Skip to main content Accessibility help

Developing a Consensus Framework and Risk Profile for Agents of Opportunity in Academic Medical Centers: Implications for Public Health Preparedness

  • Brenna M. Farmer, Lewis S. Nelson, Margaret E. Graham, Carly Bendzans, Aileen M. McCrillis, Ian Portelli, Meng Zhang, Judith Goldberg, Sheldon D. Rosenberg, Lewis R. Goldfrank and Michael Tunik...


Agents of opportunity (AO) in academic medical centers (AMC) are defined as unregulated or lightly regulated substances used for medical research or patient care that can be used as “dual purpose” substances by terrorists to inflict damage upon populations. Most of these agents are used routinely throughout AMC either during research or for general clinical practice. To date, the lack of careful regulations for AOs creates uncertain security conditions and increased malicious potential. Using a consensus-based approach, we collected information and opinions from staff working in an AMC and 4 AMC-affiliated hospitals concerning identification of AO, AO attributes, and AMC risk and preparedness, focusing on AO security and dissemination mechanisms and likely hospital response. The goal was to develop a risk profile and framework for AO in the institution. Agents of opportunity in 4 classes were identified and an AO profile was developed, comprising 16 attributes denoting information critical to preparedness for AO misuse. Agents of opportunity found in AMC present a unique and vital gap in public health preparedness. Findings of this project may provide a foundation for a discussion and consensus efforts to determine a nationally accepted risk profile framework for AO. This foundation may further lead to the implementation of appropriate regulatory policies to improve public health preparedness. Agents of opportunity modeling of dissemination properties should be developed to better predict AO risk.

(Disaster Med Public Health Preparedness. 2010;4:318-325)


Corresponding author

Correspondence: Address correspondence and reprint requests to Dr Brenna Farmer, Department of Emergency Medicine, New York Presbyterian Hospital/Weill-Cornell Medical Center, 525 E 68th St, M-130, New York, NY 10065 (e-mail:


Hide All
1.Sternberg, E, Lee, GC.Meeting the challenge of facility protection for homeland security. J Homeland Secur Emerg Manag. 2006;3:1.
2.Chipley, M, Kaminskas, M, Lyon, W, Beshlin, D, Hester, M.Reference manual to mitigate potential terrorist attacks against buildings. Published December 2003. Accessed March 28, 2010.
3.American College of Medical Toxicology. Chemical agents of opportunity for terrorism: the medical and psychological consequences of TICs (toxic industrial chemicals) and TIMs (toxic industrial materials). Accessed March 28, 2010.
4.Török, TJ, Tauxe, RV, Wise, RP, et alA large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. JAMA. 1997;278 (5):389395.
5.Kolavic, SA, Kimura, A, Simons, SL, Slutsker, L, Barth, S, Haley, CE.An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. JAMA. 1997;278 (5):396398.
6.Muller, RA.The dirty bomb distraction. Published June 23, 2004. Accessed October 3, 2010.
7.Wax, PM, Becker, CE, Curry, SC.Unexpected “gas” casualties in Moscow: a medical toxicology perspective. Ann Emerg Med. 2003;41 (5):700705.
8.Department of Homeland Security. Information bulletin: false hospital inspections. Published April 25, 2005.Accessed March 28, 2010.
9.Rotz, LD, Khan, AS, Lillibridge, SR, Ostroff, SM, Hughes, JM.Public health assessment of potential biological terrorism agents. Emerg Infect Dis. 2002;8 (2):225230.
10.Centers for Disease Control and Prevention. National select agent registry. 7 CFR Part 331, 9 CFR Part 121, and 42 CFR Part 73. Accessed March 28, 2010.
11.Drug Enforcement Administration. Controlled Substances Act. Title 21: Food and Drugs; Chapter 13: Drug Abuse Prevention and Control. Accessed March 28, 2010.
12.Nuclear Regulatory Commission. Radionuclides of Concern. Accessed March 28, 2010.
13.Black, S, Hultquist, MLHealth care facility hazards. In: Sullivan JB, Krieger GR, eds. Clinical Environmental Health and Toxic Exposures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:600-614.
14.Sullivan, JB, Micale, LMMedical waste and blood-borne pathogen exposures. In: Sullivan JB, Krieger GR, eds. Clinical Environmental Health and Toxic Exposures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:623-630.
15.Wax, PM.Antiseptics, disinfectants, and sterilants.In: Flomenbaum N, Goldfrank LR, Hoffman RS, eds, et al. Goldfrank's Toxicologic Emergencies. 8th ed. New York: McGraw-Hill; 2006:1384-1397.
16.Burgess, JL.Hospital evacuations due to hazardous materials incidents. Am J Emerg Med. 1999;17 (1):5052.
17.Centers for Disease Control (CDC). Listeriosis outbreak associated with Mexican-style cheese--California. MMWR Morb Mortal Wkly Rep. 1985;34 (24):357359.
18.National Infrastructure Protection Plan. Partnering to Enhance Protection and Resiliency. Washington, DC: Department of Homeland Security; 2009.
19.Hauschild, VD, Bratt, GM.Prioritizing industrial chemical hazards. J Toxicol Environ Health A. 2005;68 (11-12):857876.
20.Dun, S, Wood, J, Martin, B.Decontamination, cleanup, and associated issues for sites contaminated with chemical, biological, or radiological materials. EPA/600/R-05/083. Published October 2005. Accessed March 28, 2010.
21.Department of Homeland Security. Appendix to chemical facility anti-terrorism standards. Published 2007. Accessed March 28, 2010.
22.Department of Defense. Minimum antiterrorism standards for buildings. UFC 4-010-01. October 8, 2003. Accessed March 28, 2010.
23.Barnett, DJ, Balicer, RD, Blodgett, D, Fews, AL, Parker, CL, Links, JM.The application of the Haddon matrix to public health readiness and response planning. Environ Health Perspect. 2005;113 (5):561566.
24.Riley, RL, Mills, E.Aerial disseminability of pulmonary tuberculosis. Am J Hyg. 1959;70:185196.
25.Butler, AS, Panzer, AM, Goldfrank, LR.Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington, DC: Institute of Medicine; 2003.
26.Environmental Protection Agency. Whitman details ongoing agency efforts to monitor disaster sites, contribute to cleanup efforts.!OpenDocument. Published September 18, 2001. Accessed March 28, 2010.
27.Varney, S, Hirshon, JM, Dischinger, P, Mackenzie, C.Extending injury prevention methodology to chemical terrorism preparedness: the Haddon Matrix and sarin. Am J Disaster Med. 2006;1 (1):1827.
28.Arnold, JL.The 2005 London bombings and the Haddon matrix. Prehosp Disaster Med. 2005;20 (5):278281.
29.Graham, ME, Tunik, M, Farmer, BM, et alAgent of opportunity task mitigation: people, engineering and security efficacy. Disaster Med Public Health Prep. 2010;4:291299.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed