"While fire, hazardous materials (HAZMAT), EMS, law enforcement, and emergency management agencies prepare to meet the threat of a terrorist attack, hospitals provide the majority of first aid, decontamination, and antidote therapy to disaster victims. Hospitals must safely assess, decontaminate and treat victims. Planning and training should be a seamless extension of existing hazardous materials policies and procedures used to treat contaminated patients. If a hospital can safely decontaminate and appropriately treat HAZMAT victims, these same policies and procedures can be used to treat survivors of a terrorist attack."
Excerpted from: Aftermath... Hospitals are on the front lines after acts of terrorism. Are you prepared?

News

(5/6/02) The American Medical Association published a Consensus Statement on Anthrax as a Biological Weapon, 2002 Updated Recommendations for Management in JAMA

(2/7/02) American Medical Association AMA encourages senior physicians to prepare for bioterrorism threat The AMA Senior Physician Services (AMA-SPS) office was a step ahead of President Bush last week. Just days before Bush’s State of the Union call for retired U.S. physicians and nurses to be ready to mobilize in major emergencies, the AMA-SPS sent a mailing to its 6000 senior members with the same message. The AMA letter included educational resources on biological agents, contact information for state departments of public health, and information on actions being taken by the AMA and state, local and specialty societies. It also included information on volunteer registration, and a list of locum tenens companies that could be used to help mobilize physicians in the event of an emergency. The letter strongly encouraged senior physicians to get trained for disaster preparedness and to contact local health departments to offer their services.

(1/29/02) Yahoo / Reuters:U.S. Moves to Improve Response to Bioterrorism The first installment of emergency federal anti-bioterrorism money will be used to make more US cities better able to respond to a biological or chemical attack and bolster a laboratory network to identify disease outbreaks, US health officials said on Friday.

(1/29/02) CDC: Evaluation of Postexposure Antibiotic Prophylaxis to Prevent Anthrax In response to the recent bioterrorist attacks associated with intentional release of Bacillus anthracis, approximately 10,000 persons potentially exposed to anthrax in Connecticut, Florida, New Jersey, New York City, and Washington, D.C., were recommended to take at least 60 days of postexposure anti-biotic prophylaxis. Surveillance for adverse events and adherence to antibiotics has been conducted through surveillance and cross-sectional studies. CDC is evaluating the program to distribute antimicrobial agents and assessing adverse events and adherence. The objectives of this evaluation are to assess the provision of antimicrobial agents and educational materials to affected persons, to determine adverse events associated with the antimicrobial agents, and to characterize adherence to the recommended regimen. The information from this evaluation will be critical to CDC's effort to improve the technical assistance and supplies needed with future anthrax postexposure prophylaxis campaigns and to comply with Food and Drug Administration regulations for monitoring for adverse events.

(1/29/02) ProMed The deliberate use of biological and chemical agents to cause harm: public health response In recent months, health ministries of several countries have reported that they have increased their state of alert for the intentional malevolent use of pathogens or chemicals, such as pesticides, by spread through air, water or food. Their responses, based on various scenarios, have included:

(a) increased preparedness within the national public health system, including identifying the location -- and even stockpiling -- of critical medicines and other commodities;
(b) informing members of the public, particularly those thought to be at greatest risk; and
(c) readiness to handle large numbers of "suspect incidents".
Increased preparedness of the public health system usually includes improved surveillance of incidents and illness, enhanced contingency planning and more effective national response capacity.

(12/27/01) FEMA Independent Study Courses Include Emergency Response to Terrorism In response to recent events, the Federal Emergency Management Agency’s (FEMA’s) Emergency Management Institute (EMI) has developed an independent study course called "Emergency Response to Terrorism." This self-paced, independent study program is designed to provide the basic awareness training needed to prepare first responders for incidents of terrorism. Students who successfully complete the exam will be eligible for a FEMA certificate of training.The course is just one of many offered by EMI, which provides a wide range of self-paced courses for people with emergency management responsibilities. All course materials are available free of charge on EMI’s Web site at http://www.fema.gov/emi/ishome.htm.

(12/27/01) JEMS Funding for Bioterrorism Efforts The U.S. House of Representatives has passed two antibioterrorism bills. One would give state and local governments and health-care providers $1 billion to improve their ability to respond to bioterror attacks.Emergency workers responded to thousands of false alarms during anthrax episodes in the past few months. Some were mistakes, caused by panic over such harmless materials as powdered sugar. But others were intentional hoaxes that required time-consuming and expensive responses and caused fear and disruption.

(12/21/01) HHS announces new options for responding to anthrax exposure This week, the Department of Health and Human Services (HHS) announced new options for preventive treatment for persons exposed to inhalational anthrax. Many of those who were exposed to inhalational anthrax in the recent mail attacks are presently concluding their 60-day course of preventive antibiotic treatment. HHS is providing two additional options beyond the 60-day antibiotic course for those who wish to pursue them: an extended course of antibiotics and investigational post-exposure treatment with anthrax vaccine. HHS will make anthrax vaccine available to those who were exposed to inhalational anthrax, who have concluded their antibiotic treatment and who wish to receive the vaccine as an investigational product. For more information, visit the Centers for Disease Control and Prevention (CDC) Web site at http://www.bt.cdc.gov To order the videotape "CDC Responds: Update on Options for Preventive Treatment for Persons at Risk for Inhalational Anthrax," call the Public Health Foundation at (877) 252-1200 from 9:00 a.m. - 5:00 p.m. EST.

(12/10/01) News:

• Bioterrorism and the People: How to Vaccinate a City against Panic
• AMA rejects nationwide smallpox vaccinations (CNN/ AP) The American Medical Association has refused to endorse smallpox vaccinations for all Americans, rejecting calls from doctors who say the disease could be used as a biological weapon.
• CDC Broadcast and Webcast: Smallpox: What Every Clinician Should Know
  • December 13, 2001 12 PM 2 PM EST
  • December 17,2001 5 PM - 7 PM EST
• JAMA has posted five articles on bioterrorism by the Working Group on Civilian Biodefense: consensus statements on anthrax
  

(12/1/01) AMA provides quick reference guide to bioterrorism agents To help physicians and other health care workers become more familiar with possible bioterrorism agents, the AMA has created a table outlining the characteristics and management of selected agents. The reference guide outlines information including the incubation period, clinical symptoms, diagnostic tests and treatment of biochemical agents such as anthrax, inhalational tularemia, pneumonic plague, smallpox and encephalitis. To see the guide in Microsoft Excel, go to http://www.ama-assn.org/ama/upload/mm/415/chart_excel.xls, or go to http://www.ama-assn.org/ama/upload/mm/415/chart_pdf.pdf to see it as an Adobe PDF.

(12/1/01) CDC Releases Draft Smallpox Response Plan – The Centers for Disease Control and Prevention (CDC) today released "Interim Smallpox Response Plan and Guidelines," which outlines CDC's strategies for responding to a smallpox emergency. A summary of the plan is posted www.cdc.gov/nip/diseases/smallpox.

• AP article about the plan: "Health authorities should not force people to be vaccinated against smallpox, even if the virus reappears and begins to spread, the government's top bioterrorism adviser said Monday as officials released their response plan. "
• AP: U.S. to Stockpile Smallpox Vaccine The Bush administration says it will have enough smallpox vaccine on hand within a year to inoculate every American, but officials have no plans to use it absent a return of the virtually extinct but deadly virus. The Department of Health and Human Services (news - web sites) signed a contract Wednesday to buy 155 million doses of vaccine from a British company, preparing for the possibility terrorists would try to spread the highly contagious disease.

(11/27/01) Two new resources from the CDC's Emerging Infectious Diseases Page:

• Biological Warfare A summary of testimony presented by Joshua Lederberg on August 24, 2001, to the Committee on Foreign Relations, Senator Joseph R. Biden, Chair. This testimony is particularly pertinent in view of the recent terrorist attacks and subsequent episodes of anthrax.
• Modeling Potential Responses to Smallpox as a Bioterrorist Weapon

(11/24/01) the University of Tennessee and the Detroit Medical Center are working together to provide a free, real-time course taught by 20 emergency medical practitioners with expertise in bioterrorism agents. They expect 10% of the nation's 30,000 emergency-room physicians to take the three-hour course. The course is called BT101

(11/16/01) Canadian Medical Journal: Does smallpox still pose a threat? "Although these reports are difficult to confirm, the recent collapse of the Soviet Union has resulted in mounting concern that existing stocks of the virus, along with the intelligence information and the equipment needed to deliver it, may have passed into non-Russian hands. This has raised once again the spectre of the potential use of smallpox as a biological weapon, and it means that, in light of the terrorist acts on Sept. 11, physicians once more have to be taught about this potential threat."

(11/16/01) AMA has created a bioterrorism index to help scan resources Since the first anthrax case was discovered in late September, the AMA has been updating its disaster preparedness Web site almost daily to help educate physicians and the medical community on the constantly changing issue of bioterrorism. Now, to make the resources even more user-friendly, the AMA has created a bioterrorism index to help users find the information they're looking for quickly and easily. The index at http://www.ama-assn.org/ama/pub/category/6671.html features information on numerous topics ranging from the "basics" of anthrax and other biological agents such as smallpox to federal and state resources and educational broadcasts from the CDC.

(11/11/01)

• New CDC Information: Update: Smallpox Outbreak Readiness, Current Case Count, and Telebriefings
• Yahoo / AP: New Clue Helps Sort Anthrax, Flu "Doctors have a new clue to help sort out whether people with aches and coughs have the ominous first signs of inhaled anthrax or ordinary colds and flu: Anthrax victims don't have runny noses."
• AAMC Announces Bioterrorism Initiative: "...the Association of American Medical Colleges (AAMC) announced a bioterrorism initiative to help educate and prepare the nation's physician workforce to respond appropriately to terrorist attacks."
• MMWR: Notice to Readers: Considerations for Distinguishing Influenza-Like Illness from Inhalational Anthrax "CDC has issued guidelines on the evaluation of persons with a history of exposure to Bacillus anthracis spores or who have an occupational or environmental risk for anthrax exposure (1). This notice describes the clinical evaluation of persons who are not known to be at increased risk for anthrax but who have symptoms of influenza-like illness (ILI). Clinicians evaluating persons with ILI should consider a combination of epidemiologic, clinical, and, if indicated, laboratory and radiographic test results to evaluate the likelihood that inhalational anthrax is the basis for ILI symptoms. "

(11/4/01) New CDC Information:

• Update: Guidelines for Evaluation of Persons with Possible Anthrax This report includes interim guidelines for the clinical evaluation of persons with possible anthrax, and asks clinicians to be alert for new cases of Bacillus anthracis infection.
• Updated recommendations for antimicrobial prophylaxis among asymptomatic pregnant women after exposure to Bacillus anthracis Antimicrobial of choice for initial prophylaxis in pregnant women is ciprofloxacin; amoxicillin also may be considered for penicillin-susceptible strains.
• Use of Ciprofloxacin or Doxycycline for Postexposure Prophylaxis for Inhalational Anthrax No evidence suggests that ciprofloxacin is more or less effective than doxycycline, but broad cipro use may more likely lead to increased antimicrobial resistance among common pathogens.

(11/4/01) US Army Offering Live Satellite Broadcast on Bioterrorism Live Satellite Broadcast November 28, 29, & 30, 2001 12:30-4:30 PM ET The events of 11 September 2001 have significantly increased concern about the potential use of biological and chemical weapons by terrorists. This concern is heightened by concurrent intelligence assessments of offensive programs in certain foreign countries, numerous recent bioterrorism threats, advances in molecular biology, and the ease of information dissemination through the Internet. Military and civilian medical and public health professionals must become proficient in the recognition and management of biological and chemical casualties, and in notifying the appropriate response agencies. This live, interactive, three-day satellite broadcast will inform and educate health professionals about the proper medical response in the event of an intentional biological or chemical agent release. World-renowned experts from the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), and other organizations will present this program at no charge. The program will be hosted by the Medical Research and Materiel Command at no charge to the viewer.

(11/4/01) From American Healthcare Consultants: Bioterrorism Update .Current Guidelines and Recommendations for Prevention and Treatment of Biological Threats: Part I

(10/28/01) Medscape (free registration required) archived the webcast "Anthrax: What Every Clinician Should Know" on their site. You'll need RealPlayer (there's a link on the webcast page). Objectives: To provide physicians, nurse clinicians and other health care workers serving in private offices, hospitals and public health settings with an update of how to correctly recognize, test, diagnose, treat and report cases that could be attributed to Bacillus anthracis exposure.

(10/26/01) The CDC has added an excellent (and comprehensive) Anthrax resource page

(10/20/01)

• Yahoo / AP: Federal Smallpox Plan Ready Even a single case of smallpox would be an international emergency, triggering vaccinations for dozens of people close to the patient in an urgent attempt to contain the highly contagious disease, says a federal plan obtained by The Associated Press.
• MMWR Recognition of Illness Associated with the Intentional Release of a Biologic Agent On September 11, 2001, following the terrorist incidents in New York City and Washington, D.C., CDC recommended heightened surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with the terrorist attacks.

(10/18/01) More on Anthrax

• CDC Press Release, Update: Facts about anthrax testing and on-going investigations in Florida, Nevada, New York, and Washington, D.C.

(10/13/01) RE: Anthrax threat

• CNN.com What is anthrax?
• CDC: Facts about Anthrax (Adobe Acrobat file)

(10/8/01) Medscape: When Disaster Strikes: A Look at Emergency Response to the World Trade Center Disaster To help us gain some perspective on aspects of the physical trauma suffered by victims during and immediately after the World Trade Center disaster in New York City, we spoke with Dr. Richard Westfal, Associate Director of the Department of Emergency Medicine at St. Vincent's Catholic Medical Center of New York, who was in the Emergency Department on the day of the attack on the World Trade Center.

(10/8/01) Yahoo / AP Scientists Seek Germ Warfare Vaccines Vaccine experts say the question has come up often since Sept. 11, and though certainly a reasonable one, many doubt population-wide shots will be a practical defense anytime soon against the deliberate release of deadly microbes. The possible health hazards of mass vaccination could easily outweigh the benefits, they say, especially considering that no one really knows the likelihood of such a catastrophe.

(10/6/01) Yahoo / Reuters: US Strives to Strengthen Bioterrorism Defense The public health workers and healthcare providers the US government would rely on to defend and protect Americans from a possible bioterrorism attack are largely untrained and lack key resources, bioterrorism experts say.

(10/4/01) More valuable insight from the EMED listserv

(10/3/01) An interesting exchange, captured on the EMED listerv

(10/2/01) AMNews Attacks a "wake-up call" to boost emergency services "Emergency departments' problems now seem more urgent as the nation prepares for possible future assaults." and Terrorism in America: Time for medicine to prepare "The Sept. 11 terrorist attack suggests that even more devastating weapons might be used against Americans and that doctors might be the ones on the front lines."

(9/29/01) Morbidity and Mortality Weekly Report: Notice to Readers: New York City Department of Health Response to Terrorist Attack, September 11, 2001 "In response to two jet aircraft crashing into and causing the collapse of the 110-storied World Trade Center (WTC) towers and the subsequent destruction of nearby portions of lower Manhattan, the New York City Department of Health (NYCDOH) immediately activated its emergency response protocol, including the mobilization of an Emergency Operations Center. "

(9/29/01) Yahoo / Reuters: Water Security Tightens After FBI Advisories "US water companies are ratcheting up security in the wake of the attacks on the United States--from increasing patrols at reservoirs to shutting down roads--after warnings from law enforcement officials that the nation's water supply could face sabotage. "

(9/28/01) Web Scan:

• Yahoo / Reuters: Health Chief: U.S. Prepared for Terrorist Attacks The US is far more prepared to deal with a domestic terrorist attack than has been previously reported by the media or discussed by talk show pundits, Secretary of Health and Human Services (HHS) Tommy Thompson said Thursday.
• Yahoo / Reuters: US Developing Chemical Attack Sensor for Subways The United States is preparing to test a revolutionary system for detecting chemical attacks in subway stations, a government official says.
• Yahoo / Healthscout: Progress Slow in Locating 911 Calls from Cell Phones Cell phones are pressed into service during smaller-scale emergencies every day by people witnessing crimes, car accidents and heart attacks. But when this happens, cell phone users are at a disadvantage because, unlike callers from homes or offices, 911 operators can't pinpoint where the call is coming from. The problem is complicated if the caller is on unfamiliar ground and doesn't know where he is, either. Crucial seconds are lost. That disadvantage is expected to change, but some public safety officials say the change is too slow in coming.

(9/27/01) Time Magazine: Agents of Death

(9/27/01) Yahoo / AP U.S. Unprepared for Bioterrorism ``How prepared are we? We are more prepared than we were two years ago. A lot of efforts are under way. But we are woefully unprepared,'' says Bruce Clements, associate director of St. Louis University's Center for the Study of Bioterrorism and Emerging Infections.

(9/27/01) JEMS EXPOSED: Signs, symptoms & EMS management of nerve-agent poisoning Nerve agents represent a unique and deadly terrorist threat. By understanding the mechanism of toxicity, symptoms and treatment of these deadly compounds, prehospital providers can mitigate the threat. Prehospital care should focus on airway management and positive pressure ventilation. Early antidotal therapy with atropine and pralidoxime is important. Also, frequent practice drills using full PPE and decontamination resources are essential components of preparation for nerve-agent terrorism.

(9/26/01) From Health Data Management: AHA: Time to Review Disaster Plans "The American Hospital Association has issued a disaster readiness checklist to assist hospitals in taking a new look at their preparedness levels. The Chicago-based association recommends focusing on developing an .all hazards . plan that is flexible to deal with unforeseen crises. .The terrorist attacks have revealed that the unimaginable can become reality, . according to the association .s advisory." AHA Disaster Readiness Advisory

(9/27/01) Modern Healthcare Worst-case scenario: Experts call on hospitals, agencies to be prepared "Government experts are calling on hospitals and public health agencies to beef up their ability to respond to terrorist attacks, saying they may not have the capacity or expertise to treat large numbers of victims from a conventional or biological strike. But hospital representatives are opposing a government panel's recommendations that hospital accreditation agencies rate them on their ability to respond to terrorist attacks and that every hospital have at least one decontamination unit. Government officials, meanwhile, said they may not fund such upgrades through Medicare and Medicaid payments or new disaster-preparedness programs "

(9/26/01) CNN.com: WHO warns on germ attack "The World Health Organization is warning Western governments to be on the alert for attacks using chemical and biological weapons. Countries need to strengthen their national contingency plans to respond to any attack, said Gro Harlem Brundtland, Director General of the World Health Organization. "We must prepare for the possibility that people are deliberately harmed with biological or chemical agents," Brundtland told a meeting of Health Ministers from the Western Hemisphere in Washington on Monday. ".

(9/26/01) Yahoo: Nations Must Prepare for Bio-Attack: UN "Top UN health officials believe more must be done to help nations around the world mount a quick response to the threat of bioterrorism. ``We must prepare for the possibility that people are deliberately harmed with biological or chemical agents,'' said Dr. Gro Harlem Brundtland, director general of the United Nation's World Health Organization."

(9/26/01) Public Health System Needs to Stem Possible Biological Attacks and HHS Announces $126M in Relief Funds For Health Services

(9/22/01) Another copy of a post to the EMED listserv. Another first person account of the ED-based response to the WTC attack.

(9/22/01)"As a public service, HCPro is offering a free 12-page special report that addresses disaster planning across a variety of health care settings: ambulatory, long-term care, assisted living, acute care, and laboratories. This recently published special report also includes an article and sample form on how to conduct a hazard vulnerability analysis at your facility. This is being offered for free in tribute to our health care colleagues in New York and Washington, DC, who continue to complete their very important duties in the face of a national disaster. To access this free report electronically, please visit: http://www.healthsafetyinfo.com/pdf/disaster.pdf " (Adobe Acrobat format)

(9/21/01) Health Data Management HHS Puts Disaster Information Online "The U.S. Department of Health and Human Services has redesigned its Web site, www.dhhs.gov, to make it easier to access information on the Sept. 11 terrorist attacks."

(9/20/01) Reuters / Yahoo: UK Reviews Biological Attack Response Plans "Government officials are reviewing contingency plans for dealing with a potential biological attack by terrorists in the UK. The review, prompted by last week's events in the United States, is focusing on national procedures and protocols for dealing with the release of biological agents such as anthrax or plague by terrorists."

(9/20/01) Copy of a post to the EMED listserv. A first person account and critique of the ED-based care provided to some of the WTC victims.

(9/20/01) Hospitals, Public Health System Not Prepared For Bioterrorism "By a number of indicators, the U.S. public health and hospital systems are "woefully" unprepared to deal with a possible bioterrorist attack, the Wall Street Journal reports. Even before last week's attacks on the Pentagon and the World Trade Center, government officials were assessing the nation's preparedness against terrorist, biological or chemical attacks. While the likelihood of such an attack is debatable, the potential consequences are so severe that many experts believe it warrants greater attention. "

Links

American College of Emergency Physicians (ACEP): Bioterrorism Links Includes:

• Response Plans
• Diagnosis and Treatment Information
• Bioterrorism Updates
• ACEP Resources
• Additional Resources

Medline Plus (National Library of Medicine) Anthrax Page

American Medical Association Bioterrorism Index Page. See also: American Medical Association's Coping with crisis and looking ahead "The medical community long has been on the front lines of dealing with and preparing for disaster. As the nation copes with the events of September 11 and steels itself for what may lie ahead, the AMA has created this Web site to provide physicians and the public with resources ranging from how to deal with the emotional effects of disaster to materials for physicians on bioterrorism. We encourage you to revisit the site often, as the AMA will continue to add resources to the page.

• The American Medical Association published a Consensus Statement on Anthrax as a Biological Weapon, 2002 Updated Recommendations for Management in JAMA "

American Hospital Association's Emergency Preparedness Resources, includes EDs unprepared for terrorism incidents, survey finds, and Hospital Preparedness for Mass Casualties Added 10/26 Bioterrorism Readiness Plan: A Template for Health Care Facilities

• A link to the complete plan (an Adobe Acrobat file)

American College of Emergency Physicians' (ACEP) NBC Final Report (Adobe Acrobat format)
The College's Nuclear, Biological and Chemical (NBC) Task Force has completed work on their contract to develop objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from NBC incidents. Their complete report which contains the training objectives for Awareness and Performance Level training is attached.

Healthcare Association of Hawaii Treatment (NBC) Protocols (click on "TxProtocols")

Illinois Department of Public Health Bioterrorism Preparedness

CNN.com Biological and chemical weapons: What they are and what they do

New York State Department of Health Ten Critical Steps for Handling Possible Bioterrorism Events (Adobe Acrobat file)

New IDPH (Iowa Department of Public Health) Webpage Devoted to Terrorism. "This past week, IDPH established a webpage devoted to terrorism. This webpage may be accessed from the Department's home page by clicking on "terrorism" or may be accessed directly using the following URL: http://www.idph.state.ia.us/Terrorism/default.htm As of now, this site contains links to our fact sheets on several bioterrorist agents and has links to other sites on terrorism. Additional information will be added to the site in the future."

eMedicine

• Warfare: Chemical, Biological, Nuclear and Explosives
• EMS and Terrorism
• Disasters
• eMedicine Disaster and Trauma eBook eMedicine.com, the publisher of the world¹s largest online, current medical reference, has compiled its extensive collection of terrorism-related medical content into a free PDA eBook for medical professionals and the public. This customized book fills recent requests for a reliable information source following the recent terrorist attacks. The PDA reference includes nearly 2,000 pages of the most current information on Trauma, Terrorism, and Biochemical and Radiologic Warfare. The book is designed for field and hospital work and will run on both PALM and Pocket PC PDAs.

Medscape: Disaster and Trauma
"Regularly updated collection of news, notices, articles, and related links to provide the latest information and resources related to caring for those affected by the September 11th terrorist attacks."

Medscape: Medicine's Response to Disaster
" In the wake of the terrorist attacks on New York City and Washington, DC, Medscape has set up a special discussion area for members seeking to share experiences and information about emergency resources. "

Medscape: Bioterrorism: Preparing for the Future
"Are we prepared for a bioterrorist attack? Read the latest findings from recent conferences and other up-to-the-minute resources available on Medscape."

National Fire Academy Emergency Response to Terrorism: Self-Study This course is self-paced, paper-based document and is designed to provide the basic awareness training to prepare first responders to respond to incidents of terrorism safely and effectively. Students who successfully complete the exam will be eligible for a FEMA/BJA certificate of training. The ERT:SS may be downloaded in Adobe Acrobat portable document format (PDF).

US Army Medical Research Institute of Chemical Defense: Chemical Casualty Care Division The agency's mission is to educate medical personnel in the medical management of chemical and biological agent casualties.

Prepared for Biological Terrorism?
In a Cyberounds program entitled, "Bioterrorism and the Emergency Department" by Martin Carey, M.D., the ability of a physician to suspect, identify and appropriately respond to a biological agent exposure is explored.

Office of the Surgeon General Medical NBC Information Server
A distributed learning and reference source for medical NBC information. While the system is being developed for U.S. Army medical personnel, the site will be available to any medical practitioner with access to the Internet.

Armed Forces Infectious Diseases Society

Centers for Disease Control and Prevention (CDC) (main site)

• CDC's bioterrorism preparedness and response website
• CDC pandemic plan for influenza

Chemical , Biological, and Nuclear Terrorism/Warfare: A Bibliography
Dudley Knox Library Naval Postgraduate School

Emergency Response to Chemical/Biological Terrorist Incidents
Emergency Response & Research Institute

Environmental Protection Agency's (EPA) EPA Capabilities: Responding to Nuclear-Biological-Chemical (NBC) Terrorism
The U.S. Environmental Protection Agency (EPA) has statutory authorities and responsibilities to prepare for and respond to emergencies involving oil and hazardous substances, including certain radiological substances, for all natural and manmade incidents, including those caused by acts of terrorism. EPA carries out its preparedness and response efforts primarily under the mandate of the National Oil and Hazardous Substances Pollution Contingency Plan (NCP) and the Radiological Response Program.

Chemical, Biological, Radiological and Nuclear (CBRN) Terrorism
Canadian Security Intelligence Service
In the wake of the March 1995 sarin attack on the Tokyo subway, as well as other recent high-casualty terrorist incidents, governments and publics alike are viewing with growing concern the potential threat posed by chemical, biological, radiological, or nuclear (CBRN) weapons in the hands of terrorists. How easy would it really be for an individual terrorist or terrorist group to manufacture or otherwise obtain such weapons? Perhaps even more important: How easy would it be for them to deliver such weapons, or disperse such agents, and to what effect?

Non-Conventional Terrorism: Chemical, Nuclear, Biological
The International Policy Institute for Counter-Terrorism
Many scholars who have studied terrorism agree today that it is only a matter of time, now that the Supreme Truth cult in Japan has paved way for others of its ilk, until other such groups use non-conventional weapons on their attacks. Modern history abounds with examples of terrorist organizations on one side of the globe that mimic a modus operandi and weapons that have proven themselves on the other side of the globe.

USAMRIID website

Association of Professionals in Infection Control and Epidemiology
Contains bioterrorism response plan

Johns Hopkins University Center for Civilian Biodefense

Anthrax Vaccine Implementation Program

ProMed International Society for Infectious Diseases

British Journal of Medicine

• Chemical weapons
• Biological warfare and bioterrorism

Agency for Healthcare Research and Quality and the University of Alabama at Birminham:

• Five Online Courses

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