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Bioterrorism Preparedness

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Survey on eve of anthrax attacks shows need for bioterrorism training

A survey taken shortly after September 11, 2001, showed that on the eve of last year's anthrax attacks, primary care doctors felt unprepared for bioterrorism incidents that could expose their patients to the unusual diseases that might be spread by terrorists. The survey was sponsored by the Agency for Healthcare Research and Quality and the American Academy of Family Physicians (AAFP).

Researchers led by the AAFP's John Hickner, M.D., and Frederick M. Chen, M.D., of AHRQ, found that three-quarters of doctors said at that time they felt unprepared to recognize bioterrorism-related illnesses in their own patients. The national survey of family physicians, conducted in October 2001, also found that 38 percent rated their knowledge of the diagnosis and management of bioterrorism-related illnesses as poor.

AHRQ and other HHS agencies are working with private-sector partners on a broad training initiative that recognizes the key role of family physicians who may be among the first to recognize and respond to unusual symptoms that may signal a bioterrorist attack. According to HHS Secretary Tommy Thompson, HHS is supporting wide new training, information, and communication resources throughout the Nation's public health and health care systems. Earlier this year, HHS provided more than $1 billion in new grants to States and major metropolitan areas to support training, communications, disease surveillance, and epidemiology networks, as well as hospital improvements.

In the survey, roughly 18 percent of the 614 family physicians said that they had prior bioterrorism training, and these doctors were much more likely than those without such training to report having the skills and knowledge necessary for responding to a bioterrorist attack. Nearly all the family physicians agreed that it was important to be trained to identify a bioterrorist attack, and 93 percent said they would like to have such training.

Family physicians felt more comfortable responding to natural disasters and public health emergencies such as natural infectious disease outbreaks involving well-known pathogens. But being familiar with the public health system for such events did not prepare them for knowing what to do in case of a bioterrorist attack. While 93 percent of the doctors said that they report notifiable infectious disease cases to their health department, only 57 percent reported knowing at the time of the survey whom to call to report a suspected bioterrorism case.

These findings underscore the importance of preparedness for primary care physicians. Because the symptoms caused by many bioterrorism agents mimic those of common illnesses, patients may seek care first from their primary care physicians.

The AAFP, which represents more than 93,500 physicians and medical students, promotes Web-based training resources for physicians. To access the training resources, select

AHRQ is expanding the medical providers' bioterrorism training Web site that the Agency sponsors at the University of Alabama at Birmingham. To get more information on the courses for the Nation's 265,000 primary care physicians, select

AHRQ's effort is part of a broad initiative by several HHS agencies to provide training and information for health care providers:

  • AHRQ has developed an online bioterrorism preparedness tool for use by hospitals.
  • The Centers for Disease Control and Prevention (CDC) supports the Centers for Public Health Preparedness program. It funds centers, based at universities and elsewhere, to train State and local health care providers and public health officials. More than 200,000 individuals have received training so far. In addition, CDC is collaborating with the Association of American Medical Colleges to launch a new program called "First Contact, First Response" that will provide curricula through medical schools for medical students and physicians. CDC is also working with the Association of Public Health Laboratories to provide more training and information to public health lab workers in dealing with potential agents for bioterrorist attacks.
  • The National Institutes of Health (NIH) has been working to educate physicians about biodefense through a variety of efforts, including educational conferences in the Washington, DC, area, monthly biodefense lectures to internal medicine residents who rotate through the NIH inpatient wards, and technical assistance to physicians on an ad hoc basis.
  • HHS also has provided training in emergency preparedness for first-responders through the Department's National Disaster Medical System.
  • The Health Resources and Services Administration (HRSA) plans to launch next year a $60 million training program on bioterrorism preparedness for hospital workers.
  • CDC's Health Alert Network also links over 1 million medical, public health, and emergency workers with up-to-date information on disease outbreaks. The network reaches all 50 States and is being further expanded to reach every county health department in the Nation.

For more details, see "On the front lines: Family physicians' preparedness for bioterrorism," in the September 2002 Journal of Family Practice 51(9):745-750.

Reprints (AHRQ Publication No. 02-R091) are available from the AHRQ Publications Clearinghouse.

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