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Researchers calculate staff needed for antibiotic distribution centers after bioterrorism-related disease exposure

A large-scale aerosol release of a biological agent such as anthrax, plague, or Q-fever could infect more than 250,000 people downwind and would require immediate large-scale prophylaxis campaigns to prevent massive loss of life. States are now required to develop local mass prophylaxis plans to receive Federal funding for bioterrorism response, and little research has been done to assist local planners in these efforts.

A new computer model simulating such a bioterrorism event calculates that for an antibiotic distribution center in affected areas to process about 1,000 people per hour, it would require 93 staff for a low-prevalence scenario to 111 staff for a high-prevalence scenario. This staffing would avoid large lines at entry screening, triage, medical evaluation, and drug distribution stations, explains Nathaniel Hupert, M.D., M.P.H., of the Department of Public Health, Weill Medical College of Cornell University.

Dr. Hupert and his colleagues used discrete-event computer modeling to simulate time-dependent processes in which patients interact with resources such as beds or nurses in the distribution centers set up throughout affected communities. Process times were based on reports of mass prophylaxis and emergency medical care during real epidemics or simulated terrorist attacks. The researchers modeled low (1 percent), medium (10 percent), and high (20 percent) prevalence rates of attack-related illness. Based on evidence from prior anthrax cases, they assumed that 25 percent of symptomatic cases in each scenario would be critically ill on arrival to the distribution center, another 25 percent would be moderately ill, and the remaining 50 percent only mildly ill.

The researchers also assumed that 10 percent of the noninfected population would either be "worried well" or have non-bioterrorism-related illness warranting onsite evaluation. For the purposes of this model, they did not consider other critical logistical components of response plans such as drug re-supply, crowd control, or criminal investigation activity taking place inside the distribution center, important parts of the public health response to the 2001 anthrax attacks. Their research was supported in part by the Agency for Healthcare Research and Quality (contract 290-00-0013).

See "Modeling the public health response to bioterrorism: Using discrete event simulation to design antibiotic distribution centers," by Dr. Hupert, Alvin I. Mushlin, M.D., Sc.M., and Mark A. Callahan, M.D., in the September/October 2002 Medical Decision Making 22(Suppl.), pp. S17-S25.

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