Forensic Epidemiology in Law Enforcement and Public Health 2004 California Medical and Health Disaster Management Conference

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Forensic Epidemiology in Law Enforcement and
Public Health2004 California Medical and Health
Disaster Management Conference

• Gregory Evans
• Institute for Bio-Security
• Saint Louis University
• School of Public Health

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Botulism

• Mode of Exposure
• Inhalational
• Food-borne
• Clinical Features
• Muscle paralysis
• Respiratory failure
• Treatment
• Botulinum antitoxin
• Supportive care

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Consequence Management

• Local and State Public Health Departments
• Local Medical Care facilities
• Support from Centers for Disease Control and
  Prevention

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Observations from National Exercises

• Local sources of supplies
• identify reserve medical personnel
• Number and types of treatment beds available
• Number and type of medical and security personnel
  
• Have hard copies of all material you might need

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Observations from National Exercises

• Types and amounts of medications needed
• Algorithm for who will receive treatment
• Source of nurses or respiratory therapists for
  ventilators
• Determine auxiliary facilities for treating
  patients
• Determine how hospital facilities can be maximized

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Observations from National Exercises

• Do not assume area hospitals will be able to take
  overload
• Need content experts for most common bioterrorist
  agents

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Differences Can Create Difficulties

• Whos in Charge?
• Early Notification!

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New Partners, New Paradigms

• Security Clearances
• Chain of Custody
• Confidentiality Issues

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Public Health and Law Enforcement Interviews

• Much of the information both investigators need
  to obtain is the same
• However, both investigators have unique
  perspectives/background/experience

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Public Health and Law Enforcement Goals Compared

• Law Enforcement
• Stop further food poisonings
• Control the panicking public
• Collect information to apprehend and convict the
  terrorists

• Public Health
• Stop further food poisonings
• Coordinate treatment of victims
• Collect epidemiologic information that might
  prevent future attacks

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Epidemiology

• Originally, the study of epidemics
• Outbreak is a more localized term for epidemic
• Study of the factors that contribute to illness
  in individuals and communities, and how to reduce
  disease by altering those factors

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Public Health Emergencies

• Bioterrorism have focused attention on public
  health preparedness for emergencies
• In the case of botulism poisoning, public health
  has moved from secondary responder to one of the
  primary responders

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Local-State-Federal Relationships

• Local health agencies
• State health agencies
• Federal agencies

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Public Health Police Powers

• Inspect or close premises
• Limit the movements of people (isolation,
  quarantine)
• Require vaccination, testing, or treatment

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Public Health Police Powers

• Seize, embargo, impound food and other hazardous
  substances, or stop their sale
• Board planes, trains, buses, and ships as part of
  disease control
• Review medical and hospital records
• Interview whoever and whenever information is
  needed for investigation of a public health
  problem

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How Do Infectious Diseases Spread?

• Common source
• Person-to-person
• Vector-borne
• Airborne

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Steps in an Outbreak Investigation

• Detect problem
• Verify diagnosis
• Confirm epidemic
• Identify cases
• Characterize data time / place / person
• Take immediate control measures

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Signs of an Intentional Outbreak

• Cases of an extremely rare disease
• Ordinary disease but out of season or area or
  with wrong mode of spread or other unusual
  characteristics
• Cannot solve outbreak with usual techniques
• Threats received
• Group taking credit
• Plausible accusations

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Signs of an Intentional Outbreak

• Victims attended a common event
• Victims share a common workplace or other locale
• A dissemination device is found
• Victims live in same geographical area
• Victims have recently traveled by common
  conveyance

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For Additional Information

www.bioterrorism.slu.edu