Bioterrorism Resources

   Bioterrorism Resources

Daily news reports warn us of the threats of terrorism. Of particular concern are warnings of the use of chemical, nuclear and biological agents as weapons of mass destruction.

A biological attack calls for a much different approach than the traditional emergency management response to chemical or nuclear events. Nurses are uniquely positioned to assume leadership in local, state and national responses. It is up to each nurse to assume responsibility for expanding individual professional practice to encompass terrorist attacks. The Tennessee Nurses Association has identified some excellent sources of up-to-date information to help you to prepare. Please take a few minutes to learn more.

Individual and Family Protection

Checklists for individuals, families, schools and businesses in preparation for a variety of disasters and terrorist events are available from the American Red Cross at http://www.redcross.org/services/disaster.

The U.S. Department of Justice offers United for a Stronger America: Citizens’ Preparedness Guide at http://www.ojp.usdoj.gov/ojpcorp/cpg.pdf. 

The Federal Emergency Management Agency offers a detailed 121-page publication Are You Ready? A Guide to Citizen’s Preparedness at http://www.fema.gov/areyouready. 

FEMA also has an excellent site on national security emergencies for parents and children at http://www.fema.gov/kids.

The U.S. Department of Homeland Security offers a new campaign Get Ready
Now at http://www.ready.gov.

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Potential Bioagents

The Centers for Communicable Disease Control and Prevention has categorized potential diseases/agents according to the degree of threat of use as a vehicle for bioterrorism.   

Category	Descriptors	Diseases
A   (Greatest Threat)	Category A Diseases/Agents “The U.S. public health system and primary healthcare providers must be prepared to address various biological agents, including pathogens that are rarely seen in the United States. High-priority agents include organisms that pose a risk to national security because they can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness.	Anthrax (Bacillus anthracis)  Botulism (Clostridium botulinum) toxin  Plague  (Yersinia pestis)  Smallpox (Variola Major)  Tularemia (Francisella tularensis)  Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo]
B	Category B Diseases/Agents Second highest priority agents include those that are moderately easy to disseminate; result in moderate morbidity rates and low mortality rates; and require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.	Brucellosis (Brucella species)  Epsilon toxin of Clostridium perfringens  Food safety threats (e.g., Salmonella species, Escherichia coli 0157:H7, Shigella)  Glanders  (Burkholderia mallei)  Melioidosis (Burkholderia pseudomallei)  Psittacosis (Chlamydia psittaci)  Q fever (Coxiella burnetii)  Ricin toxin from Ricinus communis (castor beans)  Staphylococcal enterotoxin B  Typhus fever (Rickettsia prowazekii)  Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]) Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
C	Category C Diseases/Agents Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability; ease of production and dissemination; and potential for high morbidity and mortality rates and major health impact.	Emerging infectious disease threats such as Nipah virus and hantavirus
Adapted from  http://www.bt.cdc.gov

Go to  http://www.bt.cdc.gov/Agent/agentlist.asp  for more specific information on these agents.

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Signs of Biological Attack

Available from the Centers for Disease Control online publication Morbidity and Mortality Weekly Report is an article entitled Recognition of Illness Associated with the Intentional Release of a Biological Agent at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5041a2.htm.

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If You Suspect Illness Associated with 
the Intentional Release of a Bioagent

If you suspect a bioterrorist attack or the presence of a bioagent, contact your local public health office. To locate the phone number and address, visit http://www2.state.tn.us/health/LocalDepts/index.html.

Also, contact the FBI. For your nearest office’s contact information, go to http://www.fbi.gov/contact/fo/fo.htm.

Other agencies that you may need to contact include:

Tennessee Emergency Management Agency at  http://www.tnema.org 

Phone: 615-741-0001

This site also contains contact information for local emergency management agency offices at http://www.tnema.org/misc/localema.htm

Tennessee Office of Homeland Security at http://www.state.tn.us/homelandsecurity

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Recommended Web Sites

There are numerous websites with information about nuclear, chemical and biological warfare. The following list contains some recommended sites:

The most recommended site is the Centers for Communicable Disease Control and Prevention at http://www.bt.cdc.gov. This is the single best source of daily updates and topical webcasts on bioterrorism. This organization will be a lead agency in the event of a bioterrorist attack.

Educational resources, including information and photographs can be found at the Public Health Image Library, known as PHIL. This can be found at http://phil.cdc.gov/Phil.

Hospital preparedness is included in the publication Bioterrorism Readiness Plan: A Template for Healthcare Facilities, available for download at http://www.apic.org/educ/readinow.cfm or as a PDF document 

Mass casualty response information can be found by visiting http://www.cdc.gov/masstrauma.

Nuclear events information can be found at  http://www.bt.cdc.gov/radiation/index.asp

Chemical events information can be found at  http://www.bt.cdc.gov/agent/agentlistchem.asp.

Weekly in-depth epidemiological reports can be found at Morbidity and Mortality Weekly Report at http://www.cdc.gov/mmwr.

 

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Additional Sites

American Academy of Pediatrics 
http://www.aap.org 

American Hospital Association 
http://www.AHA.org

American Medical Association
http://www.ama-assn.org
Use search engine to obtain information on specific diseases.

American Nurses Association 
http://www.nursingworld.org/news/disaster

Association for Professionals in Infection Control and Epidemiology (APIC) http://www.apic.org/bioterror/ 

Center for Biosecurity of the University of Pittsburgh Medical Center (faculty and staff formerly at the John Hopkins Center for Civilian Biodefense Strategies)
http://www.upmc-biosecurity.org

Centers for the Study of Bioterrorism and Emerging Infections (Saint Louis University School of Public Health)   
http://www.slu.edu/colleges/sph/csbei

Counter Terrorism Training and Resources (Law Enforcement) http://www.disasterhelp.gov (Includes information on a variety of potential hazards)

Homeland Security Week E-Newsletter  
www.homelandsecurity.org/newsletter  

Nuclear Control Institute  
http://www.nci.org

Tennessee Emergency Management Agency  
http://www.tnema.org

This site also contains contact information for local emergency management agency offices. Go to http://www.tnema.org/misc/localema.htm

Tennessee Office of Homeland Security  
http://www.state.tn.us/homelandsecurity

United States Army Medical Research Institute of Chemical Defense (USAMRICD) 
http://ccc.apgea.army.mil

United States Army Research Institute of Infectious Diseases (USARIID) 
Look there for a copy of the Medical Management of Biological Casualties Handbook. 

http://www.usamriid.army.mil/education/bluebook.html

United States Department of Health and Human Services   http://www.dhhs.gov/disasters/index.shtml

United States Department of Homeland Security 
http://www.dhs.gov 

United States Veteran’s Administration  
Clinical Practice Guides for Chemical, Biological and Radiant Emergencies  http://www.oqp.med.va.gov/cpg/bcr/bcr_base.htm

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Online Courses

Disaster Preparedness and Response for Nurses
Free case study from the American Red Cross and the Honor Society of Nursing, Sigma Theta Tau International, is now available online at the Sigma Theta Tau Web Site. Use the “Select a Topic” menu and go to “Disaster Readiness” for the disaster preparedness and response course.
http://www.nursingsociety.org/education/ceonline.html

University of Alabama at Birmingham series. 
The Agency for Healthcare Research and Quality (AHRQ) teaches hospital-based physicians and nurses hot to diagnose and treat rare infections and exposures to bioterrorist agents such as anthrax and smallpox. This program was designed by researchers at the Center for Disaster Preparedness at the University of Alabama  at Birmingham (UAB). The site current offers five free online courses.
http://www.bioterrorism.uab.edu.

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What Can Nurses Do Now?

1.      Dialogue with local, state and national officials regarding current preparation.

2.      Acquaint legislators and congressional members about the need to fund proposals to rebuild the public health infrastructure and strengthen communications among public health officials, emergency planners, first responders, and emergency department personnel.

3.      Become familiar with your employer’s plan for dealing with the consequences of a weapons of mass destruction (WMD) attack.

4.      Prepare yourself to identify clinical signs and symptoms of possible biological attack as relevant to your particular area of practice.

5.      Prepare yourself for a role in case of a major bioterrorist event.

6.      Commit to being a role model. (Serving as a calm, knowledgeable resource in the time after an incident can do much to reduce panic and post-traumatic stress.

7.      Promote family disaster planning. 

8.      Promote increased educational preparation for nurses. 

Adapted from Urbano, M. T. (February, 2002). What can nurses do to prepare for terrorist attacks?  Tennessee Nurse, p. 8-10. 

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Opportunities for Volunteering 

National Disaster Medical System—DHHS Office of Emergency Preparedness http://www.ndms.dhhs.gov 

U.S. Freedom Corp  
http://www.usafreedomcorps.gov 

U.S. Medical Reserve Corp  
http://www.citizencorps.gov

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