How Ready Are Health Responders for Terrorist Attacks

1
How Ready Are Health Respondersfor Terrorist
Attacks?
Lois M. Davis, Ph.D. June 26, 2003
2
How Prepared Local Health Responders Are
forTerrorist Attacks Has Been an Ongoing Concern

• The June 2001 Dark Winter exercisewhich
  simulated intentional release of smallpox in
  three U.S. citiesraised warning flags
• Dark Winter further demonstrated how poorly
  current organizational structures and
  capabilities fit with the management needs and
  operational requirements of an effective
  bioterrorism response. Responding to a
  bioterrorist attack will require new levels of
  partnership between public health and medicine,
  law enforcement, and intelligence. However,
  these communities have little past experience
  working together and vast differences in their
  professional cultures, missions, and needs.
• 9/11 attacks and anthrax attacks in Fall 2001
  further called into question how prepared health
  responders were

3
Todays Focus

• How prepared are local health responders for
  biological and chemical terrorism?
• RAND nationwide surveys of state and local
  responders prior to 9/11 and at the one-year
  anniversary
• Results of other survey efforts since 9/11
  OIG/DHHS survey and GAO case studies
• What role should the media play in informing the
  public health response to terrorism?

4
Questions and Answers
Questions
Answers

• How prepared are local health responders for
  biological and chemical terrorism?
• What role should the media play in informing the
  public health response to terrorism?

• Preparedness efforts are improving since 9/11,
  but fundamental readiness concerns persist

5
Prior to 9/11, Only 1/3 of Local Public
HealthDepartments Had SOPs for Biological Attacks
Have Response Plans or SOPs for . . .
. . .Biological Incidents
. . .Chemical Incidents
Local public health
27 (4)
25 (4)
Overall
Hospitals
32 (7)
54 (7)
32 (11)
Large Metropolitan Counties
36 (11)
40 (15)
69 (12)
24 (5)
26 (5)
Other Counties
31 (7)
50 (8)
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
Percent
Percent
6
Prior to 9/11, Only 1/3 of Local Public
HealthDepartments Had SOPs for Biological Attacks
Have Response Plans or SOPs for . . .
. . .Biological Incidents
. . .Chemical Incidents
Local public health
27 (4)
25 (4)
Overall
Hospitals
32 (7)
54 (7)
32 (11)
Large Metropolitan Counties
36 (11)
40 (15)
69 (12)
24 (5)
26 (5)
Other Counties
31 (7)
50 (8)
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
Percent
Percent
Slightly better for chemical attacks and among
large metropolitan counties
7
Prior to 9/11, Very Few Organizations
HadExercised Their Response Plans for
Bioterrorism
Response Plans or SOPs Last Exercised for . . .
. . .Chemical Incidents
. . .Biological Incidents
Within Past 12 Months
16 (6)
37 (9)
10 (5)
36 (9)
Local public health
Hospitals
19 (7)
9 (5)
Between 12 Years Ago
27 (8)
7 (5)
18 (8)
20 (9)
2 or More Years Ago
34 (14)
15 (7)
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
Percent
Percent
8
Prior to 9/11, Very Few Organizations
HadExercised Their Response Plans for
Bioterrorism
Response Plans or SOPs Last Exercised for . . .
. . .Chemical Incidents
. . .Biological Incidents
Within Past 12 Months
16 (6)
37 (9)
10 (5)
36 (9)
Local public health
Hospitals
19 (7)
9 (5)
Between 12 Years Ago
27 (8)
7 (5)
18 (8)
20 (9)
2 or More Years Ago
34 (14)
15 (7)
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
Percent
Percent
Better for chemical attacks
9
Prior to 9/11, Only Half of Health
OrganizationsParticipated in WMD-Focused Task
Forces
Interagency Disaster Preparedness Task Force
Exists in Region
Task Force Addresses Planning for WMD-Related
Incidents
Local public health
61 (6)
53 (6)
Hospitals
Overall
76 (6)
53 (8)
77 (11)
Large Metropolitan Counties
73 (15)
90 (7)
88 (8)
50 (7)
59 (6)
Other Counties
72 (7)
44 (9)
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
Percent
Percent
10
Other Findings Showed Local Health/Medical
Response to Terrorism Inadequately Addressed

• Surge capacity that may be required
• Plans for communicating with other health
  providers, emergency responders, media, or the
  public
• What role other responders, such as law
  enforcement, may play in the response to, or the
  investigation of, bioterrorist incidents

11
OIG/DHHS Survey Showed Improvements inTerrorism
Preparedness Capabilities Since 9/11

• OIG Study Purposive sample of 12 states and 36
  local health departments
• All state health departments and nearly 89
  percent of local ones were writing or had written
  bioterrorism response plan
• Local health departments have begun to integrate
  public health preparedness activities with those
  of other emergency response organizations
• Most local health departments reported belonging
  to terrorism-related task forces, working groups,
  or committees

12
GAO Case Studies at Sites in Seven Cities Show
Similar Improvements

• Most cities had undertaken steps to improve
  coordination among local response organizations
• Hospitals and other organizations that had not
  been involved in local response planning
  increased participation
• State/local jurisdictions/response organizations
  have begun to incorporate bioterrorism in overall
  plans
• However, plans for regional coordination were
  lagging
• Most states were in the process of undertaking
  assessments of capacity
• Applying for DHHS funding helped states identify
  problems in bioterrorism preparedness and focus
  planning efforts

13
GAO Case Studies at Sites in Seven Cities Show
Similar Improvements

• Most cities had undertaken steps to improve
  coordination among local response organizations
• Hospitals and other organizations that had not
  been involved in local response planning
  increased participation
• State/local jurisdictions/response organizations
  have begun to incorporate bioterrorism in overall
  plans
• However, plans for regional coordination were
  lagging
• Most states were in the process of undertaking
  assessments of capacity
• Applying for DHHS funding helped states identify
  problems in bioterrorism preparedness and focus
  planning efforts

However, despite improvements, fundamental public
health readiness issues remain
14
Written Comments from RAND Follow-up Survey
Highlight Local Health Organizations Concerns

• If additional funding is not provided to
  hospitals, the cost of WMD preparedness will be
  difficult if not impossible to meet.
• We are a rural medical facility. Financial
  survival is difficult in the current climate.
  Funding is not available for training. . . .
• Difficult to find balance between efforts for
  preparedness vs. other public health priorities
  in a shrinking resource environment.
• Federal bioterrorism funding is just now
  resulting in ability to recruit and hire
  dedicated staff for bioterrorism preparedness.

15
Funding of Bioterrorism Preparedness Activities
Remains a Fundamental Readiness Concern

• Post 9/11, federal funding for bioterrorism
  preparedness has increased, esp. for public
  health
• However, wide variation across states in how
  funding is being allocated
• Much of the focus is on capacity building and
  improving public health infrastructure
• Some states are taking a comprehensive approach
  to include coordination, response planning, etc.
• Degree to which funding will reach local level is
  a concern
• Hospitals only now receiving bioterrorism funding
  in any substantial amounts (complex incentives
  for investing in preparedness)
• Question of whether supplantation may occur in
  current fiscal crisis

16
Workforce Issues Are Another Fundamental
Readiness Concern

• Health officials have cited workforce shortages
  as impediments that funding alone will not solve
• Shortages of trained epidemiologists, lab
  personnel, and hospital personnel
• Manpower shortages limiting ability to implement
  active surveillance systems
• Health departments reluctant to hire new staff
  without guarantees of sustained federal (or
  state) funding

17
Concern Over Effects of Increasing Focus
onBioterrorism Is Also a Fundamental Issue

• Some public health officials fear overemphasis on
  bioterrorism to exclusion of other types of
  public health threats/emergencies
• State and local health officials concerned that
  focus on bioterrorism may divert attention and
  resources from other public health functions and
  programs
• Recent implementation of smallpox vaccination
  program
• Forcing cutbacks in other basic health services,
  such as childhood immunizations and tuberculosis
  prevention

18
DHHS Review of States Bioterrorism Plans Also
Identified Shortcomings

• Some States workplans inadequately addressed
  coordination
• With the Metropolitan Medical Response System
  (MMRS) cities
• Between health departments and hospitals
• With bordering states or countries
• DHHS also requested priority be given to
  development of plans for
• Receiving materials from the National
  Pharmaceutical Stockpile
• Ensuring adequate surge capacity within hospital
  regions
• Provisions be made for isolation rooms in
  hospital ERs

19
At Most Fundamental Level Is Question of How to
Know How Much Readiness Is Enough

• Current metrics for assessing how prepared a
  community really is for bioterrorism are
  inadequate
• CDCs list of critical benchmarks
• DHS Advisory Councils statewide template
  initiative
• Need to go beyond these efforts to develop
  quantifiable performance measures and model of
  preparedness that
• DHS can use to assess how prepared U.S. is
• Communities can use to assess local preparedness
  and inform resource allocation decisions
• Individual health organizations can use to assess
  where they stand relative to their peers

20
Questions and Answers
Questions
Answers

• How prepared are local health responders for
  biological and chemical terrorism?
• What role should the media play in informing the
  public health response to terrorism?

• Preparedness efforts are improving since 9/11,
  but fundamental readiness concerns persist

• Media can help with public education and provide
  input to communications plans being developed

21
Communications with the Media and Public During
9/11 and Anthrax Attacks Was Poor

• There was a problem of health officials not
  speaking with one voice
• Spokespersons who contradicted guidance from
  public health officials
• Public health officials appeared unresponsive to
  what citizens wanted to know
• Individuals risk for contracting anthrax, need
  for antibiotics, etc.
• Lack of coordination between local, state, and
  federal levels

22
Evidence Suggests Such Problems Still Exist
After 9/11

• DHHS review of state risk communications plans
• Lacked sufficient details on communications with
  the public or media
• Several did not identify public information
  officers
• OIG survey found most health departments did not
  have complete risk communication plan for
  communicating with public and media
• Only 25 of state health departments 33 of
  local ones

23
Evidence Suggests Such Problems Still Exist
After 9/11

• DHHS review of states risk communications plans
• Lacked sufficient details on communications with
  the public or media
• Several did not identify public information
  officers
• OIG survey found most health departments did not
  have complete risk communication plan for
  communicating with public and media
• Only 25 of state health departments 33 of
  local ones

Health departments are working to rectify
problems and develop communications plans
24
Improving Communications About Preparednessand
Response to Bioterrorist Incidents

• Public health officials should undertake public
  education component in advance
• Provide frank assessment of where jurisdictions
  stand on response planning, quarantine plans,
  evacuation plans, etc.
• Media can play a role in educating the public
• Media can help inform communications plans
• Make public health officials aware of what media
  needs to know and is going to be asking during an
  event
• Make them aware that there must be a go-to
  person among health officials to get information
  when an incident occurs . . . or will go elsewhere