Medical Preparedness and Response to Terrorism with Biological and Chemical Agents -- Present Status in USA

Abstract

Over the past decade, acts of terrorism have ranged from dissemination of aerosolized Anthrax spores, intentional food product contamination, release of chemical weapons in major metropolitan subway systems and suicide attacks using explosive devices. Unfortunately, predicting when and how such attacks might occur has proven to be very difficult. Since the bombing attacks at the World Trade Center in New York in 1993 and 2001, the Federal Building in Oklahoma City in 1995, US embassies in Kenya and Tanzania in 1998 and just recently in Saudi Arabia and Morocco, and the release of impressively weaponized anthrax spores in the US Postal System during the autumn of 2001, large-scale terrorist attacks on civilian populations using weapons of mass destruction no longer seem in the realm of the fantastic. At their worst, the New York, Oklahoma City, and Tokyo attacks may represent the crossing of a grim threshold, weakening long-standing taboos and increasing the likelihood of analogous attacks in the future. Preparing the medical community to address these threats is a formidable challenge, but the consequences of being unprepared could be devastating. The medical and healthcare infrastructure must be prepared to both prevent and treat illness and injury that would result from CBRNE terrorism, especially a covert terrorist attack. This article outlines steps for strengthening medical and public health capacity to protect against these dangers that have been taken in the USA. Investments in scientific knowledge, public health and hospital and healthcare systems provide the best defense against terrorism and will improve our ability to successfully respond to other public health threats that will emerge in the twenty first century.