Responding to bioterrorist smallpox in San Antonio

We used discrete-event simulation to help the San Antonio public health and acute medical care communities to plan their response to a bioterrorist attack. The analysis, based on a scenario positing an attack with aerosolized smallpox, indicated the resources and strategies needed for an effective response. We found that a mixture of public-health measures designed to stop the spread of the disease would form a more robust and effective response than any single measure. However, unless the attack is very small, the public-health system is unlikely to be able to prevent a surge in demand for acute care that will require community-wide coordination of resources, a definitive patient-triage policy, and temporary treatment practices. The San Antonio communities are integrating our recommendations into their plans.