Healthcare facilities may be the initial site of recognition and response to bioterrorism events. The four diseases with recognized bioterrorism potential are anthrax, botulism, plague, and smallpox. Anthrax is an acute infectious disease occurring most frequently in sheep, goats, and cattle. Humans can become infected through skin contact, ingestion, or inhalation of spores from infected animals or animal products. Botulism produces spores that are present in soil and marine sediment throughout the world. Foodborne botulism is the most common form of disease in adults. Plague is an acute bacterial disease that is usually transmitted by infected fleas, resulting in lymphatic and blood infections. Smallpox is an acute viral illness and can be transmitted via the airborne route. Bioterrorism may occur as covert events or announced events. Covert events are events where persons are unknowingly exposed and an outbreak is suspected only upon recognition of unusual disease clusters or symptoms. Announced events are when persons are warned that an exposure has occurred. Rapid response to a bioterrorism-related outbreak requires prompt identification of its onset. The management of patients must be well organized and rehearsed. Strong leadership and effective communication are paramount. The need for decontamination depends on the suspected exposure and in most cases will not be necessary. 15 references and 2 appendices.