"Unlike other forms of terrorism, in which an acute exposure or traumatic injury is rapidly inflicted and quickly recognized, such as the 9/11 attacks, bioterrorism may involve an incubation period of days or even weeks," says Bruce W. Clements, MPH, associate director of the Institute for Bio-Security at Saint Louis University School of Public Health, and the lead author of the article.
"During these events, patients will turn to their most trusted adviser on health issues -- their doctors -- who will be expected to recognize sometimes rare conditions and take appropriate action. This means doctors will be the tip of the sword -- not the military, not the police, not the firefighters."
Clements presents his argument in an article published in the Dec. 18 issue of the medical journal, The Lancet.
Clements, and his co-author R. Gregory Evans, Ph.D., MPH, director of the Institute for Bio-Security at Saint Louis University, argue that this transfer of first-responder status puts greater responsibility on doctors, a responsibility that they currently are not prepared to shoulder.
"They will be in the driver's seat deciding how an outbreak will be managed so they must be trained for it," Clements says. "The challenge lies in finding the balance between suspicion and hysteria."
Clements says it is a delicate balance because most potential bioterrorism agents listed by the Centers for Disease Control and Prevention (CDC) -- such as those that cause smallpox, anthrax, botulism, plague, tularemia -- initially present in patients as flu-like symptoms.