Reports and talk of terrorism is ubiquitous in most media outlets today. Many would dismiss the usage of biological agents as a mere theoretical threat. However, history dates bioterrorism as far back as 184 B.C. Biological agents have been shown to be a significant supplementary tool for war and terrorism. The United States local and national government have been preparing for what is called "not if, but when and how extensive" biological terrorism. Anesthesiologists also need to prepare and have a sound understanding of biological and chemical agents and how to treat victims of such attacks. Anesthesiologists are professionals in resuscitations and airway management and can be vital resources when aiding victims of biological warfare. Intro Before the September 11th attacks on the United States, terrorism was rarely on the forefront of the American mind. Today, terrorism is reported and analyzed in almost every media outlet. Terrorism has become so prevalent, it is not a question of if but when another mass casualty like the events of September 11th will happen again, according to the Department of Defense (DOD). With this in mind, it is in the interest of every health care provider to aid in preparing for another mass casualty response. Anesthesiologists have a special knowledge of resuscitation and airway management that will make them a vital resource in the health care team when responding to these mass injuries. 1 The prior knowledge of bioterrorism agents including the history of their usage, pathophysiology, diagnosis and treatment of victims will result in more lives saved.Terrorists have used many agents to further their cause including biological agents. 2 Bioterrorism “involves the threat or use of biological agents by individuals or groups motivated by political, religious, ecological, or other ideological objectives.” 3 It is also defined by the CDC as ‘‘the intentional release of bacteria, viruses or toxins for the purpose of harming or killing civilians'‘ 4 Many would dismiss the usage of biological weapons as merely a theoretical possibility with these four arguments. l) The use of biological weapons is historically rare and they will not be an issue in the future. 2) Their usage is so morally repugnant that no one would have the impudence to release them. 3) The science behind biological warfare is so sophisticated and expensive that only highly technological refined laboratories could produce such agents. 4) The use of biological warfare is so destructive and unpredictable that its usage is unthinkable. 5 These four arguments fail to take in account a complete history of warfare. A 2000 report of the U.S. intelligence agency described bioterrorism as “nontraditional” threat. However, many argue biological infectious disease is the most traditional threat. 6 It must be remembered that bioterrorism is not new to this century, it can be dated back as far as antiquity. 7 Historical usage of bioterrorism Pre bacterial Some of the first known written description of bacterial and chemical weapons dates back to earlier Greek mythology. The stories of the Greek hero Hercules told of his battles with Hydra using burning firebrand. 8 In 184 B.C the great Carthaginian leader Hannibal, during a naval battle against King Eumenes, cast pots of snakes into the midst of their enemies. The attack of an unexpected biological weapon caused the Pergamene to lose the battle. 6
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