Clinicians confronted with the first victims must put themselves into the mind of the
enemy. Diagnostic, therapeutic, and infection control decisions must be quickly implemented,
and often based upon inadequate data. They should take into account the possibility of a second
pathogen in the same patient or different pathogens in subsequent patients early in the outbreak
before there is an alteration in the initial and usually most stringent isolation precautions.
Epidemiologic, clinical, laboratory, and historical data on the first patients will often be
the key to identifying the pathogen(s), means of distribution, and the culprits responsible.
Again, the terrorists may be among the first and most critically ill patients presenting to the
intensive care unit.
Cannon to right of them, Cannon to left of them, Cannon behind them Volley’d and thunder’d;
Storm’d at with shot and shell, While horse and hero fell, They that had fought so well Came
thro’ the jaws of Death Back from the mouth of Hell, All that was left of them, Left of six
hundred. When can their glory fade? O the wild charge they made! All the world wondered.
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