Among the most common questions I received from clinicians in the days after the first reports of human anthrax surfaced in Florida and Washington was: “How can I prepare to diagnose, treat and educate my patients on these diseases?” Recognizing that we are all busy clinicians and have limited time available to digest reams of technical and clinical information we need rapid and easily available information. Most of us are not infectious disease experts and, despite the media perception to the contrary, events of this time are sufficiently rare that little is gained by making every clinician in the United States a complete bioterrorism expert. My suggestions for all clinicians who are willing to devote approximately 60 minutes to bioterrorism preparation:
Become educated; review basic disease information and epidemiologic principles
Often lost in the rush of obtain factual information is the fact that most clinicians have completed postgraduate training that included basic microbiology, infectious disease and epidemiology. What is required often is a “dusting off” of this knowledge coupled with selected clinical information regarding the agents that represent a threat or lend themselves to bioterrorism use. Of all the excellent websites available I prefer the Centers for Disease Control. This website has clinical monographs on all of the human threat agents as well as useful epidemiologic links. In addition, information relevant to current disease outbreaks will either be posted here or linkages provided. The articles prepared by the Johns Hopkins group, published in the Journal of the American Medical Association are excellent tools for all clinicians, regardless of discipline, for rapidly summarizing the needed clinical information on a particular agent.
Be clinically suspicious of unusual diseases and presentations
Irrespective of our clinical setting, attention to unusual diseases and presentations are the most important means for early “active” surveillance. Take this opportunity to determine the contact methods for communication with local public health authorities and develop a relationship with them. It is not necessary that a suspicion of bioterrorism exist prior to contacting public health, indeed a potential secondary benefit of heightened awareness of potential bioterrorism is the earlier recognition and reporting of the “routine” public health outbreaks of natural disease and food borne illnesses.
Educate your patients on the issues
All of us are educators of our patients. They look to us for factual truth and health information customized to their unique situations. Whether reassuring our patients that they don't have anthrax or that having ciprofloxacin in the house is unnecessary, individual clinicians play a key role in community education and community health information dissemination in the event of a disease outbreak.
Tell the truth and be flexible. It's ok to say “I don't know”
Our patients generally appreciate and respond to factual information and have proven their ability to do a risk assessment once in possession to factual information. Accept the fact that information will change in the course of a disease and that decisions often need to be made on the basis of incomplete information. As additional information becomes available recommendations may need to be revised. It is not a marker of flawed information, rather it is a consequence of a dynamically changing event.
Understand your role in the community response system
We all practice within a larger group, health system, community, or region. Take this opportunity to understand how your local health system integrates into the area, region and state emergency plans. All groups should have designated emergency planners who can assist with identifying the appropriate contacts and describing the response systems. It is best to meet and become familiar with them now rather than in the midst of a disease outbreak.