Chemical and Biological Terrorism Research and Development to Improve Civilian Medical Response (1999) / Chapter Skim
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5 Recognizing Covert Exposure in a Population
5 Recognizing Covert Exposure in a Population
Pages 65-77
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From page 65... ...
This chapter will therefore focus on what we have previously termed scenario two, a covert attack with an agent producing signs and symptoms in those exposed only after an incubation period of several hours, days, or weeks, when the victims might be widely dispersed. In these circumstances, effective medical response to many covert terrorist actions will be critically dependent not upon Hazmat teams, emergency medical technicians, and other "first responders," but upon the ability of individual clinicians, who may be widely scattered around a large metropolitan area, to identify, accurately diagnose, and effectively treat an uncommon disease.
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From page 66... ...
These systems are based on voluntary collaboration with state and local health departments, which in turn depend on physician-initiated reports of specific diseases or information from state health laboratories regarding bacterial or viral isolates. The best known system is the National Notifiable Disease Surveillance System, which the CDC describes as the backbone of collaborative reporting procedures involving clinicians, state, and local health departments, and the CDC.
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From page 67... ...
, under which grants are awarded to state or local health departments for improving epidemiological and laboratory capability. One of the basic benefits the EIP provides for state-based communicable disease surveillance is more trained professionals to follow through with investigations that might not have been initiated because of limited resources.
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From page 68... ...
In this effort, selected reporting relationships are established with medical specialty groups like the Infectious Disease Society of America, the International Society of Travel Medicine, and a group of about 100 emergency departments called the Emerging Infectious Disease Network. These specialists are likely to treat persons with infectious diseases and are periodically contacted about any specific or unusual conditions.
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From page 69... ...
link university and government laboratories in an effort to track diseases of importance. Health Canada, Canada's federal health department, is developing a system to scan the Internet for evidence of new disease outbreaks, utilizing a new search engine technology designed to constantly search a large number of predesignated sites, popular as well as scientific.
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From page 70... ...
No hard data exist on the current knowledge of state and local health departments regarding chemical and biological terrorism. From that information, specific educational and training efforts could be developed and implemented for all state and local health departments.
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From page 71... ...
was established to provide communication among sentinel stations around the world capable of detecting unusual outbreaks of infectious diseases or toxic exposures, including those that might result from a biological attack. Scientists from around the world, including many national and global infectious disease experts, participate in a daily exchange of information regarding infectious disease cases and outbreaks.
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From page 72... ...
Most laboratories will thus not be prepared to immediately conduct the specific analytical test needed to identify the agent, even when the attending physician is astute enough to ask for the test. Veterinary diagnostic laboratories may be more likely sources for a rapid confirmatory assay, since many of the biological agents are significant sources of disease in domestic animals (nonhuman species may even be the first victims of a biological attack, unintentionally or as part of a effort to avoid discovery)
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From page 73... ...
Ideally, such a network would involve strengthening diagnostic expertise and laboratory capability at all major medical centers, but given the expected frequency of cases involving biological warfare agents, a more realistic goal might be a regional approach based on state and local public health laboratories. Knowledge regarding the laboratory recovery of a pathogen or positive diagnostic assay is a key element that public health epidemiologists will need in their investigation.
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From page 74... ...
By identifying distinct features of different genes, it is possible to identify not only microbes of interest but specific strains and thus more precisely track infectious disease outbreaks. This "fingerprinting" technique will be useful as a sentinel indicator that a new strain has entered a community and in distinguishing natural from intentional releases by identifying microbial or viral strains foreign to the normal community flora or by matching new outbreak pathogens with pathogen strains from suspect terrorist groups or intelligence sources.
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From page 75... ...
However, the time constraints associated with an incident of chemical terrorism will not permit a significant real-time surveillance role for the HSEES. AIDS FOR CLINICAL DIAGNOSIS BASED ON SIGNS AND SYMPTOMS Emergency medical personnel, both at the scene of a hazardous materials incident and at hospital emergency departments, have a wide selection of reference materials to call upon for guidance in patient management.
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From page 76... ...
, and possibly the hemorrhagic fevers, the initial signs and symptoms produced by the biological agents considered here are nonspecificfever, chills, fatigue, headache, muscle or joint pain, a cough or chest pain. Blood in the excrete or petechiae (pinpoint-sized, hemorrhagic spots in the skin)
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From page 77... ...
These improvements mustfocus on communicable disease epidemiology and laboratory programs and on poison control centers. 5-2 Evaluate the current educational/training needs of state and local health departments regarding all aspects of a biological or chemical terrorist incident.
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