FMMS PRIMER ON BIOTERRORISM

Ten Critical Steps for Handling Possible Bioterrorist Events

 

1 - Maintain an index of suspicion.

In an otherwise healthy population, some associations are very suggestive, especially when seen in clusters, high numbers, or unusual presentations.

“Clustered” Symptoms

Potential Bioagents

Hemoptysis

Plague

Flaccid Paralysis

Botulism

Purpura

Viral Hemorrhagic Fevers (VHF)

Wide mediastinum

Anthrax

Centripetal rash

Smallpox

2 - Protect yourself and your patients

Use appropriate personal protection equipment (PPE). Prophylaxis: vaccines, if available; or antibiotics, if risks are known

3 - Adequately assess the patient

Review and assess the patient’s history. Also, ask:

  • Are others ill?
  • Were there any unusual events?
  • Was there an uncontrolled food source or other environmental factor?
  • Was there vector exposure?
  • Has the patient been traveling?
  • What is the patient’s immunization record?

Perform a physical examination with special attention to the respiratory system nervous system, skin condition, and hematologic and vascular status

4 - Decontaminate as appropriate

Do not use bleach on exposed people. Soap, water and shampoo are perfectly adequate for all biological and most chemical agents. Chemically contaminated clothes should be removed and discarded safely.

Biologically contaminated clothes can be laundered with soap, water and, perhaps, bleach.

5 - Establish a diagnosis.

Think clinically and epidemiologically; always send specimens for culture.

Symptom (individuals)

Possible Diagnosis

Pulmonary

Tularemia, plague, staph enterotoxin B (SEB)

Neuromuscular

Botulism, Venezuelan equine encephalitis (VEE)

Bleeding/purpura

VHF, ricin, plague (late)

Rash (various types)

VHF, T2 mycotoxin, smallpox, plague

Flu-like symptoms

Varies

Immediate Symptoms (large numbers)

Possible Diagnosis

Pulmonary

SEB, mustard, Lewisite, phosgene, cyanide

Neurologic

Nerve gases, cyanide

Delayed Symptoms (large numbers)

Possible Diagnosis

Pulmonary

Biologic agents, mustard, phosgene

Neurologic

Botulism, VEE, other encephalitis

6 - Render prompt treatment.

Airway, Breathing, Circulation.

7 - Provide good infection control
  • Gown, gloves, mask and hand washing, and eyewear if necessary, are sufficient.
  • Recommended isolation precautions for biologic agents include:
  • Standard Precautions - For all individuals/patients
  • Contact Precautions - Viral Hemorrhagic Fevers
  • Droplet Precautions - Pneumonic Plague and Tularemia
  • Airborne Precautions - Smallpox

8 - Alert the proper authorities.

CALL FIRST: Fresno-Madera County Division of Community Epidemiology: Monday-Friday - (619) 515-6620, Weekends, after hours - (858) 565-5255

FBI & CDC will be contacted by County: FBI (858) 565-1255 , Center for Disease Control (CDC) – (800) 311-3435

9 - Assist in the epidemiologic investigations

Steps in an epidemiologic investigation so as to determine who may be at risk.

  • Count cases;
  • Relate to the at-risk population;
  • Make comparisons;
  • Develop hypotheses;
  • Test hypotheses;
  • Make inferences;
  • Conduct studies;
  • Interpret and evaluate.

10- Know and spread this information