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Letter from the Health Officer


    Hospital Emergency Room Directors
    Emergency Room Physicians
    Urgent Care, Clinic and Primary Care Physicians
    Laboratory Directors
    Emergency Medical Services Personnel
                                      Martin Fenstersheib, MD, MPH, Health Officer and
                                      Sara Cody, MD, Communicable Disease Control Officer
                                    Re:   Recognizing Terrorism Agents
                                    It is crucial that emergency room physicians and other clinicians have a clear understanding of how to recognize a patient presenting with possible exposure to a biological or chemical agent or radiation.  Although this situation has not presented in Santa Clara County, there are truly dire consequences of not recognizing a potential incident and reporting it to the Public Health Department.
                                    In October 2000, we published the first Zebra Packet: Bioterrorism Information for Clinicians. In the decade since the Zebra Packet was first designed, much has changed.  Clinical protocols have been refined and disease reporting instructions have evolved.  Most importantly, quick access now means immediate viewing on a smart phone or downloading a document from a website. We also recognize the need to add medical management guidelines for exposure to chemical agents and radiation.
                                    This updated Zebra Packet carefully summarizes the Medical Management Guidelines (MMGs) published by the Center for Disease Control and Agency for Toxic Substances and Disease Registry (CDC/ATSDR).  Links are provided back to the CDC/ATSDR websites for further information.
                                    We all remember the medical school adage, “When you hear hoof beats, think horses, not zebras”.  But today, the public health and medical community continues to be challenged by the threat of terrorism incidents.  It remains vital to increase awareness of clinical syndromes and medical management of each potential terrorism agent.
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