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Bioterrorism Awareness for EMS

Terrorism is defined as the unlawful use of force against persons or property to intimidate or coerce government, the civilian population or any segment thereof in the furtherance of political or social objectives. Potential terrorist events could involve biological, chemical, radiological and explosive emergencies. In virtually every incident, EMS, fire and law enforcement personnel will be among the first responders.

Prevention, preparedness, response and recovery are considered the four phases of contingency planning in terms of dealing with any potential scenario. Many governmental and private agencies have implemented preventive measures to ward off terrorist threats, but prevention alone may not suffice. While we may not be able to prevent every event from occurring, we can be prepared to recognize and respond.

Biological Agents

The Federal Emergency Management Agency (FEMA) defines biological agents as organisms or toxins that have illness-producing effects on people, livestock and crops. They can be dispersed as aerosols or airborne particles. Terrorists may use biological agents to contaminate food or water because they are extremely difficult to detect. And, because they can't be easily detected and may take time to show their effects, it is almost impossible to know that an attack has occurred. The Centers for Disease Control and Prevention (CDC) lists three categories of biological agents: A, B and C. These are the diseases and agents, both old and new, that could confront our nation.

High-priority agents (Category A) include organisms that pose a risk to national security because they can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness.

  • Anthrax (Bacillus anthracis)
  • Botulism (Clostridium botulinum toxin)
  • Plague (Yersinia pestis)
  • Smallpox (variola major)
  • Tularemia (Francisella tularensis)
  • Viral hemorrhagic fevers (filoviruses such as Ebola, Marburg)
  • Arenaviridae (e.g., Lassa, Machupo).

The second highest priority agents (Category B) include those that are moderately easy to disseminate; result in moderate morbidity rates and low mortality rates; and require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.

  • Brucellosis (Brucella species)
  • Epsilon toxin of Clostridium perfringens
  • Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella)
  • Glanders (Burkholderia mallei)
  • Melioidosis (Burkholderia pseudomallei)
  • Psittacosis (Chlamydia psittaci)
  • Q fever (Coxiella burnetii)
  • Ricin toxin from Ricinus communis (castor beans)
  • Staphylococcal enterotoxin B
  • Rickettsia prowazekii
  • Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis])
  • Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum).

The third highest priority (Category C) agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability; ease of production and dissemination; and potential for high morbidity and mortality rates and major health impact.

Response Issues

An individual affected by a biological agent requires immediate medical attention, yet many first responders will probably be unaware that a biological substance is involved. Adding to an already complex situation is the fact that some agents are contagious, and victims may need to be quarantined. In fact, some medical facilities may not wish to receive victims for fear of contaminating the hospital population. This puts first responders at even greater risk.

Should government officials become aware of a biological attack, either through an informant or a warning by terrorists, they will most likely instruct the public to seek shelter and seal the premises or evacuate immediately. However, it is more likely that first responders will already have treated and transported victims to applicable facilities before information or confirmation of biological agent use is made. In fact, fire, EMS or law enforcement personnel may not be the initial first responders to an incident. It is just as likely that members of the public will already have sought medical treatment from family physicians. This means that first responders in many biological scenarios could be nurses, doctors, hospitals and private physicians, rather than traditional emergency response personnel.


FEMA suggests that everyone, including first responders, take the following precautions:

  • Be alert and aware of the surrounding area. The very nature of terrorism suggests that there may be little or no warning.
  • Take precautions when traveling. Be aware of conspicuous or unusual behavior. Do not accept packages from strangers or leave luggage unattended.
  • Learn where emergency exits are located. Think ahead about how to evacuate a building, subway or congested public area in a hurry. Learn where staircases are located.
  • Notice your immediate surroundings. Be aware of heavy or breakable objects that could move, fall or break in an explosion.


It is important to understand that the issues surrounding bioterrorism and all weapons of mass destruction are complex. In an effort to enhance response to such events, EMS should handle all incidents from the perspective of an all-hazards approach. Prevention, preparation, response and recovery are essential to the safe mitigation of all incidents. Organizations must be prepared. Plan now for a safer tomorrow. Your personnel and communities depend on you.

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