Bioterrorism and critical care

With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is important for intensive care providers to be prepared to meet the challenge of large-scale airborne epidemics causing mass casualty respiratory failure. The severe acute respiratory syndrome outbreak exposed the vulnerability of health care workers and highlighted the importance of establishing stringent infection control and crisis management protocols. Patients who have acute lung injury and acute respiratory distress syndrome who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Controversy remains regarding the use of high-frequency oscillatory ventilation and noninvasive positive pressure ventilation. Standard, contact, and airborne precautions should be instituted in intensive care units, with special care taken when aerosol-generating procedures are performed.

Francisella tularensis (F. tularensis) has been designated by the CDC as 1 of the 10 organisms most likely to be engineered for bioterrorism. Symptoms of tularemia in humans are non-specific, thus making the disease difficult to diagnose. If not quickly diagnosed and treated, the disease has a high mortality rate – thus methods for early and specific diagnosis are of critical importance.

This immunoaffinity MALDI MS/MS (iMALDI) assay provides unambiguous detection of F. tularensis peptides at attomole levels from peptide solutions, and at low CFU levels from bacteria. The addition of stable-labeled versions of the peptide as internal standards allows absolute quantitation of F. tularensis peptides with a linear dynamic range spanning two orders of magnitude. The ability of mass spectrometry to obtain amino acid sequence data on affinity-captured peptides provides absolute specificity and avoids “false positives” from the non-specific binding. The F. tularensis iMALDI assay has been applied to different samples, such as nasal swabs.

This novel quantitative diagnostic F. tularensis iMALDI assay allows the safe, sensitive, and specific detection of F. tularensis. The assay can be easily adapted to other target peptides and therefore has broad application potential in clinical diagnosis of other pathogens and diseases.

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.

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.

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.

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.