Development of Models for Emergency Preparedness: Personal Protective Equipment, Decontamination, Isolation/Quarantine, and Laboratory Capacity

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Development of Models for Emergency
PreparednessPersonal Protective Equipment,
Decontamination, Isolation/Quarantine, and
Laboratory Capacity

• Bettina M. Stopford R.N.
• Director
• Public Health and Medical Emergency Preparedness
• Homeland Security Support Operations
• Science Applications International Corporation
• McLean, VA

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Project Overview Goals

• AHRQ Bioterrorism Initiative
• To examine current evidence-based best practices
  and present them in an operationally pertinent
  format for the end user.
• Review research and obtain key stakeholder input
  4 topic areas
• To assess, identify, measure, and prepare
  guidelines and models for evidence-based,
  best-demonstrated practices
• Identify research gaps, shortfalls and future
  needs
• Identify health care-focused enhancements to the
  existing automated exercise and assessment
  program scenarios, (AEAS).

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Methodology

• Open-source literature research
• Government/industry regulation reviews
• Subject matter expert interviews
• Stakeholder review of draft document and models
• Stakeholder conference

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Stakeholders

• Broad spectrum of Federal, State, local,
  academic, civilian, military, regulatory,
  operations, and clinical subject matter experts
• JCAHO, OSHA, NIOSH, DHS ODP, HHS, CDC, SBCCOM,
  ATSDR, ENA, ACEP, AHA, ANA, APIC, ABSA, ASHE,
  ASTM, IACP, IAFC, IAEMT, DoD, APHL, NDMS, ASHRM,
  HRSA, USAMRIID, Risk Management, Law,
  Universities, public health, medical, nursing,
  bioethics, laboratory and hazardous materials
  professionals, among others

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Goals of Model Development

• Create operational planning user tool
• Evidence-based, best-demonstrated practices
• Results
• Four sets of guidelines/models developed
• One electronic, interactive model for review

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Guideline Questions for Model

• Adaptability Is the best practice suitable for
  use in any region?
• Throughput How many victims of a WMD attack
  will the best practice aid?
• Cost How much will it cost regions to implement
  the best practice?
• Operational Impact What are the operational
  considerations of implementing best practice?
• Training What level of training does this best
  practice require?

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Guideline Questions for Model

• Resources Does the practice build on existing
  practices/infrastructure? Are there available
  resources to implement the practices?
• Morbidity and Mortality What impact will this
  practice have on saving lives?
• Evidence-based Practice vs. Theory Is there a
  body of professional research supporting this
  practice or is it theoretical?
• Regulatory Compliance Does the practice comply
  with existing regulations or does it require a
  regulatory change?

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Personal Protective Equipment (PPE)

• Distinguish between a contaminated patient event
  vs. an infectious patient event
• PPE choice for an infectious patient/agent is
  determined by infection control guidelines
• PPE choice for a contaminated patient is guided
  by new OSHA standards
• PPE should be selected based on the results of a
  community-based hazards vulnerability analysis
  (HVA) that should reveal credible threats, as
  well a role (such as EMS vs. facility based)

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Isolation/Quarantine

• Best practices model for plan development
  includes the following components
• Hazards Vulnerability Analysis
• Review of existing community action plans
• Gap analysis
• Establish isolation barriers
• Designated isolation/quarantine facilities

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Isolation/QuarantineBest practices model for
plan development includes the following
components

• Ease in fiscal restraints
• Technology use
• Legal and regulatory authority
• Surge capacity
• Mobile medical units

• Training and education
• Active, early surveillance
• Reporting incentives
• Increased Epi capacity
• Rapid ID, isolation, notification

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Laboratory Capacity

• Laboratories will play a critical role in the
  response to any BT event
• Ensuring a practiced, streamlined system is
  paramount to achieve maximum laboratory surge
  capacity
• Timeliness, accuracy and security of lab
  diagnostics will have a direct impact on
  containment, mitigation and clinical treatment
• Laboratory surge capacity issues must be
  addressed at local, State and national levels
• Three elements of containment determine BioSafety
  (BSL) level
• Laboratory practices and techniques, safety
  equipment, and facility design

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Decontamination

• A spiral development approach is required to
  build a community or regions capacity
• Decontamination should be fully integrated into
  Planning Organization Equipment Training and
  Exercises (POETE)
• Decontamination best practices were quantified in
  an interactive emergency planning

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RESEARCH
PRACTICE