JANAC Vol. 13, No.
5, September/October 2002
Porche / Bioterrorism Agents
10.1177/105532902236783
Biological and Chemical
Bioterrorism Agents
Demetrius J. Porche, DNS, RN, CS, FNP
Bioterrorism of a chemical or biological nature
poses a potential public health threat to our nation at a
time when the health care infrastructure is challenged.
This article reviews the history of bioterrorism
research, some potential biological and chemical
agents, and concludes with a review of the five func-
tions that should be addressed in a bioterrorism
response plan. The offending biological or chemical
agent is reviewed with the clinical presentation and
methods of treatment and prevention.
Key words: biological agents, bioterrorism,
bioterrorism response plan, chemical agents,
chemical terrorism
B ioterrorism, weapons of mass destruction, germ
warfare, chemical warfare, national security, and
disaster/bioterrorism preparation have become daily
words in the American vocabulary. These words are
accompanied by feelings of fear and anxiety resulting
from the September 11, 2001, attack on the United
States of America. Health care providers are also expe-
riencing fear and anxiety in relation to the clinical pre-
sentation and management of illnesses caused by bio-
logic or chemical agents. Most health care providers
have limited clinical experience with the biologic or
chemical agents used by terrorists to cause morbidity
and mortality of civilians.
All health care professionals have a significant role
in the preparation and management of repercussions of
attacks using biological and chemical agents. This
article provides clinical information on the presenta-
tion and management of bacterial, viral, and chemical
agents that can be used to inflict an attack on individu-
als and communities. Health care provider and
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 13, No. 5, September/October 2002, 57-64
DOI: 10.1177/105532902236783
Copyright © 2002 Association of Nurses in AIDS Care
community preparedness and functions are addressed
in a bioterrorism response plan.
History of Bioterrorism Research
Historically, biological agents have been used to
wage war. In the Sixth Century B.C., the Assyrians poi-
soned enemy wells with rye ergot. Solon used the pur-
gative herb hellebore during the siege of Drissa. In
1346, plague devastated the Tartar army in the siege of
Kaffa. The attackers threw corpses infected with
plague over the enemy walls to spread the infectious
agents, thereby causing morbidity throughout the
community. In 1710, Russia used the same infected
corpse measure in their war against Sweden. Smallpox-
infected clothing was presented to enemies during sev-
eral wars (Kortepeter, 2001) to covertly infect the
enemy.
Japan had a very aggressive biological war program
during World War II. In 1940, a plague epidemic that
struck China and Manchuria was suspected to be the
result of Japanese planes dropping plague-infected
fleas over those areas.
Biological war programs continued in Japan until
1945. It has been suspected that the Soviet Union con-
tinued to create biological weapons regardless of the
1970 treaty banning such practices. It has been
reported that the Soviets created viral cocktails in
which one viral disease would mask the presentation
Demetrius J. Porche, DNS, RN, CS, FNP, is associate pro-
fessor and associate dean for nursing research and evalua-
tion at the Louisiana State University Health Science Cen-
ter School of Nursing, New Orleans, Louisiana.
58 JANAC Vol. 13, No. 5, September/October 2002
of the other more pathogenic disease (Anderson,
2000). These incidents provide historical evidence that
biological attacks are not new but do pose a new and
imminent threat to our nation.
Since 1985, the number of terrorist events that
threatened the use of or actually used chemical, bio-
logic, radiologic, or nuclear materials sharply
increased. Hoaxes involving chemical or biologic
agents have shown two peaks over the past 30 years;
the first in 1986 was a chemical hoax inspired by the
Tylenol® poisonings, and the second, a dramatic
increase in 1998, was attributed to a flurry of anthrax
threats (Tucker, 1999). Potential hoaxes became very
real in 1995, when 12 people were killed by the release
of sarin, a nerve gas, in a Tokyo subway.
As of January 31, 1999, an open-source database of
all publicly known cases of domestic or international
criminals or terrorists seeking to acquire or use chemi-
cal, biologic, radiologic, or nuclear materials con-
tained 415 incidents. These incidents are divided into
three categories—terrorist events, criminal events, and
state-sponsored assassinations. To be classified as a
terrorist event, the incident must involve an organiza-
tion or person that conspires to use violence instru-
mentally to advance a political, ideologic, or religious
goal. In contrast, criminal events involve extortion,
murder, or some other nonpolitical objective (Tucker,
1999).
The most recent terrorist incident used anthrax
spores distributed through the United States Postal
Service as a means to produce fear and possibly infect
unsuspected individuals with anthrax. Americans have
asked the question “Why?” Tucker (1999) reports that
the main motivations in descending order of impor-
tance are to promote nationalist or separatist objec-
tives, retaliate or take revenge for a real or perceived
injury, to protest government policies, and to defend
animal rights. Regardless of the motivations behind
such events, these historical and recent biological ter-
rorist acts pose multiple health treats to Americans and
challenges in the prevention, control, and management
of biological, and chemical terrorist attacks.
Bioterrorism Agents
Multiple agents exist that can cause morbidity and
mortality as a result of terrorist acts. Bacterial, viral,
toxin, and chemical agents are identified as potential
sources of a bioterrorism attack.
Bacterial Agents and Toxins
The Centers for Disease Control and Prevention
(CDC) have identified six bacterial agents most likely
to be used to inflict harm from bioterrorist acts.
Anthrax
Antrhax is an acute infectious disease that most
commonly occurs in warm-blooded animals (Chin,
2000). Anthrax infection is caused by Bacillus
anthracis, a gram-positive spore-forming bacillus.
Bacillus anthracis is transmitted through the handling
of infected animal products, by inhaling anthrax
spores from contaminated animal products, or eating
undercooked meat from infected animals. Person-to-
person transmission is possible but rare. The incuba-
tion period is from 1 to 7 days after spore contact
(Chin, 2000). Anthrax can present in three clinical
forms—inhalation (respiratory), gastrointestinal, or
cutaneous.
Respiratory anthrax infection presents with signs
and symptoms that resemble a common cold. The
signs and symptoms progress to severe shortness of
breath and shock. If untreated, death can occur in 1 to 2
days after the onset of acute symptoms. Intestinal
anthrax presents with initial signs of nausea, loss of
appetite, vomiting, and fever. These symptoms prog-
ress to abdominal pain, vomiting of blood, and severe
diarrhea. Gastrointestinal anthrax infection can result
in death in 25% to 60% of the cases. Cutaneous
anthrax initially presents as a raised itchy bump often
resembling an insect bite. In one to two days it devel-
ops into a vesicle, then painless ulcer that is about 1 to
3 cm in diameter with a characteristic black necrotic
area in the center of the ulcer. The surrounding area
may exhibit lymphedema (Inglesby et al., 1999).
Prevention of anthrax infection may be averted
through appropriate prophylaxis (see Table 1). Treat-
ment for anthrax infection should be initiated early.
Untreated infection can be fatal. Penicillin,
erythromycin, tetracycline, or chloramphenicol can be
used to treat active infection (see Table 2). Infection
control measures consist of standard precautions.
Masks are encouraged if coughing is present, and
 Porche / Bioterrorism Agents 59

Table 1. Postexposure Prophylaxis

Biological
Agent Population Medication Comments
Anthrax Adults (including pregnant Ciprofloxacin 500 mg BID for 60 days or Tetracyclines are not typically used during
and immunocompromised) doxycycline 100 mg po BID for 60 days. pregnancy. If this is a life-threatening sit-
uation, use should be considered.
Children Ciprofloxacin 15 to 20 mg/kg po Q qw Ciprofloxacin should not exceed 1 gram/
hours for 60 days or doxycycline for 60 day in children.
days:
> 8 years and > 45 kg—100 mg po BID,
> 8 years and < 45 kg—2.2 mg/kg po
BID, < 8 years—2.2 mg/kg po BID.
Tularemia Adults (including pregnant Doxycycline 100 mg po BID for 14 days
and immunocompromised) or ciprofloxacin 500 mg po BID for 14
days.
Children Ciprofloxacin 15 to 20 mg/kg BID for 14
days or doxycycline for 14 days:
> 8 years and > 45 kg—100 mg po BID, >
8 years and < 45 kg—2.2 mg/kg po BID,
< 8 years—2.2 mg/kg po BID.
Plague Adults (including pregnant Doxycycline 100 mg po BID for 7 days. Dosage duration is from the time of last
and immunocompromised) known contact.
Children Doxycycline for 7 days: > 8 years and >
45 kg—100 mg po BID, > 8 years and <
45 kg—2.2 mg/kg po BID, < 8 years—
2.2 mg/kg po BID.

NOTE: BID = twice daily, po = by mouth, Q = every.

gowns are used for a potential splash of body fluids
(DeKalb County Board of Health, 2001; Inglesby
et al., 1999).
Brucellosis
Brucellosis is an infectious disease caused by bacte-
ria from the genus Brucella. Brucella infects sheep,
goats, cattle, deer, elk, pigs, dogs, and other animals.
Humans are infected through contact with animals or
animal products that are contaminated with Brucella.
Brucella is transmitted through eating or drinking con-
taminated food (unpasteurized milk), inhaling the
organism, or entrance of the bacteria through non-
intact skin. Direct person-to-person transmission is
extremely rare. Brucella infection can also be trans-
mitted through breastfeeding. The incubation period
ranges from 5 to 60 days (Chin, 2000).
Clinical presentation of brucellosis consists of mild
flu-like illness to severe central nervous system infec-
tion. Chronic symptoms can include recurrent fevers,
joint pain, and depression.
Prevention consists of pasteurizing milk, cheese,
and ice cream. Animal handlers should use gloves.
Treatment for brucellosis consists of doxycycline and
rifampin (Chin, 2000).
Plague
Plague is a human and animal infection caused by
Yersinia pestis, a gram-negative bacillus. Yersinia
pestis is transmitted through fleas that feed on rodents.
Plague is an endemic infection in the Southwest. The
incubation period for plague is 1 to 7 days, and for
plague pneumonia, 1 to 4 days. There are three clinical
presentations—bubonic, septicemic, and pneumonic.
Bubonic and septicemic plague are not transmitted
from person to person. Pneumonic plague can be
transmitted by close contact with someone with the
disease through the dispersion of large droplets (Chin,
2000).
Bubonic plague presents as a nonspecific fever,
chills, malaise, myalgia, nausea, prostration, sore
throat, and headache with a swollen, inflamed tender
60 JANAC Vol. 13, No. 5, September/October 2002

Table 2. Treatment Regimen

Biological
Agent Population Medication Comments
Inhalation Adults (including Intravenous (IV) IV medication should be switched to oral
Anthrax pregnant and Ciprofloxacin 400 mg BID for 7 days medication to complete the 60-day
immunocompromised) or doxycycline 100 mg BID for regimen. Oral doxycycline not
7 days or erythromycin 15 to recommended for more than 14 days of
20 mg/kg/day in divided doses for therapy during pregnancy.
7 days or penicillin G 20 MU/day
in divided doses for 7 days.
Oral
Ciprofloxacin 500 mg BID for 60 days
or doxycycline 100 mg BID for 60 days.
Children Intravenous IV medication should be switched to oral
Ciprofloxacin 15 mg/kg Q 12 hours or medication to complete the 60-day
doxycycline for 7 days: > 8 years and regimen.
> 45 kg—100 mg BID, > 8 years and
< 45 kg—2.2 mg/kg in 2 divided doses,
< 8 years—2.2 mg/kg po BID.
Oral
Ciprofloxacin 15 to 20 mg/kg Q 12 hours for
60 days or doxycycline for 60 days: >
8 years and > 45 kg—100 mg BID, >
8 years and < 45 kg—2.2 mg/kg BID, <
8 years—2.2 mg/kg po BID.
Tularemia Adults (including Gentamicin 3 to 5 mg/kg/day IV or IM or Q When switching from gentamicin to oral
(pneumonic) pregnant and 8 hours (or 3 divided doses) for 7 to 14 days doxycycline, gentamicin should be con-
immunocompromised) or doxycycline 100 mg IV BID for 21 days tinued for 21 days. IV treatment with
or ciprofloxacin 400 mg IV BID for 10 to doxycycline or ciprofloxacin can be
14 days. switched to oral when clinically
appropriate.
Children Gentamicin 6.0 to 7.5 mg/kg/day IV or IM in 21 days of gentamicin therapy is required
3 divided doses for 7 to 14 days or if switching to oral therapy. IV
doxycycline for 21 days: > 8 years and doxycycline or ciprofloxacin can be
> 45 kg—100 mg IV BID, > 8 years and changed to oral therapy when clinically
< 45 kg—2.2 mg/kg/day IV in 2 divided appropriate.
doses, < 8 years—2.2 mg/kg IV BID, or
ciprofloxacin 15 mg/kg IV Q 12 hours for
10 to 14 days.
Plague Adults (pregnant and Gentamicin 3 to 5 mg/kg/day IV or IM Q IV gentamicin or doxycycline can be
immunocompromised) 8 hours or in divided doses for 10 days or switched to oral when clinically
doxycycline 100 mg IV BID for 10 days or appropriate.
doxycycline 100 mg po BID for 10 days.
Children Gentamicin 6.0 to 7.5 mg/kg/day IV in IV doxycycline can be switched to oral
3 divided doses for 10 days or doxycycline for doxycycline when clinically appropriate.
10 days: > 8 years and > 45 kg—100 mg
IV BID, > 8 years and < 45 kg—2.2 mg/kg/
day IV in 2 divided doses, < 8 years—2.2 mg/
kg IV BID, or doxycycline for 10 days:
> 8 years and > 45 kg—100 mg po BID,
> 8 years and < 45 kg—2.2 mg/kg/day
po BID, < 8 years—2.2 mg/kg po BID.

NOTE: BID = twice daily, po = by mouth, Q = every, IV = intravenous.


lymph node. Pneumonic plague can be secondary to
bubonic plague. Pneumonic plague presents with
fever, malaise, dyspnea, cough, sputum production,
and cyanosis (Inglesby et al., 2000).
Standard and droplet precautions are used with
plague. Prophylaxis should be provided for anyone
exposed to pneumonic plague. Streptomycin,
gentamicin, doxycycline, or ciprofloxacin can be used
to treat plague (see Table 2) (DeKalb County Board of
Health, 2001; Inglesby et al., 2000).
Tularemia
Tularemia is a bacterial disease caused by
Francisella tularensis, an aerobic gram-negative
coccobacillus. Francisella tularensisis transmitted
through tick bites, handling or ingestion of under-
cooked meat from infected animals, drinking contami-
nated water, or inhalation of dust from contaminated
soil, grain or hay. Direct person-to-person transmis-
sion does not occur. The incubation period ranges
from 1 to 14 days, but usually is 3 to 5 days (Chin,
2000).
Cutaneous tularemia infection presents as a skin
lesion with swollen lymph nodes. Ingestion of
Francisella tularensis produces a throat infection,
abdominal pain, diarrhea and vomiting. Inhalation of
Francisella tularensis produces a fever alone or with
pneumonia-like illness (Dennis et al., 2001).
Tularemia infection can be prevented by wearing
gloves when skinning or handling animals, thoroughly
cooking wild animals, avoiding fly and tick bites,
avoiding drinking, bathing, or swimming in untreated
water, and avoiding handling sick or dead animals (or
using gloves). Gentamycin and tobramycin have
reported effectiveness against tularemia infection (see
Table 2) (DeKalb County Board of Health, 2001; Den-
nis et al., 2001).
Q Fever
Q fever is an acute febrile rickettsial disease caused
by Coxiella burnetti. Coxiella burnetti is primarily
found in cattle, sheep, and goats. These organisms are
excreted in milk, urine, and feces of infected animals
and during birth. Transmission occurs through air-
borne dissemination from infected dust, birth fluids,
and animal excreta. Ingestion of contaminated milk or
Porche / Bioterrorism Agents 61
the inhalation of airborne particles from food products
can also transmit Coxiella burnetti. Tick bites and
person-to-person transmission is also possible. The
incubation period is 2 to 3 weeks (Chin, 2000).
Q fever presents with the sudden onset of one or
more of the following: high fever, severe headache,
sore throat, chills, sweats, nonproductive cough, nau-
sea, vomiting, diarrhea, abdominal pain, and chest
pain. The fever lasts for about 1 to 2 weeks.
Prevention of Q fever consists of standard precau-
tions with gloves for handling items and surfaces con-
taminated with blood or body fluids. Masks should be
worn if there is coughing, and gowns worn to prevent
the splash of potentially infected fluids on skin and
clothing. Other prevention measures include pasteur-
izing milk; appropriate disposal of animal placenta,
birth products/fluids, aborted animal fetuses; and ani-
mal quarantine. Doxycycline is the treatment of choice
for Q fever.
Botulism
Botulism is a paralytic illness caused by a nerve
toxin produced by an infection with Clostridium botu-
linum, a spore-forming anaerobe. Clostridium botuli-
num is transmitted from eating foods containing the
botulism toxin, primarily canned vegetables and fruits,
infection of a wound with Clostridium botulinum, or
consuming Clostridium botulinum spores that grow in
the intestines with the eventual release of a toxin. The
incubation period is from 12 to 72 hours but can occur
as late as 10 days after contact (Chin, 2000).
The classic presentation of botulism is double
vision, blurred vision, drooping eyelids, slurred
speech, difficulty swallowing, dry mouth, and muscle
weakness. If untreated, paralysis of the arms, legs,
trunk, and respiratory muscles can occur. Infants pres-
ent as lethargic, feeding poorly, constipated and with a
weak cry and poor muscle tone (Arnon et al., 2001).
Boiling canned foods for 10 minutes prior to con-
sumption can prevent botulism infection. Infected
wounds should be treated promptly. Children younger
than 12 months of age should not be fed fresh honey
that has not been processed. Antitoxin can be used to
treat botulism. Contaminated food may be removed
from the intestines by inducing vomiting or using ene-
mas. Supportive care may include mechanical ventila-
tion. Surgical debridment of wounds may be required
62 JANAC Vol. 13, No. 5, September/October 2002
to remove toxin-producing bacteria (Arnon et al.,
2001; DeKalb County Board of Health, 2001).
Viruses
Smallpox
Smallpox is an acute viral illness caused by an
Orthopoxvirus, variola. Smallpox is transmitted
through large and small droplets. It is a very conta-
gious viral infection that is transmitted from person to
person. Infected persons are contagious at the onset of
the rash and remain contagious until the scabs separate
in about 3 weeks. Smallpox was eradicated in 1980;
therefore, a single case is considered an international
health emergency (Chin, 2000).
The first 2 to 4 days of the illness presents as influ-
enza. Skin lesions appear on the face and extremities
(not on the palms or soles) progressing from macules
to vesicles. The rash appears simultaneously on the
body rather than in a progressive nature. The rash
forms scabs in 1 to 2 weeks (Henderson et al., 1999).
Smallpox prevention includes standard precautions
and airborne and contact precautions. Vaccination pre-
vents smallpox. Smallpox is treated with antibiotic
therapy for the secondary infections and supportive
treatment (Henderson et al., 1999).
Chemical Agents
Chemical agents are substances that can injure or
kill an individual through a variety of mechanisms.
These agents are usually produced by the commercial
industry. Chemical agents are typically classified
according to their affect on individuals. Chemical
agents are classified as choking, blood, blister, or
nerve agents (Smith, 2000). The review of potential
chemical agents will be limited to agents that are most
likely to be used in an attack and that will cause the
most significant morbidity and/or mortality.
Choking or irritating agents cause an irritation to
the eyes and respiratory tract. Two choking agents are
phosgene and chlorine. Both agents are available com-
mercially. These agents are heavier than air and settle
in low areas. These agents produce coughing, dyspnea,
chest pain, and pulmonary edema that results in
asphyxiation. Serious symptoms may not develop for
2 to 3 hours after exposure. If exposed, immediate
decontamination is necessary with water only; bleach
solutions should not be used (Smith, 2000).
Blood agents are hydrogen cyanide (AC) and
cyanogen chloride (CK), cyanide-based products.
These agents are used in liquid form and rapidly vapor-
ize once released. Both agents smell like bitter
almonds. AC is lighter than air, but CK is heavier than
air; therefore AC will remain suspended longer and
have a greater dispersion in the air. These agents have
both inhalation and skin contact hazards. Inhalation
produces immediate effects of appearing flushed, with
reddish skin and possibly blue lips. The individual
gasps for air, progresses to unconsciousness and then
possibly death if not treated rapidly. The victim should
be decontaminated with water and exposed to fresh air
(aeration) immediately (Smith, 2000).
Blister agents affect the respiratory tract and skin.
Blister agents include mustard, lewisite and phosgene
oxime. Blister agents are heavier than air. Mustard is a
liquid agent that has an odor similar to garlic. The
vapors cause blistering of the skin and can severely
damage the lungs. Mustard is rapidly absorbed into the
skin within a few hours, with reddening of the skin and
blister formation occurring later. Lewisite smells simi-
lar to geraniums. Lewisite and phosgene oxime con-
tamination occur through absorption and inhalation.
Both agents also produce immediate pain upon contact
with the skin. Phosgene oxime has an irritating smell.
Decontamination procedures use a 10:1 bleach and
water solution. These agents should be removed from
the skin immediately. Flushing with water is important
(Smith, 2000).
Nerve agents, tabun, sarin, soman, and VX (methyl-
phosphonothioic acid S-[2-[bis(1-methylethyl)
amino]ethyl]O-ethylesterare) are considered super
hazardous materials. These are extremely fast acting
agents that pose an inhalation and skin contact threat.
VX is considered more a skin hazard than an inhala-
tion hazard. Tabun and sarin have a fruity odor, soman
has a camphor odor, and VX smells like sulfur. These
agents produce a runny nose (rhinorrhea), dyspnea,
chest pain, decreased visual acuity, constricted pupils
and seizure activity. Individuals exposed to nerve
agents need immediate injections of atropine and/or 2-
PAM chloride. Clothing needs to be flushed with a
10:1 bleach and water solution (Smith, 2000).

Bioterrorism Response Plans
There are five primary functions in detecting,
responding to, and recovering from a bioterrorist
attack that should be addressed in a bioterrorism
response plan. Detection and diagnosis, incident man-
agement, prevention and control, fatality manage-
ment, and environmental surety are the five primary
functions. Detection and diagnosis refer to the surveil-
lance actions that are continual and ongoing to detect
potential terrorist attacks. Incident management is the
actual response to a bioterrorist event. Prevention and
control are the population-based interventions, medi-
cal services, and the policy and legal investigations
that are implemented to prevent bioterrorist attacks.
Fatality management ensures the proper handling of
potentially large numbers of victims. Environmental
surety is the containment action that renders the physi-
cal environment safe and nonthreatening to the com-
munity. Bioterrorism response plans should address
each of the five primary functional areas. Each primary
functional area will be explored below (DeKalb
County Board of Health, 2001).
Detection and diagnosis consist of ongoing surveil-
lance, unusual event report, laboratory diagnosis and
testing, and case investigations. Surveillance should
include notifiable disease surveillance, index case
investigations, promulgated case investigations, and
outbreak investigations. Clinicians need to be astute to
detect sentinel events as unusual and to detect unusual
illness patterns (DeKalb County Board of Health,
2001; Khan & Sage, 2000).
Incident management or response consists of law
enforcement command and control, health profes-
sional command and control, public information dis-
semination, and the activation of an emergency opera-
tions center. Law enforcement will assess the validity
of a bioterrorist threat. The local health department or
state health department in collaboration with local
health care facilities will coordinate access to health
care services. The dissemination of information to the
media and public should be coordinated in collabora-
tion with local and federal agencies. A local official
should be identified to coordinate the activation of
emergency operations. The emergency operations
center serves as the command center for the
bioterrorist response coordinating all event patterns
Porche / Bioterrorism Agents 63
(DeKalb County Board of Health, 2001; Khan & Sage,
2000).
Prevention and control consists of health investiga-
tion to identify the source and type of exposure, inves-
tigation of the crime, and the provision of medical
care. The health investigation may include patient
interviews, obtaining and testing specimens, conduct-
ing site investigations, and reviewing medical records
and other supporting data. Health investigations occur
in coordination with local law enforcement agents.
Law enforcement agents should take the lead in con-
ducting the criminal investigation and share any evi-
dentiary discoveries with the health care profession-
als. Control of the bioterrorist attack requires the
assurance of adequate medical personnel, supplies,
and facilities that can treat ill and exposed individuals,
physically and mentally. Prevention of the promul-
gated transmission requires administration of appro-
priate prophylaxis and decontamination of exposed or
at risk individuals. Isolation and quarantine measures
may be instituted as a public health control measure to
reduce spread of infections agents (DeKalb County
Board of Health, 2001).
Fatality management consists of investigation,
identification, notification, and disposition of victims.
The local medical examiner/coroner will be responsi-
ble for investigating the cause of death and victim
identification in consultation with local law enforce-
ment and health care professionals. Notification of the
next of kin is typically the responsibility of the medical
examiner/coroner. Disposition of the deceased victims
will be coordinated between the medical examiner/
coroner, next of kin, and local funeral director. Com-
munication of any potential communicable risk and
specific treatment of the human remains must be com-
municated to the next of kin and funeral directors as a
measure to prevent and control infectious transmission
of biological or chemical agents (DeKalb County
Board of Health, 2001).
Environmental surety consists of sampling and test-
ing, vector control, and remediation. The physical
environment inclusive of air and water may need to be
tested. Public safety officers with environmental
health officials collect samples and test the physical
environment. Vector control of insects, rodents or
other animals may be implemented to decrease the risk
of transmitting infections. Environmental remediation
64 JANAC Vol. 13, No. 5, September/October 2002
may include the handling and disposal of hazardous
agents. The environmental health officer for the local
public health department should be consulted regard-
ing appropriate environmental remediation patterns
(DeKalb County Board of Health, 2001).
Health care professionals need to be aware and pre-
pared to manage the repercussions of bioterrorist
attacks on our nation. This article has presented a
review of biological and chemical agents that can be
used to cause morbidity and mortality. It has con-
cluded with a review of the five primary functions for
detecting, responding to, and recovering from a bio-
terrorist attck on our nation.
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