Food Fight - Bioterrorism & Emergency Response Capabilities

Many anti-U.S. socio-political goals can be attained by launching a biological attack on the nation’s food supply. One distressing example of how that could be done occurred in 1984 when a small commune in Oregon launched a food-based attack in an attempt to control local land-use policy positions – by, of all things, contaminating the restaurant salad bars in the area with salmonella poisoning. In other cases, even the rumor of infected beef, vegetables, and/or other foods has led to moratoriums on both imports and exports being imposed at the national/international level – and/or resulted in consumer boycotts at local distribution sites.

In many states, kitchen and wait staff are required to attend food handling es such as ServeSafe – a program that was created by the National Restaurant Association to train employees in the rules required to avoid accidentally tainting products. Bartenders and other staff go through similar training such as Health Communications Inc.’s TIPS (Training for Intervention ProcedureS) program – to learn the rules of safely serving alcohol to prevent or at least reduce intoxication, drunk driving, and underage drinking. In all of these es, the addition of a module on bioterrorism – the signs to look for and, more importantly, information on who to contact if an attack is suspected – would put extra eyes on the ground.

However, although there are historical precedents for responding to large-scale biological attacks, the early detection of such attacks at any scale is of paramount importance. Many major cities and regions have already put in place the systems needed for syndromic surveillance – i.e., the monitoring of acute illness. This type of surveillance can be effective because bioterror attacks generally follow a limited number of common pathways at the onset of symptoms – respiratory symptoms, usually, and/or severe gastrointestinal distress. Many of the systems already created track indicators of the volume of such cases, usually to spot a statistical rise in their incidence prior to announcement of an attack by terrorists – an outcome that is usually contrary to the goals of the terrorists. Some of the more robust syndromic surveillance systems integrate the large volume of data received from hospital emergency rooms, EMS (Emergency Medical Services) systems, death certificates, school nurses, veterinarians, and pharmacies.

Close Monitoring, Accurate Diagnoses & “Just in Case” Check-Ins In at least some states in which the monitoring of EMS cases is not yet required, legislation is being considered to make such monitoring mandatory throughout the state. In addition, many infectious diseases must be reported to the U.S. Centers for Disease Control and Prevention (CDC) and/or to state and local public health officials. In most instances, it is not practical to make EMS personnel mandatory reporters of individual cases, if only because most EMS units do not have the laboratory resources needed to make a specific diagnosis. In addition, the vast majority of “significant” cases of such diseases will usually end up in hospital emergency rooms, where they can and will more easily be reported.

Information packets about specific bioterror agents and the illnesses they cause also should be made available for distribution to the response community, particularly to the EMS community. Briefing sheets are already available from the CDC as well as from many state public health agencies. The briefing sheets would serve as a scientific/medical basis for the packets, which must also address such other important issues as: (a) the personal protective equipment (PPE) available to responders; (b) reminders of the appropriate treatment for infectious disease cases; and (c) emergency plans – including the names and locations of specific hospitals or wards that may be set aside for suspected bioterror victims.

Additional information also should be made available to the general public, obviously, so that everyday citizens also will be better prepared and informed about what they can do to protect themselves. As with all similar threats, the EMS and public health community share a number of common goals for the most important aspects of effective response: (a) early recognition; (b) the effective use of available resources; and, above all (c) full and frequent communications to the medical staff and to the public. In short, providing additional information, as quickly as possible, on bioterror agents and their warning effects will help medical systems reduce the risk of being overwhelmed by the “worried well” who, although not personally displaying any of the symptoms accompanying a particular disease, may still decide to check themselves into the nearest hospital on a “just in case” basis.


For additional information on: The Oregon salad bar-attacks/threats, visit or

Food service training, visit or

Beef infection and the resulting import bans, visit

The CDC’s role in countering bioterrorism, visit

Syndromic surveillance, visit

Information sheets from CDC and other agencies, visit, or

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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