“Rather than invading our beaches or launching bombers, adversaries may … deploy compact and relatively cheap weapons of mass destruction—not just nuclear, but also chemical or biological, to use disease as a weapon of war.” President William J. Clinton, May 22, 1998
A bioterrorism incident may occur quietly with no explosion and no forewarning. In one possible situation, the emergency physician on shift slowly becomes aware of an unusually large number of patients in the ED with nonspecific complaints. At the end of his or her shift, hours after discharging the first young man with those vague symptoms, the patient returns acutely short of breath, cyanotic, and hypotensive.
Biological weapons (BWs) are the terrorist’s perfect weapon; they are relatively easy to make, difficult to detect, and a significant threat of morbidity and mortality. A terrorist needs to go no further than an Internet connection to download the appropriate “recipe” with easily obtainable ingredients.
It is sobering. The question no longer is “What if?” Rather, the question is “When?” As emergency medicine physicians providing acute health care for the nation, the next question, without hesitation, should be “What are we going to do about it?”