Human-induced public health emergencies such as the anthrax bioterrorism event and the terrorism events of September 11, 2001 in the United States have increased awareness of the nation's vulnerability to large-scale emergencies. Scant attention has been given to preparing physicians in sparsely populated areas for public health emergencies. This study introduces a conceptual model developed from participants' responses that can be used to improve our understanding of rural physicians' preparedness regarding public health emergencies such as a bioterrorism event. The conceptual model is valuable because it illustrates some areas of question, concern, and future inquiry regarding bioterrorism preparedness. This study used a qualitative research approach and grounded theory methods for data analysis. Semistructured interviews were conducted among six rural physicians in Florida. Florida was considered a particularly appropriate location given that the state was an initial site of the 2001 anthrax attacks. In addition, approximately half of Florida's counties are considered rural. The findings of this study suggest that not all rural physicians in Florida believe that they are adequately prepared for a bioterrorism event. The conceptual model elements--cognitive, clinical, expectation, and simulation--emerged from an analysis of participant responses. According to participant responses and the formulation of the conceptual model it may be postulated that preparedness may be effectively achieved if physicians are aware of the possibility of bioterrorism through education and seminars, able to suspect and recognize an event when it occurs, and institute appropriate medical management.
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