Watch for patterns of symptoms in the ED
Be on the lookout for suspicious symptoms so you can recognize and report a possible bioterrorism incident, urges Ali S. Khan, MD, MPH, deputy director for the Atlanta-based Centers for Disease Control and Prevention’s (CDC) Bioterrorism Preparedness and Response Program.
"The sooner you recognize an outbreak, the sooner you can find all affected persons and offer them prophylaxis or vaccines," he says.
The ED will be the first place that a biological or chemical attack is noticed, says Robert Suter, DO, MHA, FACEP, medical director for the North Texas region at Questcare Emergency Services in Plano, who also serves on the faculty of the department of military and emergency medicine at the Uniform Services University of Health Sciences, in Bethesda, MD.
Identify problem early
The biggest obstacle to identifying a bioterrorism incident is that at the very beginning, you don’t realize there is a problem, says Suter. "Many of the biological agents, including anthrax, are highly treatable if discovered early. But if discovered late, the mortality rates approach 100%," he notes.
Be suspicious of illnesses or symptoms that are unusual for your community or the season, Suter recommends. "If it looks like your ED is being hit with a big flu outbreak in June, that is out of the ordinary and should be reported," he says.
If a biologic attack occurs during the flu season, it would be more difficult to detect, notes Suter. "But even during flu season, if the volume of patients with certain complaints is significantly above what you historically expect, you need to be concerned," he says. "You are basically looking for anything out of the ordinary."
Don’t hesitate to report your suspicions to local agencies, says Suter. "Every ED staff member should feel they are a public health deputy in helping to identify unusual illness outbreaks," he says. "This is not something that nurses should leave to the physicians."
Three doctors might have worked various shifts in the previous day, Suter points out. "They may not notice an unusual pattern developing, but the nursing staff do," he says.
Contact public health
If you suspect there is an unusual pattern, contact the CDC or bring it to the attention of the public health surveillance in your community, recommends Suter. (See Resources for contact information, p. 110.)
"That’s how these things are identified in a timely enough manner to save lives," he says. "If you wait for somebody else to figure it out, it may be too late."
To report an unusual pattern of illness, contact:
• Centers for Disease Control and Prevention, Emergency Preparedness and Response Branch, 4770 Buford Hwy., Mail Stop F38, Atlanta, GA 30341-3724. Fax: (770) 488-7107. E-mail: [email protected]. The bioterrorism emergency response hotline is answered 24 hours a day, seven days a week. Telephone: (770) 488-7100.
For technical assistance and consultation, contact:
• Centers for Disease Control and Prevention, Hospital Infections Program, 1600 Clifton Road, Mail Stop E69, Atlanta, GA 30333. Telephone: (404) 639-6413. Fax: (404) 639-6459. E-mail: [email protected].
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