Title: The National Advisory Committee on Children and Terrorism and Current U'S' Changes in How Preparedne
1The National Advisory Committee on Children and
Terrorism and Current U.S. Changes in How
Preparedness is Evaluated
- Peter D. Rumm, MD, MPH, FACPM
- Director, Center for Public Health Readiness and
Communication - Drexel School of Public Health
- pdr26_at_drexel.edu
- or 215-762-1652
2Most Famous Anthrax Disaster Sverdlovsk
- In late April of 1979, an outbreak of pulmonary
anthrax occurred in Sverdlovsk (now
Yekaterinburg) in the former Soviet Union. - While, originally, the outbreak was described as
being due to ingestion of infected meat, it was
later discovered that the cause was from an
accidental release of anthrax in aerosol form
from the Soviet Military Compound 19, a huge
Soviet bioweapons facility. - Residents living downwind from this compound
developed high fever and difficulty breathing,
and a large number died. The final death toll was
estimated at the time to be between 200 and
1,000.
3Cutaneous Anthrax (day 5)
4Anthrax Inhalation Cases (10) and their Timeline
5The Challenge of Bioterrorism
- Biological weapons are a formidable challenge.
The use of a bioagent as a weapon is a
multidimensional problem because of the diversity
of bioagents, the large number of vulnerable
targets, and the varied routes of dissemination. - Terrorists using biological warfare can decimate
a large population, inflict enormous
psychological and economic hardship, and incite
political unrest by merely attacking small
populations in multiple sites over a long period
of time.
6US Postal Cases
- In October 2001, anthrax spores were sent through
the U.S. mail and caused 18 confirmed cases of
anthrax (11 inhalation, 7 cutaneous). Five
individuals with inhalation anthrax died none of
the cutaneous cases was fatal. - One of the cutaneous cases was a child that did
well. - We learned a lot about the potential
vulnerability of children, the aged and other
populations.
7Soviet Union and Russia
- Although the former Soviet Union was a
signatory to the Biological Weapons Convention,
their development of biological weapons only
intensified after the accord and continued with
full steam into the 1990s.
8Overlooked Populations
- Many groups of people are frequently overlooked
in response plans, including those regarding
mental health, and the needs of children,
elderly, disabled, and ethnic minority groups
that are vulnerable to backlash or hate crimes.
9Some Resources
- American Academy of PediatricsChildren,
Terrorism and Disasters Disaster Preparedness to
Meet Childrens Needs - Columbia University Mailman School of Public
HealthThe National Center for Disaster
Preparedness, Program for Pediatric Preparedness - American Red CrossChildren and Disasters
10Other Populations
- Disabled American Red CrossSpecial Needs
Concerns Disaster Preparedness for People with
Disabilities - Hate crimes Council on American-Islamic
RelationsMuslim Community Safety Kit - Seniors International Longevity
CenterEmergency Preparedness for Older People - Mental Health American Psychological
AssociationBriefing Sheet The Psychological
Impact of Terrorism on Vulnerable Populations
11Children may be most vulnerable population, at
home or in schools
- A survey by the National Safety Resource
Officers in Schools in 2003 stated that 68 of
schools unprepared for a disaster or act of
terrorism. - Children have special vulnerabilities both
physiologically and mentally. - According to the WHO in 2002 most casualties of
both man made and natural disasters were children.
12Purpose of the NACCT
- Created by joint legislation introduced first by
Senator Hillary Clinton in 2001. - The objective of the National Advisory Committee
on Children and Terrorism (NACCT) as specified in
the legislation was to assess and provide
recommendations for Health and Human Services
Secretary Tommy Thompson
13Public Health Security and Bioterrorism
Preparedness and Response Act of 2002
- Established a National Advisory Committee on
Children and Bioterrorism assured that our
national system of responding and countering
bioterrorism. - Provided training to health professionals on the
special needs of children - Promoted 211 hotlines and other communications
systems.
14Background Information
- There are more than 70 million children under the
age of 18 in the United States today, and more
than 22 million are ages five and younger. - In the event of a terrorist attack, these
children would be among the most vulnerable
populations in our society - As recently as 1997, data collected by FEMA
showed that no state disaster plans had pediatric
components.
15Reports Consensus
- Children are not simply small adults. Children
breathe faster and have faster heart rates than
adults, making them more vulnerable to
aerosolized biological and chemical agents. - Children metabolize drugs differently, requiring
different dosages of drugs and different
antidotes to many agents, as well as specially
sized equipment to administer many treatments.
16Classic Presentation of a Severe Case about 1
Week, 10 Days
17Committee Consensus
- Ill and injured children react differently than
adults to stress, and their psychological
vulnerabilities in the aftermath of disasters and
emergencies are still only imperfectly
understood. - On every level, physical, medical, psychological,
emotional and social, children have unique needs
and vulnerabilities that must be taken into
account.
18Focus Areas
- Primary Care Pediatricians, Office-Based Practice
Urgent Care Centers - Community Involvement
- Childrens School and Childcare
- Research and Data
- Training
- Mental Health Response Phase
- Children with Special Health Care Needs
- Mental Health Recovery and Mitigation Phase
- Hospital Preparedness
- Public Health Departments
- Pre-Hospital and Critical Care
19Methods
- Each of 12 members began working with 3-4 CDC
staff and consultants wrote a 30-50 page draft
report on their focus area that they led. This
involved a massive literature review and seeking
out expert opinions. - Four meetings were held in two places (DC,
Atlanta)
20Methods Continued
- Over a 3-4 month time we each spent hours working
with the CDC and HHS senior staff and other staff
to compose report. - Report is available on line at www.bt.cdc.gov and
a supplement has also been published at - J Sch Health. 2004 Feb74(2)39-51.Schools and
terrorism. A supplement to the report of the
National Advisory Committee on Children and
Terrorism.
21Key Recommendation
- 1.3 Conduct a national survey of Federal, state
and local terrorism and disaster plans that
includes a specific assessment of preparedness
and training for the medical and psychological
effects of terrorism on children.
22Key Recommendation of This Committee
- 1.2 Assure that the unique physical and mental
health needs of children are recognized and
resources provided for in all DHHS terrorism
preparedness and response funding initiatives,
strategic plans and priority setting activities.
23History of Bioterrorism Not New!
- Before the era of modern microbiology brought the
prospect of germ warfare to the world of the 21st
century, ancient armies used filth, cadavers,
animal carcasses and contagion as weapons against
each other. - They knew that fear of infectious diseases could
rapidly demoralize and dismantle enemy forces. - During the North American colonization, British
forces purposely spread smallpox among the native
Indian population by sending smallpox-infested
blankets as "gifts" to Indian tribes who
resisted British authority.
24Key Recommendation
- 1.6 Expand the State Children's Health Insurance
Program (SCHIP) to provide financial mechanisms
for States to support post-disaster physical and
mental healthcare to all children.
25Key Recommendation focus on mental health and
resiliency
- 3.1 Conduct research relating to identifying
patterns of child trauma, resilience, coping and
recovery in the aftermath of disasters and
terrorism. - This research should include studying the topic
of resiliency.
26Key Recommendations on Risk Communication and
Translational Research
- 9.1-3 Implement risk communication strategies to
positively affect the nation as a whole during
times of elevated threat levels and actual
terrorist events, in light of the special effects
these threats and events have on children. - Develop clear, concise and situation-specific
guidance for parents, caregivers and teachers
concerning helping children to cope with
terrorism and disasters, and ensure that
consistent information is disseminated by all
DHHS agencies.
27Public Health Ramps Up for Terrorism
- The CDC over the last four years has spent
approximately 1.2 billion per year on terrorism
preparedness. - They use about 150 million per year internally to
improve internal terrorism preparedness and the
syndrome biosurveillance initiative. - The rest of the money is distributed primarily to
state agencies and US territories through annual
appropriations (some goes directly to large
cities) - The U.S. DHHS has also spent billions on hospital
and medical training primarily through the Human
Resources Services Administration. - www.cdc.gov/fmo.fmofybudget.htm
28Future etc?
- Former members of the NACCT believe that funding
for children and special populations is
increasing for this usage but is not enough per
recent conference calls. - Will the Committee be reinstated?
29Red Cross and Special Populations
- During emergencies and disasters, it is
especially important to provide assistance to
those people with special needs. These include
the elderly and disabled and people with limited
English proficiency (LEP). - The Red Cross has developed materials to assist
these individuals. - http//www.redcross.org/services/
disaster/beprepared/disability.html
30FEMA (Federal Emergency Management Agency)
- Promotes self-help networks are arrangements of
people who agree to assist an individual with a
disability in an emergency. Discuss with the
relative, friend or co-worker who has a
disability what assistance he or she may need.
(http//www.fema.gov/rrr/assistf.shtm)
31A Renowned Local Effort
- One of the best is in the San Francisco area that
was spurred by the earthquake during the 1997
baseball World Series. - PrepareNow.org provides the tools, expertise and
access to resources to assist anyone engaged in
disaster planning for individuals with special
needs. - http//www.preparenow.org/purpose.html
32Past Measures to Gauge Preparedness
- Centered around U.S CHC and HRSA guidance that
dealt with focus areas. - Centered on Capacity several instruments done
on volunteer basis - National BTAIP by ASTHO revealed a nation better
but still underprepared in workforce,
information systems and surveillance.
33Billions for What?
- Sidell and Cohen others blast wasted spending
since 911 and anthrax attacks. - Rumm and others challenge that spending has at
least improved our public health system and
especially our laboratories. - Trust for America Report continues to blast some
state efforts and calls for common metrics. - Gursky calls for a Force Protection Agency.
34Gaskin and Rumm Study
- Over 50 assessments, few on children and special
needs. - Continuing lack in some sectors in training,
communications, surveillance systems and most
importantly in workforce. - Has been substantial improvement in laboratory
capacity and some improvement in hospital surge
capacity.
35Today Movement toward Metrics away from
capacity toward capability!
- CPHRC leadership on the Lehigh Valley Study and
the Federal Regional Preparedness Metrics. - Commonality of metrics coming under the
leadership of the U.S. DHS Disaster Response Plan
and Target Capabilities. - CDC and other Capability studies including those
by RAND is this a good thing?