Examining the Military and Law Enforcement Terrorism Counteraction Model:
A Template for Medical Response to Biological Terrorism?

William L. Bograkos, D.O., FACOEP and Daniel J. Kaszeta


Summary / Abstract:

The greatest emerging biological threat is not a particular pathogen or toxin nor is it a novel method of dissemination.  It is the lack of cogent emergency planning.  The United States government has expended significant funds and effort to increase the preparedness of local, state, and federal agencies to respond to incidents involving Weapons of Mass Destruction (WMD).   Although the government devotes much effort to training and exercises, there is a paucity of consistent and useful planning guidance, particularly for hospitals and medical professionals.  The majority of the domestic preparedness effort is devoted to educating and equipping fire, EMS, and law enforcement agencies.   Clearly, hospitals, physicians, and public health agencies are the front line in the defense against biological terrorism, a reality that is not consistently realized among policy makers.   Biological warfare and biological terrorism are not only technical threats but management threats as well.  

In the 1980's, the United States Army developed a conceptual model to prevent, deter, and respond to terrorism.  (See below.)  This model represents a solid contingency planning thought process that can be adapted and fine-tuned for use as a planning tool to guide responders.   The seven step process, as refined for biological terrorism, is as follows: (Note: sub-sections are not all-inclusive at this time.)

STEP 1 - Intelligence 		
Medical surveillance begins
Agent awareness begins
STEP 2 - Threat Analysis		
Credibility Assessment
Agent Characteristics (behavior)
STEP 3 - Physical Security
Hospital Security
Facility integrity
Decontamination
Hazardous Materials Mitigation
STEP 4 - Personal Security
Personal Protection
Chemoprophylaxis
Immunization
STEP 5 - Operational Security
Situational Awareness
Information Security
Logistics Security
Vector control
STEP 6 - Authority and Jurisdiction
Quarantine
STEP 7a - Crisis Management Planning
Treatment
Logistics
Public Affairs
Liaison / Communication
STEP 7b - Performing
FOLLOW UP AND FEEDBACK