Bioterrorism - Preparedness and Response

Preparing for and Responding to
Bioterrorism: Information for

Primary Care Clinicians
Northwest Center for Public Health Practice

University of Washington School of Public Health and Community Medicine, July 2002
Bioterrorism Preparedness
and Response
CDC
UW Northwest Center for Public Health Practice

Bioterrorism Preparedness & Response
Learning Objectives
 Be familiar with:
 The role of the clinician in bioterrorism
preparedness and response
 The roles of local and national agencies
involved in bioterrorism preparedness and
response

Learning Objectives
 Be familiar with:
 The purpose and functions of the Health
Alert Network (HAN) and the National
Pharmaceutical Stockpile (NPS)
 How to contact the appropriate local agency
to report potential bioterrorism or other
public health concerns

Crisis & Consequence Management
 Crisis management: law enforcement response

to terrorist acts
 Local, state, federal law-enforcement agencies
 Consequence management: response to the

disaster focusing on the alleviation of damage,
loss, hardship, or suffering
 Public health, medical, & emergency mgt personnel
 Falls under ESF-8 (public health) of Federal Disaster
Response Plan
PDD-39
UW Northwest Center for Public Health Practice This link will take you away from the educational site
National Responders
 Health and Human
Services (HHS)
 Centers for Disease
Control and Prevention
(CDC)
 Federal Emergency
Management Agency
(FEMA)
 FBI
 Environmental
Protection Agency
(EPA)
 Department of
Agriculture
 Department of Defense
State and Local Responders
 Health care providers &

facilities
 Local and state health
departments
 Law enforcement,
 Emergency National Guard
management agencies
 State emergency
 Search & Rescue, management agency
EMS, & HAZMAT
teams
 Political leaders
 Volunteers
 Community service
organizations
National Preparedness
1999 Initiative
 National Bioterrorism Preparedness and

Response Initiative
 1999 DHHS Initiative to prepare the nation to
respond to potential BT activity
 CDC designated lead in upgrading nation’s
public health capacity and in developing a BT
preparedness & response plan
More on 1999 Initiative...

CDC Activities
 CDC bioterrorism preparedness & response

activities
 Preparedness and prevention
 Detection and surveillance
 Diagnosis and characterization of biological
and chemical agents
 Response
More on CDC program...

CDC Activities, cont.
 CDC bioterrorism preparedness & response

activities
 Education and training
 Improved communication systems – HAN,
LRN
 National Pharmaceutical Stockpile

Other DHHS activities
 Medical Consequence Management: HHS

Office of Emergency Preparedness (OEP),
expanding efforts to develop medical response
capabilities at local and national levels

National Pharmaceutical Stockpile
Purpose
 Provides resources to respond to both biological

and chemical attacks
 Requested by governor
 Managed by the Centers for Disease Control

and Prevention
More on NPS...
This link will take you away from the educational site
Push Packages
 12-hour “Push Packages” in cargo-sized

containers weighing approximately 37 tons each
 Located around the country at strategic

locations
 Held in environmentally controlled and secured

warehouses
 Can reach its destination within 12 hours of

being requested
Push Packages
 Contain color-coded inventory
 Pharmaceuticals - stock rotated before

expiration
 IV supplies, airway supplies, ventilators
 Bandages & personal protective equipment

Push Packages
 Materials pre-packaged for immediate

dispensing
 Support staff will accompany the package
 Receiving state responsible for logistics of

repackaging and distribution
Vendor-Managed Inventory
 Agreements with pharmaceutical manufacturers

to make large stocks available on demand
 Shipped to arrive within 24-36 hours after

requested
 VA hospitals have an agreement with CDC to

assist in the procurement & maintenance of
NPS
Health Alert Network
Definition
 A nationwide, integrated information and

communications system designed to:
 Ensure communications capacity at all local
and state health departments
 Ensure capacity to receive distance-learning
offerings from CDC, et al.
 Ensure capacity to broadcast and receive
health alerts at every level
More on HAN...
How It Works
 Links local health departments to one another

and to other organizations critical for
preparedness and response:
 Community first-responders
 Hospital and private laboratories
 State health departments
 CDC
 Other federal agencies

National Electronic Disease Surveillance
 Information system “highway” for the National

Electronic Disease Surveillance System
(NEDSS)
 NEDSS supports automated collection and
transmission of disease reports from
clinicians’ offices, laboratories, & hospitals to
local & state health departments and CDC

Community Preparedness
A Coordination of Efforts
 Partnerships between public health and:

 Clinicians and health care facilities
 Public safety: law enforcement, fire, HAZMAT
 Emergency management
 Coordinate response across agencies at the

local, state, and federal levels
Know Whom to Contact
 Know how to activate the biological disaster

response plan in your practice setting
 Who’s in charge?
 Communication
 Know the 24/7 contact number for your local

health department
Role of Public Health
 Coordinate preparedness & response

activities
 Requires collaboration with medical
professionals, first responders, and other
partners
 Provide information to health professionals,

government leaders, and the public
 Detection and evaluation of biological disaster

 Requires robust surveillance, epidemiology, and
disease investigation infrastructure plus new
detection methods
 Facilitate medical management of exposed

persons
 Provide information on diagnosis, treatment,
prophylaxis, and infection control issues
 Coordinate and engage state and federal

resources
 Education, training, and information
 Surveillance, disease case and outbreak

investigation
 Inventory and address deficiencies in regional

resources
 Hospital response capacity/preparedness
 EMS/first responder capacity/preparedness
 Mass treatment and prophylaxis
 Mortuary capacity/preparedness
 Law enforcement/security
Role of the Clinician as “First Responder”
 1.Prompt recognition, evaluation, and

management of suspicious cases
 Recognize clinical presentations consistent with
potential BT agents
 2.Be familiar with the “epidemiological clues”
 Requires thorough, targeted history
 Occupation, travel, contacts, recent
“exposures,” threats
 3.Differentiating the “worried well” from the
ill
Role of the Clinician as “First Responder”
 4.Report confirmed or suspicious cases to
public health
 Be familiar with 24/7 reporting procedures for
suspected cases or potential outbreak
 Know how to engage local emergency
responders
 5.Be familiar with the disaster response plan
for your hospital or practice setting
 6.Know the immunization status and eligibility
of your staff for vaccine preventable diseases

Role of the Clinician - Preparedness Planning
 1.Long-term consequence management and

remediation
 Identify and manage late-onset cases
 Monitor for and manage adverse effects of
treatment or prophylaxis
 Identify and manage psychological sequelae
 2.Be familiar with local procedures for
evaluation of suspicious substances (“white
powder”): role of law enforcement & public
health
 3.Participate in preparedness planning

 4.Identify resources needed for biological
mass casualty event
 Medical, nursing, other professional, and
support staff
 Antibiotics and other pharmaceuticals
 Supplies for mass treatment/vaccination
 Ventilators and related respiratory support

equipment
 Identify resources needed for biological mass

casualty event, continued
 Hospital ICU and isolation beds
 Mental health resources
 Post-mortem management
 Triage, security and crowd control
 Communication – internal, external, public

relations/media
Hoaxes and Evaluation of
Suspicious Powders
 If a suspicious package or substance is received
 Cover package/substance (do not try to clean
up any spilled contents)
 Leave the room and close the door
 Turn off air conditioning system
 Wash hands with soap & water
 Report to local law enforcement (call 911)
 Notify building security

Hoaxes and Evaluation of
Suspicious Powders, cont.
 Additional steps to take, if exposed to a

suspicious powder or substance
 Remove contaminated clothing & place in
plastic bag or other sealed container
 Shower with soap & water (bleach is not
necessary)
 Contact local health jurisdiction
 Symptom monitoring and/or prophylaxis
may be needed for others in the room/area

Bioterrorism Preparedness and Response
Summary of Key Points
 BT preparedness and response requires

coordination between clinicians, public health,
emergency first responders, and law
enforcement.

Bioterrorism Preparedness and Response
Summary of Key Points
 BT preparedness for clinicians involves

 Ability to recognize unusual clinical
presentations and clusters of cases
 Knowledge of diagnosis and management of
diseases of BT origin
 Awareness of their health care facility or
practice’s disaster response plan
 Knowledge of disease reporting
requirements, and how and when to contact
local public health authorities

Bioterrorism - Preparedness and Response

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Preparing for and Responding to

Bioterrorism: Information for

Northwest Center for Public Health Practice

UW Northwest Center for Public Health Practice

UW Northwest Center for Public Health Practice

UW Northwest Center for Public Health Practice

 Crisis management: law enforcement response

 Consequence management: response to the

 Health care providers &

 National Bioterrorism Preparedness and

More on 1999 Initiative...

 CDC bioterrorism preparedness & response

More on CDC program...

 CDC bioterrorism preparedness & response

UW Northwest Center for Public Health Practice

 Medical Consequence Management: HHS

UW Northwest Center for Public Health Practice

 Provides resources to respond to both biological

 Managed by the Centers for Disease Control

 12-hour “Push Packages” in cargo-sized

 Located around the country at strategic

 Held in environmentally controlled and secured

 Can reach its destination within 12 hours of

 Contain color-coded inventory

 Pharmaceuticals - stock rotated before

 IV supplies, airway supplies, ventilators

 Bandages & personal protective equipment

 Materials pre-packaged for immediate

 Support staff will accompany the package

 Receiving state responsible for logistics of

 Agreements with pharmaceutical manufacturers

 Shipped to arrive within 24-36 hours after

 VA hospitals have an agreement with CDC to

 A nationwide, integrated information and

 Links local health departments to one another

UW Northwest Center for Public Health Practice

 Information system “highway” for the National

UW Northwest Center for Public Health Practice

 Partnerships between public health and:

 Coordinate response across agencies at the

 Know how to activate the biological disaster

 Know the 24/7 contact number for your local

 Coordinate preparedness & response

 Provide information to health professionals,

 Detection and evaluation of biological disaster

 Facilitate medical management of exposed

 Coordinate and engage state and federal

 Education, training, and information

 Surveillance, disease case and outbreak

 Inventory and address deficiencies in regional

 EMS/first responder capacity/preparedness

 Mass treatment and prophylaxis

 1.Prompt recognition, evaluation, and

UW Northwest Center for Public Health Practice

 1.Long-term consequence management and

 3.Participate in preparedness planning

 Supplies for mass treatment/vaccination

 Ventilators and related respiratory support

 Identify resources needed for biological mass

 Mental health resources

 Triage, security and crowd control

 Communication – internal, external, public