title: Lessons learned from clinical anthrax drills: evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments.
abstract: OBJECTIVE
  Emergency department (ED) physicians and nurses are considered critical sentinels of a bioterrorist attack. We designed a special hospital drill to test EDs' response to inhalational anthrax and assess the level of preparedness for anthrax bioterrorism. We hypothesized that the occurrence of such a drill in an ED would improve the knowledge of its physicians, even those who had not actually participated in the drill.
  
  
  METHODS
  We conducted 23 drills at all Israeli general hospitals' EDs. An actor entered the walk-in triage area, simulating a febrile patient with lower respiratory complaints. A chest radiograph with mediastinal widening, as can be seen in early anthrax disease, was planted in the hospital's imaging results system. Patients were instructed to give additional epidemiologic clues, such as having a few friends with a similar syndrome. Either before or after the drills, we distributed multiple choice tests about diagnosis and management of anthrax to the 115 senior emergency physicians at these hospitals.
  
  
  RESULTS
  In 91% of EDs, a decision to admit the patient was made. Sixty-one percent included anthrax in the differential diagnosis and activated the appropriate protocols. Only 43% contacted all relevant officials. Average score on the anthrax tests was 58 (of 100). Physicians who were tested before the drill (in their institution) achieved a mean score of 54.5, whereas those who were tested after their ED had been exercised achieved a mean score of 59.3.
  
  
  CONCLUSIONS
  A national framework of drills on bioterrorism can help estimate and potentially augment national preparedness for bioterrorist threats. It is not, on its own, an effective educational tool. More emphasis should be given to formal accredited continuing medical education programs on bioterrorism, especially for emergency physicians and ED nurses, who will be in the front line of a bioterrorist attack.
authors.affiliation: Israeli Defense Forces Home Front Command, Ramat-Gan, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Leiba
authors.forename: Avi
authors.initials: A
authors.lastname: Goldberg
authors.forename: Ariel
authors.initials: A
authors.lastname: Hourvitz
authors.forename: Yoram
authors.initials: Y
authors.lastname: Amsalem
authors.forename: Adi
authors.initials: A
authors.lastname: Aran
authors.forename: Gali
authors.initials: G
authors.lastname: Weiss
authors.forename: Ronit
authors.initials: R
authors.lastname: Leiba
authors.forename: Yoav
authors.initials: Y
authors.lastname: Yehezkelli
authors.forename: Avishay
authors.initials: A
authors.lastname: Goldberg
authors.forename: Yehezkel
authors.initials: Y
authors.lastname: Levi
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-Dayan
mesh_terms: D000881:Anthrax / Q000175:diagnosis* / Q000628:therapy*; D023482:Bioterrorism; D004189:Disaster Planning / Q000458:organization & administration; D004636:Emergency Service, Hospital; D006801:Humans; D007557:Israel; D016544:Patient Simulation; D013902:Radiography, Thoracic; D014218:Triage