daily workload—thereby reducing the number of staff medical professionals for handling the bioterrorism-related workload.

In most urban communities of the United States, a bioterrorism attack could pose major problems for the hospital emergency departments, which are already close to their maximum utilization capacities. Some capabilities do exist for reducing the usual workload under such circumstances: patients with marginal cases of illness or minor injuries could be quickly discharged from specialty-care units; elective cases of treatment or surgery could be delayed; and incoming emergency patients could be triaged. However, a large number of patients would continue to need care so that they did not deteriorate into a more serious state. Numerous off-duty medical personnel could be pressed into longer hours of service in a crisis, but the amount of time during which they could respond without relief is still finite. Thus, although the prehospital care agencies might be able to gear up quickly into a disaster mode and accommodate a sudden influx of patients with illnesses related to an acute attack, there is not high confidence that emergency departments in most cities could do the same.

The initial symptoms of the illnesses caused by virtually all infective agents, be they bacterial, viral, or fungal in nature, are very similar. In fact, in everyday clinical practice it is common to confuse a serious bacterial infection with a trivial viral infection, with a loss of opportunity for effective intervention and curative treatment. If individuals or government agencies outside the medical community have knowledge about a pending attack with a specific agent, they may still not be able to dispel such confusion; no mechanism currently exists for the transmission of that information to the medical community so that it can recognize infected individuals and respond to their needs more quickly.

The federal government already has systems in place for responding to disasters. HHS coordinates Disaster Medical Assistance Teams, Disaster Mortuary Operational Response Teams, Veterinary Medical Assistance Teams, and other medical specialty teams located throughout the country. These units can be deployed immediately in the event of natural disasters. In addition, HHS coordinates the National Medical Response Teams for Weapons of Mass Destruction—weapons of mass destruction include chemical, biological, radiological, nuclear, or explosive (CBRNE) agents—to deal with the medical consequences of such incidents, and it is helping metropolitan areas across the nation prepare to deal with such incidents through the Metropolitan Medical Response System.

The Metropolitan Medical Response System emphasizes enhancement of local planning and response capabilities, as well as that of local hospital capacities, tailored to each jurisdiction so that it can best apply local resources to care for victims of a terrorist incident involving a weapon of mass destruction. The resulting systems are characterized by a concept of operations; specially trained responders; a special stockpile of pharmaceuticals; equipment for the detection of biological, chemical, and nuclear agents along with personal protective equip-



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