Terrorism Preparedness 101

The two patients had initially sought medical care in mid-October for "mild, nonspecific illnesses" and were sent home. The first had complained of abdominal pain, while the second had flu-like symptoms. Days later, both were dead.

Despite the different initial symptoms, the two postal workers shared the same cause of death: inhalation anthrax. With a more timely diagnosis and an immediate course of antibiotics, the postal workers would have had a better chance at survival.

Since last fall, John Bartlett, MD, has been working to ensure that clinicians across the country have the information they need to diagnose and treat any future victims of bioterrorism. Bartlett's method is to electronically link physicians and others to dependable information on biological agents like anthrax, smallpox, tularemia, and others.

Bartlett, a founding director of the Center for Civilian Biodefense Strategies and chief of the Division of Infectious Diseases in the School of Medicine, set up a listserv, essentially an e-mail list. He sends information weekly to more than 18,000 infectious disease specialists, microbiologists, clinicians, and others across the country.

"The perception is that the medical care community has never been in the loop and that always bothered me," says Bartlett. "But the Johns Hopkins Hospitals of the world, the practitioners, they are a very important part of the health care delivery team."

So far the listserv has distributed an anthrax primer with information on diagnosis, treatment, and prophylaxis; reports from scientific meetings; and updates on the latest research.

The Center for Civilian Biodefense Strategies was recently awarded a $1 million grant from the Blum-Kovler Foundation, a portion of which will bolster the listserv project by paying for technical help and adding content.

In addition to the listserv, Bartlett and his team have added the Center's recommendations on the treatment of anthrax and other biological agents to the Guide to Antibiotics and Infectious Diseases, a Hopkins-produced electronic antibiotics guide for desktop PCs or handheld devices like PalmPilots. The guide, designed to provide quick answers, is already used by 60,000 physicians, according to Bartlett.

Bartlett also plans to develop a regional listserv of all infectious disease specialists in Maryland. In the future, Maryland physicians in this network will be able to notify or query each other immediately via handhelds or e-mail about unusual illnesses, flu cases with atypical symptoms, and so on.