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Research Paper HSM541 Anna Hall
Research Paper HSM541 Anna Hall
The Readiness and the Effectiveness of the U.S. Healthcare Delivery System in Responding to a
Anna Hall
Devry University
HSM541
Abstract
release of biological agents (bacteria, viruses, or other germs). This is also referred to as germ
warfare. Terrorism is defined by the United States government as the "unlawful use of force and
population, or any segment thereof, in furtherance of political or social objectives." The term
"terrorism" does not imply what weapon is being used. In addition to biological agents, terrorists
can also utilize traditional weapons (guns), chemical agents and nuclear bombs.
While a biological agent may injure or kill people, animals, or plants, the goal for the terrorist is
to further their social and political goals by making their civilian targets feel as if their
government cannot protect them. Many biological agents are found in nature; however, they can
be modified by the terrorist to make them more dangerous. Some of these agents can be
transmitted from person to person, and the infection may take hours or days to become apparent.
There is a lot of interesting topics when it comes to bioterrorism and all of them are very
important for us to know what are the biological agents that can be utilized for bioterrorism,
what are the causes of bioterrorism in food, what are other sources for detailed information on
bioterrorism, how can we prepare ourselves for a bioterrorism attack, what are the warning signs
of a bioterrorism attack, what should we do if there has been a bioterrorism attack, how do we
know if somebody has been exposed to a bioterrorism agent, should we have some antibiotics on
hand just in case we get exposed, does the U.S. healthcare delivery system ready and prepared
The Readiness and the Effectiveness of the U.S. Healthcare Delivery System in Responding to a
Bioterrorism
Biological agents are organisms or toxins that can kill or incapacitate people, livestock
and crops. A biological attack is the deliberate release of germs or other biological substances
There are three basic groups of biological agents that could likely be used as weapons:
bacteria, viruses and toxins. Biological agents can be dispersed by spraying them into the air,
person-to-person contact, infecting animals that carry the disease to humans and by
A biological attack may or may not be immediately obvious. In most cases local health
care workers will report a pattern of unusual illness or there will be a wave of sick people
seeking emergency medical attention. The public would be alerted through an emergency radio
or TV broadcast, or some other signal used in your community, such as a telephone call or a
The following are things you can do to protect yourself, your family and your property
Check with your doctor to ensure all required or suggested immunizations are up
furnace return duct, which will filter out most biological agents that may enter
your house
The first evidence of an attack may be when you notice symptoms of the disease caused
by exposure to an agent. In the event of a biological attack, public health officials may not
immediately be able to provide information on what you should do. It will take time to determine
exactly what the illness is, how it should be treated, and who is in danger.
Watch tv, listen to the radio, or check the Internet for official news and
medications or vaccinations are being distributed and where you should seek
If you become aware of an unusual and suspicious substance, quickly get away.
Cover your mouth and nose with layers of fabric that can filter the air but still
allow breathing. Examples include two to three layers of cotton such as a t-shirt,
handkerchief or towel.
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 5
germs.
If you have been exposed to a biological agent, remove and bag your clothes and
Wash yourself with soap and water and put on clean clothes.
Contact authorities and seek medical assistance. You may be advised to stay away
If your symptoms match those described and you are in the group considered at
Pay close attention to all official warnings and instructions on how to proceed. The
delivery of medical services for a biological event may be handled differently to respond to
increased demand.
The basic public health procedures and medical protocols for handling exposure to
biological agents are the same as for any infectious disease. It is important for you to pay
attention to official instructions via radio, television, and emergency alert systems.
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 6
What are the biological agents that can be utilized for bioterrorism?
While any germ, bacteria, or virus could potentially be utilized by terrorist, there are a
number of biological agents that have been recognized as being more likely to be utilized. The
reason for these agents being of concern is based on their availability to terrorists and the ease by
which these agents can be disseminated. The U.S. Centers for Disease Control and Prevention
(CDC) has developed a classification system for biological terror agents, which is available on
their web site (Categories). The classification is based on the likelihood of the agent being used
and the risk posed by each agent. The agents (and the diseases they cause) are listed in table 1,
including hyperlinks for those wishing to learn more about a specific agent or disease. However,
it is almost impossible for most people to memorize all the details about each of these agents. It
is more important for the general public to understand the risk of bioterrorism and the
Disease caused by
Biologic agent
the agent
Filoviruses (for example, Ebola, Marburg) and arenaviruses (for Viral hemorrhagic
example, Lassa, Machupo) fevers
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 7
Disease caused by
Biologic agent
the agent
Ricin toxin
Ricinus communis (castor beans)
poisoning
Here’s a medical journal about Anthrax, Then and Now. We all know that there was a
Experts have said that it is a matter of when, not if, a large act of bioterrorism carried out
in the U.S. Why "bio" terrorism? Biologic weapons are cheaper and more devastating than
chemical weapons and maybe even nuclear weapons. Deadly quantities of infectious agents are
easy to hide, transport, and spread throughout the population. Indeed, the U.S. already
experienced a bioterrorism attack. In 2001, powder containing the bacterium called anthrax was
distributed through the U.S. mail. Altogether, 22 people became infected with anthrax. These
people lived in South Florida, New York City, New Jersey, Maryland, Connecticut,
Pennsylvania, Virginia, and Washington, DC. Eleven people seem to have inhaled the anthrax,
and 11 others were infected through the skin. The FBI and CDC (Center for Disease Control) are
Because of this outbreak, most Americans are now aware of the infectious disease called
anthrax. Most are also aware that it is usually a disease of animals and that it is a rare cause of
There are number of bacteria and bacterial toxins that could potentially be used to infect
the food supply. These include Clostridium botulinum toxin, Clostridium perfringens toxin,
Salmonella species, Escherichia coli O157:H7, Shigella, and Staphylococcal enterotoxin B. The
one that is most dangerous and most likely to be used in bioterrorism is Clostridium botulinum
There are many different government-based web sites that have up-to-date information
2. http://www.bt.cdc.gov/bioterrorism
4. http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html
6. http://www.ready.gov/be-informed
8. The American Red Cross, in cooperation with the CDC, has developed a detailed
plan that gives people the proper steps to take to prepare in the event there is a
bioterrorism attack
(http://www.redcross.org/preparedness/cdc_english/home.asp).
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 10
The first step starts long before there is an attack. People must have appropriate supplies
stored in a safe place in their house, where they work, and even in their cars. Although
individuals may want to vary the list based on their needs, the list taken from the American Red
Cross' web site (see below) is a good place to start. A similar list can be found on the U.S.
invaluable to have on hand during natural disasters, which are more likely to occur than a
terrorist attack.
Water: 3 gallons for each person who would use the kit and an additional 4
gallons per person or pet for use if you are confined to your home
Food: a three-day supply in the kit and at least an additional four-day supply per
person or pet for use at home (You may want to consider stocking a two-week
Items for infants, including formula, diapers, bottles, pacifiers, powdered milk,
Items for seniors, disabled people or anyone with serious allergies, including
special foods, denture items, extra eyeglasses, hearing aid batteries, prescription
and nonprescription medications that are regularly used, inhalers, and other
essential equipment
Kitchen accessories: a manual can opener, mess kits or disposable cups, plates
and utensils, utility knife, sugar and salt, aluminum foil and plastic wrap,
One complete change of clothing and footwear for each person, including sturdy
work shoes or boots, rain gear, and other items adjusted for the season, such as
comb and brush, lip balm, sunscreen, contact lenses, any medications regularly
used, toilet paper, towelettes, soap, hand sanitizer, liquid detergent, feminine
supplies, plastic garbage bags (heavy-duty) and ties (for personal sanitation uses),
medium-sized plastic bucket with tight lid, disinfectant, and household chlorine
bleach
Other essential items: paper, pencil, needles, thread, small A-B-C-type fire
Entertainment: including games, books, favorite dolls, and stuffed animals for
small children
A map of the area marked with places you could go and their telephone numbers
An extra set of keys and IDs: including keys for cars and any properties owned
Although the government continues to search for an early detection system for biological,
chemical, and radiation terrorist attacks, none of these systems have been perfected. The medical
community is advised to look out for unusual diseases not typically seen in the area. Other
potential clues that raise suspicion for a bioterrorism attack include new types of antibiotic
resistance in bacteria, because some biologic agents are modified (weaponized) to make them
more lethal, unusual numbers of cases of a disease, and atypical presentation of diseases.
The public should constantly be vigilant for bioterrorism. Events that might suggest an
attack including a large number of ill or dead people in a small geographic area, multiple dead
animals of different species, and patients with multiple different diseases, indicating a mixed
attack.
If you think that you have been exposed to a biological agent, the most important thing to
do is to quickly remove your clothing and wash off your skin. Most biological agents cannot
penetrate intact skin. Showering with soap and water will remove most agents from the skin. If
you have already inhaled or ingested the agent, decontamination using soap and water may not
help you but might help prevent exposing other family members or coworkers.
If the biological agent has been released into the air but you do not believe (or do not
know) you have been exposed, you can utilize masks to help prevent inhalation of the agent. The
problem is that standard surgical masks offer little protection. Specialized high-efficiency
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 13
particulate air (HEPA) masks are available that offer better protection; however, they are more
expensive, not easily found, and should be fitted to the person using them.
The two most important tools used by public health officials will be isolation and
quarantine. Isolation is keeping people known to be ill away from other people. Quarantine is
keeping people who may have been exposed away from other people. The problem is that many
times we may not know who has been exposed. In these cases, the public health officials will
likely recommend that everyone stay in their homes and avoid all public gatherings. By doing
this, we will isolate those sick and quarantine those infected but who do not yet have symptoms.
Those cities that utilized this technique during the Spanish flu pandemic of 1918 had much lower
rates of death than did cities that did not practice good quarantine procedures.
If there has been a bioterrorism attack, the first important step is to get information
immediately from the news media as to the right course of action. For some terrorist attacks, it
may be correct to try and leave the area; however, for other events, it may be more appropriate to
shelter in place. With bioterrorism, there may be the possibility of transmission of disease from
one human to another (for example, measles, influenza, avian flu, smallpox, plague, and viral
hemorrhagic fevers). In the case of either a bioterrorism attack or just a natural outbreak, it may
be necessary to avoid contact with infected people or just remain inside in a period of time until
the infected people are no longer contagious. Again, the key action is to understand the
recommendations from public health officials as delivered through the news media.
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 14
The symptoms of illness caused by the different bioterrorism agents are frequently very
nonspecific. Many of the agents cause a "flu-like" illness. These symptoms would include fever,
cough, nausea, vomiting, and headache. It is very hard to differentiate many of the different
diseases initially, and tests to confirm the diagnosis often must be done at specialized state
laboratories and may require weeks until the results are received.
It is best to stay informed through news media on what symptoms to look for and when to
seek medical care. The health care system simply cannot handle every member in the community
demanding to be tested for the disease. Many diseases do not even have a treatment other than
While there are a few biological agents that can be prevented by taking antibiotics (for
example, anthrax), it is not recommended that you stockpile antibiotics. Antibiotics have a
limited shelf life and would likely be unusable by the time an attack might occur. Also, there are
many different types of infectious agents, each requiring different antibiotics. All drugs,
including antibiotics, have side effects, and taking them inappropriately could cause more harm
than good.
Because the likelihood of a biological attack is small, it is better to wait until there has
been an attack before getting medications. The U.S. government has stockpiles of drugs that will
be immediately flown into a community that has experienced a biological attack (these supplies
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 15
are rotated to keep them current). Additionally, many large communities also have stockpiles of
To help prepare our country for possible bioterrorism attacks, FDA is working with other
federal agencies to make sure adequate supplies of medicine and vaccines are available to the
American public. This page provides links to the most current information on drug therapy and
FDA plays a critical role in protecting the United States from chemical, biological,
radiological, nuclear, and emerging infectious disease threats. FDA ensures that medical
devices) that may be used in the event of a potential public health emergency stemming from a
MCMs can be used to diagnose, prevent, protect from, or treat conditions associated
diseases.
drugs
identify threat agents, and personal protective equipment (PPE), such as gloves,
with partners at all levels of government—local, state, national and international—to support
MCM-related public health preparedness and response efforts. FDA is part of the U.S.
Department of Health and Human Services (HHS) Public Health Emergency Medical
FDA also works with non-government organizations, universities and research centers,
and industry to further the development of MCMs for public health emergency preparedness.
Depending on the emergency and public health need, during a public health emergency,
MCMs may be provided by the Strategic National Stockpile (SNS), which is overseen by the
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 17
Centers for Disease Control and Prevention (CDC), or through state and local stockpiles or other
pharmaceutical caches. MCMs are usually dispensed or administered by health care workers and
public health responders under official federal, state, and/or local emergency response plans.
In some cases, at the time of a public health emergency, MCMs may be approved by
FDA and will be used in approved ways during a response. Some MCMs may not be approved
yet, or they may be approved but not for the indication under consideration during the
emergency.
Because of its role in regulating medical products, and the nature of some of these
products, FDA may need to use special authorities to allow the use of such MCMs in impacted
populations during or in anticipation of emergencies. Mechanisms FDA can use to allow the
emergency use of MCMs include the Emergency Use Authorization (EUA) authority and several
Before a medical product can be approved by FDA, the sponsor must demonstrate
efficacy—that the product works. In some cases, such as developing MCMs for potential
bioterror threats, human challenge studies (exposing people to the threat agent) would not be
ethical or feasible.
In these cases, FDA may grant approval based on well-controlled animal studies, when
the results of those studies establish that the drug or biologic product is reasonably likely to
produce clinical benefit in humans. The product sponsor must still demonstrate the product’s
safety in humans.
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 18
FDA is committed to protecting national health and security. We are working to foster
the development and availability of medical products that will be needed to counter a public
available MCMs
technology developments
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 19
The last terrorist attack was the September 11 bombing in New York., The United States
has never been prepared in such a state of alert. The use of biological weapons could be the
greatest treat because of the portability and the easy distribution of the agents. The U.S.
healthcare system is not fully capable of handling a biological terrorist attack because of funding
needed to prepare for such disasters, resources to operate and overcome, and effective
communication with the different agencies that would be involved. What modifications and
adjustments does the U.S. healthcare delivery system need to implement to ensure that we will
be 100% ready and prepared for bioterrorist attack? Now that the government knows such
attacks are possible, is there a national emergency plan in place for health care delivery? If so,
what is the plan? Who is responsible for it? Which agency has the lead role? What other agencies
have major roles? What is the command-and-control structure? Has the government made sure
that one agency is responsible for coordinating the efforts of all other agencies? What authority
resides with the newly established Office of Homeland Security? Are the responsibilities
transferred from other agencies, or new? Are the authority and responsibility for combating
bioterrorism clearly designated at the federal level? If not, by when will these be established?
According to the GAO, “under the Federal Response Plan, CDC is the lead [HHS]
agency provides assistance to state and local governments for five functions:
(1) health surveillance, (2) worker health and safety, (3) radiological, chemical, and
biological hazard consultation, (4) public health information, and (5) vector control.
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 20
The CDC has established a process to prepare public health agencies for a biological
Prepare educational materials that will inform and reassure the public during and
resistant strains.
For responding to a biological attack, the CDC has issued broad plans in its biological
Assist state and local health agencies in organizing response capacities to rapidly
deploy in the event of an overt attack or a suspicious outbreak that might be the
Ensure that procedures are in place for rapid mobilization of CDC terrorism
response teams that will provide on-site assistance to local health workers,
Government officials must act swiftly to develop a plan for stockpiling and distributing
medicine and delivering treatment to all Americans. Such a plan must be developed and
announced through the mass media to ensure public confidence and that appropriate actions are
taken by health care providers and the public in the event of an emergency. This
HHS through its Office of Public Health Preparedness must keep the public informed
about its efforts to enhance HHS’ response to anthrax and other biological threats. This can be
done via public service announcements on television, radio, and the print media, via HHS’ Web
site, through mass mailings and billboards, and as a specific request to news agencies to provide
this information. A national toll-free desk must be established to field questions and respond to
HHS must ensure that states and localities are adequately prepared to deal with a
biological or chemical attack. A valid assurance would include a detailed and sufficient plan of
RESPONDING TO A WIDESPREAD BIOTERRORISM EVENT 22
action for quickly locating and treating an affected population in the wake of a biological or
chemical attack. Inclusive in this plan would be specific locations for distribution of
pharmaceutical supplies and the active notification of the public regarding these locations.
Adequate plans must be subjected to a national review and confirmation from HHS on a scale of
one to five, with five being the highest rating, and recertification would be required on a yearly
basis. Plans receiving a rating of less than five, or failing to receive any rating, would be
provided a six-month period in which to improve one scale rating or achieve a rating of one, and
a year to achieve a five rating. Ratings would be tailored to the needs of individual states and
An underlying weakness of the nation’s health care system is that it ignores the nexus
between population group membership and the receipt of health care. Health care disparities
exist between various population groups. Past failures to take disparities into account give rise to
questions about the government’s readiness to treat all Americans if bioterrorism escalates. The
federal government must take minority health disparities into consideration and immediately
The CDC should develop model emergency response plans for state and local
jurisdictions that will take variations in resources and infrastructures. Additionally, partnerships
must be created between well-prepared states (such as Illinois) and others (such as New
Federal, state, and local governments must identify, recruit, and train a network of
multilingual volunteers and personnel who can be deployed to assist with limited-English-
Following a bioterrorist attack, the federal government must ensure that everyone,
regardless of race, ethnicity, and socioeconomic class, is provided with long-term medical care.
To accomplish this, it is necessary that federal, state, and local governments and health care
providers develop relationships and the mechanisms to communicate with and inform racial and
ethnic minorities.
Protocols for responding to a bioterrorist attack must be established by federal, state, and
local governments and health care professionals. These protocols must clearly state, among other
points, how everyone in a city will be notified following a bioterrorist attack and that everyone
will receive the same treatment regardless of race, ethnicity, and socioeconomic class.
The deterioration of the health care “safety net” over many years demands that the
number of trained health care volunteers be increased. More health care volunteers are not only
required in the event of a bioterrorist attack but are also needed to combat the long-term
References