A course at New Jersey Medical School teaches preparedness in dangerous times

Leonard Cole
Leonard Cole of Rutgers New Jersey Medical School says modern terror tactics have forced physicians to think in new ways about diagnosing and treating patients.
Photo: Rob Forman/Rutgers University

'Most likely something terrible would have to happen for me to put these skills to use, but I would like to be prepared.'
–Eugenio Villareal

Ask many Americans what anthrax is, and they probably will tell you it’s something dangerous associated with terrorism. Deadly anthrax bacteria are firmly in the public consciousness.

That’s now. Back in 2001, however, while health professionals certainly knew what anthrax was, for most of them it was out of sight, out of mind. So when patients began showing up in the weeks after 9/11 with black lesions on their skin, most of their physicians did not consider anthrax as a possible cause.

“Several doctors presumed that what they saw were spider bites,” says Leonard Cole, director of the program on terror medicine and security at Rutgers New Jersey Medical School. “Only in retrospect, when a photojournalist died after receiving anthrax in the mail, was there an understanding that other cases of anthrax-related sickness had been missed.”

To raise awareness among future physicians, Cole has designed a new two-week elective course called “Terror Medicine.” It includes sessions taught by experts in emergency medicine, surgery, psychiatry and bioterror – areas of crucial importance in a medical response to a terror attack. And it presents examples of how dangerous times have forced health professionals’ basic instincts to change.

For instance, Cole says, symptoms that might have been diagnosed in the past as simple food poisoning could actually come from exposure to a bioweapon that causes botulism, or a gardener who seems to have inhaled too much pesticide might have been exposed to the nerve gas sarin – which happened in Japan in the 1990s.

While chances seem small that any individual might be caught up in a gas attack, a mass shooting or a bombing, Cole says that if the worst ever happens, “preparedness can mean the difference between patients living and dying.” But he fears that health professionals as a group still have a long way to go before they can consider themselves truly ready.

That includes having a sense ahead of time about choices that might be necessary. If a bomb goes off and a doctor is nearby, should that physician race to the victims? That sounds like a no-brainer, but maybe not, because past experience shows that a “secondary bomber” might be waiting to set off explosives after responders arrive – compounding the toll of dead and injured.

If you’re an emergency room physician, you may be comfortable treating a patient with penetration injuries, or one who has a punctured lung, or someone with burns or crush wounds. But what if your patient arrives with all of those problems simultaneously, as can happen after an especially savage bombing? How do you know where to start? Determining what needs immediate attention and what can wait, a process known as triage, is crucial, and making quick, hard choices correctly can save lives in a crisis situation.

Able to step in if the unthinkable happens

Eugenio Villarreal, a fourth-year student in the course who is training to be an emergency physician, is very conscious that one of his own future patients might survive because he has learned these lessons. “Most likely something terrible would have to happen for me to put these skills to use,” says Villarreal, “but I would like to be prepared.”

As a future neurosurgeon, Katherine Wagner is even less likely to be called on to treat disaster victims. “Brains and spines” will be her medical specialty. But she wants to be ready to help if mass casualties come her way. “If ever I need to face a crisis," says Wagner, "it will be good to know how to work with my emergency medicine colleagues and let them focus on what they need to do.” In medical school Wagner has learned skills she might never need as a neurosurgeon, such as how to stop severe bleeding or clear the airway of someone who can’t breathe. One day that knowledge could suddenly be essential.

Designing systems for organizing emergency response teams – and creating protocols for training hospital staffs and treating victims – are also vital tasks. Michael Hayoun’s ambition is to be the person who does that, whether for a hospital, a city, a state, or the entire nation. He helped Cole put the course together with those goals in mind. In the shorter term, Hayoun, like Villarreal, will pursue an emergency medicine residency.

Leonard Cole says his students would be wise to absorb lessons from the 2013 Boston Marathon bombing, where he says emergency response was superb. Casualties were transported quickly and evenly distributed among several hospitals so that no emergency room would be overloaded. The professionals at the hospitals had gone through frequent drills beforehand – which improved their performance as teams.

In the first session of the terror medicine class, Cole said it was a badge of honor for the various responders in Boston that every patient who reached a hospital that day survived. If ever these Rutgers students find themselves working at a hospital in a similar situation, Cole hopes the terror medicine course will leave them better prepared to perform equally well.

Journalists are invited to contact Jeff Tolvin of Rutgers University News and Media Relations at jeff.tolvin@rutgers.edu or 973-972-4501.