Bioterrorism by definition is the use of microorganisms or toxins to kill or sicken people, animals or plants. The main difference between biological terrorism and conventional terrorism (i.e. bombs, hijackings, etc.) is the duration from the time of attack to the presentation of victims of the attack. Depending on the agent, the incubation period can be up to 60 days. It is highly probable that hospitals, not traditional first responders, will be the first to recognize a bioterrorism event secondary to the unfolding epidemiology and gradual increase in attack rates of a communicable agent.

Brief History:
The use of infectious agents to produce disease in a population is not a new concept and many countries have seen the likes of such travesties before.

BT Timeline:

• 1754 – During the French and Indian War soldiers distributed blankets used by smallpox infected patients to the Native Indian population to dissipate their numbers
• 1939 – During WWII the Japanese army was accused of dropping plague infected fleas over China
• 1979 – Accidental release of anthrax from a military microbiological facility in Sverdlovsk, Russia resulted in death of 68 people
• 1984 – Religious commune in Oregon deliberately contaminated restaurant salad bars with Salmonella sickening 751 people
• 1990 – Religious cult Aum Shinrikio attempt to release botulism toxin in Tokyo, Japan as well as US military bases in Japan; these attacks failed
• 2001 – Anthrax laden mail results in cutaneous and inhalational disease in America

Category A Agents:
Based on a risk assessment and probability of use, distribution, and availability, the Centers for Disease Control and Prevention (CDC) has delineated 6 Category A agents. These agents are considered to have the highest likelihood of successful use. Agents in bold face type are communicable. Please refer to individual diseases for further description.

• Anthrax
• Smallpox
• Plague
• Viral Hemorrhagic Fevers
• Tularemia
• Botulism

Hospital-Based Preparedness:
Since the events of September 11, 2001 the US healthcare system has been struggling to determine the most appropriate means to enact preparedness. Preparing to be prepared for an unlikely event is a daunting task for many hospitals that in this financially strained healthcare environment, may not have the fiscal ability to purchase supplies and equipment that may or may not be needed. Therefore, prioritization and decision tree analysis are necessary to facilitate action.

At JHH efforts have been underway since 1999 with the formation of a committee known as the Bioterrorism Task Force. This multidisciplinary committee has completed the development of our Hospital’s Bioterrorism Plan known as Operation Orange.

Key lessons learned related to bioterrorism preparedness:

• Multidisciplinary approach is most successful.
• Administrative by-in is instrumental and helps to facilitate completion of planning.
• Communication and coordination is paramount both internally and with city and state government.
• Know what resources are currently available and utilize those first.
• Don’t “what if” yourself to death. “What if” situations can hamper the decision making process. After the initial brainstorming activities attempt to limit the “what if” situations.
• Look at current disaster management protocols and involve individuals with knowledge of how your system works in a mass casualty event.
• Develop an umbrella document that provides general direction; each department should then coordinate to determine how to appropriately respond with their own departmental plan.

To see an up–to–date list of cases, Visit the Center for Civilian Biodefenses

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