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Vol 22, No 4 December 2003

Bioterrorism: Introduction

Man’s inhumanity to manMakes countless thousands mourn

Robert Burns (1786)

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ike a tornado, without any heralding event, asym-metric warfare or terrorism can strike with dev-

stating consequences. Anesthesiologists, similar toany physicians, have little formal training in com-

ating such vicious attacks. But we are deemed to berst responders and as such, the ability to provideapid assessment and emergency care while main-aining personal protection must be anticipated.

In this issue, several noted physician scientistsave outlined the principle dangers of bioterrorismoday and defined the involvement of anesthesiol-gists in preparing for and dealing with an attack.any bioagents are designed to incapacitate the

espiratory system and therefore it is clear that weill likely be the first called to establish and main-

ain the airway. But our practice may be changed ineveral ways. In an overwhelming situation, asatient load reaches or exceeds hospital capacity,upplies may be quickly exhausted and our mind-et may have to return to that of reusing “dispos-ble” equipment or using people power as ventila-ors. Other chemicals used as weapons (some 70ifferent agents are reported to have been stock-iled), are defined as nerve paralyzing, vesicants,yanogenic, choking toxins, and psychomimetic.n all these situations, our knowledge and famil-arity with cardiorespiratory physiology, pharma-ology and reversal agents make us leaders (and

eachers) of the emergency care team. o

eminars in Anesthesia, Perioperative Medicine and Pain, Vol 22, N

The concept of biologic warfare is not new.rom Biblical times and perhaps even earlier, manas sought to destroy his enemy with toxins, in-ectious material, and diseased animals. During the0th century, several governments developed ex-ensive biologic weapons programs, some to beaintained as scientific curiosities and others for

iabolic use. The ability to cultivate viruses such asmallpox, or anthrax spores and then release themnto society became reality. It has been suggestedy more than one authority that the recent outbreakf Severe Acute Respiratory Syndrome (SARS)ay have had terrorist origins and was aimed at

ausing economic havoc in defined regions. In-eed, the last case, which occurred in a 27-year-oldostdoctoral student in Singapore, was reported toave been caused by “inappropriate laboratorytandards and a cross contamination of West Nileirus samples with SARS coronavirus” indicating

hat quantities of the virus are available and can beeleased (New York Times, Sept 24th 2003, pA6).

The use of radiation and nuclear devices as aeapon or threat by terrorists is a hazard of mod-

rn society. The release of radioactive materials inities or at large gatherings may result in greatumbers of victims requiring emergency care. An-sthesiologists in the accident unit must becomeamiliar with decontamination techniques and the

rganization of casualties and patient flow. It is

219o 4 (December), 2003: pp 219-220

important to remember that secondary radiationinjury from a contaminated patient to medical per-sonnel is minimal and care should focus on surgi-cal emergencies (although donning of protectiveclothing is advisable). Knowledge and identifica-tion of the degree of hazard is essential to controlhysteria that stems from ignorance and fear.

In a speech to the American Bar Association inLondon in 1985, Prime Minister MargaretThatcher remarked, “We must find ways to starvethe terrorist and the hijacker of the oxygen ofpublicity on which they depend.” But until that

time comes we can be in a position to deal with anattack by preparing our hospitals and ourselveswith an awareness of the consequences of bioter-rorism. Equipment and personnel requirements canbe identified. Frequent and realistic drills must beorganized. The latest word to become part of theanesthesiologist’s lexicon should be bioprepared-ness.

Elizabeth Frost, MDGuest Editor

220 ELIZABETH FROST