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Bioerrorism, Physician Education, and the Internet In the United States meeting the challenge of effectively managing domestic bioterrorism using infectious agents is a new issue for our country as a whole and for the civilian health care sector in particular. Individually practicing physicians and nurses need to consider four issues if they are to effectively meet these bioterorrism challenges.
The web is a uniquely well positioned source to fulfill these informational and educational requirements as long as reliable Internet sources are accessed. Particulars about new or different outbreaks can be rapidly disseminated at relatively little expense. Tutorial materials that contain text, images and audio can be made readily available. Government, university, and medical organizations have web pages devoted to bioterrorism and physician education. Web category one continuing medical education credits on issues addressing bioterrorism are now being offered. To be included as references in this paper sites had have peer reviewed, evidenced-based sources of information, document authorship, be timely updated, and be freely available on the Internet.
American Medical Association Physician Resource Center on Terrorism This AMA resource center is divided into biological, radiological, and chemical sections which deal with these three aspects of terrorism, and a fourth section which addressees the issue of preparedness. Each of the four areas lists germane organizations with have expertise in the respective areas. AMA Consensus and Update Articles JAMA and the Archives have published a variety of articles on bioterrorism and the AMA is making many of these articles available in the full text version to the public free of charge. The six consensus articles on bioterrorism by the Working Group on Civilian Biodefense address anthrax, botulinum toxin, hemorrhagic fever, plague, smallpox, and tularemia. Each article gives in depth information about their respective diseases. Updates are published as needed and the anthrax consensus statement was revised in May 2002. Although not a bioterrorism tool the nerve agent Sarin is discussed in detail and tables for the treatment for Nerve Agents (Tabun, Sarin, Soman, and VX ) are presented in the JAMA article: Clinical Manifestations of Sarin Nerve Gas Exposure.
Association for Professionals in Infection Control and Epidemiology
Center for Disease Control (CDC) bioterrorism pages This is the CDC directory for information on bioterrorism issues. It has a
wide audience as it is directed to the general public, providers, and public
health officials. For
physicians the Agents and Disease
page
contains detailed information or direct links to disease/agent specific
information. Items such as case definitions, treatment recommendations, and
isolation guidelines can be found. Both biological and chemical agents are
referenced. Emphasis is placed on Category A diseases. CDC defines them as
agents that pose a risk to national security because they can be easily
disseminated or transmitted person-to-person; cause high mortality; have the
potential for major public health impact; might cause public panic and social
disruption; and require special action for public health preparedness. The five
diseases in this category are Bacillus anthracis (anthrax) Clostridium botulinum
toxin (botulism) Yersinia pestis (plague) variola major (smallpox) and
Francisella tularensis (tularemia). Class B and C diseases are also discussed
and there is a section devoted to chemical agents.
The CDC Morbidity and Mortality Weekly Report (MMWR)
Electronic Textbook of Dermatology
Medcscape Bioterorism Resource Center To access some of the resources on Medscape you need to register. This center contains links to timely news and reference material about potential bioterrorism agents and recognizing their clinical signs and symptoms. There is also a section on CMEs dealing with this subject, and the CDCs Public Response Hotline (888) 246-2675 is posted. Also on the Medscape Web site is the Journal Neurosurgical Focus. Volume 12, 3 from 2002 is devoted in large part to weapons of mass destruction. While directed toward neurosurgeons much of what is discussed is useful to any physician who is interested in or may have to deal with such events. There are five articles:
The primary focus of USAMRIID is bioterrorism protection in the context of military operations. However much of what it does and its laboratories are germane to bioterrorism in the civilian sector. There are liaisons between it and CDC, the World Health Organization and academic medical centers. It has expertise in investigating infectious diseases that require special containment, and formulates strategies, procedures, and training programs for medical defense against biological threats.
At its web site there is a section on programs it sponsors and educational
tools dealing with bioterrorism. Some of these resources are available to the
civilian sector and the book USAMRIID's
MEDICAL MANAGEMENT
OF BIOLOGICAL CASUALTIES HANDBOOK Fifth
Edition, August 2004 can be downloaded at no
charge. An ER could put it on their computer and quickly go from section
to section. For the various diseases and chemical agents one can obtain a
succinct summary covering important information such as isolation
recommendations, diagnostic criteria, and
treatment protocols.
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