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The possibility of a bioterrorism event haunts all healthcare organizations. We believe a bioterrorism event is more likely in an urban area, and that urban multiprovider systems will be the “first line healthcare responders.” Due to the lack of empirical research on this topic and firsthand experience with a bioterrorism event, this paper will provide the theoretical underpinnings to support the rationale for multiprovider systems as “first responders.” This chapter outlines the nature and challenges of bioterrorism for a healthcare organization, the likely “state of the art” preparations for such events on the part of the four categories of healthcare organizations, and finally, the implications for the structuring of multiprovider systems to enhance their ability to plan for, and respond to bioterrorism events. Potential future research issues are also addressed.

Although we have yet to experience a major bioterrorism event in the U.S., we are nevertheless preparing for such an event. In this paper, we consider the nature of bioterrorism and the threats and challenges it brings to managing health care organizations. Because existing managerial theory may be inadequate in responding to bioterrorism events, management scholars are advised to approach their research with a great deal of humility and openness. Inasmuch as emerging theoretical frameworks based on complexity science and chaos theory are not fully developed, we propose that stakeholder management theory may be the best approach at this juncture.

This paper presents an overview of the articles used in this edition of Advances in Health Care Management. The beginning of the article gives the reader a history of bioterrorist activity within the United States, and how these events have led to current situations. It also provides a model for health care leaders to follow when looking at a bioterrorist attack. The model includes descriptions of how the articles within this book relate to an overall bioterrorist formula. Through this, the reader shall be able to deduce which individual article fits into the vastness of healthcare research pertaining to bioterrorism.

The threat of future biological attacks within the United States forces the additional responsibility of preparedness and response onto health care managers. An endless amount of information on this topic can be readily obtained from a variety of sources. The purpose of this resource guide is to provide health care managers with a well-organized, up-to-date listing of credible sources that can be accessed electronically. This resource guide is designed to facilitate the retrieval of relevant information that is crucial in the process of health care managers designing a bioterrorism preparedness and response plan.

The implications of a bioterrorist attack within the United States were well observed in the 2001 anthrax attacks. The effects of these attacks were not only felt by the primary victims but also reached into communities and health care organizations that treated patients. The concerns for future attacks have spurred an enormous amount of interest and forced health care administrators to implement safety measures and develop plans encompassing preparedness and response. With respect to this topic, a major problem facing health care managers is the ability to obtain relevant, up-to-date, reliable information.

Many health care managers are aware of the endless amount of resources that are available pertaining to preparedness and response planning. It should also be noted that the information concerning bioterrorism rapidly changes and the available information can be overwhelming. To that end, the authors have compiled an array of selected websites that provide excellent, up-to-date, and unique resources in attempts to facilitate the gathering of knowledge and make that experience more efficient.

The objective of the following resource guide is to provide a comprehensive list of topics in a “user-friendly” format that can be obtained electronically. To facilitate information retrieval, electronic resources have been categorized according to topic. For example, up-to-date information concerning the multitude of biological agents can be obtained by using the links contained within the biological agents category. Under this topic heading you will find a listing of important resources. Each listing contains a heading that identifies the sponsoring organization, a short explanation of information and materials that can be expected, and a web address identifying its location.

The authors’ compilation was not intended to be exhaustive nor do the authors necessarily endorse or warrant the reliability of the information/products. Websites may change regularly; please visit www.bioterrorism@ba.ttu.edu to obtain an electronic version of this resource guide and for updates to web addresses.

Matthew Wynia and his co-authors and Charmers Clark, in their two chapters, take on thorny issues concerning the moral responsibilities of physicians – and, by implication, all health care professionals – regarding preparation for and response to epidemics (Clark, 2006; Wynia, Kurlander, & Green, 2006). Their chapters are especially timely, inasmuch as they address ethical challenges associated with bioterrorism, which, should it occur, could create an epidemic of catastrophic proportions, at least for the locality or localities in which the bioterrorism occurs. In this commentary, I provide a critical assessment of their chapters. I begin with a review of the foundational concept of the Wynia et al. chapter, social-trustee professionalism, and of the Clark chapter, a covenant of public trust. I then take up four issues: the moral demands of social-trustee professionalism and how the social-contract theory of medical ethics advocated by the framers of the 1847 American Medical Association Code of Ethics (American Medical Association, 1847) should be understood; social-role related obligations as ethically-justified limits on fiduciary responsibility in bioterrorism events and how such obligations should be addressed in a preventive ethics fashion by health care organizations; legitimate self-interests as ethically-justified limits on fiduciary responsibility and how such interests should be distinguished from mere self-interests and be addressed in a preventive ethics fashion by health care organizations; and the nature and limits of the standard of care in the large-scale emergencies that bioterrorism events could create.

The threat of bioterrorism presents an opportunity for health care organizations to transform into more resilient, learning organizations. Rather than focusing solely on preparing for what is known or expected in a bioterrorist attack, organizations should strengthen their infrastructures to better manage surprises of all types. We advocate a combination of guidelines derived from conventional and complexity science perspectives on organizational change, including the need for leadership commitment, self-organization, culture change, and interorganizational connections.

Preparing for a potential bioterroism is a difficult task for health care leaders because of the fundamental unpredictability of bioterroist acts. Complexity science thinking is presented as an approach that can help in this task. Basic concepts from complexity science, especially the role of relationships, are presented. Specific recommendations for action including sensemaking, learning, and improvisation are made. A case study is used to illustrate the power of complexity science thinking in assisting health care leaders addressing potential bioterroism. Questions for further research are presented.

As a key component of the American health care system, the physician office could be the front line in a bioterrorist attack. Nationally and locally, the primary focus on this subject appears to be from a hospital preparedness and public health agency perspective, with little attention devoted to primary physician providers in their own offices, and those specialists to whom patients may be referred. While unrelated to bioterrorism, the recent SARS outbreak also brings to the forefront the need for physicians offices to be able to clinically, operationally, and managerially respond to illnesses that mirror the symptoms of known illnesses, but may be more virulent new organisms or hybrids of existing organisms. If the face of bioterrorism is subtle and slow in its presentation, physicians, in their own offices, could be the first providers of care. Will they be prepared, or will they be among the first fatalities in a bioterrorist attack?

Aims to highlight how food contamination, whether accidental or deliberate, can have far‐reaching impact on individuals, organisations and the food supply chain.

This paper focuses on the use of agents such as foreign animal disease (FAD). The research included a literature review and evaluation to determine the mechanisms currently in place to counter‐act bioterrorism in the food supply chain with particular emphasis on poultry.

Food terrorism, where the contaminant is a FAD, would cause severe economic disruption by direct costs due to the culling of livestock and the compensation paid to growers. It could also lead to consequential loss to the local or national economy, loss of consumer confidence in the food supply chain and loss of political confidence and support following the mass culling of livestock, with some agents having the ability to impact directly on human health.

This paper analyses the current state of preparedness for food terrorism in the food supply chain and is of relevance to a cross‐section of the industry.

A Note from the Editors of Bioterrorism, Preparedness, Attack and Response This thematic volume on preparing for bioterrorism, bioterrorist attacks, and the response to such attacks is, in part, the collective response of both the authors of specific chapters as well as that of the three editors to the events of September 11, 2001.