The Role of an Advanced Practice Public Health Nurse in Bioterrorism Preparedness Cristin Mondy, M.S.N./M.P.H., R.N., David Cardenas, M.P.H., and Margaret Avila, R.N./N.P., M.S., M.S.N. Abstract The 2001 anthrax events have vividly illustrated that terrorism involving the release of a biological agent is a major public health emergency requiring an immediate and well- coordinated response. If healthcare professionals and emergency responders are to be prepared to manage such attacks, unprece- dented cooperative efforts at the national, state, and local levels arenecessary.Toaidsuchefforts,advancedpracticepublichealth nurses (PHNs) must exercise their ability to collaborate with a variety of disciplines and communities. Using the Los Angeles CountyPublicHealthNursingPracticeModel,advancedpractice PHNs can be trained to deal effectively with acts of bioterrorism. This model defines the practice of public health nursing as working on a population-based level to create conditions under which healthy people can live within healthy communities. This articlewilldiscussthethreatofbioterrorismanddescribehowthe Public Health Nursing Practice Model can be applied to assist advanced practice PHNs in the development of a public health plan for preparedness and response to bioterrorism. Six specific interventions that enable advanced practice PHNs to affect populations at the community and systems level will be discussed along with the implications of bioterrorism for advanced practice public health nursing. BACKGROUND Bioterrorism is defined as ‘‘the use of biologic agents (bacterial, viral or parasitic) to intentionally produce disease or intoxication in a susceptible population to meet terrorist aims’’ (Los Angeles County, Department of Health Services, Acute Communicable Disease Control, 2003). The spectrum of bioterrorism ranges from hoaxes to the use of nonmass casualty devices or agents by individuals and small groups to state-sponsored terrorism employing classic biological warfare agents to produce mass casualties. As recent events have illustrated, terrorist groups have already been successful in attempts to use biological agents, both domestically and internationally (McDade & Franz, 1998). In fact, it is the effectiveness of such attempts that has made bioterrorism a likely option for terrorist groups. Biological weapons are attractive to terrorists because they are relatively easy to obtain, require minimal scien- tific knowledge and skill to produce and weaponize, and can cause mass destruction at relatively low cost. These agents are also difficult to detect (invisible, odorless, tasteless) and have a delayed onset of illness, allowing perpetrators time to escape (Ball, 1998). The east coast anthrax attacks of 2001, for example, led to widespread panic and social disruption and clearly illustrated the potentially devastating effect of bioterrorism. HISTORICAL PERSPECTIVE The use of biological agents as weapons is not necessarily an outgrowth of recent technological advances or of an expanding terrorist knowledge base. In fact, according to Cristin Mondy is a Public Health Nurse and David Cardenas is an Epidemiologist, Bioterrorism Preparedness and Response Unit, Acute Communicable Disease Control Program, and Margaret Avila is Nursing Director, Public Health Nursing, Los Angeles County Department of Health Services, Los Angeles, California. Address correspondence to Cristin Mondy, MSN/MPH, RN 27525 Halescorner Road, Rancho Palos Verdes, CA 90275. E-mail: cmondy@ dhs.co.la.ca.us Public Health Nursing Vol. 20 No. 6, pp. 422–431 0737-1209/03/$15.00 Ó Blackwell Publishing, Inc. 422