Transcript Preparing and Responding to Bioterrorism: Information for

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
Acknowledgements
This presentation, and the accompanying instructor’s manual
(current as of 7/02), were prepared by Jennifer Brennan Braden, MD,
MPH, at the Northwest Center for Public Health Practice in Seattle, WA,
and Jeff Duchin, MD with Public Health – Seattle & King County and
the Division of Allergy & Infectious Diseases, University of WA, for the
purpose of educating primary care clinicians in relevant aspects of
bioterrorism preparedness and response. Instructors are encouraged
to freely use all or portions of the material for its intended purpose.
The following people and organizations provided information and/or
support in the development of this curriculum. A complete list of
resources can be found in the accompanying instructor’s guide.
Patrick O’Carroll, MD, MPH
The Centers for Disease Control and Prevention
Project Coordinator
Judith Yarrow
Health Policy & Analysis, University of WA
Design and Editing
UW Northwest Center for Public Health Practice
Jane Koehler, DVM, MPH
Communicable Disease Control,
Epidemiology and Immunization
section, Public Health - Seattle & King
County
Ed Walker, MD; University of WA
Department of Psychiatry
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
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Bioterrorism Preparedness & 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
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Bioterrorism Preparedness & Response
Crisis & Consequence Management
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Crisis management: law enforcement response
to terrorist acts
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Local, state, federal law-enforcement agencies
Consequence management: response to the
disaster focusing on the alleviation of damage,
loss, hardship, or suffering
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Public health, medical, & emergency mgt personnel
Falls under ESF-8 (public health) of Federal Disaster
Response Plan
PDD-39
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National Responders
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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
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Health care providers &
facilities
Local and state health
departments
Emergency
management agencies
Search & Rescue,
EMS, & HAZMAT
teams
Volunteers
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Law enforcement,
National Guard
State emergency
management agency
Political leaders
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...
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National Preparedness
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...
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National Preparedness
CDC Activities, cont.

CDC bioterrorism preparedness & response
activities
 Education and training
 Improved
communication systems – HAN,
LRN
 National
Pharmaceutical Stockpile
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National Preparedness
Other DHHS activities

Medical Consequence Management: HHS
Office of Emergency Preparedness (OEP),
expanding efforts to develop medical response
capabilities at local and national levels
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National Pharmaceutical Stockpile
Purpose
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Provides resources to respond to both biological
and chemical attacks
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Requested by governor
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Managed by the Centers for Disease Control
and Prevention
More on NPS...
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National Pharmaceutical Stockpile
Push Packages
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12-hour “Push Packages” in cargo-sized
containers weighing approximately 37 tons each
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Located around the country at strategic
locations
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Held in environmentally controlled and secured
warehouses
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Can reach its destination within 12 hours of
being requested
National Pharmaceutical Stockpile
Push Packages
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Contain color-coded inventory
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Pharmaceuticals - stock rotated before
expiration
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IV supplies, airway supplies, ventilators
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Bandages & personal protective equipment
National Pharmaceutical Stockpile
Push Packages
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Materials pre-packaged for immediate
dispensing
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Support staff will accompany the package
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Receiving state responsible for logistics of
repackaging and distribution
National Pharmaceutical Stockpile
Vendor-Managed Inventory
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Agreements with pharmaceutical manufacturers
to make large stocks available on demand
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Shipped to arrive within 24-36 hours after
requested
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VA hospitals have an agreement with CDC to
assist in the procurement & maintenance of
NPS
Health Alert Network
Definition
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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...
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Health Alert Network
How It Works

Links local health departments to one another
and to other organizations critical for
preparedness and response:
 Community
 Hospital
 State
first-responders
and private laboratories
health departments
 CDC
 Other
federal agencies
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Health Alert Network
National Electronic Disease Surveillance
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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
UW Northwest Center for Public Health Practice
Community Preparedness
A Coordination of Efforts
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Partnerships between public health and:
 Clinicians and health care facilities
 Public safety: law enforcement, fire, HAZMAT
 Emergency management
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Coordinate response across agencies at the
local, state, and federal levels
Community Preparedness
Know Whom to Contact
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Know how to activate the biological disaster
response plan in your practice setting
 Who’s in charge?
 Communication
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Know the 24/7 contact number for your local
health department
Community Preparedness
Role of Public Health
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Coordinate preparedness & response activities
 Requires collaboration with medical
professionals, first responders, and other
partners
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Provide information to health professionals,
government leaders, and the public
Community Preparedness
Role of Public Health
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Detection and evaluation of biological disaster
 Requires robust surveillance, epidemiology, and
disease investigation infrastructure plus new
detection methods
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Facilitate medical management of exposed
persons
 Provide information on diagnosis, treatment,
prophylaxis, and infection control issues
Community Preparedness
Role of Public Health
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Coordinate and engage state and federal
resources
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Education, training, and information
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Surveillance, disease case and outbreak
investigation
Community Preparedness
Role of Public Health
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Inventory and address deficiencies in regional
resources
 Hospital
response capacity/preparedness
 EMS/first
 Mass
treatment and prophylaxis
 Mortuary
 Law
responder capacity/preparedness
capacity/preparedness
enforcement/security
Bioterrorism Preparedness & Response
Role of the Clinician as “First Responder”
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Prompt recognition, evaluation, and management
of suspicious cases
 Recognize
clinical presentations consistent
with potential BT agents
 Be
familiar with the “epidemiological clues”
 Requires
thorough, targeted history
 Occupation,
travel, contacts, recent
“exposures,” threats
 Differentiating
the “worried well” from the ill
Bioterrorism Preparedness & Response
Role of the Clinician as “First Responder”
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Prompt recognition, evaluation, and management
of suspicious cases, continued
 Know how to access current resources and
information on infection control, treatment, and
post-exposure prophylaxis
 Local and state public health, CDC
 Infectious disease consultants, hospital
epidemiologist, or infection control
professionals
 Be familiar with procedures for obtaining &
submitting clinical specimens for testing by
clinical & health dept labs
Bioterrorism Preparedness & Response
Role of the Clinician as “First Responder”

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
 Be familiar with the disaster response plan for
your hospital or practice setting
 Know the immunization status and eligibility of
your staff for vaccine preventable diseases
UW Northwest Center for Public Health Practice
Bioterrorism Preparedness & Response
Role of the Clinician - Preparedness Planning
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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
 Be familiar with local procedures for evaluation
of suspicious substances (“white powder”): role
of law enforcement & public health
UW Northwest Center for Public Health Practice
Bioterrorism Preparedness & Response
Role of the Clinician - Preparedness Planning
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Participate in preparedness planning
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Identify resources needed for biological mass
casualty event
 Medical,
nursing, other professional, and
support staff
 Antibiotics
 Supplies
and other pharmaceuticals
for mass treatment/vaccination
 Ventilators
and related respiratory support
equipment
UW Northwest Center for Public Health Practice
Bioterrorism Preparedness & Response
Role of the Clinician - Preparedness Planning

Identify resources needed for biological mass
casualty event, continued
 Hospital
 Mental
ICU and isolation beds
health resources
 Post-mortem
 Triage,
management
security and crowd control
 Communication
relations/media
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– internal, external, public
Bioterrorism Preparedness and Response
Role of the Clinician
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To report a potential BT incident or threat in King
County
 Notify Public Health – Seattle & King County:
206-296-4774 (24hr number)
 If no one available, call the Washington State
Department of Health: 1-877-539-4344
 Notify your hospital epidemiologist or infection
control practitioner
 Notify other partners as identified on your
facility’s biological disaster response plan
 Consider activating your site disaster
response plan
UW Northwest Center for Public Health Practice
Hoaxes and Evaluation of
Suspicious Powders
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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
UW Northwest Center for Public Health Practice
Hoaxes and Evaluation of
Suspicious Powders, cont.
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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
UW Northwest Center for Public Health Practice
Bioterrorism Preparedness and Response
Summary of Key Points

BT preparedness and response requires
coordination between clinicians, public health,
emergency first responders, and law
enforcement.
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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
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Resources
National
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Centers for Disease Control and Prevention
Strategic Plan for Preparedness & Response MMWR 49(RR-4)
Bioterrorism Web site: http://www.bt.cdc.gov
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Emergency Preparedness & Response
branch 24-hour notification telephone
number: (770) 488-7100
 CDC Public Inquiry Hotlines
English (888) 246-2675
Español (888) 246-2857
 National Domestic Preparedness Office:
(202) 324-9026 M-F 8am-5pm EST
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Resources
Washington State
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Washington State Department of Health
http://www.doh.wa.gov
 Communicable
Disease Epidemiology
 (206) 361-2914
 1-877-539-4344 - 24-hour emergency
number
 Julie Wicklund, BT Surveillance
Epidemiologist (206) 361-2881
 Washington State Emergency Management
Division http://www.wa.gov/wsem/
UW Northwest Center for Public Health Practice
Resources
Local
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
Public Health – Seattle & King County
 To
report illness or discuss suspicious
substances (206) 296-4774 (24 hr)
http://www.metrokc.gov/health/bioterrorism
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Resources
Emergency Management
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State Emergency Management duty officer
(800)258-5990
 Regional Emergency Coordinator,Region X
(206) 615-2266
 FBI
 Western WA and after hrs, Statewide:
(206) 622-0460
 Eastern WA: (509) 747-5195
 Federal Emergency Management Agency
(FEMA) http://www.fema.gov- includes links to
emergency management courses
UW Northwest Center for Public Health Practice
Resources
Health Care Facility Preparedness
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
American Hospital Association Disaster
Readiness site
http://www.aha.org/Emergency/EmIndex.asp
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Association of Professionals in Infection Control
and Epidemiology (APIC) http://www.apic.org
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APIC & CDC BT readiness plan template for
health care facilities
http://www.cdc.gov/ncidod/hip/Bio/13apr99APIC-CDCBioterrorism.PDF
UW Northwest Center for Public Health Practice
In Case of An Event…
Web Sites with Up-to-Date Information and
Instructions
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Centers for Disease Control and Prevention
http://www.bt.cdc.gov/EmContact/index.asp
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Saint Louis University, CSB & EI
http://bioterrorism.slu.edu/hotline.htm
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WA State Local Health Departments/Districts
http://www.doh.wa.gov/LHJMap/LHJMap.htm
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Level A Lab Protocols: Presumptive Agent ID
http://www.bt.cdc.gov/LabIssues/index.asp
UW Northwest Center for Public Health Practice
In Case of An Event…
Web Sites with Up-to-Date Information and
Instructions
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FBI Terrorism Web Page
http://www.fbi.gov/terrorism/terrorism.htm
WA State Emergency Mgt Division – Hazard Analysis
Update http://www.wa.gov/wsem
 Mail Security
http://www.usps.com/news/2001/press/serviceupdates.htm
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Links to your state health department
http://www.astho.org/state.html
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NIOSH – Worker Safety and Use of PPE
http://www.cdc.gov/niosh/emres01.html
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