Months have passed since the first reports of anthrax related fatalities shook an already frightened and besieged nation. The expected circuit of news specials on bioterrorism has come and gone, and the sleeping giant of American consciousness has seemingly turned its attention elsewhere. Would that family physicians could do the same.

As it stands, no one knows who authored the letters and enclosed their deadly contents, although many suspect a domestic source. The threat of an international terrorist attack using biological weaponry looms as great as it ever has. Like it or not, America is at war, and in this arena, physicians are the country’s first line of defense.

American physicians must be prepared to recognize some of the world’s most dangerous diseases, some of which have been considered eradicated in this country for decades. They must be able to react quickly, advising patients and officials alike, but many of today’s family doctors have never seen these diseases and a false alarm could cause a national panic.

On Dec. 14, AAFP President Warren Jones, M.D., and Jonathan Temte, M.D., Ph.D., a family physician and infectious disease researcher, addressed the National Press Club in Washington, D.C., explaining the importance of family physicians in the fight against biological terrorism. “As family physicians, we would be the first to have contact with patients who may be suffering from a nuclear, biological or chemical attack,” Jones said, adding, “as such, we must be prepared to recognize, treat and report such outbreaks.”

Both physicians stressed to the assembled reporters that the relationships and trust doctors build with their patients will be crucial in dealing with any attack. “The real force multiplier in biological terrorism is panic, misinformation and paranoia associated with it,” Temte said. “The early recognition and response to bioterrorism will depend primarily on a well educated physician force interacting with public health officials and having the trust of patients.”

The relationships physicians have within their communities will help ensure calm, but access to credible information is necessary to maintain such a high level of trust. According to Jones, the AAFP is committed to providing that information and support. The academy has posted a comprehensive resource for physicians on its Web site at www.aafp.org/btresponse. The site contains material and resources on infectious diseases, bioterror and emergency preparedness, and patient handouts available for duplication and distribution at the point of care. The site lists a host of links connecting family physicians to a vast supply of off-site resource material. Among others, the list includes links to the U.S. Army Medical Research Institute of Infectious Diseases, the Centers for Disease Control and the Johns-Hopkins Center for Civilian Biodefense.

In November, Jones sent a letter to all members of the academy outlining a sizeable list of resources the academy has put together and encouraging physicians to step into the role the nation needs them to fill—to become sentinel family physicians. In this role, physicians must be able to:

  • recognize terrorist threats and events without overreacting,

  • help patients recognize these threats without overreacting,

  • treat patients when appropriate, and

  • know what, when and where to report.

  

“As sentinels in this war, we are charged with protecting the public health and as physicians, we are responsible to our patients and to maintaining their trust,” Jones told the National Press Club. “As an organization, we are committed to providing the means necessary to meet these and all of the other responsibilities we have to our patients, our communities and to our nation.”

Closer to home, the TAFP has begun mobilizing its resources to assist Texas’ physicians in preparing for the threat of future attacks. First, in an effort to educate and assist Texas physicians, the Texas Medical Association has created a Bioterrorism Task Force. At the initial Task Force meeting on Nov. 7, TAFP President Justin Bartos, M.D., joined physicians and bioterror experts from across the country to discuss and begin coordinating organized medicine’s response and activities. Among other things, the task force will study and recommend the best ways to educate physicians and patients on bioterror, assist the creation of local protocols in the event an attack occurs, and perhaps most importantly, ways to improve the public health infrastructure with the hopes that Texas will be able to quickly deal with any disaster in the future. 
 

Also in attendance at that meeting was the recently appointed commissioner of health, Eduardo Sanchez, M.D., of Austin. A family physician formally in private practice, Sanchez outlined a six-point plan he envisions for the Texas Department of Health during the coming months:

  • create early response teams to quickly mobilize, identify and respond to potential events;

  • expand and enhance TDH’s laboratory response and technological capabilities, allowing TDH to quickly process potential agents and respond appropriately; 

  • enhance and centralize TDH and local health office surveillance units;

  • enhance the TDH Health Alert Network;

  • create a State Office of Epidemiologists to be directed by nationally recognized bioterror expert Dennis Perrotta, Ph.D, and employing as many as 60 epidemiologists; and

  • expand TDH laboratory chemical terror capabilities.

Sanchez explained that TDH will immediately begin implementing this plan and has been given an initial $12 million budget from the state to commence. Additionally, Sanchez encouraged Texas physicians to quickly report to TDH any unusual illnesses or suspected outbreaks by calling (800) 705-8868. He pointed out that the most effective response to any outbreak or attack is quick recognition, communication and coordination. TDH is Texas’ public health office and stands ready to assist physicians and patients in the event of a potential outbreak or disaster, he said.

On another front, TAFP has begun the process of creating bioterror CME opportunities for physicians. Recognizing that physician education and quick diagnosis is the most important aspect of responding to a biological attack, TAFP leadership has directed its staff to fast-track these CME seminars. In January 2002, TAFP is hosting six Prime-CME seminars on bioterror. The TAFP Web Site, www.tafp.org, has also been updated with links to information on bioterror and contains information on the upcoming CME events. TAFP will continue to evaluate and address the educational needs of its members as events dictate.

Following the lead of his predecessor President George W. Bush, Texas Gov.Rick Perry announced the creation of the Texas Homeland Security Task Force on Oct. 1. In announcing its creation, Governor Perry directed the task force to coordinate efforts with the Federal Office of Homeland Security, neighboring states, and Mexican officials. The governor named current Texas Land Commissioner David Dewhurst as Chair of the group. As Commissioner of Health, Dr. Eduardo Sanchez is also a member of the task force. It is charged with:

  • assuring Texans of state and local preparedness to respond to threats;

  • assessing the ability of state and local government agencies to respond to threats and to effectively provide victims assistance;

  • aiding coordination among federal, state and local efforts; and

  • developing recommendations to improve Texas’ ability to detect, deter and coordinate response to any terrorist events.

The State of Texas has also presented the Federal Emergency Management Agency with a request for $430 million dollars to combat terrorism. Part of this request has been targeted for TDH in an effort to further strengthen its capabilities. A question left unanswered at this time is how does an already troubled economy and an extremely strapped state budget pay for everything it needs to accomplish in the war against terrorism? As with the ongoing war on terror, the answer may not be known for years to come.

The developing military situation, both abroad and at home, has highlighted an ever present need in the military reserves. The Texas Army National Guard reports a 50 percent shortage of physicians, especially in the primary care specialties, needed to conduct its operations.

In November, Texas Army National Guard Recruiter Warrant Officer Travis Evans made a presentation to the Family Practice Residency Advisory Committee outlining the shortage and the incentives to join the National Guard. Evans stated the Guard has a $50,000 student loan repayment option, signing bonuses of up to $30,000, and additional training assistance monies available to physicians who join. If interested, you may contact Warrant Officer Evans at (512) 782-5318 or e-mail travis.evans@tx.ngb.army.mil..

  
AAFP’s online resources

The AAFP has compiled clinical information on potential bioterrorist pathogens to help you recognize and treat the effects of these weapons. The material is available at www.aafp.org/btresponse on the AAFP Web site. Other features online include:

  • an e-mail discussion list, letting you share your news and views on bioterrorist agents such as anthrax and smallpox;

  • patient handouts on bioterrorism, available for duplication and distribution in your office;

  • the latest bioterrorism news updates;

  • related articles from recent issues of the CDC’s Morbidity and Mortality Weekly Report;

  • links to more information about biological, chemical and nuclear weapons of mass destruction;

  • resources for both patients and physicians about post-disaster mental health concerns; and

  • contact information for your state’s public health agencies and FBI field offices.

Poster for patients

A link on the site will allow you to download a page you can duplicate and post in your exam rooms (http://www.aafp.org/news/presletter/poster.pdf Adobe PDF format, 267KB). The AAFP Web site is listed for your Internet-friendly patients who want quick access to information. The notice suggests—in a reassuring, short message—that you’re available to respond to your patients’ concerns, to diagnose infections such as anthrax and to discuss whether treatment is indicated.