Threat of Bioterrorism
Lead Author: Richard Usatine, MD
Clerkship/Post-Clerkship
Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander
Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin,
MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark.
E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore,
MD, Richard Usatine, MD
OVERVIEW
The derivation of the word terror comes from
the Greek words trein, which means "to be
afraid, flee," and tremein, which means "to
tremble." Terrorism is the systematic, deliberate induction
of fear and anxiety into an individual, community, or population.
Biological warfare involves the deliberate release of pathogenic
organisms or substances into a community. Such deliberate
release of pathogenic material for the purpose of provoking
community-wide or population-wide fear or anxiety has been
termed bioterrorism.
Experts speak of "vulnerability, capability, and intention"
as the main components of a successful terrorist event.
The intention to cause terror has been called the great
asymmetric threat. The vulnerability and weaknesses in our
health care system help make us a target for bioterrorism.
There is limited "surge capacity" to deal with a large-scale
outbreak of any illness requiring emergency care, treatment,
or hospitalization.
The reality of recent events dictates that all health care
providers, particularly primary care providers, develop
competencies in the likely presentations and clinical scenarios
resulting from biological warfare agents. At the same time,
dealing with the "worried well," and coping with the manifestations
of terror and anxiety, will be the most common scenario
that occurs in response to bioterrorism threats.
TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)
Patient Care
GOAL: Students will assess the impact of terrorism and
the threat of bioterrorism on patients, their families,
and communities.
OBJECTIVES: Students will be able to:
- Demonstrate skill
and sensitivity in discussing the impact of terrorism
and the threat of terrorism.
- Communicate to patients
about their relative risk of contracting a bioterrorism-related
illness.
GOAL: Students will appropriately treat the manifestations
of anxiety disorders, including generalized anxiety disorder,
panic attacks, and post-traumatic stress disorder.
OBJECTIVES: Students will be able to:
- Diagnose anxiety disorders,
including generalized anxiety disorder, panic attacks,
and post-traumatic stress disorder.
- Make appropriate
referrals for mental health treatment, including individual
counseling and support groups.
Medical Knowledge
GOAL: Students will know the major biological and chemical
agents used to create terror, and the presenting signs and
symptoms of affected individuals.
OBJECTIVES: Students will be able to:
- List the major biological
and chemical agents utilized to create terror.
- Describe
current treatment modalities for major biological and
chemical agents of terror.
- Assess the real risks in
a particular patient exposure.
GOAL: Students will recognize the signs and symptoms of
anxiety disorders and post-traumatic stress disorder (PTSD).
OBJECTIVES: Students will be able to:
- Accurately diagnose
anxiety disorders, including generalized anxiety disorder,
panic attacks and PTSD.
- Recommend current therapy
for common anxiety disorders.
Practice-Based Learning and Improvement
GOAL: Students will be able to access accurate information
related to the threat of bioterrorism.
OBJECTIVES: Students will be able to:
- Quickly and efficiently
locate high-quality information on the Internet related
to bioterrorism and associated mental health issues.
- Use
critical appraisal skills to assess the validity of
resources.
Interpersonal and Communication Skills
GOAL: Students will use effective communication skills
in dealing with patient and family concerns about the threat
of bioterrorism.
OBJECTIVES: Students will be able to:
- Demonstrate active
listening skills and empathy for patients.
- Reassure
anxious patients with concerns about bioterrorism-related
symptoms.
- Demonstrate the ability to counsel patients
about anxiety disorders and provide appropriate treatment.
Professionalism
GOAL: Students will demonstrate ethical decision-making
in the use of resources in response to a public health crisis.
OBJECTIVES: Students will be able to:
- Reflect upon personal
reactions and concerns to a public health crisis or
threat.
- Assess the limits of their own personal knowledge
and seek appropriate information sources.
Systems-Based Practice
GOAL: Students will analyze individual, institutional,
and public health system responses to large-scale threats
to public health.
OBJECTIVES: Students will be able to:
- Explore issues related
to distribution of resources for public health needs--assessing
risk of biological warfare versus known dangers.
- Investigate
the political, economic, and social issues involved
in drug recommendations and public health policy.
- Develop
plans and strategies, to advocate for policy changes
on behalf of patients and communities.
EDUCATIONAL METHODS AND RESOURCES
Clinical Experience
Independent Learning
Small-Group Learning
- Tours or videotapes of local health departments
with review of disaster planning and preparation
- Develop
and present a plan for a specific bioterrorism attack
or natural disaster.
- Partner with your local American
Red Cross to provide training for students - Eastern
Virginia Medical School, Chris Matson, MD - contact person.
Problem-Based Learning
- Small group with scripted scenarios and role
plays
Electives
- Public health department rotation
- Centers for Disease
Control
Curricula
Published Material
- Galea S, Ahern, J, Resnick H, Kilpatrick H,
Bucuvalas M, Gold J, and Vlahov J. Psychological Sequelae
of the September 11 Terrorist Attacks in New York City.
- Borio,
Frank, et al. Death due to bioterrorism related inhalational
nthrax, JAMA. 2001;286:2554-2559.
- Mayer, et al. Clinical
presentation of inhalational anthrax following bioterrorism
exposure. JAMA. 2001; 286:2549-2553.
- Coico R, Kachur
E, Lima V, and Lipper S. Guidelines for Preclerkship
Bioterrorism Curricula. Acad Med. 2004; 79:366 ??375.
Lectures
Web Sites
Multimedia
ASSESSMENT STRATEGIES
Standardized Patient Cases
- Maria Torres- "Influenza-like Infection & Anthrax,"
UCLA, Richard Usatine,
MD - author
- "Christine Mahan- Smallpox & PTSD" Florida
State University, Richard
Usatine, MD - author
FACULTY DEVELOPMENT
Revised March 3, 2003 |
