Jones & Bartlett Learning Health Blog

    Bioterrorism and Health Care Managers

    Posted by sharonb on Oct 6, 2014 8:00:11 AM

    Four years ago, I posted a blog asking the question, "Are health care professionals prepared for disasters?"  and closed with the following:

    In light of intelligence findings that smaller targets will be next, we can no longer pretend that it won’t happen to us. We cannot undo the horrific events of 9-11, Hurricane Katrina or the earthquakes in Haiti. We can, however, learn from them and take action as citizens and as healthcare professionals. It’s time for us all to get involved and get prepared before disaster hits.

    At the time, the focus of Homeland Security's anti-terrorist efforts in the United States was on large symbolic targets.  Now, however, we know "softer" targets, such as sports stadiums, amusement parks, schools, and hospitals are potential sites for attacks. A terrorist attack could be as subtle as a patient walking into the emergency department with a highly contagious disease, one not easily amenable to vaccinations or treatment, such as the recent case of Ebola virus that appeared in Texas. In that case, the patient did not reveal he had cared for someone who died of the virus. When he presented at the Emergency Department with fever, diaphoresis, diarrhea, healthcare providers who were unfamiliar with the virus, did not recognize the disease.  His family is now under quarantine and many others, including members of Congress, are concerned about exposure. While this patient is not considered a bioterrorist, he or others like him could be planted as human time bombs carrying deadly contagion.

    If you think such a scenario couldn't happen in your local hospital or ambulatory care center, perhaps you should read the work of Elin A. Gursky, ScD, Senior Fellow for Biodefense and Public Health at the ANSER Institute for Homeland Security.  Her 2004 report on bioterrorism readiness in rural hospitals commissioned by the National Defense University reads like a litany of what health care managers should not do. This in-depth case study approach examined five rural hospitals' preparedness for biologically induced mass casualties. Hospitals were selected for their "proximity to military installations, nuclear or chemical plants, large-scale agricultural production, an international border, or major waterways" (Gursky, 2004, p. 15). In interviews with key informants, Dr. Gursky found unprepared staff and out-of-date facilities which could be overwhelmed with small numbers of casualties, much less large ones. Here is a partial listing of her findings:

    • Lack of training on how to identify early signs of potential biological hazards;
    • Lack of reliable communication equipment, especially in areas where cell phones are not usable;
    • Lack of vaccinations, such as smallpox, due to travel distances to vaccination programs;
    • Lack of quarantine facilities or seriously out of date facilities;
    • Lack of up-to-date Personal Protection Equipment (PPE) and knowledge of how to use PPE;
    • Lack of emergency inventory in case the facility is unable to bring in materials;
    • Lack of security, e.g., some hospitals left doors open 24/7, some had no security guards;
    • Lack of suspicion, e.g., the feeling that everyone in town was "like family."

    Many of these shortcomings are under the control of hospital administrators. A survey conducted among 400 nurses by National Nurses United found over half (60%) indicated their hospitals were "not prepared to handle patients with Ebola and over three-quarters (80%) indicated their administration had not communicated with them any policy regarding the disease." In addition, almost one-third (30%) of the nurses indicated they had insufficient PPE gear (e.g., eye goggles and fluid resistant gowns) on hand to protect themselves from bodily fluids, the main method of transmission of the disease.

    Health care managers are responsible for planning, organizing, controlling, and monitoring resources.  Staffing, training, equipment, inventory, communication trees, inventory control, and security measures--all of these are under the purview of health care managers. As the national "See Something, Say Something" campaign has demonstrated, people can be trained to become more cautious and alert, with positive results.

    Per the American College of Healthcare Executives, health care managers are expected to be prepared to take action in times of disaster.  In an already crowded curriculum, it can be a challenge to educate our students about disaster preparedness, much less biological weapons of mass destruction. However, there are ways to address all hazards emergencies within existing courses and in volunteer hours for community service. Here are a few suggestions for how to integrate this important topic into your curriculum. Please note, higher order thinking skills are needed for all of these assignments.

    • Analysis of case studies of real or imagined disasters in online and face to face discussions;
    • Creation of a case study by the student on a potential threat in their workplace or school;
    • Research papers for courses such as Leadership, Operations Management, Financial Management, etc, that analyze disaster preparation within the relevant course content ;
    • Face to face interviews with health care executives as part of a Professional Development course that include questions on the executive's perceptions of risk and disaster preparedness;
    • Capstone projects, where students assess the facility's preparedness and write a report on their findings, recommendations for improvement, and evaluation metrics;
    • An all class disaster management table top exercise for a given health care facility with assigned characters to be role played by the students; and,
    • Participation in disaster simulations and scenarios role playing patients or health care workers.

    The United Nations Environmental Programme (UNEP) (2014) reported natural and man-made disasters are increasing in frequency and size of impact. UNEP is responding with disaster prevention and preparedness educational training programs. As health care management educators, it is incumbent upon us to join in this global work and to educate the health care executives of the future on better ways to respond to and prepare for all hazards emergencies, including bioterrorism.

    Sharon B. Buchbinder, RN, PhD

    Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

    Here are some references if you are interested in this topic:

    American College of Healthcare Executives (ACHE). (2013, November 16) Healthcare executives’ role in emergency preparedness: Policy Statement.

    Blair, J.D. (2005, September). Is the healthcare industry prepared for terrorism? All-Hazards “HVA” for Non-Federal Healthcare CBRNE Readiness:  A Level Playing Field? Inside Homeland Security. Retrieved from

    Buchbinder, S. (2010). Are healthcare professionals prepared for disasters?

    Gursky, E.A. (2004). Hometown hospitals: The weakest link? Bioterrorism readiness in America's rural hospitals.  Washington, D.C., Center for Technology and National Security Policy of the National Defense University.

    Gursky, E.A. & Fierro, M.F. (2012). Death in large numbers: The science, policy, and management of mass fatality events. Chicago, IL, American Medical Association.

    Hearne, S.A., Segal, D.N. & Segal, L.M. (2003). Public health laboratories: Unprepared and overwhelmed. Washington, D.C., Trust for America's Health.

    Steenhuysen, J. (3 October 2014). U.S. nurses say they are unprepared to handle Ebola patients.

    United Nations Environmental Programme. (2014).

    UPMC Center for Health Security. (2014).

    Topics: administration, health administration, Health Administration, health care management, Sharon B. Buchbinder, bioterrorism, disaster preparedness, Sharon Buchbinder Blog, Diseases

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