Transcript WalksOct29 - 40th IFPA

“Anticipating and Defending Against Bioterrorism
in our Diverse Healthcare Environments”
Planning for and Responding to Threats to the U.S. Homeland
October 29, 2004
Ivan C.A. Walks, M.D.
Ivan Walks and Associates, LLC
“Invest in Health: Improve the Quality of Life”
The “Preparedness” Era
• Framework for Comprehensive Crisis
Planning, Response and Recovery/
CONTINUITY
• Developing and Supporting Healthcare
Leadership in “Public” Health
• Assessing and Accessing Community
Resources / Addressing Challenges
“Invest in Health: Improve the Quality of Life”
“The Public” - M I P S
• Hx of conventional terror attacks (Israeli
Ministry of Health 2002) Psych vs Physical
response as high as 10:1
• Some non-conventional terror scenarios
project mass psychogenic or sociogenic
illness consistent with a contagious
epidemic (Bartholomew 2002)
“Invest in Health: Improve the Quality of Life”
MIPS and the Terrorism Response
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Bioterrorism 1900 – 2001 (Regis – 2001)
66% Hoax, 21% Failed, 13% Materialized
24% in USA with <10 deaths
$Billions in response
Little focused on depression and anxiety
Emergency decontamination equipment and
negative pressure isolation rooms focus vs.
mental health infrastructure
“Invest in Health: Improve the Quality of Life”
Communicating in a Crisis:
Risk Communication Guidelines for
Public Officials - HHS, SAMHSA 2002
• Risk Communication: An interactive process of exchange
of information and opinion among individuals, groups and
institutions; often involves multiple messages about the
nature of risk or expressing concerns, opinions or
reactions to risk messages or to legal and institutional
arrangements for risk management
• First Do No Harm: “ASSESS THE ENVIROMMENT”
Crisis + heightened public emotions + limited access to
facts + rumor, gossip, speculation, assumption and
interference = an unstable information environment
“Invest in Health: Improve the Quality of Life”
Relevant “Public (s)”
• Culturally, Ethnically and Linguistically
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Diverse
Physically and Psychologically Diverse
Physiologically Diverse
(ethnopsychopharmacology)
Financially, Socially and Historically Diverse
Literacy / Health Literacy
“Invest in Health: Improve the Quality of Life”
Hallmark Psychosocial Events
The Baltimore Sun, 09/12/01
“Invest in Health: Improve the Quality of Life”
Information Dissemination
Information sharing with the public
• The public needs accurate and timely
information they can trust
• A core repository is needed for the most
up-to-date information
• A unified message throughout the region
• Must have everyone on the same page
• Avoid unnecessary confusion and fear
“Invest in Health: Improve the Quality of Life”
Diverse Public / Diverse Media
“Invest in Health: Improve the Quality of Life”
Cross-Jurisdictional System Design,
Procurement and Operation:
inclusive, multi-system, multi-level
• All stakeholders represented in Disaster
Preparedness, “All Hazards” planning
• Research – epidemiology and interventions
• Service / Treatment Resources – “Formulary”
• Data: Gathering and Dissemination
• “Cultural Quality” Based Assessment – measure value, efficiency,
“Invest in Health: Improve the Quality of Life”
Non-Terrorist Incidents
• West Nile, Flu, Weather
• 2003 Unattended Mercury spill - high school
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and homes evacuated
2004 Lead in drinking water supply
2004 Flu Shots
What are the technical, political/policy
challenges?
Lessons?
“Invest in Health: Improve the Quality of Life”
World Trade Center Terrorist Attack:
Air Quality Concerns - Then and Now
The Baltimore Sun, 09/12/01
Accountable Preparedness, Response
and Recovery/Continuity
• Housing, feeding and “safety” of responders
• Dual use incident management tools
• Cost accounting, planning, training, logistics,
resource inventory management and tracking,
and cost recovery preparedness via “Scenarios
Training”
• Secure Information and Knowledge
Management
“Invest in Health: Improve the Quality of Life”
Bioterror-Preparedness Challenges
• Syndromic Surveillance labor intensive
• Incident and Communicable disease reporting
to DOHs not timely and consistent
• Manual exchange of information within and
among organizations
• Information technologies used within diseasespecific registries and program areas are not
interoperable
• New funding leading to additional “stovepipes”.
“Invest in Health: Improve the Quality of Life”
Healthcare Intelligence
ADSS Objectives
• Electronic linkage among stakeholder organization systems;
Alerting system; GIS capability
• Real-time or “near real-time” digital data flow
• Computer-aided statistical analysis and reporting
• Infectious and communicable disease decision support
• Centralized data repository provides access to data from
multiple sources
“Invest in Health: Improve the Quality of Life”
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Take Home Lessons
“Fail to Plan, Plan to Fail”
Flexible Implementation
Relationships Matter
Psychosociocultural Community Diversity
Cross-Jurisdiction, Multi-agency Coordination
Informed, Caring, Careful, Redundant Leadership
Credible, Real-time Reporting
Tell the Public‘s’ the Truth & in Plain Talk - (Cultural
Competence)
• When Things Speed Up, Slow Down
“Invest in Health: Improve the Quality of Life”