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BIOTERRORISM Tintinalli Chap. 10

BIOTERRORISM Tintinalli Chap. 10. The Threat. Bioterrorism Response. One of the most challenging issues facing the modern emergency physician Adequate response requires effective coordination of many entities Public Health Mental Health Law Enforcement Emergency Management.

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BIOTERRORISM Tintinalli Chap. 10

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  1. BIOTERRORISMTintinalli Chap. 10

  2. The Threat

  3. Bioterrorism Response • One of the most challenging issues facing the modern emergency physician • Adequate response requires effective coordination of many entities • Public Health • Mental Health • Law Enforcement • Emergency Management

  4. Bioterrorist Event • Release of a biological agent among a civilian population for the purpose of creating Fear, Illness, and Death • Anthrax Dissemination of 2001 • Widespread • 22 confirmed cases • 11 inhalational • 11 cutaneous • 5 dead • Millions lived in fear

  5. Biological Agents • Classified into Two Groups • Infectious • Contagious • Noncontagious • Biological Toxins • Act as chemical agents

  6. Agents of Concern: CDC ranked agents into 3 categories based on their overall potential for adverse public impact • Class A agents • Most severe potential • Variola major (Smallpox) • Bacillus anthracis(Anthrax) • Yersiniapestis(Plague) • Clostridium botulinum • Francisellatularensis • Filaviruses and arenaviruses (Ebola) • Class B agents • Less potential • Coxiellaburnetii(Q fever) • Toxins (Ricin) • Food Safety Threats • Salmonella, E. coli • Water Safety Threats • cholera • Class C agents • Emerging threats • Hantavirus

  7. Recognition of a Bioterrorist Event • May not be immediately recognizable unless release is openly announced or the terrorist is caught in the act • Initial symptoms of most agents are not readily distinguishable from more common, less threatening illnesses (fever, bodyaches, malaise)

  8. Recognition of a Bioterrorist Event Enhanced Knowledge Among Practitioners Public Health Surveillance Systems Collect and analyze information from many sources Hospitals Clinics Nursing Homes Pharmacies EMS systems Independent Laboratories Medical Examiners General Businesses Absenteeism rates • Currently the best method for improving the capability to detect a bioterrorist event • Pathologic Principles • Modes of Dissemination and Transmission • Disease Signs and Symptoms • Recommended Diagnostic Testing • Recommended Therapy • Infection Control Practices

  9. Initial Response to a Bioterrorist Threat • Initial Notification and Plan Activation • Notify Administration, Infection Control, Infectious Disease, and Laboratory Services • Infection Control Procedures • Protect staff and other patients • Standard versus Droplet Precautions • Decontamination • Only if exposure is acute • Contact Local Department of Public Health • They then contact regional/state Departments, CDC, local law enforcement, and FBI

  10. Local Department of Health • Epidemiologists • Define the size and scope of the incident, the at-risk population, and other incident parameters • Case Definition • Provides clinical and diagnostic criteria for an individual to be considered “exposed,” “suspicious,” or a definitive victim • Evaluation and Treatment Protocol • Criteria to establish a patient’s individual risk for exposure and to further evaluate and treat • Essential because confirmatory testing will rarely be immediately available • Information Coordination • Protocols will evolve • Requires regularly scheduled updates • Reporting Requirements

  11. Treatment, Prophylaxis, and Immunization • Variola major • Vaccination • Not recommended for general public use • Required for all DOD personnel deploying to CENTCOM • Useful in preventing disease if given within 4 days of exposure • Prophylaxis • Immune Globulin • Within 2-3 days of exposure • Limited supply • Treatment • Supportive • Cidovir shows some efficacy in monkey models

  12. Treatment, Prophylaxis, and Immunization • Bacillus anthracis • Vaccination • 6-part series at 0, 2, 4 weeks and then at 6, 12, 18 months with annual boosters afterward • Required for all DOD personnel deploying to CENTCOM • Prophylaxis • Cipro or Doxy for 60 days • Concurrent vaccination • Treatment • Cipro or Doxy with 2 of the following: • Clindamycin, rifampin, imipenem, aminoglycoside, chloramphenicol, vancomycin, streptomycin, and some macrolides

  13. Treatment, Prophylaxis, and Immunization • Clostridium botulinum • Vaccination • Not available to the public • Prophylaxis • Not applicable • Treatment • Antitoxin may preserve remaining neurological function

  14. Treatment, Prophylaxis, and Immunization Yersiniapestis Francisellatularensis Vaccination Under investigation Prophylaxis Cipro or Doxy for 14 days Treatment Streptomycin or Gentamicin • Vaccination • No longer available • Prophylaxis • Cipro or Doxy for 7 days • Treatment • Streptomycin or Gentamicin

  15. General Emergency Operations • Surge Capacity • Disease Containment • Isolation • Personal Protective Equipment • Management of Personnel • Many are untrained and reluctant • Supplies • Equipment and pharmaceuticals • Hospital • Community • Pharmacies

  16. Patient Management • Education • Why or why not receiving particular therapies • Preprinted Instructions • Appropriate Follow-up • Proper Record Keeping • Call backs if situation changes • Risk vs Benefit • Children and pregnant women

  17. Sources of Expert Information • Local Department of Public Health • Poison Control • Online • Journal of the American Medical Association • CDC • Department of Defense • Association for Professionals in Infection Control and Epidemiology

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