Enhancing bioterrorism preparedness and response

In the wake of Sept. 11, the Johns Hopkins Center for Civilian Biodefense Studies in Baltimore received many requests for specific guidance regarding bioterrorism preparedness and response.

In answer to these requests, the center has provided the following list of suggestions for hospitals, physicians, and public health practitioners.


• Review all relevant disaster response plans and assure appropriately designated staff are familiar with the contents and strategies.

• Establish internal and external lines of communication. Assure that medical staff are aware of the need to report suspicious cases of illnesses to public health authorities, and are familiar with who these authorities are. Have in place dedicated staff, phones, and fax machines to support rapid reporting.

• Hospital leaders should establish collaborative strategies for communicating with neighboring hospitals, civic leaders, and public health authorities.

• Quantify pharmaceutical and antibiotic supplies, both at central and satellite facilities. Routinely update this list.

• Assess routine staffing and emergency call-up plans and assure that these are supported with communication and transportation strategies. Update the roster of essential personnel.

• Maintain ongoing primary and redundant communication systems.

• Assure that appropriate health care professionals (e.g., emergency department and urgent care department personnel, infection control, and infectious diseases professionals) are aware of the importance of reporting unusual disease presentations, disease clusters, and atypical patterns of hospital use and know the mechanisms to do reporting.


• Develop an increased awareness of the ongoing threat of bioterrorism.

• Become familiar with and develop a working knowledge of the most likely and dangerous pathogens as viewed by the Centers for Disease Control and Prevention (CDC). (See web sites and phone numbers in the web site information section, in this issue.)

• Become familiar with relevant lines of communication, and important phone numbers, such as the hospital epidemiologist, state epidemiologist, local health department (city or county), and the CDC emergency number.

• Monitor disease patterns and patient volumes in clinics and offices. Immediately notify the appropriate authorities if you suspect an unusual event or need medical guidance.

• Patients can also be referred to the CDC public inquiry phone number (see CDC numbers below right) regarding information about infectious diseases and bioterrorism preparedness response efforts. Have referral numbers for mental health and support services as needed.

• The CDC is aware that a number of physicians have received requests for prescriptions for antibiotics to be used in the event of a bioterrorist attack. It should be known that CDC maintains a national pharmaceutical stockpile of large quantities of antibiotics and vaccines that could be distributed in the event of an epidemic brought on by an act of bioterrorism.

Public health

• Local and state public health agencies should collectively review bioterrorism response plans. Attention should be given to assuring the integration of response plans, including mechanisms for sharing resources and personnel as needed.

• Syndromic surveillance procedures should be put in place to monitor and detect atypical disease presentations and clusters. Both passive and active surveillance systems should be examined and refined across public health agencies and with reporting sources.

• Establish and maintain capacity to accept reports of unusual disease events 24 hours a day, seven days a week. Assure systems of continual, bi-directional communication between public health agencies and hospitals under their purview.

• Appropriately trained disease investigation staff should be available for immediate mobilization and deployment as needed. Staffing levels should be reviewed and plans put in place to determine nonurgent public health functions and clinics should it be necessary to pull additional clinical and field staff for urgent investigation activities.

• Assess communication systems, including procedures for immediately contacting public health and political leaders. Systems should be assessed to assure that appropriate authorities could be contacted at the outset of an emergency. Mechanisms for maintaining ongoing communication, including pagers, cell phones, and wireless e-mail systems, should be assessed and tested. All staff who provide on-call and disease investigation response and decision making should be adequately resourced for 24/7 communication.

• Hold regular meetings with all appropriate government and nongovernment agencies and organizations to continually review and refine plans.

Municipal leaders

• Ensure that leaders are generally familiar with what a bioterrorism attack might demand of civil authorities, and what resources are available to meet these demands. Identify and, if feasible, meet with public health and medical experts who might provide guidance to key decision makers during a public health emergency.

• Put in place primary and backup communication systems to assure that civil authorities can contact key medical, public health, and emergency response workers 24/7 in the event of a public health emergency.

• Assure that civil authorities can quickly broadcast emergency messages, health alerts, and educational information across multiple media including radio, television, and web sites. If older civil alert systems, e.g., air horns, etc., are available, educate the public regarding their possible use and meaning.

• Identify existing gaps in linkages, coordination of response and communication between hospitals, public health agencies, and emergency response workers.

• Develop transportation plans that facilitate movement of emergency vehicles, entrance to and egress from hospitals and care centers, and rapid deployment of essential health care workers from their homes or off-site locations to primary hospital and health care sites.

• Designate a dedicated point of contact to receive information from medical and public health agencies in the event of a bioterrorism attack.

Important web sites, information

  • CDC Emergency Number: (770) 488-7100
  • CDC Emergency Chemical and Biological Hotline: (770) 424-8802
  • CDC Public Inquiry Number: (404) 639-3534, (800) 311-3435
  • CDC bioterrorism web site: www.bt.cdc.gov

Source: Johns Hopkins Center for Civilian Biodefense Studies, Baltimore. Web site: www.hopkins-biodefense.org/interim.htm.