Title: Preparing for and Responding to Bioterrorism: Information for the Public Health Workforce
1Preparing for and Responding to Bioterrorism
Information for the Public Health Workforce
2Acknowledgements
This presentation, and the accompanying
instructors manual, were prepared by Jennifer
Brennan Braden, MD, MPH, at the Northwest Center
for Public Health Practice in Seattle, WA, for
the purpose of educating public health employees
in the general aspects of bioterrorism
preparedness and response. Instructors are
encouraged to freely use all or portions of the
material for its intended purpose. The
following people and organizations provided
information and/or support in the development of
this curriculum. A complete list of resources
can be found in the accompanying instructors
guide.
Patrick OCarroll, MD, MPH Project Coordinator
Centers for Disease Control and Prevention
Judith Yarrow Design and Editing Health Policy
and Analysis University of WA Washington State
Department of Health
Jeff Duchin, MD Jane Koehler, DVM,
MPH Communicable Disease Control, Epidemiology
and Immunization Section Public Health - Seattle
and King County Ed Walker, MD University of
WA Department of Psychiatry
3Emergency Response Planning
4Emergency Response Planning Learning Objectives
- Identify the different agencies involved in
response to a bioterrorism event - Describe the Incident Command System and how this
system may be integrated into an agencys
bioterrorism response plan - Identify factors to consider and include in the
development of a local emergency response plan
5Emergency Response Planning Learning Objectives
- Describe national and local efforts in the area
of BT preparedness and response - Describe the roles of public health in
bioterrorism preparedness and response
6Bioterrorism Preparedness and ResponseCrisis and
Consequence Management
- Crisis management law enforcement response to
terrorist acts - Local, state, and federal law-enforcement
agencies - Consequence management response to the disaster
focusing on the alleviation of damage, loss,
hardship, or suffering - Public health, medical, and emergency mgt
personnel - Falls under ESF-8 (Health Medical Services) of
Federal and State Disaster Response Plan
PDD-39
7Community PreparednessA Coordination of Efforts
- Partnerships between public health and
- Clinicians and health care facilities
- Law enforcement
- Public safety fire, HAZMAT
- Emergency management
- Coordinate response across agencies at the local,
state, and federal levels
8Local Emergency Response Planning Committees
(LEPCs)
- Established under the Emergency Planning and
Community Right-to-Know Act - Membership includes a wide variety of
stakeholders in the community - Develop comprehensive plans to prepare for and
respond to hazardous substance emergencies
9National Responders
- Health and Human Services (HHS)
- Centers for Disease Control and Prevention (CDC)
- Federal Emergency Management Agency (FEMA)
- FBI
- Environmental Protection Agency (EPA)
- Department of Agriculture
- Department of Defense
10State and Local Responders
- Health care providers and facilities
- Local and state health departments
- Emergency management agencies
- Search and Rescue, EMS, and HAZMAT teams
- Volunteers
- Law enforcement, National Guard
- State emergency management agency
- Political leaders
- Community service organizations
11The Emergency Response System
Emergency occurs and is detected by
Local citizen
Health surveillance system
Clinician/hospital
Local health jurisdiction
State health dept
Calls 911
Local emergency management office
State Emergency Mgt Dept
Local law enforcement
Fire
EMS
HAZMAT
FBI
12Incident Command System Definition
- A model for how to conduct and coordinate efforts
in response to an emergency - Required to be used in HAZMAT incidents also
used in other types of emergencies - Five major components
- Command
- Planning
- Operations
- Logistics
- Finance/administration
13Incident Command System Some Basic Principles
- Unity of command
- Each person in an organization reports to only
one designated person - Unified command structure
- Used when more than one agency responds
- All agencies involved in response establish a
common set of objectives and strategies
14Incident Command System Some Basic Principles
- Modular organization (expands or contracts as
required) - Common terminology
- Common names/titles used for all personnel and
equipment
15Differences in Public Health and Law Enforcement
Investigations
Public Health Law Enforcement
Event Recognition Surveillance or calls from clinicians Announced by attacker or otherwise evident
Initial Data Collection Hypothesis generation Questioning witnesses and suspects, follow-up on tips
Goal of Investigation Effective disease prevention and control measures Prevention and deterrence of future attacks, arrest of perpetrators
Adapted from Butler et al. EID, 2002
16Emergency Operations Plan
- A document that
- Assigns responsibility to organizations and
individuals for carrying out specific actions at
projected times and places in an emergency that
exceeds the capability or routine responsibility
of any one agency
BT and Emergency Response Plan
Clearinghouse bt.naccho.org
17Emergency Operations PlanTypes of Plans
- Describes the response to any emergency affecting
the agency, county, or state - Health-related emergency response plan a subset
of overall EOP - Lead and supporting agencies in an emergency
depend on the type of emergency - Roles designated by emergency support function
(ESF) - ESF 8 health and medical services public
health agency has lead role in response
activities
18Emergency Operations PlanState and Local Roles
- Public health terrorism plan integrated into or
annexed to overall state/county EOP - Local government responds first
- State government
- Assists local when capabilities overwhelmed
- Responds first in certain emergencies
- Works with federal government when federal
assistance necessary
WA's Emergency Management Plan
19Developing a Local Public Health Emergency
Operations Plan
- Establish a planning team
- Analyze capabilities and hazards
- Current resource base
- Geographic factors affecting response
- Special needs populations
- Develop and implement the plan
- Work the plan
- Regular drills to
- Ensure understanding of procedures/roles
- Test and update procedures
Emergency Mgt Guide for Business and Industry
20Legal Issues to Consider in Planning for a
Health Emergency
- What is the legal authority for
- Undertaking actions to protect public health and
safety? - Enforcing quarantine of infected individuals?
- Waiving legal liability to emergency workers?
- Provision of disaster services by coroners,
medical examiners, or mortuary workers? - Access to, use of, and reimbursement for private
sector resources in an emergency?
21Legal Issues to Consider in Planning for a
Health Emergency
- What are the legal responsibilities of different
agencies/officials in emergency response? - What is the scope of authority of different
agencies/officials in emergency response efforts?
- How do local laws compare with state and federal
laws? What circumstances warrant early state or
federal involvement?
22Workplace Emergency Response Plans
- Workplace-specific emergency operations plan
- Plan should include a bioterrorism component
- Be familiar with your agencys plan
- Who activates it and when it might be activated
- Your responsibilities
- Evacuation plans
- Communication procedures (i.e., phone
tree/call-down roster)
23National Preparedness1999 Initiative
- National Bioterrorism Preparedness and Response
Initiative - 1999 DHHS Initiative to prepare the nation to
respond to potential BT activity - CDC designated lead in upgrading nations public
health capacity and in developing a BT
preparedness and response plan
More on 1999 Initiative...
24National PreparednessCDC Activities
- CDC bioterrorism preparedness and response
activities - Preparedness and prevention
- Detection and surveillance
- Diagnosis and characterization of biological and
chemical agents - Response
More on CDC program...
25National PreparednessCDC Activities, cont.
- CDC bioterrorism preparedness and response
activities - Education and training
- Improved communication systems
- Health Alert Network
- Laboratory Response Network
- National Pharmaceutical Stockpile
More on CDC program...
26National PreparednessOther DHHS activities
- Medical Consequence Management HHS Office of
Emergency Preparedness (OEP), expanding efforts
to develop medical response capabilities at local
and national levels
27Community Preparedness Role of Public Health
- Coordinate preparedness and response activities
- Requires collaboration with medical
professionals, first responders, and other
partners - Provide information to health professionals,
government leaders, and the public
27
28Community Preparedness Role of Public Health
- Detection and evaluation of biological disaster
- Requires robust surveillance, epidemiology, and
disease investigation infrastructure, plus new
detection methods - Facilitate medical management of exposed persons
- Provide information on diagnosis, treatment,
prophylaxis, and infection control issues
28
29Community Preparedness Role of Public Health
- Coordinate and engage state and federal resources
- Education, training, and information
- Surveillance, disease case and outbreak
investigation
Public Health Preparedness and Response Capacity
Inventory http//www.phppo.cdc.gov/od/inventory
29
30Community Preparedness Role of Public Health
- Inventory and address deficiencies in regional
resources - Hospital response capacity/preparedness
- EMS/first responder capacity/preparedness
- Mass treatment and prophylaxis
- Mortuary capacity/preparedness
- Law enforcement/security
30
31Summary of Key Points
- BT preparedness and response requires
coordination between public health, clinicians,
emergency management, first responders, and law
enforcement officials. - The Incident Command System is a hierarchical and
unified system of managing an emergency response
involving single or multiple agencies. - All agencies should include a bioterrorism
component in their overall emergency response
plan.
32Summary of Key Points
- Emergency response planning in public health
includes - Development and evaluation of detection systems
- Development and evaluation of policies and
response procedures - Awareness of relevant laws
- Evaluation and coordination of resources
- Education and training
33ResourcesNational
- Centers for Disease Control and Prevention
-
- Emergency Preparedness and Response branch
24-hour notification telephone number (770)
488-7100 - CDC Public Inquiry Hotlines
- English(888) 246-2675 Español (888) 246-2857
- National Domestic Preparedness Office
- 1-202-324-9026 M-F 8am-5pm EST
Bioterrorism Web site http//www.bt.cdc.gov
34Resources Washington State
- Washington State Department of Health
- Communicable Disease Epidemiology
- 1-877-539-4344 - 24-hour emergency number
- (206)-361-2914
- Julie Wicklund, BT Surveillance Epidemiologist
(206) 361-2881 - Washington State Emergency Management Division
http//www.doh.wa.gov
35Resources Emergency Management
- State Emergency Management duty officer
1-800-258-5990 - Regional Emergency Coordinator,Region X
206-615-2266 - FBI
- Western WA and after hrs, Statewide
- (206) 622-0460
- Eastern WA (509) 747-5195
- Federal Emergency Management Agency (FEMA)
- Incident Command System Self-study Course
http//www.fema.gov
http//training.fema.gov/EMIWeb/crslist.htm
36Resources Emergency Response Planning
- Bioterrorism and Emergency Response Plan
Clearinghouse - Washington State Comprehensive Emergency
Management Plan - Emergency Management Guide for Business and
Industry (FEMA)
http//bt.naccho.org/
http//www.wa.gov/wsem/3-map/a-p/cemp/cemp-idx.htm
http//www.fema.gov/library/bizindex.shtm