Bioterrorism: Preparing for the impossible or the improbable

Objective: To review the current literature surrounding the history of bioterrorism, the relative risk of a bioterrorist attack, methods of surveillance for biological agents, identification and management of various biological agent casualties, as well as the role of the intensivist in managing a bioterrorist attack. Methods: Internet and Medline search (from 1966 to 2004) for articles relating to bioterrorism, biological agents, biological warfare, hospital preparedness, disaster management, and intensive care. Conclusions: There are few instances of a successful large-scale biological weapons attack in history. Weaponization of biological agents for aerosol dispersal is difficult and has often proved to be the rate-limiting step for a successful attack. Although a successful biological attack is currently unlikely, it is still feasible. More importantly, the threat of one is likely to cause much panic in the public, while a successful attack would overburden the current healthcare infrastructure. Intensivists will need to have specific knowledge of identifying and managing casualties from various biological agents. In addition, they will need to play an integral part in the preparedness of their institutions and communities for managing a bioterrorist event.