ABSTRACT
The threat of domestic and international terrorism involving weapons of mass destruction-terrorism (WMD-T) has become an increasing public health concern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated medical problems might include the need for large quantities of medical equipment and supplies, as well as capable and unaffected health care providers. In the setting of WMD-T, triage may bear little resemblance to the standard approach to civilian triage. To address these issues to the maximum benefit of our patients, we must first develop collective forethought and a broad-based consensus that these decisions must reach beyond the hospital emergency department. Critical decisions like these should not be made on an individual case-by-case basis. Physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply. It is for this reason that emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision making before an acute bioterrorist event.
Subject(s)
Emergency Service, Hospital/standards , Emergency Treatment/standards , Ethics, Medical , Health Care Rationing/organization & administration , Patient Selection , Practice Guidelines as Topic , Terrorism , Triage/organization & administration , Algorithms , Decision Trees , Humans , Organizational Policy , Patient Advocacy , Physician's Role , United StatesABSTRACT
Currently, there is no standardized curriculum for training of emergency physicians about the health hazards related to weapons of mass destruction. Opportunities for the widespread teaching of this material have remained limited, and the range of knowledge regarding even general disaster medical care is also variable among most residency training programs in the United States. We developed a survey to ascertain whether any formal training in biological weapons is conducted in emergency medicine programs; to determine the overall subjective ability of program directors or residency directors to recognize and clinically manage casualties of biological weapons agents; and to identify which resources might be used by emergency physicians to identify and treat biological warfare casualties. We also document a baseline of current practices regarding biological weapons training in emergency medicine residency programs.
Subject(s)
Biological Warfare , Emergency Medicine/education , Internship and Residency , Violence , Biological Warfare/prevention & control , Delphi Technique , Disaster Planning , Humans , United States , Violence/prevention & controlABSTRACT
Rhabdomyolysis is a syndrome often associated with alcohol and drug abuse. It may also be seen following viral infections, but is a complication not often considered. We report a case of severe rhabdomyolysis following an influenza-like illness. Despite the extreme elevation of creatinine phosphokinase, 230,600 IU/L, this patient did not develop acute renal failure in contrast to most of the previously documented case reports of rhabdomyolysis associated with influenza virus. This case report illustrates the difficulty in predicting which patients are at risk for developing acute renal failure and emphasizes the need for aggressive treatment of any patient suspected of having rhabdomyolysis.
