CHICAGO — The photograph of a patient's forearm bore a telltale sign of anthrax poisoning — a black, ulcerated sore illustrating how anthrax, Greek for "coal," got its name.
The color is typical of cutaneous anthrax and a big tip-off that the ailment is anything but ordinary, a Veterans Affairs emergency medicine specialist told a roomful of doctors Monday at the American College of Emergency Physicians' annual meeting.
More than 250 people attended a forum that was a crash-course on identifying skin rashes from anthrax, plague, smallpox and other potential biological and chemical weapons.
"We need to know how to recognize these. We may be the first people to see these patients," said Dr. Kristi Koenig, national director of a Veterans Health Administration emergency management group.
Dr. Eric Mailman, an emergency room physician at Swedish Hospital in Seattle, called the presentation an excellent lesson in cases he, like most attendees, have never seen.
Already, Mailman said, worried patients are showing up in his emergency room with colds and flu they think might be anthrax "and we're not even deep into the cold and flu season."
Koenig told doctors to reassure such patients, but also to look for suspicious symptoms and inquire about experiences that might indicate exposure to poisons.
"I don't think any hospital in the country is prepared for mass casualties" from bioterrorism, Koenig said in an interview, and a survey released at the meeting suggests she may be right.
Emergency room workers at 30 hospitals in four states and Washington, D.C., were queried last year, and those at just one said they had stockpiled medicines for a bioterrorism attack. Twenty-six hospitals reported they could handle only 10 to 15 victims at once.
Twenty-two hospitals said they were not prepared to handle a mass chemical weapons or nuclear attack, and only seven said their staff had some training in managing casualties from an attack involving weapons of mass destruction.
The study by Dr. Janet Williams and colleagues at West Virginia University sampled 22 rural hospitals and eight urban hospitals in Washington, D.C., Pennsylvania, Maryland, Virginia and West Virginia. Results will be published in the November issue of group's medical journal, Annals of Emergency Medicine.
Dr. Stephen Cantrill, associate director of emergency medicine at Denver Health Medical Center, said the results are not surprising.
"If fully prepared means you can handle 10 times your normal load, we'll never be fully prepared," he said.
But he said hospitals' quick response to the nation's isolated anthrax cases shows "a great deal of heightened awareness" prompted by the Sept. 11 terrorist attacks.
That awareness suggests preparedness is improving, Cantrill said at the convention, where the agenda was revised to include extra sessions on dealing with terrorism.
Dr. Michael Carius, ACEP's president, said the attacks and the potential for more come at a critical time for emergency medicine, already grappling with emergency room overcrowding brought on by a decade of funding cuts, hospital closures and nursing shortages.
An adequate response to mass casualties will require a "massive commitment on the part of government to put back into the system what has been taken out," Carius said.
While ACEP scrambled to add special courses this year, it's not the first time the meeting has addressed the issue. The group represents more than 20,000 doctors who specialize in emergency medicine and consider themselves "the front line" in treating victims of a mass attack.
Doctors attending the four-day event said they used to feel like Chicken Little, calling for better preparations for disaster. Not anymore.
"We've been talking about this for years and people in general have not been interested," said Dr. Jonathan Burstein of Harvard Medical School, a member of the college's task force on weapons of mass destruction. "Now, of course, everyone's coming to us and saying, 'Well, gee, we understand this is a problem."'