Docs at Front Line of Terror War.

Like a special forces team without a target, the biggest problem for doctors on the front lines of healthcare today is not knowing where the enemy lurks or how it may strike. For a healthcare system responsible for handling the aftermath of terrorism in its many forms, preparing for the unexpected in the post-9/11 world is an unprecedented challenge.

After the attack on 9/11, emergency room personnel in New York City anxiously awaited injured survivors from the World Trade Center. Weeks later, physicians and healthcare providers across the country faced a deluge of worried patients who feared they might have been exposed to anthrax spores. And earlier this year, a thwarted "dirty bomb" plot had doctors rushing for a refresher course in treating radiation exposure.

As these events have shown, unmasking a terrorist attack can be as simple as reporting a suspicious rash to the local health department. But at the same time, hospitals have to be prepared for something as complex as mass hysteria and a rapid influx of casualties.

That means doctors and healthcare providers have now joined the ranks and are an integral part of the country's defense in the war against terrorism. And they're finding that the learning curve is both steep and broad.

Preparing for the Unknown

"Hospitals across the country are looking at ways of becoming prepared, but there are a lot of problems," says emergency room physician Howard Levitin, MD, of St. Francis Hospital and Health Centers in Indianapolis. "Number one, no one has really defined what preparedness is."

Levitin recently completed a study of the nation's healthcare system's ability to respond to a bioterrorist attack. It was funded by the Agency for Healthcare Research and Quality (AHRQ) -- the research arm of the Department of Health and Human Services.

"For example, the media often reports that hospitals aren't prepared for bioterrorism. Well, if you look at the anthrax cases that occurred in October, I'd say we were well prepared," says Levitin. "It's not a big effort to take care of a few additional sick patients, and that's what we saw during the anthrax events."

"If we define preparedness as being prepared to take care of tens and hundreds of patients, then hospitals are not prepared, and it will be difficult to ever be prepared because they have a hard time meeting the patient load they see every single day," Levitin tells WebMD. "We can't handle the flu, let alone think about handling a bioterror event."

Before last fall, Levitin says federal domestic preparedness programs for healthcare professionals focused on how to deal with large-scale biowarfare with high numbers of casualties.

Bioterror: Spotting the Signs

The biggest difference between biological agents and conventional weapons of war is that the germs that cause potentially deadly diseases can spread long before any telltale signs appear, making them virtually impossible to detect before the damage is already done. And the first to respond to a bioterrorist attack is likely to be a healthcare provider rather than a police officer or firefighter.