Early Warnings
Identification of bioterrorism and infectious disease emergency events has become a national priority and a moral imperative for occupational health and emergency department nurses.
THE anthrax incident of 2001 was a small bioterrorism attack in terms of the amount of agent used (the letter addressed to Senator Daschle contained only two to three ounces of anthrax spores, and the other letters contained similar amounts) and the resulting morbidity and mortality. (There were only 22 cases of anthrax and five deaths).1 Compared to the morbidity and mortality of other infectious diseases in the United States, such as tuberculosis or meningitis, the anthrax incident was miniscule. However, the overall impact of the bioterrorism attack was staggering.
Total costs have yet to be determined, but early estimates put the total cost at over $2.5 billion, and the psychological impact has been tremendous.2 Larger bioterrorism attacks using contagious agents, such as smallpox, would likely result in significantly higher morbidity, mortality, and costs than the 2001 attack.3 The potential consequences of being unprepared for such an event are enormous.3
With the changing political and social climate, the need for nursing involvement in bioterrorism planning and response has escalated sharply. As the largest group of health care workers, nurses play a critical role in the nation's bioterrorism preparedness efforts because they will be at the forefront in patient management. In recognition of nurses' vital role in bioterrorism response, the National Institute of Nursing Research has declared bioterrorism preparedness to be a necessity for nurses in all expertise and practice areas.4
There is an added benefit: Bioterrorism readiness prepares nurses to recognize and respond to any infectious disease emergency. This is because the response to these incidents is very similar. Whether naturally occurring (outbreaks of emerging pathogens) or man-made (bioterrorism), infectious disease emergencies pose a serious threat to the health and safety of U.S. citizens, can result in high morbidity and mortality, and can have a tremendous impact on citizens' mental health. Recent events, such as the 2001 anthrax incident and outbreaks of Monkeypox and severe acute respiratory syndrome (SARS), have illustrated how truly unprepared we are as a nation to adequately respond to various types of infectious disease emergencies.5,6 Many experts, including the Centers for Disease Control and Prevention, indicate it is only a matter of time before the world is facing a global outbreak of an infectious disease, such as avian influenza. It is imperative that nurses become better prepared to recognize and respond to this type of event.
Regardless of whether the event is naturally occurring or man-made, an infectious disease emergency would likely result in large numbers of victims and could easily become a global problem. Infectious diseases strike across all social lines and are not restricted by geographical borders. The SARS outbreak illustrated how rapidly a contagious disease can spread. SARS was first reported by a Vietnamese epidemiologist in March 2003 and within a few short days had spread to countries around the world.6,7,8 Another such event would result in large influxes of patients to health care facilities and could quickly overwhelm current medical capacities. In addition, an outbreak probably would also have a significant impact on industry because the absenteeism rate is likely to be much higher than normal.9
There are a number of topics with which Emergency Department and occupational health nurses should become familiar as part of infectious disease emergency preparedness. These topics include epidemiological clues of a potential incident, infection control prevention measures, patient triage and management, when and to whom to report an event, psychosocial issues, development of a personal response plan, and communication. Many of these topics are the same as for traditional emergency preparedness and will not be addressed in this article. The topic that will be addressed is identifying the epidemiological clues of a possible incident.
Recognition of a Bioterrorism Attack or Outbreak of an Emerging Infection
Infectious disease emergencies are unlike traditional disasters, such as earthquakes, floods, tornadoes, or terrorism attacks using incendiary devices, in that they may not be readily apparent or easily detected. Biological agents are odorless, colorless, and tasteless when aerosolized; thus, bioterrorism attack identification will likely be delayed until patients develop symptoms and access the medical system, which could occur days to weeks after the release.
Following a naturally occurring outbreak of an emerging pathogen, detection would also be delayed because initial cases probably will not seek medical care or will present to health care facilities in a slow trickle. Even when patients do access medical care, their disease will be difficult to diagnose because patients are likely to present with non-specific symptoms early in the disease course, and there are no available laboratory tests for many new or unusual pathogens. This was the scenario when SARS was first identified.6 The outbreak began slowly, built to a crest before falling off, and there were no rapid diagnostic tests. Despite this, it is crucial to identify these outbreaks and incidents as soon as possible. The sooner the event and individuals at risk are identified, the higher likelihood of decreasing morbidity, mortality, and associated costs.
This article originally appeared in the November 2005 issue of Occupational Health & Safety.