Prior to the 12th I know of no one in our EDs( NYU and Bellevue) that

one with antibiotics. Now that there is anthrax documented in New York,

will changed.

The Department of Health's official recommendation is to treat only the NBC employees who were on the 3rd, 7th floor or in the mailroom on Sept. 18th or 25th. Asymptomatic people were being treated on site with cipro and had nasal cultures taken. Patients with any "symptoms" were being referred to the Bellevue ED. I treated and discharged one NBC employee who had a runny nose and sore

(nothing else) with a nasal swab and levofloxin who "probably" was on

floors. I saw another person who works for a magazine publisher who got a white powder on her hands hours before the NBC exposure was announced. She was already on levofloxin for a a sinus infection so I swabbed her nose and notified

on-site CDC person. For everyone else without the hint of credible exposure I have been treating with reassurance that their rash or cold is not anthrax,

This same thread just had a posting from a practitioner who was met with "we don't care, go somewhere else" by several agencies (including the Fat Dumb & Ignorant) when trying to report a possible case. -- Yours, J.A. Terranson sysadmin@mfn.org ---------- Forwarded message ---------- Date: Sat, 13 Oct 2001 19:47:22 -0400 From: Richard Paley Reply-To: EMED-L -- a list for emergency medicine practitioners. To: EMED-L@ITSSRV1.UCSF.EDU Subject: Re: [EMED-L] [Hazmat-WMD] Anthrax - When do we worry? In Florida, the state department of health is telling us not to do any cultures for Anthrax. We are to refer asymptomatic patients who sent at least one hour in the AMI building to the health department for interviewing and testing ----- Original Message ----- From: "douglas yoshida" To: Sent: Saturday, October 13, 2001 5:16 PM Subject: Re: [EMED-L] [Hazmat-WMD] Anthrax - When do we worry? treated any things throat those the though what

a credible exposure is will probably change if more cases/sites arise. Other ED attendings have been taking nasal swabs of non-NBC employees who give a vague history of exposure (e.g. there was white dust in the taxi cab driven by a dark skinned man).

I could find no data that states how sensitive or specific a nasal swab is for anthrax exposure, does any one know?

Douglas Yoshida MD Bellevue and NYU hospitals

"Henry J. Siegelson, MD, FACEP" wrote:

...

I have had to deal with several individuals and families that were worried that they might have been anthrax victims. THey either visited Florida recently or had an upper respiratory infection.

What is everyone doing to workup these patients?

How are you advising treatment?

Henry J. Siegelson, MD, FACEP Atlanta ----- Original Message ----- From: To: Sent: Saturday, October 13, 2001 11:25 AM Subject: [Hazmat-WMD] Anthrax - When do we worry?

...

I think it's time we started talking about how to evaluate whether or not this anthrax business is a big deal or not. Here are some things that would make me worry:

1. The various samples are genetically similar. 2. Similar handwriting on the letters. 3. Brown powder vice white starts showing up. (Anthrax is usually brown. You can find any white powder in any kitchen.) 4. More people actually get sick (NOT mass psychogenic illness).

What do the rest of you think?

Vance Bennett Hazmat Curmudgeon

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