In September, we published the results of a recent ADA conference on bioterrorism, in which a panel of experts addressed dentistry’s response to this new menace. Who could have imagined, a few scant months ago, that such an appalling threat would come to cast a shadow over our professional and personal lives? The very idea is dreadful, unthinkable. Yet, as the panel made clear, we have both the duty and the ability to play an active part in the defense against bioterrorism.

The question is, are we ready?

In the routine of daily practice, it’s easy to forget that we—dentists and auxiliaries—are exceptionally well-prepared to save lives. We have the skills, the equipment and the drugs to respond to medical emergencies. Infection control is second nature. Our offices are widely dispersed in the community, often closer and more accessible than urban medical centers. We have the education and experience not only to diagnose familiar medical conditions, but also to come rapidly up to speed on unfamiliar ones.

All the pieces are there. But are we ready?

First, consider the basic clinical skills needed to sustain life. We all learned them, but how fresh is that knowledge? Is our equipment up to date and in good order? At a minimum, these are the skills we must keep current:

– ventilation: since mouth-to-mouth techniques will obviously be inappropriate, you’ll need to be ready with a positive pressure ventilating bag. You probably already have oxygen in your office; how about a pulse oximeter?

– defibrillation: an automatic or semiautomatic electronic defibrillator is affordable, and should be part of your emergency kit. Just make very sure that everyone who may need to use this equipment is properly trained.

– phlebotomy and catheterization: while every dentist is adept at injections, we may need practice starting an intravenous line, or even drawing venous blood. The same holds true for emergency catheterization.

– pharmacology: our license to prescribe drugs, and the education that underlies it, will be a critical asset in the event of a medical crisis. We must be prepared to deal with medical emergencies far beyond our normal experience. Know the drug regimens used to treat each likely threat; if you can’t stock the medicines yourself, make sure that you know exactly how to get your hands on them quickly.

Take stock of your equipment and your drug cabinet. Take stock, too, of your skills and those of your office staff. Where you find deficiencies, take a refresher course—and take it seriously.

So far, so good. Basic life support is always "job one." But bioterrorism is not like a normal office emergency. It employs unfamiliar and deadly agents. It strikes dozens or hundreds of individuals at a time, generally without warning. Are we ready for the encounter?

All of us, dentists and physicians alike, need a crash course on the specifics of bioterror weapons. The agents that seem most likely to be used—anthrax, smallpox, botulism, plague—read like a chronicle of medieval calamities. Horrible they may be, but they are also well-understood; you can start your homework today. Learn to recognize the symptoms of each stage of each disease. Learn what can be done for the victim, by you and by others. Learn how each disease is transmitted, and how to protect yourself and others from infection. Armed with hard facts, we’ll be prepared to deliver appropriate care without panic.

Like it or not, many people rely on their dentists for at least part of their general medical information. Are we ready to provide solid factual answers—not just a rehash of last night’s newscast—when our patients ask about bioterrorism?

If we have read up on the subject as I suggested, then yes, we are. We will be able to give worried patients the plain facts, possibly allaying some of their worst fears, but in any case advising them how to respond in an emergency. Emphasize that the diseases they have heard about differ widely in mode of transmission, rapidity of onset and response to treatment; in particular, that few are invariably fatal. Warn against panicky overreactions that will do more harm than good (for instance, prophylactic antibiotics). And finally, direct the concerned patient to reliable sources of information on bioterrorism; we’re emphatically not the experts in this field.

From our very limited experience with bioterrorism to date, one thing is crystal clear: the importance of a rapid, coordinated response by health care and law enforcement personnel. If an attack comes, there will be no time to waste; hesitation, confusion and jurisdictional disputes are not tolerable. Are we ready with an action plan that will work even under the stress of widespread disaster?

For this, sturdy self-reliance won’t suffice. Only the federal government can orchestrate a truly integrated response to bioterrorism. I realize that agencies at all levels are working hard to refine their emergency plans, and that the president and Congress are united (more or less) on the need to coordinate these efforts. The effort is herculean, and it won’t be completed anytime soon. What I would like to see right away, though, is a single, permanent, unambiguous, reliable way for health practitioners to contact the right people and get the right information regarding a suspected bioterror attack.

Think of it as a nationwide "9-1-1" emergency number ... something you can post by the phone, print on flyers and memorize ... a contact point that works the same in Anchorage as it does in Altoona. A Web site, as a supplement or alternative, is an excellent source of broadcast information, but contact by telephone will also be necessary if a real emergency happens. The key is that there be enough lines, enough people, sufficient Web access and enough knowledge at the other end so that every request is handled promptly and appropriately, even (especially) at times of high need.

There’s no reason why the rudiments of such a communication nexus couldn’t be set up in almost no time—presumably by the Centers for Disease Control and Prevention, which is the de facto lead agency for bioterror health care—and then continuously upgraded as new resources come online. We should press Washington to put just a small fraction of its effort into setting up this kind of "central command" right now, without waiting for political debate or bureaucratic fine-tuning. (The Centers for Disease Control and Prevention has a 24-hour emergency hotline at 1-770-488-7100 and a useful bioterror Web site at "www.bt.cdc.gov".)

Is all this preparedness necessary? I truly hope not. I hope that the bioterror manuals will get yellow and brittle, that the phone operators will play computer solitaire until they retire, that our children will see the whole exercise as quaint and rather ridiculous. But you know what they say about eternal vigilance. It’s not really such a high price to pay.