Bioterrorism: Preparing for the impossible or the improbable.

Objective: To review the current literature surrounding the history of bioterrorism, the relative risk of a bioterrorist attack, methods of surveillance for biological agents, identification and management of various biological agent casualties, as well as the role of the intensivist in managing a bioterrorist attack.

Methods: Internet and Medline search (from 1966 to 2004) for articles relating to bioterrorism, biological agents, biological warfare, hospital preparedness, disaster management, and intensive care.

Conclusions: There are few instances of a successful large-scale biological weapons attack in history.