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Ferrada P, Cannon JW, Kozar RA, Bulger EM, Sugrue M, Napolitano LM, Tisherman SA, Coopersmith CM, Efron PA, Dries DJ, Dunn TB, Kaplan LJ. Surgical Science and the Evolution of Critical Care Medicine. Crit Care Med 2023; 51:182-211. [PMID: 36661448 DOI: 10.1097/ccm.0000000000005708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.
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Affiliation(s)
- Paula Ferrada
- Division of Trauma and Acute Care Surgery, Department of Surgery, Inova Fairfax Hospital, Falls Church, VA
| | - Jeremy W Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemary A Kozar
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eileen M Bulger
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington at Seattle, Harborview, Seattle, WA
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, County of Donegal, Ireland
| | - Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Craig M Coopersmith
- Division of General Surgery, Department of Surgery, Emory University, Emory Critical Care Center, Atlanta, GA
| | - Phil A Efron
- Department of Surgery, Division of Critical Care, University of Florida, Gainesville, FL
| | - David J Dries
- Department of Surgery, University of Minnesota, Regions Healthcare, St. Paul, MN
| | - Ty B Dunn
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Section of Surgical Critical Care, Surgical Services, Philadelphia, PA
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2
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Al-Zinati M, Alrashdan R, Al-Duwairi B, Aloqaily M. A re-organizing biosurveillance framework based on fog and mobile edge computing. MULTIMEDIA TOOLS AND APPLICATIONS 2020; 80:16805-16825. [PMID: 32837246 PMCID: PMC7244940 DOI: 10.1007/s11042-020-09050-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 05/29/2023]
Abstract
Biological threats are becoming a serious security issue for many countries across the world. Effective biosurveillance systems can primarily support appropriate responses to biological threats and consequently save human lives. Nevertheless, biosurveillance systems are costly to implement and hard to operate. Furthermore, they rely on static infrastructures that might not cope with the evolving dynamics of the monitored environment. In this paper, we present a reorganizing biosurveillance framework for the detection and localization of biological threats with fog and mobile edge computing support. In the proposed framework, a hierarchy of fog nodes are responsible for aggregating monitoring data within their regions and detecting potential threats. Although fog nodes are deployed on a fixed base station infrastructure, the framework provides an innovative technique for reorganizing the monitored environment structure to adapt to the evolving environmental conditions and to overcome the limitations of the static base station infrastructure. Evaluation results illustrate the ability of the framework to localize biological threats and detect infected areas. Moreover, the results show the effectiveness of the reorganization mechanisms in adjusting the environment structure to cope with the highly dynamic environment.
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Affiliation(s)
- Mohammad Al-Zinati
- Department of Software Engineering, Jordan University of Science and Technology, Irbid, 22110 Jordan
| | - Reem Alrashdan
- Department of Software Engineering, Jordan University of Science and Technology, Irbid, 22110 Jordan
| | - Basheer Al-Duwairi
- Department of Network Engineering and Security, Jordan University of Science and Technology, Irbid, 22110 Jordan
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3
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Rapid Detection Device for Salmonella typhi in Milk, Juice, Water and Calf Serum. Indian J Microbiol 2018; 58:381-392. [PMID: 30013283 DOI: 10.1007/s12088-018-0730-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022] Open
Abstract
A limit of detection of 200 CFU/mL of Salmonella typhi spiked in various sample matrices were achieved in 30 min. The sample matrices were raw/unprocessed milk, commercially available milk, juice from packed bottles, fresh juice from carts, potable water, turbid water and calf serum. The complete protocol comprised of three steps: (a) cell lysis (b) nucleic acid amplification and (c) an in situ optical detection. The cell lysis was carried out using a simple heating based protocol, while the loop-mediated isothermal amplification of DNA was carried out by an in-house designed and fabricated system. The developed system consists of an aluminum block fitted with two cartridge heaters along with a thermocouple. The system was coupled to a light source and spectrometer for a simultaneous in situ detection. Primers specific for STY2879 gene were used to amplify the nucleic acid sequence, isolated from S. typhi cells. The protocol involves 15 min of cell lysis and DNA isolation followed by 15 min for isothermal amplification and simultaneous detection. No cross-reactivity of the primers were observed at 106 CFU/mL of Escherichia coli, Vibrio cholerae, Salmonella typhimurium, Salmonella paratyphi A, Pseudomonas aeruginosa, Bacillus cereus, Lysteria monocytogenes, Clostridium botulinum, Staphylococcus aureus and Salmonella havana. In addition, the system was able to detect S. typhi of 200 CFU/mL in a concoction of 106 CFU/mL of E. coli, 106 CFU/mL of V. cholerae, and 106 CFU/mL of hepatocyte-derived cellular carcinoma HUH7 cells. The proposed rapid diagnostic system shows a promising future in the field of food and medical diagnostics.
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4
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Abstract
Regular review of the management of bioterrorism is essential for maintaining readiness for these sporadically occurring events. This review provides an overview of the history of biological disasters and bioterrorism. I also discuss the recent recategorization of tier 1 agents by the U.S. Department of Health and Human Services, the Laboratory Response Network (LRN), and specific training and readiness processes and programs, such as the College of American Pathologists (CAP) Laboratory Preparedness Exercise (LPX). LPX examined the management of cultivable bacterial vaccine and attenuated strains of tier 1 agents or close mimics. In the LPX program, participating laboratories showed improvement in the level of diagnosis required and referral of isolates to an appropriate reference laboratory. Agents which proved difficult to manage in sentinel laboratories included the more fastidious Gram-negative organisms, especially Francisella tularensis and Burkholderia spp. The recent Ebola hemorrhagic fever epidemic provided a check on LRN safety processes. Specific guidelines and recommendations for laboratory safety and risk assessment in the clinical microbiology are explored so that sentinel laboratories can better prepare for the next biological disaster.
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Affiliation(s)
- Elizabeth Wagar
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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5
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Grundmann O. The current state of bioterrorist attack surveillance and preparedness in the US. Risk Manag Healthc Policy 2014; 7:177-87. [PMID: 25328421 PMCID: PMC4199656 DOI: 10.2147/rmhp.s56047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The use of biological agents as weapons to disrupt established structures, such as governments and especially larger urban populations, has been prevalent throughout history. Following the anthrax letters sent to various government officials in the fall of 2001, the US has been investing in prevention, surveillance, and preparation for a potential bioterrorism attack. Additional funding authorized since 2002 has assisted the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the Environmental Protection Agency to invest in preventative research measures as well as preparedness programs, such as the Laboratory Response Network, Hospital Preparedness Program, and BioWatch. With both sentinel monitoring systems and epidemiological surveillance programs in place for metropolitan areas, the immediate threat of a large-scale bioterrorist attack may be limited. However, early detection is a crucial factor to initiate immediate response measures to prevent further spread following dissemination of a biological agent. Especially in rural areas, an interagency approach to train health care workers and raise awareness for the general public remain primary tasks, which is an ongoing challenge. Risk-management approaches in responding to dissemination of biological agents, as well as appropriate decontamination measures that reduce the probability of further contamination, have been provided, and suggest further investments in preparedness and surveillance. Ongoing efforts to improve preparedness and response to a bioterrorist attack are crucial to further reduce morbidity, mortality, and economic impact on public health.
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Affiliation(s)
- Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA
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6
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Classifying infectious disease outbreaks to improve timeliness and efficiency of response. Disaster Med Public Health Prep 2014; 8:89-94. [PMID: 24612828 DOI: 10.1017/dmp.2014.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Following the intentional dissemination of B.anthracis through the U.S. Postal Service in 2001, use of the term "naturally occurring" to classify some infectious disease outbreaks has become more evident. However, this term is neither a scientific nor an epidemiologic classification that is helpful in describing either the source or the mode of transmission in outbreaks. In this paper, the authors provide examples of how and when the public health community has recognized potentially flawed or misleading taxonomy in the past and taken steps to improve the taxonomy's accuracy and usefulness. We also offer examples of alternative terms for classifying outbreaks since inaccurate descriptions of outbreaks could potentially lead to a flawed or incomplete set of underlying assumptions about the outbreak's causal factors. This, in turn, could lead to implementing a flawed or incomplete intervention or response strategy which could extend the duration of the outbreak, resulting in avoidable morbidity and mortality.
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Abstract
Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.
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Affiliation(s)
- Michael D Christian
- Royal Canadian Air Force, Department of National Defence, 600 University Avenue, Room 18-232-1, Toronto, Ontario M5G 1X5, Canada.
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9
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Biosurveillance: a review and update. Adv Prev Med 2012; 2012:301408. [PMID: 22242207 PMCID: PMC3254002 DOI: 10.1155/2012/301408] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 09/18/2011] [Accepted: 11/10/2011] [Indexed: 11/18/2022] Open
Abstract
Since the terrorist attacks and anthrax release in 2001, almost $32 billion has been allocated to biodefense and biosurveillance in the USA alone. Surveillance in health care refers to the continual systematic collection, analysis, interpretation, and dissemination of data. When attempting to detect agents of bioterrorism, surveillance can occur in several ways. Syndromic surveillance occurs by monitoring clinical manifestations of certain illnesses. Laboratory surveillance occurs by looking for certain markers or laboratory data, and environmental surveillance is the process by which the ambient air or environment is continually sampled for the presence of biological agents. This paper focuses on the ways by which we detect bioterrorism agents and the effectiveness of these systems.
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Cutaneous manifestations of category A bioweapons. J Am Acad Dermatol 2011; 65:1213.e1-1213.e15. [DOI: 10.1016/j.jaad.2010.08.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 08/06/2010] [Accepted: 08/06/2010] [Indexed: 11/22/2022]
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Rokach A, Cohen R, Shapira N, Einav S, Mandibura A, Bar-Dayan Y. Preparedness for anthrax attack: the effect of knowledge on the willingness to treat patients. DISASTERS 2010; 34:637-643. [PMID: 20187905 DOI: 10.1111/j.1467-7717.2010.01161.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Little is known about the factors that may impact on the willingness of physicians and nurses to treat patients during a bioterrorism attack. This survey was conducted among 76 randomly selected nurses and physicians in the emergency rooms of three public hospitals in order to analyse the relationship between knowledge, profession and the willingness to treat anthrax. The study finds that the willingness of physicians and nurses to come to work is 50% greater among the group with the highest knowledge about anthrax (P < 0.0001). Within that group, the willingness to treat patients suspected of being infected with anthrax was 37% greater (P < 0.0001) and the willingness to treat patients diagnosed with anthrax was 28% greater (P = 0.004) than in the other groups. These results imply that enhancement of knowledge among health care workers may improve their willingness to come to work and treat patients infected with anthrax during a bioterrorism attack.
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Affiliation(s)
- Ariel Rokach
- NBC Hospital, Israeli Defense Forces Home Front Command Medical Department, Israel
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12
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Abstract
There has been an abundance of different bioterrorist attack scenarios and consequently an unclear biodefense strategy so far. We present a framework for bioterrorism risk assessment that we believe would be useful for policymakers and understandable without needing to be an expert in this field. We retrieved the Medline database via PubMed (from January 1987 to January 2009) and cross-referenced and reviewed the terms biological weapons, biological attacks, bioterror, bio(defense), bio(strategy) and epidemiologic models, and risk assessment. Additionally, we conducted an internet search with the same terms and strategy. We divided bioterrorist attacks into 3 categories: strategical (large-scale), operational (middle-scale), and tactical (small-scale). A bioterrorist attack is presented as a 4-component chain model, including perpetrators, agents, means of delivery, and targets. For any of these 4 components, we propose quantitative and qualitative risk assessment parameters. Here we present a simple scoring system within our model applied to the 2001 U.S. anthrax attacks.
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14
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Rubin GJ, Amlot R, Rogers MB, Hall I, Leach S, Simpson J, Wessely S. Perceptions and reactions with regard to pneumonic plague. Emerg Infect Dis 2010; 16:120-2. [PMID: 20031056 PMCID: PMC2874346 DOI: 10.3201/eid1601.081604] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We assessed perceptions and likely reactions of 1,005 UK adults to a hypothetical
terrorist attack involving pneumonic plague. Likely compliance with official
recommendations ranged from good (98% would take antimicrobial drugs) to poor (76% would
visit a treatment center). Perceptions about plague were associated with these
intentions.
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Affiliation(s)
- G James Rubin
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, James Black Centre, 125 Coldharbour Lane, Camberwell, London SE5 9NU, UK.
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15
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Rebmann T. Assessing hospital emergency management plans: a guide for infection preventionists. Am J Infect Control 2009; 37:708-14.e4. [PMID: 19699558 PMCID: PMC7132688 DOI: 10.1016/j.ajic.2009.04.286] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 04/13/2009] [Accepted: 04/14/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospital emergency management plans are essential and must include input from an infection preventionist (IP). Multiple hospital planning documents exist, but many do not address infection prevention issues, combine them with noninfection prevention issues, or are disease/event specific. An all-encompassing emergency management planning guide for IPs is needed. METHODS A literature review and Internet search were conducted in December 2008. Data from relevant sources were extracted. A spreadsheet was created that delineated hospital emergency management plan components of interest to IPs. RESULTS Of the sources screened, 49 were deemed relevant. Eleven domains were identified: (1) having a plan; (2) assessing hospital readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) having laboratory support; (8) addressing surge capacity issues; (9) having anti-infective therapy and/or vaccines; (10) providing infection prevention education; and (11) managing physical plant issues. CONCLUSION Infection preventionists should use this article as an assessment tool for evaluating their hospital emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.
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Affiliation(s)
- Terri Rebmann
- Institute of Biosecurity, Saint Louis University, School of Public Health, St Louis, MO 63104, USA.
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16
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Fulmer T, Portelli I, Foltin GL, Zimmerman R, Chachkes E, Goldfrank LR. Organization-based incident management: developing a disaster volunteer role on a university campus. ACTA ACUST UNITED AC 2007; 5:74-81. [PMID: 17719508 DOI: 10.1016/j.dmr.2007.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 06/22/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catastrophic events are an ongoing part of life, affecting society both locally and globally. Recruitment, development, and retention of volunteers who offer their knowledge and skills in the event of a disaster are essential to ensuring a functional workforce during catastrophes. These opportunities also address the inherent need for individuals to feel necessary and useful in times of crisis. Universities are a particularly important setting for voluntary action, given that they are based in communities and have access to resources and capabilities to bring to bear on an emergency situation. METHODS The purpose of the study was to discern how one large private organization might participate and respond in the case of a large scale disaster. Using a 2-phase random sample survey, 337 unique respondents (5.7%) out of a sample of 6000 replied to the survey. RESULTS These data indicate that volunteers in a private organization are willing to assist in disasters and have skills that can be useful in disaster mitigation. DISCUSSION Much is to be learned related to the deployment of volunteers during disaster. These findings suggest that volunteers can and will help and that disaster preparedness drills are a logical next step for university-based volunteers.
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Affiliation(s)
- Terry Fulmer
- New York University College of Nursing at the College of Dentistry, New York, New York, USA
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Abstract
Avian influenza or Influenza A (H5N1) is caused by a viral strain that occurs naturally in wild birds, but to which humans are immunologically naïve. If an influenza pandemic occurs, it is expected to have dire consequences, including millions of deaths, social disruption, and enormous economic consequences. The Department of Health and Human Resources plan, released in November 2005, clearly affirms the threat of a pandemic. Anticipating a disruption in many factions of society, every segment of the healthcare industry, including nursing homes, will be affected and will need to be self-sufficient. Disruption of vaccine distribution during the seasonal influenza vaccine shortage during the 2004/05 influenza season is but one example of erratic emergency planning. Nursing homes will have to make vital decisions and provide care to older adults who will not be on the initial priority list for vaccine. At the same time, nursing homes will face an anticipated shortage of antiviral medications and be expected to provide surge capacity for overwhelmed hospitals. This article provides an overview of current recommendations for pandemic preparedness and the potential effect of a pandemic on the nursing home industry. It highlights the need for collaborative planning and dialogue between nursing homes and various stakeholders already heavily invested in pandemic preparedness.
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Affiliation(s)
- Lona Mody
- Divisions of Geriatric Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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18
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Abstract
A recent approach for bioterrorism risk management calls for stricter regulations over biotechnology as a way to control subversion of technology that may be used to create a man-made pandemic. This approach is largely unworkable given the increasing pervasiveness of molecular techniques and tools throughout society. Emerging technology has provided the tools to design much deadlier pathogens but concomitantly the ability to respond to emerging pandemics to reduce mortality has also improved significantly in recent decades. In its historical context determining just how 'risky' biological weapons is an important consideration for decision making and resource allocation. Management should attempt to increase capacity, share resources, provide accurate infectious disease reporting, deliver information transparency and improve communications to help mitigate the magnitude of future pandemics.
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Affiliation(s)
- Ki Suck Jung
- Department of Internal Medicine, Hallym University College of Medicine, Korea.
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Rothman RE, Hsieh YH, Yang S. Communicable respiratory threats in the ED: tuberculosis, influenza, SARS, and other aerosolized infections. Emerg Med Clin North Am 2006; 24:989-1017. [PMID: 16982349 PMCID: PMC7126695 DOI: 10.1016/j.emc.2006.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Respiratory infections are the most common communicable infectious diseases. EDs are the front line for patients with respiratory infections because of their acute nature and because the ED is the principal site of health care for those at highest risk. These diseases include influenza, tuberculosis, and measles, together accounting for 25% of infectious causes of death worldwide. These are emerging and biothreat agents that follow the same route of transmission, such as pneumonic plague. We discuss epidemiology, pathogenesis, diagnosis, and treatment of each agent. Emphasis is on the ED's role as a public health prevention arena, with attention to education and disease prevention, early identification of disease in patients at risk, and reduction of illnesses.
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Affiliation(s)
- Richard E Rothman
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Sheppard B, Rubin GJ, Wardman JK, Wessely S. Viewpoint: Terrorism and Dispelling the Myth of a Panic Prone Public. J Public Health Policy 2006; 27:219-45; discussion 246-9. [PMID: 17042122 DOI: 10.1057/palgrave.jphp.3200083] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Governments and commentators perceive the public to be prone to panic in response to terrorist attacks--conventional or involving chemical, biological or radiological weapons. Evidence from five such incidents suggests that the public is not prone to panic, although people can change their behaviours and attitudes to reduce the risk of themselves being exposed to a terrorist incident. Behavioural responses may be divided into acts of omission, such as not making unnecessary journeys, and acts of commission, such as taking prophylactic medication despite the inherent risk of side effects. Evidence suggests that the public are aware of these differences, and tend to adopt responses proportionate to the risk. Drawing upon the literature in the social and natural sciences, our discussion encompasses differing risk perceptions of terrorist threats and consequences of attacks. How do fear and anxiety interact with behavioural responses to amplify or attenuate perceptions that can be modified through risk communication undertaken by authorities?
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Affiliation(s)
- Ben Sheppard
- King's Centre for Risk Management, King's College London, Strand Bridge House, 138-142 Strand, London WC2R 2LS, UK.
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Abstract
Although the risk of an intentional biological weapon release is small for any one location, the chance that there will be an attack somewhere is real. Because surgeons will certainly be called on should this happen, they need to know the basics about the potential agents. This review covers the history of biological weapons,the major agents, and the possible specific roles for surgeons.
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Affiliation(s)
- W Brian Perry
- Department of Surgery, Wilford Hall Medical Center, 859 MSGS/MCSG, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236, USA.
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