Open-Air Biowarfare Testing and the Evolution of Values.

The United States and the United Kingdom ended outdoor biological warfare testing in populated areas nearly half a century ago. Yet, the conduct, health effects, and propriety of those tests remain controversial. The varied views reflect the limits of currently available test information and evolving societal values on research involving human subjects. Western political culture has changed since the early days of the American and British testing programs. People have become less reluctant to question authority, and institutional review boards must now pre-approve research involving human subjects. Further, the heightened stringency of laboratory containment has accentuated the safety gap between a confined test space and one without physical boundaries. All this makes it less likely that masses of people would again be unwittingly subjected to secret open-air biological warfare tests.

A Course on Terror Medicine: Content and Evaluations.

INTRODUCTION: The development of medical school courses on medical responses for disaster victims has been deemed largely inadequate. To address this gap, a 2-week elective course on Terror Medicine (a field related to Disaster and Emergency Medicine) has been designed for fourth year students at Rutgers New Jersey Medical School in Newark, New Jersey (USA). This elective is part of an overall curricular plan to broaden exposure to topics related to Terror Medicine throughout the undergraduate medical education. RATIONALE: A course on Terror Medicine necessarily includes key aspects of Disaster and Emergency Medicine, though the converse is not the case. Courses on Disaster Medicine may not address features distinctively associated with a terror attack. Thus, a terror-related focus not only assures attention to this important subject but to accidental or naturally occurring incidents as well. METHODS: The course, implemented in 2014, uses a variety of teaching modalities including lectures, videos, and tabletop and hands-on simulation exercises. The subject matter includes biological and chemical terrorism, disaster management, mechanisms of injury, and psychiatry. This report outlines the elective's goals and objectives, describes the course syllabus, and presents outcomes based on student evaluations of the initial iterations of the elective offering. RESULTS: All students rated the course as "excellent" or "very good." Evaluations included enthusiastic comments about the content, methods of instruction, and especially the value of the simulation exercises. Students also reported finding the course novel and engaging. CONCLUSION: An elective course on Terror Medicine, as described, is shown to be feasible and successful. The student participants found the content relevant to their education and the manner of instruction effective. This course may serve as a model for other medical schools contemplating the expansion or inclusion of Terror Medicine-related topics in their curriculum.

Terror medicine as part of the medical school curriculum.

Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, Newark, NJ, USA. The proposed 4-year Rutgers curriculum serves as a model that could assist other medical schools contemplating the inclusion of terror medicine in pre-clerkship and clerkship training.

Preparedness in America's prime danger zone and at the Boston Marathon bombing site.

INTRODUCTION: The area between Newark and Elizabeth, NJ, contains major transportation hubs, chemical plants, and a dense population. This makes it "the most dangerous two miles in America," according to counterterrorism officials at the Federal Bureau of Investigation. This study compares medical response capabilities for terror and disaster in Newark, New Jersey's largest city, with those in Boston in view of that city's favorable response to the Marathon bombings in April 2013. Boston's numerous world-class medical facilities offer advantages unavailable in Newark and most other metropolitan locations. Thus, preparedness in Newark, despite its prime-danger designation, can also be instructive for many communities with similar medical resources. METHODS: Three categories of response capabilities are assessed: hospital resources, relevant personnel, and symposia/exercises. Data were derived from hospital Web sites, the New Jersey and Massachusetts Hospital Asso-ciations, communications with emergency response personnel, and interviews with spokespersons for hospitals. RESULTS: Boston's population (618,000) is more than twice Newark's (278,000), and the number of hospitals and hospital beds in each city reflects that proportion. However, Boston's seven general adult hospitals include five level 1 trauma centers (which can provide comprehensive trauma care), whereas Newark's four hospitals include only one such center.Beds per 1,000 people are similarly disparate in those trauma centers: five in Boston, 1.5 in Newark. Emergency Medical Services (EMS) personnel based in Boston and Newark are comparable in numbers, though full-time hospital physicians/dentists and nurses are not. The number of doctors at Boston's five level 1 centers is more than triple that at all four of Newark's hospitals (5,284 vs 1,494). The disparity between nurses at the two sites is even greater (6,784 vs 1,566).There is greater equivalency between the two cities both in content and frequency of symposia/exercises. Hospitals in each city have conducted numerous tabletop and action exercises including on communications efficiency, power outages, and dealing with a bombing or active shooter. Hospitals in each city also have participated in citywide drills with EMS, police, fire, and other responders. CONCLUSION: Commonalities in Newark and Boston's exercise approaches suggest that Boston's successful response at the Marathon might be replicated at least in part if the Newark area were similarly challenged. Whether Newark and similarly enabled communities would respond with comparable efficiency remains conjectural. Still, maintaining rigorous preparedness efforts seems a self-evident imperative, especially in an area deemed among the country's most inviting terrorist targets.

Raising awareness about terror medicine.

Terror medicine, which is related to emergency and disaster medicine, focuses on the constellation of medical issues uniquely related to terrorist attacks. It ranges from recognizing features of biologic and chemical agents such as Bacillus anthracis (anthrax) and sarin to the treatment of multi-injury victims of suicide bombings. Medical personnel will be involved in rescue, diagnosis, treatment and recovery from a terrorist attack. Dermatologists could play a central role in diagnosis and treatment in the event of a biologic or chemical attack. The more that individuals and institutions become familiar with the issues concerning terror medicine, the greater the protection they can provide themselves and others.

Persistence of a mock bio-agent in cross-contaminated mail and mailboxes.

Among the 22 confirmed or suspected cases of anthrax during the bioterrorism incidents in 2001, all but two seemed traceable to spores from threat letters. Although no anthrax spores were found in the environments frequented by two females who died of the disease, a suspicion persists that the deaths were somehow related to the mail. This study assesses the spread and persistence of a mock biological agent from a source-letter to other mail and to a receiving mailbox. Successive placement and removal of letters were found to reduce the number of residual bio-agent particles in a mailbox. This suggests that a sweeping action is taking place that can affect the quantity of bio-agent remaining. The exercise supports the possibility that the two females were exposed to spores on mail that had been in their mailboxes although no trace of spores could later be found in their boxes.