A Clinical Approach to an Unidentified Aerosolized Bioterrorism Agent; A Narrative Review for Emergency Providers

Document Type

Journal Article

Publication Date



Clinical and experimental emergency medicine




Biological weapons; Bioterrorism; Disaster management; Emergency department; Nerve agent; Chemical weapons


The current heightened international political climate increases the risk of chemical or biological agent weaponization. Historical accounts of biochemical warfare are extensive, and in light of recent use of such agents for targeted attacks, it is important for clinicians to recognize and manage these cases. However, properties such as the color, odor, ability to be aerosolized, and long incubation period can introduce difficulties in the diagnostic and management approach. We searched PubMed and Scopus for a colorless, odorless, aerosolized substance with an incubation period of at least 4 hours. Data from articles were summarized and reported by agent. Based on the available literature, in this review, we included agents such as Nerve agents, Ricin, Botulism, Anthrax, Tularemia, Psittacosis. We also highlighted potential chemical and biological agents that could be weaponized and the optimal strategies for the diagnosis and treatment of patients exposed to an aerosolized unknown biological or chemical bioterrorism agent.


Emergency Medicine