Bioterrorism: Preparing for the impossible or the improbable.
OBJECTIVE
To review the current literature surrounding the history of bioterrorism, the relative risk of a bioterrorist attack, methods of surveillance for biological agents, identification and management of various biological agent casualties, as well as the role of the intensivist in managing a bioterrorist attack.


METHODS
Internet and Medline search (from 1966 to 2004) for articles relating to bioterrorism, biological agents, biological warfare, hospital preparedness, disaster management, and intensive care.


CONCLUSIONS
There are few instances of a successful large-scale biological weapons attack in history. Weaponization of biological agents for aerosol dispersal is difficult and has often proved to be the rate-limiting step for a successful attack. Although a successful biological attack is currently unlikely, it is still feasible. More importantly, the threat of one is likely to cause much panic in the public, while a successful attack would overburden the current healthcare infrastructure. Intensivists will need to have specific knowledge of identifying and managing casualties from various biological agents. In addition, they will need to play an integral part in the preparedness of their institutions and communities for managing a bioterrorist event.
Karwa
Manoj
M
Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. mkarva@montefiore.org
Currie
Brian
B
Kvetan
Vladmir
V
D001694:Biological Warfare / Q000266:history; D023482:Bioterrorism / Q000266:history; D002487:Centers for Disease Control and Prevention, U.S. / Q000458:organization & administration; D003140:Communicable Disease Control / Q000458:organization & administration; D003141:Communicable Diseases / Q000175:diagnosis / Q000628:therapy; D003422:Critical Care / Q000458:organization & administration*; D004189:Disaster Planning / Q000266:history; D004196:Disease Outbreaks / Q000517:prevention & control*; D004784:Environmental Monitoring / Q000379:methods; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049691:History, Medieval; D006801:Humans; D011159:Population Surveillance / Q000379:methods; D018570:Risk Assessment / Q000458:organization & administration; D014481:United States