The National Advisory Committee on Children and Terrorism and Current U'S' Changes in How Preparedne

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The 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

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Most 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.

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Cutaneous Anthrax (day 5)
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Anthrax Inhalation Cases (10) and their Timeline
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The 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.

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US 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.

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Soviet 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.

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Overlooked 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.

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Some 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

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Other 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

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Children 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.

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Purpose 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

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Public 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.

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Background 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.

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Reports 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.

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Classic Presentation of a Severe Case about 1
Week, 10 Days
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Committee 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.

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Focus 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

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Methods

• 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)

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Methods 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.

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Key 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.

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Key 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.

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History 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.

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Key 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.

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Key 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.

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Key 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.

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Public 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

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Future 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?

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Red 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/beprepar
  ed/disability.html

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FEMA (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)

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A 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

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Past 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.

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Billions 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.

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Gaskin 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.

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Today 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?