Simulated exercises of bioterrorism events are now being used to educate and build confidence in healthcare workers. Multiple evaluations have thus far found many doctors and nurses do not feel ready to handle a bioterrorism event. Therefore it is hoped that these hands-on simulations will educate and prepare healthcare workers on how to handle a public health emergency of the kind that would be caused by a bioterrorist attack.
Bioterrorism refers to the deliberate dissemination of disease-causing pathogens for the purposes of causing illness or death. The Center for Disease Control classifies bacteria, fungi, and viruses as potential bioterrorist agents based upon four factors: the mortality rates, ease of person-to-person transmission, whether or not special action from health institutions would be required, and the estimated panic and the disturbance that an outbreak would instill in the public.
The CDC currently lists 45 different pathogens that could be potentially used as a bioterrorist weapon. These agents include anthrax, botulism, small pox, and the plague.
Numerous studies have indicated the healthcare workers do not feel adequately prepared to handle a bioterrorism event. A 2009 study from Yale indicated that 71 percent of physicians said that they did not feel confident in their abilities to recognize weaponized pathogens. Other reports note that in particular older practitioners, doctors in rural areas, and surgeons have had little to no training in these matters. Another 2012 study also found that nurses similarly lack confidence in how to manage a bioterrorist attack.
In an effort to better prepare healthcare workers as to how to handle a bioterrorist attack, institutions are developing hands-on training programs to better educate their personnel. Such training programs use simulated patients that require a diagnosis and a specific treatment plan. Though medical students reported these exercises to be highly informative and valuable, collectively they were unable to correctly initiate standard protocol measures such as having themselves and the patient take respiratory precautions (e.g. face masks). However in discussions after the simulation, students reported that they felt more confident in how to deal with a bioterrorism attack and that they would be more likely to take respiratory precautions and other safety measures with their real patients.
One of the difficulties that health care workers face in dealing with a bioterrorist attack is that the weaponized agent may not resemble commonly-found disease pathogens. For example, the bacteria Yersinia pestis can cause at least three different disease variations commonly referred to as “the plague.” Plague variations are not commonly encountered in day-to-day hospital activities, and it is possible that a patient who initially presents with the characteristic fever, coughing, nausea, and/or vomiting, might be misdiagnosed for any number of other afflictions. In addition, it is speculated that a deliberately weaponized variation of the plague might result in extremely rare variations such as pharyngeal plague or ocular plague. The last person-to-person transmission of the plague in the United States was reportedly in 1925. Consequently, doctors have little or no experience with the pathogen, and would be unlikely to immediately make the correct diagnosis. This is especially troubling because Yersinia pestis causes a rapid decline in patient health and the mortality rate is quite high if treatment is not administered in 24 hours.
Hopefully these simulated exercises will adequately educate healthcare workers as to how to handle a bioterrorism event. Already heralded as an improvement over traditional lecture-based information sessions, in the future researchers and administrators might try to expand this kind of training to address other disaster scenarios.
By Sarah Takushi
UPMC Centers for Health Security