications could be spread to all organs.

This type is moderate and has rather low mortality rates. People could use these agents to terror other people. Therefore, it is necessary to know the main facts about the most spread diseases and learn how to recognize them at their early stages.

Category C

• HIV/AIDS:
  • This virus could be spread via blood, semen, and breast milk. Unsafe sex and relations with people could promote the development of this infection. Though treatment exists, it is used just to prolong lives and make people healthy as long as possible. This infection causes death only.
• SARS:
  • It is a viral respiratory illness caused by the coronavirus and characterized by fever, cough, headache, dizziness, and other flu-like symptoms. More than 700 people died in the period from 2002 to 2003. It could be spread by person-to-person contact. No confirmed treatment exists.

This category is also dangerous because of its availability and ease production. It is characterized by a high mortality rate and makes people think about their privacy and protect in society.

Threats of Bioterrorism

• Easy to use.
• Hard to notice.
• Impossible to avoid.
• Expensive to treat.

There is a threat that the above-mentioned agents could be used on military forces or even on ordinary citizens. Its uniqueness lies in the impossibility to understand and identify a true source of the problem. It is hard to notice the exposure. Still, people could be injured in a short period of time and sentenced to death without even knowing why. Besides, the government and healthcare workers have to be ready to spend much money and many efforts to deal with the problems caused by bioterrorism attacks.

Importance of Preparedness Plans

• Plan how to behave.
• Readiness to take the steps.
• Education on bioterrorism basics and threats.
• Possibilities that people cannot neglect.
• Awareness of the surroundings and possible threats.
• Responsibility for people around and readiness to help.
• Evaluation of current political or social conflicts.

People have to understand that bioterrorism attacks could happen any time. It is impossible to predict the date or clarify the outcomes. The only thing that is left is to get ready for such attacks and provide people with the information on how to behave, what to do, and how to react to the symptoms and the development of diseases. Preparedness plans help to provide people with hope. There are seven reasons for why people should use their opportunities to be ready for bioterrorism attacks.

Bioterrorism Preparedness in Healthcare

Bioterrorism preparedness is a national priority.

Response should be at the federal and healthcare levels including:

• Available medications,
• Appropriate medical supplies, and
• Effective vaccination to protect society.

Healthcare workers are properly prepared and have to help other organizations and agencies to succeed in bioterrorism preparedness.

Medical workers have to be aware of possible BT attacks and agents available.

Medical and healthcare workers have to be prepared for bioterrorism attacks in a very good way. It is the priority of the national level. As a rule, healthcare agencies are better prepared for pandemic and other bioterrorism disasters (Rebmann, Wang, Swick, Reddick, & delRosario, 2013). Therefore, they have to provide other organizations with the required portion of information. It is not enough to be aware of the epidemiology of possible disease and the ways of how to help people. It is important to know if there are enough medications available to treat people, appropriate medical supplies that could be used during and after attacks, and effective vaccines that could be offered to protect society.

Roles of Medical Workers

• Nurses:
  • Patient education;
  • Cultural evaluation;
  • Medical treatment;
  • Report of a case;
  • Patient’s care and support
• Medical Staff:
  • Safety of citizens;
  • Transportation;
  • Documentation;
  • Analysis of the environment;
  • Laboratory analysis.
• Doctors:
  • Physical evaluation;
  • Diagnosis;
  • Monitoring;
  • Treatment;
  • Symptoms’ observation and analysis.

Medical workers have to recognize their roles and know what steps they should take in case a bioterrorism attack occurs. The roles of medical workers have to be distributed properly. Nurses should never confuse their duties with those of other medical staff in order to focus on patient’s care. Doctors have to investigate patients, make appropriate diagnoses, and clarify the possibility of treatment. Finally, other members of medical staff should divide their duties in order to create safe conditions for patients, doctors, and nurses.

Key Steps in Preparing for Bioterrorism Attacks

• Be aware of the possibility of bioterrorism attacks;
• Investigate the reasons for why a bioterrorism attack occurs;
• Learn all information about BT agents, their effects, and treatment;
• Develop plans and policies in order to deal with BT attacks;
• Study and analyze the current situation with medications;
• Cooperate with doctors in order to clarify recent achievements;
• Educate other people about the threats of bioterrorism attacks;
• Cooperate with governmental organizations and discuss the possibilities of threats;
• Create financial plans to support vaccination of the population;
• Be ready to take responsibility for all people around;
• Understand the possibilities of mortal outcomes;
• Learn how to help people cope with depression, losses, and unpredictability.

Each medical worker has to be aware of the steps in order to get prepared for bioterrorism attacks. The list offered should help people understand if they are ready for such type of attacks, or some information should still be taken into consideration.

In order to the fact that healthcare workers have to be personally prepared for BT attacks, it is also necessary to understand that steps in preparing for such attacks include the participation of other people from different spheres of life including government and non-governmental organizations. Besides, the attention to ordinary people, who could become the main victims of such attacks, should be paid.

Importance of Surveillance

More than $30 billion could be spent on biosurveillance annually in the United States

Surveillance could be of different types:

1. Healthcare surveillance (systematic collection and analysis of information about BT agents).
2. Syndromic surveillance (monitoring of clinical reports).
3. Laboratory surveillance (search of markers under lab conditions).
4. Environmental surveillance (investigations of the environment and the detection of BT agents).

One of the most crucial steps in bioterrorism attack analysis and prevention is the identification of the event and the possibility to detect it at an early stage. A properly developed surveillance system is the solution that could be offered to people in assisting with quick detection (Kman & Backmann, 2012). For example, in 2001, about $32 billion was spent on bio-defence of the American population. Surveillance could be of different types, and people should recognize these types to be sure that proper steps are taken.

1st Early Detection and Surveillance Strategy

A Powerful Online Program to Scan Data (Healthcare Surveillance) that could gather different pieces of information from:

• clinical reports,
• laboratory analyses,
• Internet posts,
• drug reports;
• and make a conclusion about the possible development of the events and BT threats.

Nowadays, the technological progress makes it possible to investigate different pieces of information from the whole world and make the conclusions using special programs in a short period of time. The creation of a powerful program that could break systems and gather the required portion of information has been already promoted by several healthcare departments in New York and biomedical centers in Europe. The program similar to RODS could collect and analyze the data in order to make the required portion of conclusion and inform the developers before an attack could be spread in society.

Importance of Strategy

1. Examination of risk factors from labs, hospitals, and studies;
2. Awareness of the problem;
3. Investigation of different cases and predictions.

Why could such strategy be important? There are three main answers to be given to this question. If people have enough information about bioterrorism and the possibilities of threats, they have a chance to stay protected and survive attacks. The importance of such strategy cannot be ignored because it provides people with hope that they could control or even prevent BT attacks and help each other.

2nd Early Detection and Surveillance Strategy

Promotion of Laboratories Focused on BT Agents Detection (Laboratory Surveillance)

• Creation of federal laboratories.
• Promotion of local public laboratories.
• Categorization of labs.
• Communication between lab representatives.

Among the existing variety of ways to detect a BT threat, the creation of specialized labs seems to be one of the most effective and reliable ideas. As soon as people could have an access to be tested or to report about suspicious conditions or agents in the environment, they could detect a threat at its early stage. Communication between laboratories is a good way to exchange the information and make sure that all aspects of potential problems are considered (Kman & Bachmann, 2012).

Importance of Strategy

• People could ask for help any time.
• Ordinary people could report on suspicious things quickly.
• Lab tests provide credible and effective results.

Nowadays, people could use different methods to exchange information and share their experiences. However, the quality and reliability of such information are doubtful. Therefore, early detection should be supported by credible facts and evidence. Laboratories that could be available to all citizens in different parts of the world turn out to be the solution for people, who consider BT agents as serious threats for ordinary people. People regardless their incomes, races, ages, and educational levels have to access labs to be sure there is no bio-threat.

Interventions

The terms of isolation should be defined by medical workers not by patients in order to avoid the transmission of infections and promote focused care.

Epidemiologic investigation should be developed by specialized team not by patients to medical workers solely in order to gather enough information and consider different aspects of the problem.

Prophylaxis should be offered to patients by professional medical workers in order to use special medications and antibiotics and improve health.

There are many ideas of how to diminish the impact of bioterrorism threats and offer an in-time intervention. Healthcare workers have to understand that each intervention is a considerable portion of help that could be offered to people who have no ideas on how to cope with BT threats. These interventions are not hard to complete and easy to remember.

Preparedness Plan for a Smallpox Outbreak

1. Isolation (suspected patients should be moved to facilities and isolated to prevent the possible spread of the disease).
2. Diagnosis (physical examination is not enough, and doctors should have a lab confirmation to continue their treatment).
3. Vaccination of population (medical personnel, neighbors, and other stakeholders or friends of a suspected patient have to be vaccinated).
4. Investigation and monitoring of new cases (to make sure no threats could be spread).
5. Epidemiologic investigation (to determine if the source is liquidated or not).
6. Information exchange (to provide people with a chance to be protected and avoid the threat).
7. Communication at different levels (medical personnel, media representatives, federal agents, and other stakeholders, who could spread the information quickly, should be involved in discussions).

The Centers for Disease Control and Prevention offers common guidelines for preventing or coping with the threat of smallpox. The peculiar feature of smallpox is that it could be spread through human contact and be identified only in two or three days after contamination. Therefore, as soon as some concerns or predictions occur and could be used to prove the possibility of smallpox in population, a list of actions should be taken to save as many people as possible.

Suggestions and Improvements

People have to consider two important issues:

• EDUCATION;
• COORDINATION.

In order to promote early detection and enhanced surveillance.

People could use their abilities and technological achievements in order to promote early detection and enhanced surveillance. Still, in case they are not properly educated and aware of the matter and cannot be coordinated accordingly, they could hardly achieve success in prevention and detection of BT attacks and threats. First, people have to be educated about bioterrorism and be ready to educate each other. Only their awareness is their chance to survive BT attacks. Another important issue is coordination of the system and the possibility to establish the priorities. People should have a plan according to which they take steps and investigate the problem. As soon as they understand why they have to deal with BT threats and realize the worth of their activities, they can succeed and find the solutions for bioterrorism.

References

Kman, N.E., & Bachmann, D.J. (2012). Biosurveillance: A review and update. Advances in Preventive Medicine. Web.

Mehrotra, V., Mishra, G., Gaur, S., Garg, K., Singh, R., & Sharma, P. (2016). Role of dentist in bioterrorism: A killer for mankind. World Journal of Pharmaceutical Research, 5(3), 1522-1530.

Mishra, S., & Trikamji, B. (2014). Historical and preventive aspect of biological warfare. International Journal of Health System & Disaster Management, 2(4), 204-209.

Rebmann, T., Wang, J., Swick, Z., Reddick, D., & delRosario, J.L. (2013). Business continuity and pandemic preparedness: US health care versus non-health care agencies. American Journal of Infection Control, 41, 37-33.

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