Medical & Public Health Issues

Addressing Bioterrorist Threats: Where Do We Go From Here?
Emerging Infectious Diseases, July 1999
This article discusses the importance of comprehensive planning for consequence management at the local level for preparedness and response to bioterrorism. The author recommends strengthening the nation's public health infrastructure and increasing information sharing with medical providers.

Air Levels of Carcinogenic Polycyclic Aromatic Hydrocarbons After the World Trade Center Disaster (PDF)
Proceedings of the National Academy of Sciences of the United States of America, July 27, 2004
This study concludes that because elevated polycyclic aromatic hydrocarbons (PAH) levels were transient after the World Trade Center terrorist attacks, any elevation in cancer risk from PAH exposure should be very small among nonoccupationally exposed residents of New York City.

Altered Standards of Care in Mass Casualty Events (PDF)
Agency for Healthcare Research and Quality, May 2005
This report provides guidelines and offers a framework for officials who must deliver health and medical care in a mass casualty event. Included are recommendations from a panel of experts in bioethics, emergency medicine, emergency management, health administration, health law and policy, and public health.

Analysis of Department of Defense Plans and Responses to Three Potential Anthrax Incidents in March 2005: Executive Summary (PDF)
RAND Corporation, May 2006
In March 2005, three potential anthrax-related incidents occurred at U.S. Department of Defense (DOD) mail facilities in and around Washington, D.C. DOD asked the RAND Corporation to examine the department's response to, and management of, the three incidents, and analyze how well DOD's actions conformed with existing plans and guidelines. Among their conclusions is that DOD managers and senior leaders need to move away from ad hoc decisions and actions and follow more closely the roles and responsibilities outlined in the National Response Plan and the National Incident Management System.

Anthrax (PDF)
New England Journal of Medicine, 1999
This review article offers technical information about the pathogenesis, manifestation, diagnosis, and treatment of anthrax. It concludes by noting future challenges posed by anthrax should it be used as a weapon of bioterrorism.

Anthrax: A Possible Case History
Emerging Infectious Diseases, July-August 1999
This article describes a hypothetical anthrax attack at a professional football game and its aftermath. The article concludes with questions about preventative measures and other actions that could change the outcome of such an attack.

Anthrax 2001: Observations on the Medical and Public Health Response (PDF)
Biosecurity & Bioterrorism: Biodefense Strategy, Practice, and Science (Vol. 1, No. 2, 2003)
Using interviews with individuals who were directly involved in the response, this article describes aspects of the medical and public health response to the 2001 anthrax attacks.

Anthrax-Contaminated Facilities: Preparations and a Standard for Remediation (PDF)
Congressional Research Service, December 2005
Bacillus anthracis, the cause of the anthrax disease, was released into the U.S. postal system in autumn 2001 resulting in five deaths and contaminating several public and private facilities. Remediation costs were significant. Subsequently, extant federal procedures and policies were clarified and augmented, and new procedures and policies were created to fill identified gaps.

Anthrax Detection: DHS Cannot Ensure That Sampling Activities Will Be Validated (PDF)
U.S. Government Accountability Office, March 29, 2007
In 2001, contaminated letters laced with bacillus anthracis were mailed to two U.S. senators and to members of the media. These anthrax incidents highlighted major gaps in civilian preparedness to detect anthrax contamination in buildings. This report documents the Government Accountability Office's assessment of federal agencies' capacity to detect, contain, and manage anthrax in postal facilities.

Anthrax: What You Need To Know (PDF)
Centers for Disease Control and Prevention, July 2003
This two-page fact sheet from the Centers for Disease Control and Prevention presents, in question-and-answer format, basic facts about anthrax. It discusses transferability, symptoms, treatment, and prevention.

Anthrax as a Biological Weapon: Medical and Public Health Management (PDF)
Journal of the American Medical Association, May 1999
This article recommends measures that medical and public health professionals should take in response to the use of anthrax as a biological weapon against a civilian population. It addresses the diagnosis of anthrax, indications for vaccination, therapy for those exposed, postexposure prophylaxis, decontamination of the environment, and additional research needs.

Anthrax Detection: Agencies Need to Validate Sampling Activities in Order to Increase Confidence in Negative Results (PDF)
U.S. Government Accountability Office, March 2005
In this report, the Government Accountability Office (GAO) assessed the methods used to detect anthrax in postal facilities as a result of the anthrax-laced letters mailed through the U.S. Postal Service in September and October 2001. GAO also assessed the results of agencies' testing and whether agencies' detection activities were validated.

The Anthrax Vaccine: Is It Safe? Does It Work? Report Summary (PDF)
Institute of Medicine, March 2002
This summary presents results of an Institute of Medicine study of the anthrax vaccine that concludes that the vaccine is effective in protecting humans against anthrax. The full report is also available.

Anthrax Vaccine: Safety and Efficacy Issues (PDF)
U.S. General Accounting Office, October 1999
This report presents testimony before the House Committee on Government Reform on the results of an ongoing examination of the safety and efficacy of the anthrax vaccine.

Anthrax Vaccine: What You Need to Know (PDF)
Centers for Disease Control and Prevention, April 2003
This vaccine information statement informs vaccine recipients, their parents, or legal representatives about the benefits and risks of anthrax vaccine.

Basic Research Producing New Anthrax Therapies
University of Chicago Medical Center, August 20, 2004
Researchers at the University of Chicago have discovered three unrelated compounds that inhibit the two toxins—edema factor and lethal factor—that have made anthrax one of the most feared of potential bioterror agents. The researchers used a novel screening technique to find a small molecule that prevents edema factor from connecting to its target within the cell. A similar approach resulted in a compound that inhibits lethal factor, the other anthrax toxin. In addition, a drug already approved to treat hepatitis was also effective in the lab against edema factor.

Bayes, Bugs, and Bioterrorists: Lessons Learned From the Anthrax Attacks (PDF)
Center for Technology and National Security, National Defense University, April 2005
This report examines using risk analysis tools to manage the decisions that compose a national strategy for biodefense by developing a standardized set of issues to address before and during an emergency.

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
Mary Ann Liebert, Inc. publishers
This quarterly peer-reviewed journal provides an international forum for debate and exploration of key strategic, scientific, and operational issues posed by biological weapons and bioterrorism.

Biosurveillance: Preliminary Observations on Department of Homeland Security's Biosurveillance Initiatives (PDF)
Government Accountability Office, July 16, 2008
The U.S. Department of Homeland Security is developing two major initiatives to provide early detection and warning of biological threats: the National Biosurveillance Integration Center (NBIC), which integrates and coordinates information on biological events of national significance, and the BioWatch program, which operates systems that test the air for biological agents. The Implementing Recommendations of the 9/11 Commission Act of 2007 require a fully operational NBIC by September 30, 2008. This statement discusses the status of efforts to make NBIC fully operational by the deadline and to improve the BioWatch program's technology.

Bioterrorism as a Public Health Threat
Emerging Infectious Diseases, July-September 1998
This article describes many aspects of bioterrorism and its prospects for use. The author gives special attention to the possibility of biological attacks using smallpox.

Bioterrorism Countermeasure Development: Issues in Patents and Homeland Security (PDF)
Congressional Research Service, May 6, 2005
This publication reviews proposed Project BioShield reforms to current policies and practices associated with intellectual property, particularly patents, and the marketing of pharmaceuticals and related products.

Bioterrorism: Federal Research and Preparedness Activities (PDF)
U.S. General Accounting Office, September 2001
This report describes the federal activities and funding related to the public health and medical consequences of a bioterrorist attack, details the coordination of activities among federal agencies and identifies any shortcomings in the current coordination structure, and reviews existing evaluations of the effectiveness of these activities in preparing state and local authorities.

Bioterrorism Preparedness Training and Assessment Exercises for Local Public Health Agencies (PDF)
Rand Corporation, 2005
In 2003, the U.S. Department of Health and Human Services' Office of the Assistant Secretary for Public Health Emergency Preparedness awarded the RAND Corporation a contract to develop and test tabletop exercises on the early responses of local public health agencies to outbreaks caused by bioterrorism. RAND developed the exercises in this manual as templates that local agencies can customize and use to train public health workers in how to detect and respond to bioterrorism events and to assess the levels of preparedness of local agencies.

Bioterrorism: Preparedness Varied across State and Local Jurisdictions (PDF)
U.S. General Accounting Office, April 2003
This GAO report makes recommendations based on varying degrees to which state and local public health officials were found to be prepared to respond to a bioterrorist attack. Specifically, the study found that deficiencies exist in capacity, communication, coordination, federal guidance, and knowledge of best practices.

Bioterrorism: Public Health and Medical Preparedness (PDF)
U.S. General Accounting Office, October 2001
This report presents testimony before the Senate Subcommittee on Public Health regarding federal activities to prepare the nation to respond to a bioterrorist attack.

Bioterrorism: Public Health Response to Anthrax Incidents of 2001 (PDF)
U.S. General Accounting Office, October 2003
This report examines the public health community's response to the anthrax outbreaks of 2001. In particular, it determines lessons learned that could help improve public health preparedness at the federal, state, and local levels and the steps that have been taken to make those improvements.

Bioterrorism: Review of Public Health Preparedness Programs (PDF)
U.S. General Accounting Office, October 2001
This report presents testimony before the House Subcommittee on Oversight and Investigations regarding federal activities to prepare the nation to respond to a bioterrorist attack.

Breathing Easier? (PDF)
The Century Foundation, January 2005
This report examines how states and cities used public health funding following the anthrax attacks in fall 2001.

CDC Anthrax Vaccine Safety and Efficacy Research Program: Interim Report (PDF)
National Academy of Sciences, 2001
This report discusses the completeness and appropriateness of the Centers for Disease Control and Prevention's plan to study the effectiveness and safety of the anthrax vaccine.

Chemical Agents: Facts About Sheltering in Place (PDF)
Centers for Disease Control, February 2003
This fact sheet presents information on how to find temporary shelter in an emergency.

Chemical Facility Security (PDF)
Congressional Research Service, Updated July 29, 2005
This report evaluates the proposed requirements for reducing risks to the general public of exposure to hazardous chemicals as a result of a terrorist attack at facilities where chemicals are produced, processed, stored, and used. In addition to describing the types of terrorist acts that could threaten a chemical facility, this report explores the federal mandates and incentives for reducing the risk of accidental releases from facilities and the Administration's and private sector's initiatives to improve security at chemical facilities.

Chemical Threats
Federal Emergency Management Agency, March 21, 2006
This online document explains how individuals might protect themselves from a chemical attack.

Chronology of Incidents Involving Ricin
Center for Nonproliferation Studies, February 3, 2004
This chronology, derived from open sources, lists previous incidents that involved the possession, threat, and/or use of ricin.

Cleanup After a Radiological Attack: U.S. Prepares Guidance (PDF)
Center for Nonproliferation Studies, The Nonproliferation Review, Fall/Winter 2004
This article discusses the forthcoming guidelines from the U.S. Department of Homeland Security for response to a radiological attack, specifically the detonation of a dirty bomb or radiological dispersal device.

Combating Bioterrorism: Actions Needed to Improve Security at Plum Island Animal Disease Center (PDF)
U.S. General Accounting Office, September 19, 2003
In this report, GAO found that security at the Plum Island Animal Disease Center has improved, but fundamental concerns, including an incidence response plan that fails to consider terrorist attacks and a guard force that does not have USDA authority to carry firearms or to make arrests, leave the facility vulnerable to security breaches.

Combating Terrorism: Chemical and Biological Medical Supplies Are Poorly Managed
U.S. General Accounting Office, 2000
Presented as testimony before the Subcommittee on National Security, Veterans Affairs, and International Relations, Committee on Government Reform, House of Representatives, this document presents findings from a report on the management of federal medical stockpiles that would be used to treat civilians in a chemical or biological terrorist attack. The testimony highlights problems identified with the management of stockpiles and provides an account of the number of stockpiled supplies.

Criminal And Epidemiological Investigation Handbook (PDF)
U.S. Army Soldier & Biological Chemical Command, November 2002
This handbook, which provides an introduction to epidemiological and criminal terrorist investigations, is designed to give public health and law enforcement personnel a better understanding of each other's information requirements and investigative procedures.

Criminal And Epidemiological Investigation Report (PDF)
U.S. Army Soldier & Biological Chemical Command, December 2000
This final report of the Biological Warfare Improved Response Program NDPO/DoD Criminal and Epidemiological Investigation Workshop (held January 19–21, 2000) discusses how to coordinate the efforts of law enforcement and medical/public health communities in the event of a bioterrorist attack.

Defense Against Toxin Weapons (PDF)
U.S. Army Medical Research Institute of Infectious Diseases, 1997
This manual provides basic information about biological toxins to military leaders and health-care providers at all levels to help them make informed decisions about protecting their troops from toxins.

Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations
Michael D. Christian et al., CHEST 133(5): 8S (2008)
This article reviews the state of emergency preparedness for mass critical illness, analyzing baseline shortages of critical care staff, medical supplies, and treatment spaces and the lack of a framework for integrating critical care within the overall institutional response and coordinating critical care among local institutions and broader geographic areas.

Department of Homeland Security Working Group on Radiological Dispersal Device (RDD) Preparedness (PDF)
Medical Preparedness and Response Sub-Group, May 2003
This report discusses the medical guidelines to be followed after exposure to ionizing radiation, the psychological aspects of a radioactive event, and medical countermeasures that can be used to treat exposed individuals.

Depression, PTSD, Substance Abuse Increase in Wake of September 11 Attacks
Jill S. Williams, November 2002
Five to eight weeks after the terrorist attacks in 2001, a research survey revealed that postattack rates of depression and posttraumatic stress disorder were approximately twice the baseline levels documented in 1999. Researchers found a significant increase in substance abuse among respondents. The results reported provide insight into the needs associated with the delivery of public health services and offer clues to effective treatment strategies to help individuals cope with traumatic events.

Detecting Bioterror Attacks by Screening Blood Donors: A Best-Case Analysis
Emerging Infectious Diseases, August 2003
The authors conducted this study to assess whether screening blood donors could provide early warning of a bioterror attack. Their findings indicated that even under optimistic conditions, it is unlikely that screening blood donors would be able to determine a bioterror attack any faster than observing symptoms in patients.

Disaster Preparedness for Radiology Professionals: Response to Radiological Terrorism—A Primer for Radiologists, Radiation Oncologists and Medical Physicists (Version 2.1) (PDF)
American College of Radiology, February 2003
This report summarizes information on preparing for a radiation emergency, handling contaminated persons, and assessing the health impacts of radiation dosage and exposure. It also includes information on radiological findings related to agents of biological and chemical terrorism.

Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident
National Academies Press, December 4, 2003
Potassium iodide can prevent thyroid cancer caused by exposure to radioactive iodine, which could be released during a severe accident at a nuclear plant. According to a new report from the National Academies' Board on Radiation Effects Research, potassium iodide pills should be available to everyone age 40 or younger, especially children and pregnant and lactating women who live near a nuclear power plant.

'Don't Mass Vaccinate' Against Anthrax
News@Nature.com, December 15, 2004
According to researchers who have evaluated the outcomes for various strategies, mass vaccination is not the best way to deal with the threat of anthrax attacks by terrorists. Far better, they say, is to ensure that the right treatments will be delivered to those exposed as soon after the attack as possible.

Draft Guidance—Emergency Use Authorization of Medical Products
U.S. Food and Drug Administration, 2005
This draft guidance, when final, will explain the Food and Drug Administration's policies for authorizing the emergency use of medical products under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act) (21 U.S.C. 360bbb-3), which was amended by the Project BioShield Act of 2004 (Public Law 108-276). Section 564 permits the FDA commissioner to authorize the use of an unapproved medical product or an unapproved use of an approved medical product during a declared emergency involving a heightened risk of attack on the public or U.S. military forces.

Ebola Spreads From Animals to Hunters
Nature, Science Update, January 16, 2004
A genetic analysis has helped confirm that Ebola can spread to people when hunters handle infected animal corpses. The finding implies that an Ebola outbreak can appear anywhere at any time, making future outbreaks very difficult to predict.

Effectiveness of Safer Smallpox Vaccine Demonstrated Against Monkeypox
U.S. Department of Health and Human Services, National Institutes of Health, March 10, 2004
A mild, experimental smallpox vaccine known as modified vaccinia Ankara (MVA) is nearly as effective as the standard smallpox vaccine in protecting monkeys against monkeypox. Monkeypox is used to test the effectiveness of a smallpox vaccine because of its similarity to the smallpox virus. The study appears in the March 11 issue of Nature.

Elements of Effective Bioterrorism Preparedness: A Planning Primer for Local Public Health Agencies (PDF)
National Association of County and City Health Officials, January 2001
This report provides local public health officials with guidance in identifying their public health and safety roles in response to a bioterrorism emergency and coordinating efforts with neighboring local and state public health systems, criminal investigation agencies, and other emergency management authorities.

Emergency Response, Preparedness, and Recovery Checklist: Beyond the Emergency Management Plan (PDF)
American Health Lawyers Association, 2004
This publication is a practice tool to facilitate health care providers' emergency preparedness planning. It identifies the key legal and operational issues that will arise during a public health crisis, terrorist threat, environmental disaster, or other emergency situation.

Emerging Infectious Diseases: A Peer-Reviewed Journal Tracking and Analyzing Disease Trends
Centers for Disease Control and Prevention
This journal aims to increase the understanding of factors involved in disease emergence, prevention, and elimination. It publishes reports of interest to researchers and public health practitioners who want to learn the scientific basis for prevention programs. This monthly periodical is available in print and electronic formats.

Emerging Infectious Diseases: Asian SARS Outbreak Challenged International and National Responses (PDF)
U.S. General Accounting Office, April 2004
This report examines the responses by U.S. and Asian governments (China, Hong Kong, and Taiwan) and the World Health Organization during the SARS outbreaks of late 2002 and early 2003. It also details preparedness issues that were realized as the outbreak unfolded, including limited resources, deficiencies in Asian public health systems, and limitations of international health regulations.

Emerging Infectious Diseases: Review of State and Federal Disease Surveillance Efforts (PDF)
U.S. Government Accountability Office, September 2004
Surveillance for infectious diseases in the United States comprises various efforts at state and federal levels. In this report, the Government Accountability Office examines disease surveillance efforts by describing how state and federal public health officials conduct surveillance and reviewing initiatives intended to enhance surveillance.

Explosions and Blast Injuries: A Primer for Clinicians (PDF)
Centers for Disease Control and Prevention, March 2003
Explosions often produce unique patterns of injury and present triage, diagnostic, and management challenges to emergency care providers. Resulting from the risk of terrorist attacks in the United States, this article discusses the need for medical personnel to understand the unique physiology of explosives and blast injuries.

Exposure and Human Health Evaluation of Airborne Pollution From the World Trade Center Disaster
National Center for Environmental Assessment, 2002
After the collapse of the World Trade Center towers on September 11, 2001, New York state and federal agencies initiated numerous air monitoring activities to better understand the ongoing impact of emissions from the disaster. This report evaluates and interprets these air measurement data. The report does not evaluate pollution exposure faced by rescue or cleanup workers.

Fact Sheets on Terrorist Attacks
National Academy of Engineering of the National Academies
In cooperation with the U.S. Department of Homeland Security, the National Academies is making available fact sheets on four types of terrorist attacks: biological, chemical, radiological, and nuclear. Although designed primarily for reporters as part of the project News and Terrorism: Communicating in a Crisis, the fact sheets will be helpful to anyone looking for a clear explanation of the fundamentals of science, engineering, and health related to such attacks.

Facts About Bromine (Fact Sheet) (PDF)
Centers for Disease Control and Prevention, June 2004
This fact sheet discusses exposure to, symptoms of, and protection from bromine poisoning. It also describes treatment options and decontamination methods.

Facts About Ricin (PDF)
Centers for Disease Control and Prevention, October 13, 2003
This fact sheet discusses how ricin poison is made, symptoms of exposure, and recommended prevention, treatment, and decontamination methods.

Fast-Acting Ebola Vaccine Protects Monkeys
National Institutes of Health, National Institute of Allergy and Infectious Diseases, August 2003
A single shot of a fast-acting, experimental Ebola vaccine successfully protects monkeys from the deadly virus after only one month. If this vaccine proves similarly effective in humans, it may one day allow scientists to quickly contain Ebola outbreaks with ring vaccination—the same strategy successfully used in the past against smallpox, according to a study in Nature magazine (August 7, 2003).

Faster . . . but Fast Enough? Responding to the Epidemic of Severe Acute Respiratory Syndrome (PDF)
New England Journal of Medicine, May 15, 2003
Speed of scientific discovery and communication are hallmarks of the response to severe acute respiratory syndrome (SARS) in early 2003. This article offers perspectives on the global challenges that SARS holds for the scientific community.

First Responder Treatment and Resource Guide: A Reference Guide for Public Safety Agencies on Treatment and Management of Exposure to Biological, Chemical and Radiological Threats (PDF)
Police Executive Research Forum, 2004
This guide presents biological, chemical, and radioactive agents that pose a threat to public safety, and discusses the availability of national vaccines and antidotes.

Food and Water in an Emergency (PDF)
U.S. Federal Emergency Management Agency (FEMA)
When disasters strike communities, access to food, water, and electricity can be interrupted for long periods. By taking time in advance to store emergency food and water supplies, provisions can be made for entire families or groups. This brochure was developed by FEMA in cooperation with the American Red Cross and the U.S. Department of Agriculture.

General Information about PTSD and Trauma: Fact Sheets for the Public
National Center for PTSD
This fact sheet contains information concerning the nature of trauma, PTSD (posttraumatic stress disorder), and the consequences of trauma.

Genesis of Suicide Terrorism
Scott Atran, March 2003
Published by Science Magazine, this article cites recent studies to challenge the hypothesis that all suicide terrorists are economically deprived, undereducated, and pathological. It suggests that suicide bombing may be an institutional phenomenon and examines possibilities for dealing with it on this level. Interested persons may purchase facsimile copies or view the electronic version of this article.

The Global Threat of New and Reemerging Infectious Diseases: Reconciling U.S. National Security and Public Health Policy
RAND Corporation, April 2003
This report addresses the security implications of emerging and reemerging illnesses. It examines security and policy shortcomings and presents action items that could be initiated to address them.

Guidelines for the Management of Acute Diarrhea
Centers for Disease Control and Prevention
Increased incidence of acute diarrhea may occur in postdisaster situations where access to electricity, clean water, and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted and health care-seeking behaviors may be altered. Following are general guidelines for health care providers for the evaluation and treatment of patients with acute diarrhea in these situations.

HHS Announces New Regional Centers for Biodefense Research
U.S. Department of Health and Human Services (HHS), September 4, 2003
In September 2003, HHS awarded grants totaling approximately $350 million over 5 years to establish eight Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases Research. These multidisciplinary centers are a key element in HHS's strategic plan for biodefense research.

HHS Bioterrorism Preparedness Programs: States Reported Progress but Fell Short of Program Goals for 2002 (PDF)
U.S. General Accounting Office, February 2004
This report examines the extent to which states have completed requirements for two U.S. Department of Health and Human Services programs aimed at strengthening bioterrorism preparedness of state, local, and territorial governments: Public Health Preparedness and Response for Bioterrorism Program and National Bioterrorism Hospital Preparedness Program.

Health and Environmental Consequences of the World Trade Center Disaster
Environmental Health Perspectives, National Institutes of Health Press, May 3, 2004
This study characterizes environmental exposures resulting from the destruction of the World Trade Centers and assesses subsequent effects on human health. Results of the study show exposure was related to increases in new-onset coughing, wheezing, shortness of breath, and bronchial hyperreactivity.

High-Containment Biosafety Laboratories: DHS Lacks Evidence to Conclude That Foot-and-Mouth Disease Research Can Be Done Safely on the U.S. Mainland (PDF)
Government Accountability Office, May 22, 2008
The Department of Homeland Security is proposing to move foot-and-mouth disease (FMD) research from its current location at the Plum Island Animal Disease Center onto the U.S. mainland. FMD is the most highly infectious animal disease that is known, and a single outbreak of FMD on the U.S. mainland could have significant economic consequences. When it decided that work with FMD could be done safely on the mainland, DHS relied on a 2002 U.S. Department of Agriculture study that addressed a different question and also has flaws.

Homeland Security: Federal and Industry Efforts Are Addressing Security Issues at Chemical Facilities, but Additional Action Is Needed (PDF)
U.S. Government Accountability Office, April 27, 2005
Terrorist attacks on chemical facilities could severely damage the U.S. economy and public health. According to the Government Accountability Office, about 15,000 facilities produce, use, or store large amounts of chemicals that pose the greatest risk to public health and the environment. Formerly, the U.S. Environmental Protection Agency had the lead role in federal efforts to ensure chemical facility security; those responsibilities have now been passed to the U.S. Department of Homeland Security. This report explores the attractiveness of chemical facilities as terrorist targets, their diversity and risks, federal security requirements, and federal and industry efforts to improve facility security.

Homeland Security Report No. 165
The Homeland Security Group, September 2006
The September 2006 issue of the Homeland Security Report discusses progress made since September 11, 2001; the Boyd Cycle and nonverbal communication; activities planned for National Preparedness Month; and a microchip that may help labs diagnose influenza infections.

Hometown Hospitals: The Weakest Link? Bioterrorism Readiness in America's Rural Hospitals (PDF)
Center for Technology and National Security Policy, June 2004
This report offers an overview of the challenges facing rural hospitals as they prepare for the threat of bioterrorism as well as naturally occurring epidemics.

Hospital Emergency Departments: Crowded Conditions Vary among Hospitals and Communities (PDF)
U.S. General Accounting Office, March 2003
This GAO report examines reasons for overcrowding in emergency departments at six metropolitan hospitals and discusses ways in which crowding is managed. Among the many findings, the most common factor contributing to crowding is the inability to move patients out of emergency departments and into inpatient beds.

Hospital Preparedness: Most Urban Hospitals Have Emergency Plans but Lack Certain Capacities for Bioterrorism Response (PDF)
U.S. General Accounting Office, August 2003
This report provides information from a GAO study on the extent to which hospitals in urban areas of the United States are prepared for bioterrorism events. The study focuses on planning activities with external contacts, staff training, and response capacity of the facility (e.g., number of isolation beds) and of the equipment (e.g., number of ventilators).

Human Resources at U.S. Ports of Entry to Protect the Public's Health: Interim Letter Report
Institute of Medicine, The National Academies, 2005
Many infectious diseases have appeared in and spread to multiple continents since 1970. A significant vehicle for this spread is the speed and volume of international and transcontinental travel, commerce, and human migration. In response to these trends and the risk of bioterrorism, the U.S. Congress and the Bush Administration have mandated that the Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, more than triple the size of its system of quarantine stations at U.S. ports of entry and that it play an active role in biosurveillance. This interim letter report—the first of two reports—outlines the skills and types of professionals recommended for the quarantine system.

Identifying Remains: Lessons Learned From 9/11
National Institute of Justice, January 2007
This article summarizes lessons learned from a report, written primarily for laboratory directors, on forensic technologies, policies, and procedures to be used by officials involved in preparing comprehensive plans to identify victims of a mass fatality incident using forensic DNA analysis.

Impact of Conjoined Exposure to the World Trade Center Attacks and to Other Traumatic Events on the Behavioral Problems of Preschool Children
C.M. Chemto, Y. Nomura, and R.A. Abramovitz, Archives of Pediatric and Adolescent Medicine, February 2008
This study of preschool children found that conjoined exposure to high-intensity World Trade Center attack-related events and other trauma was associated with clinically significant emotionally reactive, anxious/depressed, and sleep-related behavioral problems. Children without a conjoined lifetime history of other trauma did not differ from nonexposed children.

Infectious Disease: Gaps Remain in Surveillance Capabilities of State and Local Agencies (PDF)
U.S. General Accounting Office, September 2003
Despite more planning, training, and laboratory upgrades, state and local public health agencies are not fully prepared to identify and respond to infectious disease outbreaks and bioterrorism. For example, some disease surveillance systems are inadequate, staff shortages exist in some localities, and most hospital emergency departments are overcrowded to some degree.

Influenza Pandemic: Applying Lessons Learned From the 2004–2005 Influenza Vaccine Shortage (PDF)
U.S. Government Accountability Office, November 4, 2005
GAO examined federal, state, and local actions taken in response to the influenza vaccine shortage of the 2004–2005 flu season. A number of lessons emerged that carry implications for handling future vaccine shortages that might occur on a national or international scale.

Influenza Pandemic: Efforts to Forestall Onset Are Under Way; Identifying Countries at Greatest Risk Entails Challenges(PDF)
U.S. Government Accountability Office, June 21, 2007
Since 2003, a global epidemic of avian influenza has raised concern about the risk of an influenza pandemic among humans which could cause millions of deaths. This report describes U.S. and international efforts to assess pandemic risk by country and prioritize countries for assistance, and strategies that have been implemented to forestall and prepare for a pandemic.

Influenza Pandemic: Plan Needed for Federal and State Response (PDF)
U.S. General Accounting Office, October 2000
This GAO study examines the availability of and demand for vaccines and antiviral drugs used to treat a pandemic. The study also looks at federal and state influenza pandemic plans and acknowledges that they are in various stages of completion and do not completely or consistently address key issues surrounding the purchase, distribution, and administration of vaccines and antiviral drugs.

Inspection of the FBI's Security Risk Assessment Program for Individuals Requesting Access to Biological Agents and Toxins (PDF)
Office of the Inspector General, U.S. Department of Justice, March 2005
This report presents the findings of an inspection of the Security Risk Assessment (SRA) program that the Federal Bureau of Investigation established under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. The SRA program is part of an interagency effort to regulate the possession and use of dangerous biological agents and toxins, such as anthrax and the Ebola virus.

Interim Guidelines for Hospital Response to Mass Casualties from a Radiological Incident (PDF)
James M. Smith and Marie A. Spano, National Center for Environmental Health, December 2003
This report identifies practical strategies that personnel at hospitals can use in conjunction with their professional training and experience to aid in the effective and efficient treatment of mass casualties stemming from a radiological terrorism event. It focuses on six key areas: notification and communication, triage, patient management, health care provider protection, surveillance, and community planning.

Internet Resources for Nurses and Nursing Students: A Sampling of Sites
Association of College and Research Libraries, April 2006
This article explains the governmental resources available to the public by dividing its list into resources directed toward professionals and health care consumers, nongovernmental health information portals, nursing specialties and disease-specific resources, study aids for nursing students, nursing associations, online forums, and discussion lists.

Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings
Centers for Disease Control and Prevention, October 2002
After the terrorist attacks on the World Trade Center and the Pentagon in 2001, envelopes containing Bacillus anthracis spores were mailed to news media companies and government officials, leading to the first bioterrorism-related cases of anthrax in the United States. This online article reports on the combined findings from the epidemiologic and laboratory investigations of those cases, conducted through coordinated efforts of medical and laboratory communities and local, state, and federal public health and law enforcement agencies.

Key Facts about the Cities Readiness Initiative Pilot Program (Fact Sheet) (PDF)
Centers for Disease Control, June 14, 2004
The Cities Readiness Initiative (CRI) will help save lives through timely delivery of medicines and medical supplies during a large-scale public health emergency. As a result of this pilot program, plans from all levels of government will be unified to ensure a consistent, effective, and timely response.

Laboratory Biosafety Manual (PDF)
World Health Organization, 2003
This manual encourages countries to codify practices for the safe handling of pathogenic microorganisms. The manual provides expert guidance for developing such codes of practice.

Looking for Trouble: A Policymaker's Guide to Biosensing (PDF)
Center for Technology and National Security Policy, June 2004
This report, written for a nontechnical audience, aims to help policymakers decide how to best provide early warnings of biological attacks. Among its recommendations is that efforts to collect medical data be increased.

Managing Hazardous Material Incidents
Agency for Toxic Substances and Disease Registry, 2001
The Managing Hazardous Material Incidents series comprises a three-volume set with an accompanying videotape of recommendations for on-scene (pre-hospital) and hospital medical management of patients exposed during a hazardous materials incident.

Managing SARS amidst Uncertainty (PDF)
New England Journal of Medicine, May 15, 2003
This article chronicles attempts by physicians to treat patients with severe acute respiratory syndrome (SARS) in light of international anxiety brought on by its novelty and rapid communicability.

Mass Fatality Incidents: A Guide for Human Forensic Identification (PDF)
Technical Working Group for Mass Fatality Forensic Identification, National Institute of Justice, June 2005
This report provides medical examiners and coroners with guidelines for preparing the victim identification portion of the disaster plan, and summarizes the process for other first responders. It discusses the integration of the medical examiner/coroner into the initial response process, and presents the roles of various forensic disciplines (including forensic anthropology, radiology, odontology, fingerprinting, and DNA analysis) in victim identification.

Measuring and Evaluating Local Preparedness for a Chemical or Biological Terrorist Attack (PDF)
RAND Corporation, 2002
This document suggests ways to measure the preparedness of local responders for chemical and biological terrorism.

Medical Aspects of Chemical and Biological Warfare
Office of the Surgeon General, Department of the Army, 1997
This textbook for health-care responders focuses on the medical defense against chemical and biological warfare, including analysis of nerve agents, incapacitating agents, riot control agents, anthrax, plague, tularemia, and other biological toxins; pretreatment; field treatment; long-term treatment; and biological defense programs.

Medical Examiners, Coroners, and Biologic Terrorism: A Guidebook for
Surveillance and Case Management
Centers for Disease Control and Prevention, June 11, 2004
This report helps public health officials understand the role that medical examiners and coroners play in surveillance of and response to biological terrorism. It also provides background information on biological agents and consequent clinicopathologic diseases, autopsy procedures, and diagnostic tests and describes biosafety risks and standards for autopsy precautions.

Medical Management Guidelines for Acute Chemical Exposures
Agency for Toxic Substances and Disease Registry (ATSDR), 2001
Medical Management Guidelines for Acute Chemical Exposures is part of the three-volume Managing Hazardous Material Incidents series that ATSDR developed to help emergency department physicians and other emergency health care professionals to manage the acute exposures that result from chemical incidents.

Medical Management of Biological Casualties Handbook, Fourth Edition
U.S. Army Medical Research Institute of Infections Diseases, 2001
This handbook provides concise supplemental reading material pertaining to biological casualty management. Originally produced as a concise pocket-size manual, this document guides medical personnel in the prophylaxis and management of biological casualties. It is designed as a quick reference and overview; it is not intended as a definitive text on the medical management of biological casualties.

Medical Management of Chemical Casualties Handbook, Third Edition (PDF)
U.S. Army Medical Research Institute of Chemical Defense, 1999
This handbook provides medical personnel in the field with a concise, pocket-size reference source for the medical management of chemical casualties. It is not intended to be a definitive text on the management of chemical casualties.

Medical Management of Radiological Casualties Handbook, Second Edition (PDF)
Armed Forces Radiobiology Research Institute, April 2003
This handbook provides information for the medical community on how to treat patients exposed to ionizing radiation and other radioactive contamination, as well as management techniques for operating in a contaminated environment.

Meeting the Mental Health Needs of Crime Victims (video)
Office for Victims of Crime, October 1997
This 40-minute video presents a panel discussion that includes two nationally recognized experts in the field of mental health. Findings from current mental health research are presented, including issues involved with crime-related psychological trauma of crime victims, identification of the major types of immediate and short-term trauma associated with crime victimization, factors related to victims' healing and recovery, and how the criminal and juvenile justice systems can address the needs of traumatized crime victims.

Mental Health Status of World Trade Center Rescue and Recovery Workers and Volunteers—New York City, July 2002–August 2004
Centers for Disease Control and Prevention, September 10, 2004
The World Trade Center Worker and Volunteer Medical Screening Program provided free, standardized medical assessments, clinical referrals, and occupational health education for workers and volunteers exposed to hazards during the WTC rescue and recovery effort. This report summarizes data analyzed from a subset of the participants evaluated from July 16 to December 31, 2002. On the basis of one or more standardized screening questionnaires, approximately half of participants met threshold criteria for a clinical mental health evaluation. Continued surveillance is needed to assess the long-term psychological impact of the September 11 attacks and to determine needs for continued treatment.

The Merck Manual of Diagnosis and Therapy
Mark H. Beers, M.D., and Robert Berkow, M.D., Editors, 17th Edition, Centennial Edition, Merck & Co., Inc.
The “Merck Manual” is a source of authoritative information for diagnosing and treating diseases and medical emergencies, such as poisoning. Web versions of the manual are posted as a free public service.

Mice Studies Illustrate Potential of Chimp/Human Antibodies to Protect Against Smallpox
National Institutes of Health, NIH News, January 23, 2006
Results from a new study indicate that hybrid laboratory antibodies derived from chimpanzees and humans may provide a potentially safe and effective way to treat the serious complications that can occur following smallpox vaccination, and could possibly protect against the deadly disease itself.

Military Study Shows Safety of Smallpox Vaccination Program
U.S. Department of Defense (DoD), June 26, 2003
Dr. William Winkenwerder, Jr., Assistant Secretary of Defense for Health Affairs, announced that DoD research conducted over a 6-month period suggests that a large-scale vaccination program can be carried out safely with few serious adverse events.

Mouse Study Gives New View of Anthrax Toxin
U.S. Department of Health and Human Services, September 2, 2003
A large-scale study of anthrax in mice has yielded new information about immune system response to anthrax bacteria. In an article published in the Journal of Clinical Investigation, researchers from the National Institute of Allergy and Infectious Diseases found that toxins released by the bacteria do not behave as previously believed. This finding could affect future drug design.

Mr. Alexander Litvinenko—Health Protection Agency Statement
Health Protection Agency, United Kingdom, November 24, 2006
Update Statement on the Public Health Issues related to Polonium–210
Health Protection Agency, United Kingdom, November 25, 2006
Update on Public Health Issues related to the Polonium–210 Incident
Health Protection Agency, United Kingdom, November 27, 2006
The Health Protection Agency of the United Kingdom is providing expert advice as part of the Metropolitan Police investigations into the death of Alexander Litvinenko in London, England. Mr. Litvinenko died November 23, 2006, as a result of poisoning by a significant quantity of the radioactive isotope Polonium–210 (Po–210) in his body. This series of news releases informs the public about the health effects of Polonium–210, as well as any remaining health risks to citizens, should any be found.

A National Public Health Strategy for Terrorism Preparedness and Response 2003–2008 (PDF)
Centers for Disease Control and Prevention, March 2004
This document outlines a national public health strategy for terrorism preparedness and response that was developed by the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry. It defines strategic imperatives, critical objectives, and key actions specific to terrorism preparedness and response efforts.

The National Report Card on the State of Emergency Medicine (PDF)
American College of Emergency Physicians, January 2006
This report discusses the support that each state provides for its emergency medicine system. It underscores the challenges facing patients who need emergency care, recognizes efforts being made to address these needs, and seeks to motivate state and national policy support for improving emergency care.

A New National Priority: Enhancing Public Safety and Health Through Domestic Preparedness
Executive Session on Domestic Preparedness, March 2001
This Perspectives on Preparedness bulletin analyzes risk associated with weapons of mass destruction and assesses the U.S. domestic preparedness program. It discusses seven key challenges to building interagency and interjurisdictional cooperation to achieve national security and public safety.

New Study on Smallpox in Monkeys Reveals Tactics of a Killer
National Institutes of Health, October 12, 2004
Results of a new study in monkeys offer scientists a rare glimpse of how, on a molecular level, the smallpox virus attacks its victims. The findings highlighted in this press release shed light on how the virus has caused mass death and suffering and will help point the way to new diagnostics, vaccines, and drugs that would be needed in the event of a smallpox bioterror incident.

New Way to Block Pox Shows Promise in Lab Study; Finding May Lead to Better Antiviral Drugs
National Institutes of Health, NIH News, February 1, 2005
Acute viral infections, including smallpox, may be halted by aiming a drug not at the virus but at the cellular machinery it needs to spread from cell to cell—an approach that might eliminate the problem of antiviral drug resistance.

News Release: Biodefense Preparedness: Record of Accomplishment
U.S. Department of Health and Human Services, April 2004
This news release describes how the Department of Health and Human Services, in cooperation with the U.S. Department of Homeland Security, has helped to strengthen the nation's defenses against biological weapons.

NIAID Ebola Vaccine Enters Human Trial
National Institute of Allergy and Infectious Diseases (NIAID), November 18, 2003
The first human trial of a vaccine designed to prevent Ebola infection has opened. The vaccine—designed by scientists from the Vaccine Research Center at NIAID—does not contain any infectious material from the Ebola virus.

OSHA Best Practices for Hospital-Based First Receivers of Victims From Mass Casualty Incidents Involving the Release of Hazardous Substances (PDF)
Occupational Safety and Health Administration, December 2004
This report assists hospitals in developing emergency management plans to protect emergency department personnel when admitting contaminated victims from mass casualty incidents. The guidelines also cover victim decontamination, personal protective equipment, and employee training.

Pandemic Influenza: Domestic Preparedness Efforts (PDF)
Congressional Research Service, November 10, 2005
This report discusses preparedness for pandemic influenza, the impact of previous pandemics, and the possibility of a pandemic caused by the H5N1 avian flu strain.

Pets Evacuation and Transportation Standards Act of 2006 (H.R. 3858, Public Law No: 109-308)
This act amends the Robert T. Stafford Disaster Relief and Emergency Assistance Act to require that the director of the Federal Emergency Management Agency ensure that operational plans for state and local emergency preparedness address the needs of individuals with household pets and how best to serve them following a major disaster or emergency.

Physical Health Status of World Trade Center Rescue and Recovery Workers and Volunteers—New York City, July 2002–August 2004
Centers for Disease Control and Prevention, September 10, 2004
The World Trade Center Worker and Volunteer Medical Screening Program provided free, standardized medical assessments, clinical referrals, and occupational health education for workers and volunteers exposed to hazards during the WTC rescue and recovery effort. This report summarizes data analyzed from a subset of the participants evaluated from July 16 to December 31, 2002. The data indicate that a substantial proportion of participants experienced new-onset or worsened preexisting lower- and upper-respiratory symptoms, with the frequent persistence of symptoms for months after their WTC response work stopped. These findings underscore the need for comprehensive health assessment and treatment for workers and volunteers participating in rescue and recovery efforts.

Plague as a Biological Weapon: Medical and Public Health Management (PDF)
American Medical Association, May 2000
Authored by the Working Group on Civilian Biodefense, this article recommends measures to be taken by medical and public health professionals following the use of plague as a biological weapon against a civilian population. The working group included 25 representatives from major academic medical centers and emergency management institutions and agencies.

Planning for Mutual Assistance in Mass Casualty Emergencies: The Example of Public Health (PDF)
U.S. Department of Homeland Security, 2004
In a public health emergency or epidemic, different government agencies must work together in a coordinated response. This publication describes the roles and responsibilities of relevant federal, state, and local organizations and officials, as well as policy and procedure for handling public health emergencies.

Plum Island Animal Disease Center: DHS Has Made Significant Progress Implementing Security Recommendations, but Several Recommendations Remain Open (PDF)
Government Accountability Office, December 17, 2007
For many years, scientists at the U.S. Department of Agriculture's (USDA's) Plum Island Animal Disease Center, located on an island off the coast of New York, have diagnosed pathogens that cause foreign animal diseases and conducted research to, among other things, develop vaccines to protect against them. Some of the pathogens maintained at Plum Island, such as foot-and-mouth disease, are highly contagious to livestock and could cause catastrophic economic losses in the agricultural sector if they were released. Other pathogens maintained at the island could also cause illness and death in humans. For these reasons, USDA conducts its work on Plum Island within a sealed biocontainment area that has special safety features designed to contain the pathogens. After the terrorist attacks on the United States of September 11, 2001, new laws and regulations required officials at the island to further restrict access to the pathogens to protect animal health and reduce the possibility of bioterrorism.

Pocket Guide to Chemical Hazards
National Institute for Occupational Safety and Health, 2003
This guide provides workers, employers, occupational health professionals, and others with general information on industrial hygiene and several hundred types of chemicals. The guide presents key information and data in abbreviated tabular form for 677 chemicals or substance groupings that are found in the work environment. The industrial hygiene information presented in the guide is designed to help readers recognize and control occupational chemical hazards.

Potassium Iodide (KI) (PDF)
Centers for Disease Control and Prevention, 2006
This fact sheet provides an overview of the chemical potassium iodide, also known as KI, and its possible uses in biochemical warfare.

Preparing for Public Health Emergencies: Meeting the Challenges in Rural America (PDF)
Harvard School of Public Health, Center for Public Health Preparedness, January 2005
This report includes proceedings from the first national conference on rural public health emergency preparedness, Bridging the Health Divide: The Rural Public Health Research Agenda. The conference, which was held in September 2004, was a collaborative effort of rural public health experts throughout the country.

Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy
Board on Neuroscience and Behavioral Health, Institute of Medicine, August 2003
This book from The National Academies Press emphasizes the need for a national public health approach for the prevention of and intervention in psychological reactions and symptoms related to terrorism. It makes recommendations in five areas: preventive measures, education and training for service providers, workplace preparedness, research needs, and ensuring preparedness through a comprehensive public health strategy.

Process Evaluation of Project Public Health Ready (PDF)
Rand Corporation, 2005
This report presents an evaluation of the pilot year of Project Public Health Ready, a voluntary program that teaches local public health agencies how to respond to bioterrorism and to protect the public's health.

Progress and Peril: Bioterrorism Preparedness Dollars and Public Health (PDF)
Elin Gursky, The Century Foundation, December 2003
This report maps out and assesses strategies used by public health sector officials to equip themselves with new competencies that respond to, mitigate, and protect against the threat of bioterrorism. Although progress is being made, interoperability among organizations remains a concern in mounting and sustaining the necessary responses to a large-scale infectious disease outbreak or bioterrorist attack.

Protection of Chemical and Water Infrastructure: Federal Requirements, Actions of Selected Facilities, and Remaining Challenges (PDF)
U.S. Government Accountability Office, March 2005
This report discusses the federal requirements for the security of the chemical and water sectors, both of which are defined as critical infrastructure systems and assets by the USA PATRIOT Act.

Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors
Centers for Disease Control and Prevention, October 2004
This all-hazards reference tool is for health professionals who are responsible for initiating the public health response during the first 24 hours of an emergency or disaster. The guide should be used in conjunction with existing emergency operations plans, procedures, guidelines, resources, assets, and incident management systems. It is not a substitute for public health emergency preparedness and planning activities.

Public Health Laboratories: Unprepared and Overwhelmed (PDF)
Trust for America's Health, June 2003
Developed by Trust for America's Health, this report focuses on the critical role of public health laboratories (including hospitals and local health departments) in America's war against terrorism. It assesses their ability to respond to specific chemical weapon events and recommends improvements for responding to both terrorism and conventional threats.

Public Health Labs Not Ready For Chemical Terrorism: Increasing Funding Vital to Strengthen Laboratory Infrastructure
Association of Public Health Laboratories, March–April 2003
This APHL study documents the ability of state public health labs to safely accept and handle samples from a weapon of mass destruction event. It concludes that response plans for biological pathogens are adequate but most labs have no plans for events involving military-grade chemicals, and suggests that greater federal funding is needed to enhance laboratory capacity.

Public Health Preparedness in the 21st Century (PDF)
RAND Corporation, March 2006
This publication outlines testimony presented before the Senate Health, Education, Labor and Pensions Committee, Subcommittee on Bioterrorism and Public Health Preparedness on March 28, 2006.

Public Health Preparedness: Response Capacity Improving, but Much Remains to Be Accomplished (PDF)
U.S. General Accounting Office, February 2004
No state is fully prepared to respond to a major public health threat. Since April 2003, states have improved their disease surveillance systems, communications and laboratory capacity, and workforce needed to respond to public health threats, but gaps in each remain. Moreover, regional planning between states is lacking, and many states lack surge capacity.

The Public/Private Response to Sudden Disease Outbreak (PDF)
Institute of Public Health Law, 2005
This summary provides a brief background of the 2003 SARS epidemic in Toronto, a description of the economic recovery plan that was developed in response, and five sets of lessons learned from the experience of the SARS economic recovery.

Radiological Dispersal Devices: Select Issues in Consequence Management (PDF)
D.A. Shea, Congressional Research Service, December 7, 2004
This report addresses controversies surrounding the health effects of low-level radiation, concerns related to decontamination following a radiological dispersal device (RDD) attack, and issues of federal research into RDD countermeasures.

Ready or Not . . . Findings and Recommendations of the APHL Chemical Terrorism Project (PDF)
Association of Public Health Laboratories, July 2003
This report illustrates gaps in state public health laboratories' readiness to respond to chemical warfare agents and summarizes research from surveys on laboratory safety, environmental testing, and workforce capabilities; site visits; and meetings of state and national experts.

Ready or Not? Protecting the Public's Health in the Age of Bioterroism
Trust for America's Health
Through an analysis of 10 indicators, this annual report assesses the level to which state and local first responders are prepared to handle bioterrorism and large-scale health emergencies. It illustrates areas of progress and areas where improvements need to be made and explains how to understand the difference in capabilities among the states, which must be able to work together during emergencies. The most current report is available online at the web site of Trust for America's Health.

Recognition of Illness Associated With the Intentional Release of a Biological Agent
Centers for Disease Control and Prevention, October 2001
This report offers health-care providers and public health personnel guidance in recognizing illnesses or patterns of illness that might be associated with the intentional release of biological agents.

Report on Biological Warfare Defense Vaccine Research and Development Program (PDF)
U.S. Department of Defense, July 2001
This report recommends ways to improve the U.S. Department of Defense's acquisition of biological defense vaccines.

Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation
Letter Report #1 (January 2003)
Letter Report #2 (March 2003)
Letter Report #3 (May 2003)
Letter Report #4 (August 2003)
Letter Report #5 (December 2003)
Letter Report #6 (July 2004)
The National Academies
At the request of the Centers for Disease Control and Prevention, the Institute of Medicine (IOM) convened an expert committee to advise on implementation of a pre-event smallpox vaccination program. IOM has provided their observations, conclusions, and recommendations in this series of reports.

Ricin As a Bioterrorist Agent
Texas Department of Health
In addition to outlining the symptoms of ricin poisoning, this fact sheet explains the diagnostic tests and supportive treatments that should be undertaken after a positive diagnosis is made.

Ricin Vaccine Protects Mice From Poisoning
Michael Hopkin, Nature Science Update, March 15, 2004
An experimental vaccine against ricin has produced encouraging results in mice. The treatment can be applied directly to the skin in the form of a patch, thus potentially eliminating the need for injections.

SARS Outbreak: Improvements to Public Health Capacity Are Needed for Responding to Bioterrorism and Emerging Infectious Diseases (PDF)
U.S. General Accounting Office, May 2003
Efforts by public health agencies and health care organizations to respond to major public health threats have improved but to what extent? According to this GAO study, workforce shortages exist; gaps in preparedness remain, specifically in disease surveillance systems and laboratory facilities; and public health responses to outbreaks of emerging infectious diseases such as SARS could be improved.

September 11: Health Effects in the Aftermath of the World Trade Center Attack (PDF)
U.S. Government Accountability Office, September 8, 2004
This report explains the health effects that have been observed in the aftermath of the World Trade Center attack and efforts to monitor and understand these ailments.

September 11: HHS Needs to Ensure the Availability of Health Screening and Monitoring for All Responders (PDF)
U.S. Government Accountability Office, July 23, 2007
Responders to the September 11, 2001 terrorist attack on the World Trade Center (WTC) were exposed to many hazards, and concerns remain about the long-term health effects of the disaster and the availability of health care services for those affected. In 2006, the Government Accountability Office (GAO) reported on problems with the Department of Health and Human Services' WTC Federal Responder Screening Program and with the Centers for Disease Control and Prevention's (CDC) distribution of treatment funding. This report assesses the status of services provided by the WTC Federal Responder Screening Program; efforts by CDC's National Institute for Occupational Safety and Health (NIOSH) to provide services to nonfederal responders residing outside the New York City area; and NIOSH awards to grantees for treatment services and efforts to estimate service costs.

September 11: Improvements Needed in Availability of Health Screening and Monitoring Services for Responders(PDF)
U.S. Government Accountability Office,  September 10, 2007
This testimony is based upon and updates the Government Accountability Office's report, September 11: HHS Needs to Ensure the Availability of Health Screening and Monitoring for All Responders . This testimony discusses the status of services provided by the Department of Health and Human Services' World Trade Center (WTC) Federal Responder Screening Program, efforts by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health (NIOSH) to provide services for nonfederal responders residing outside the New York City area, and NIOSH's awards to WTC health program grantees for treatment services.

Smallpox Vaccination: Implementation of National Program Faces Challenges (PDF)
U.S. General Accounting Office, April 2003
Amid growing concerns about a smallpox attack, the Centers for Disease Control and Prevention (CDC) is working with 62 state, local, and territorial jurisdictions to implement the civilian part of the National Smallpox Evaluation Program. This report examines implementation issues and challenges associated with the program.

The Smallpox Vaccination Program: Public Health in an Age of Terrorism (PDF)
Committee on Smallpox Vaccination Program Implementation, Institute of Medicine, The National Academies Press, 2005
The national Smallpox Vaccination Program, announced in December 2002, is the result of an extraordinary policy decision to vaccinate people against a disease that does not exist with a vaccine that poses some well-known risks. Because this decision can be considered only against the backdrop of the terrorist and bioterrorist attacks of 2001, the Centers for Disease Control and Prevention asked the Institute of Medicine to advise it on the implementation of a pre-event smallpox vaccination program. The institute's findings and recommendations are presented in this report.

Smallpox Vaccination: Review of the Implementation of the Military Program (PDF)
U.S. General Accounting Office, December 1, 2003
The National Smallpox Vaccination Program has two components: one for vaccinating civilians and another for vaccinating military personnel. This 11-page letter report from GAO describes the military component. Specifically, it addresses the steps (e.g., pilot program, tracking system, personnel education) that the U.S. Department of Defense took to implement its portion of the program.

State Mental Health Authorities' Response to Terrorism
National Association of State Mental Health Program Directors, February 2004
Created by the Medical Directors Council, this document serves as a clinical guide, a policy and planning stimulant, and a general information resource for the commissioner or medical director of the state mental health authority, who must be rapidly briefed before responding to a critical event.

Strengthening Global Preparedness for Defense Against Infectious Disease Threats
World Health Organization, September 2001
This report makes recommendations to improve national and international preparedness for defense against bioterrorism and outbreaks of infectious diseases. It examines trends and technologies affecting outbreaks and epidemics, associated costs, the need for global solutions, and a framework for disease surveillance and response.

Synopsis of Current Research of the Decontamination and Consequence Management Division (PDF)
U.S. Environmental Protection Agency, April 2005
This report reviews the current research on decontamination of buildings that have been intentionally contaminated by biological or chemical agents. The report further analyzes the contamination of air and indoor surfaces, decontamination methods, and disposal options for decontamination wastes.

Systematic Review: Surveillance Systems for Early Detection of Bioterrorism-Related Diseases (PDF)
Annals of Internal Medicine, June 1, 2004
Surveillance systems that track emerging illnesses are changing to address the threat of bioterrorism and to take advantage of the increasing availability of electronic data. The authors of this article found that few surveillance systems have been specifically designed to collect and analyze data for the early detection of a bioterrorist event. They concluded that because current evaluations of surveillance systems for detecting bioterrorism and emerging infections are insufficient, clinical and public health decisionmaking based on these systems may be compromised.

Targets for Terrorists: Chemical Facilities
Council on Foreign Relations, December 11, 2006
This resource from the Environmental Protection Agency identifies 15,000 facilities that produce, use, or store potentially dangerous quantities of hazardous chemicals.

Terrorism With Ionizing Radiation General Guidance: Pocket Guide (PDF)
U.S. Department of Veterans Affairs, August 2003
This pocket guide includes information about diagnosis, treatment considerations, decontamination procedures, and public health reporting procedures regarding exposure to radiation stemming from a terrorist attack.

Terrorist “Dirty Bombs”: A Brief Primer (PDF)
Jonathan Medelia, Congressional Research Service, April 1, 2004
This report discusses the mechanisms of radiological dispersal devices (dirty bombs), their effects and effectiveness, detection issues, and proposed responses to an attack.

The Threat of Pandemic Influenza: Are We Ready? Workshop Summary
National Academies' Press, Board on Global Assessment, 2005
According to this report, recent expert consultation convened by the World Health Organization concluded that "the unpredictability of influenza viruses and the speed with which transmissibility can improve means that the time for preparedness planning is now." Strong national infrastructures for public health law are needed to address influenza and should be developed to support the delivery of essential services, assign public health powers, and safeguard human rights.

Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Summary (PDF)
National Academy of Sciences, 2001
This summary recaps an evaluation of the Metropolitan Medical Response System (MMRS) program's effectiveness in enhancing local ability to respond to the consequences of weapons of mass destruction terrorism. The Phase I report studies almost 500 potential measures of local preparedness and provides preliminary assessments of existing community strengths and weaknesses. Phase II will develop a comprehensive assessment system for program evaluation. The full Phase I report is also available.

TOXNET Toxicology Data Network
U.S. National Library of Medicine, National Institutes of Health
The U.S. National Library of Medicine provides databases on toxicology, hazardous chemicals, environmental health, and toxic releases.

Training Physicians for Public Health Careers (Prepublication Copy) (PDF)
HTML
Committee on Training Physicians for Public Health Careers, National Academies Press, 2007
Despite advancements in public health, there is a growing shortage of public health workers and a critical shortage of public health physicians. The U.S. Congress has mandated that the Institute of Medicine undertake a study to determine what knowledge and skills are needed by public health physicians, the number of programs needed to maintain an adequate supply of physicians trained for public health careers, and how these programs can be funded. This report presents the results of the deliberations of the committee assembled to address this charge.

Triage for Civil Support: Using Military Medical Assets to Respond to Terrorist Attacks (PDF)
RAND Corporation, October 2004
This report researches the use of military medical assets to support civil authorities in the aftermath of a chemical, biological, radiological, nuclear, or conventional high explosives attack within the United States.

UCF, NIH Study: Effective, Safe Anthrax Vaccine Can Be Grown in Plants
University of Central Florida, December 19, 2005
This report discusses a molecular biologist's findings that enough anthrax vaccine to inoculate everyone in the United States could be grown inexpensively and safely with only 1 acre of tobacco plants.

U.S. Chemical Safety Board Strategic Plan: Fiscal Years 2007–2012 (PDF)
Memorial Institute for the Prevention of Terrorism, February 2007
The Chemical Safety Board revised their strategic plan in 2006 to place a heightened emphasis on investigations, studies, recommendations, and outreach efforts that have the potential to make a significant impact on chemical safety. Proposed goals include investigating chemical accidents, conducting safety studies, broadly disseminating agency findings, successfully closing safety recommendations, and targeting the development and retention of a high-performance workforce.

UT Southwestern Initiating Trials in Humans for Ricin Vaccine
University of Texas Southwestern, November 30, 2004
A potential vaccine for the deadly toxin ricin will enter the first phase of clinical testing in coming weeks at the University of Texas Southwestern Medical Center at Dallas. The Food and Drug Administration and the Southwestern Institutional Review Board have agreed that the trial can go forward in humans.

Vaccines in Civilian Defense Against Bioterrorism
Emerging Infectious Diseases, July-August 1999
This article discusses the value of vaccines in protecting the civilian population against the deliberate release of infectious agents and examines problems pertaining to smallpox and anthrax vaccines.

Vibrio vulnificus: Frequently Asked Questions
Centers for Disease Control and Prevention
Vibrio vulnificus is a bacterium in the same family as those that cause cholera. It normally lives in warm seawater and is part of a group of vibrios that are called "halophilic" because they require salt. This FAQ answers common questions about this bacterial agent and the potentially lethal illness that it produces.

Vulnerability of Populations and the Urban Health Care Systems to Nuclear Weapon Attack—Examples From Four American Cities
International Journal of Health Geographics, February 28, 2007
This report presents the potential thermal, blast, and radiation effects of 20 kiloton and 550 kiloton nuclear detonations on New York City; Chicago; Washington, D.C.; and Atlanta using 2000 block-level census data. A staggering number of hospitals, trauma centers, and other medical assets are likely to be in the fatality plume, which would render them essentially inoperable in a crisis.

What We Learn About Smallpox from Movies—Fact or Fiction (PDF)
Centers for Disease Control and Prevention, December 2004
This publication addresses some of the most notable misconceptions that might result from fictional programs about smallpox and links to detailed information about the disease.

What You Should Know About a Smallpox Outbreak (PDF)
Centers for Disease Control and Prevention, March 2004
This fact sheet provides a brief background on smallpox, details how people can be infected with smallpox and how it can spread, and offers information on treatment and prevention.

WHO Pandemic Influenza Draft Protocol for Rapid Response and Containment
World Health Organization, January 27, 2006
This draft protocol notes that although influenza pandemics are infrequent events, they spread rapidly and cause abrupt and significant changes in morbidity rates. At present, two primary stages have been implemented for addressing the current avian flu situation and reducing the threat of a pandemic. This document introduces a third complementary strategy, in which national and international planning and resources are coordinated for rapid detection near the start of any pandemic.

Who You Gonna Call? Responding to a Medical Emergency with the Strategic National Stockpile (PDF)
Center for Technology and National Security Policy, June 2004
This report reviews the history and current status of the Strategic National Stockpile (formerly the National Pharmaceutical Stockpile), its role in incident response, and its deployment in recent terrorism exercises. The report also explores legal and regulatory issues surrounding the stockpile.

World Trade Center: EPA's Most Recent Test and Clean Program Raises Concerns That Need to Be Addressed to Better Prepare for Indoor Contamination Following Disasters (PDF)
U.S. Government Accountability Office, September 5, 2007
The September 11, 2001 terrorist attack on the World Trade Center (WTC) blanketed Lower Manhattan in dust from building debris. In response, the Environmental Protection Agency (EPA) conducted an indoor clean and test program and, in 2003, EPA's Inspector General (IG) recommended improvements to the program and identified lessons learned for EPA's preparedness for future disasters. In 2004, a panel was formed to guide EPA in developing a second voluntary program, which was announced in 2006. This evaluation of EPA's second program discusses the extent to which EPA incorporated IG and panel recommendations; factors limiting the expert panel's ability to meet its goals; EPA's estimation of resources needed for the program; and the extent to which EPA has acted upon lessons learned regarding indoor contamination from disasters.