The possibility that biological weapons, such as smallpox, will be used is no longer unthinkable. Biological agents have been used since antiquity, and the threat that modern weapons will be used has increased since the events of Sept. 11. Despite international efforts to eradicate smallpox, the potential for its use as a weapon of terror is renewed. Prehospital providers should research the possibility of a vaccination program for their respective agencies and decide on its appropriateness under the guidance of the medical director. In addition, EMS personnel must prepare to handle smallpox and other biological terror weapons. Consult your medical director and local Department of Health for guidelines regarding the appropriate response, treatment and transport of patients exposed to smallpox.