Educating the podiatric physician in disaster and emergency preparedness.

Even before 9/11 there had been increased incidents and threats of domestic terrorism in the United States. Among these incidents were the 1993 bombing at the New York City World Trade Center parking lot, the bombing in 1995 at the Oklahoma City federal building (killing 168 people, 19 of whom were children), and the pipe bombing at the Summer Olympic Games in Atlanta. In addition, in 1996 there were the deaths and injuries resulting from the release of the toxic nerve agent sarin in a crowded Tokyo subway. Bioterrorism also has occurred in the United States and globally. In 1763 at Fort Pitt on the Pennsylvania frontier, British General Lord Jeffery Amherst obtained blankets and handkerchiefs from patients with smallpox to be given to Delaware Indians at an alleged peacemaking event. In the 1980s, a cult used Salmonella to poison citizens living in a small town in Oregon. More than 700 individuals became ill, and more than 40 required hospitalization. Historical documents record biological agents that have been studied or deployed as weapons since the 14th century and continuing to the present. In 1340, attackers catapulted dead horses and other animals at the castle Thun-l’Eveque in Hainault in what is now northern France. The defenders reported that ‘‘the stink and the air were so abominable. . .. They could not long endure’’ and negotiated a truce. Scientists of the infamous Unit 731, a bioweapons project of the 1930s, used human subjects, mostly Chinese and political prisoners, to test the lethality of various disease agents, including anthrax, cholera, typhoid, and plague. As many as 10,000 people were killed. During a variety of military campaigns, several hundred thousand people, mostly Chinese civilians, fell victim. In October 1940, the Japanese dropped paper bags filled with plagueinfested fleas over the cities of Ningbo and Quzhou in Zhejiang province. Other attacks involved contaminating wells and distributing poisoned foods. By the end of the Gulf War in 1991, Iraq possessed an impressive bioweapons arsenal that included anthrax, botulism, and other lethal weapons. Although Iraq is known to have used chemical weapons during the Iran-Iraq war and against the Kurds in northern Iraq, their use of bioweapons is unknown. However, it took Americans witnessing the loss of more than 3,100 lives on national television for the entire population to appreciate that the potential for bioterrorism and weapons of mass destruction is real and no longer only a theme for science fiction novels and movies. Even after 9/11, it is still questionable whether health professional schools place a high enough priority on the importance of education and training in all-hazards preparedness at the undergraduate and graduate medical levels. An Internet-based survey was sent to 48 undergraduate and fellowship representatives, with receipt of 24 responses. The survey outcome demonstrated that 22 programs before 9/11 and 14 programs after 9/11 taught principles of disaster medicine concepts. The conclusion was that there has been a decline in the number of programs offered after 9/11. Most hospitals in urban, suburban, and rural areas have well-organized disaster preparedness planning projects in accordance with city planning efforts. Many hospitals, including government institutions, such as Veterans Affairs medical centers, county health affiliates, and medical schools, collectively engage in exercises to demonstrate proficiency for public safety reasons in the skills of appropriate disaster preparedness programs. However, it was demonstrated after Hurri*Office of Education, Planning, and Research; Institute for Disaster and Emergency Preparedness; Department of Family Medicine, Nova Southeastern University, Fort Lauderdale, FL. †College of Podiatric Medicine, Western University of Health Sciences, Pomona, CA. Corresponding author: Lester J. Jones, DPM, MS, College of Podiatric Medicine, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766. (E-mail: ljones@ westernu.edu)