Perceived bioterrorism preparedness and the impediments to bioterrorism preparedness of rural physicians

Recent public health emergencies such as the September 11, 2001, terrorist attacks on the World Trade Center in New York City, the use of anthrax as a bioterrorist tool against citizens, and other natural disasters in the United States have increased awareness of the nation's vulnerability to large-scale emergencies. To moderate the risks and magnitude of public health emergencies deriving from such events, the United States has made emergency preparedness a priority for public health advocates and physicians. In particular, scant attention has been given to preparing physicians and other health care providers in the United States' sparsely populated areas for public health emergencies such as bioterrorist events. Yet emergency preparedness in rural communities is a significant issue for the nation given that roughly 80% of United States land is classified as rural and one-fourth of the United States' population lives in rural areas.;The study utilized the interview data transcripts from six rural physicians as the primary data with which to explain the state of emergency preparedness of rural physicians and to explain and better understand the barriers to preparedness encountered by these rural health care providers. The principal objectives of this study were to provide a greater description and understanding of rural physicians' perceived preparedness regarding public health emergencies such as bioterrorist events.;Physician participants expressed a lack of bioterrorism preparedness in five facets: cognitive, clinical, expectation, simulation and resource preparedness. In essence, rural physicians were unaware of the pertinent signs and symptoms of bioterrorist-inducing agents, the relevant risk factors, and the appropriate therapeutic treatments. Additionally, rural physicians described their expectation preparedness as low. Physicians explained that although simulation exercises and corresponding training opportunities existed, many of them had not availed themselves to these endeavors. A dearth of resources, specifically a lack of specialty physicians, was also cited. Thus, rural physicians felt less than fully prepared both intellectually and professionally for a bioterrorist event.;This study discovered that, although there are knowledge gaps in physician's bioterrorism education and training, these gaps appear to be the result of personal choice and discretion. This study substantiates that there appears to be a significant need to take additional decisive steps to encourage rural physicians to attend bioterrorism preparedness seminars. Furthermore, it appears there is a compelling need for improved preparedness regarding bioterrorism knowledge surrounding the associated important risk factors and therapeutic medical interventions for bioterrorist infectious agents. Furthermore, it appears from this study that if rural physicians are provided with a greater number of resources---financial, educational and technological---they will inevitably feel better prepared and perceive more auspicious health outcomes for their patients. Thus, strategically implemented health policy objectives can have a tangible impact on the impediments identified in this study which have hindered rural physician preparedness.