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10 Risk Management Pitfalls in the Management of Suspected Bioterrorism in the Pediatric Patient December 19, 2018

Posted by Andy Jagoda, MD in : Feature Update , trackback

10 Risk Management Pitfalls in the Management of Suspected Bioterrorism in the Pediatric Patient

1. “This isn’t New York City or Washington, DC; we don’t live in a target area. Bioterrorism preparedness is not a high priority for my practice.” Bioterrorism events often occur without warning—at any time, in any place. Many bioterrorism agents are highly contagious and can spread to remote areas of the country, due to travel of infected persons or wide dispersal of aerosolized agents. It is every emergency clinician’s obligation to become familiar with bioterrorism agents.

2. “If a bioterrorism patient shows up, I will be able to rely on the infectious disease and infection control teams for recommendations.” Recognizing suspicious illness patterns is an important responsibility of front-line emergency clinicians. While infectious disease and infection control specialists provide specific expertise, the protection of patients and staff depends on adherence to recommended protocols as early as possible.

3. “There are so many different agents that could be biological weapons. Trying to prepare for all the possibilities is overwhelming.” Many resources in print and online can support the emergency clinician. The CDC publishes clinical guidelines and manages electronic applications to support clinical decision making. The AAP also provides online resources for bioterrorism issues pertaining to children. (See Table 2.)

4. “Yes, he triggered the screening tool, but we have no rooms to isolate this patient. Besides, it is very unlikely that this is bioterrorism.” Failure to properly isolate patients can put other patients and staff at risk for any contagious illness. It is important to put safety first.

5. “Where would a child get anthrax? I haven’t heard anything in the news.” Children have particular physiologic and developmental vulnerabilities that put them at higher risk of being victims of bioterrorism agents. Therefore, children may show symptoms before public officials are aware that there has been an outbreak.

6. “Managing a surge from a bioterrorism event is similar to managing a mass casualty. We should be able to use similar protocols” Bioterrorism agents are often highly contagious and require public health support beyond the scope of any single healthcare facility. Specific protocols are important to best recognize and respond to the threat of bioterrorism.

7. “All children should receive postexposure pro-phylaxis after exposure to a bioterrorism agent. It’s the right thing to do.” Apply the recommended guidelines for PEP as recommended by the CDC. Not all medications or vaccines are safe for children and they should be considered in the context of the potential risks to the child.

8. “Yes, there has been a spike in pneumonic tularemia in the ED, but it’s endemic to this area, so that shouldn’t be cause for concern.” Any unusual cluster of presentations of Category A bioterrorism agents should be cause for concern. The inhalational form of any Category A illness should also be a red flag, as the aerosolized form of these agents is the most likely mechanism used for a bioterrorism attack.

9. “I don’t know how I would be able to tell if a cluster of patients had these unusual symptoms. There are at least 8 other hospitals in this city. I don’t have time to call them all to find out if they are seeing similar presentations.” Coordination with your local public health resources is essential in rare disease outbreaks. Since 2001, biosurveillance systems have been used to track unusual outbreaks and serve as a resource for health systems.

10. “Even though I have suspicions that this case could be due to a bioterrorism agent, I don’t want to cause the laboratory staff to panic. I’ll just send the culture and wait for the results.” Laboratory personnel are at high risk for exposure from the highly contagious bioterrorism agents. Most Category A agents require special reagents and tests only available in secured public health laboratories. Communicating concerns early and using appropriate personal protective gear consistently are essential to prevent further outbreak of a highly contagious illness.

 

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Last Modified: 02-18-2019
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