National Domestic Preparedness Office

1
America has been targeted
2
America has been attacked
3
America has suffered
4
Bioterrorism
A Nation Challenged
5
Domestic Preparedness and Response
6
The Challenges of Local /Federal Partnership
7
Comprehensive strategic assessment of
bioterrorism is required
8
Biothreat AssessmentCapability Intent
9
Capability

• Loose bugs readily available
• The list of threat agents is formidable and
  growing
• Relatively inexpensive due to available
  technologies for production and storage
• Dissemination now more easily accomplished
• Requisite knowledge and competency readily
  available
• Dual use technology makes it difficult to
  identify clandestine R D activities
• Emergence of genetically engineered bioagents

10
IntentNation/States, groups, and individuals
of domestic and international origins motivated
by diverse political, social, economic,
religious, or criminal intent view the increased
availability of bioagents as an opportunity to
wage asymmetric warfare
11
(No Transcript)
12
Washington PostNovember 5, 2002

• The Bush Administration concludes that four
  nations possess unsanctioned stockpiles of
  Smallpox virus.
• France, Iraq, North Korea and Russia
• two unnamed officials

13
Zealots, extremists, and malicious opportunists
will not be constrained by moral and ethical
considerations.
14
(No Transcript)
15
(No Transcript)
16
Bioterrorism

• Credible Threat
• Low Probability/High Consequence

17
Risk Assessment

• Threat/Assets/Vulnerabilities Combinations

18
America is Vulnerable
19
DeficienciesinPlanning and Preparation
20

• Federal/Community Strategies were Seriously Flawed

21
Domestic Preparedness StrategyNational
Strategy Federal Response Plan Terrorism
Incident AnnexCommunity Strategy Escalation of
E.M.S. System Response
22
Federal Strategy Assumed

• Coordination of Multiple Federal Agencies
• Appropriate Planning/Response
• Integration of Federal Family Into Community
  Response

23

Major Federal Response Initiatives

• Department of Health Human Services
• Department of Defense
• Department of Justice
• Federal Emergency Management Agency

24
(No Transcript)
25
Community Strategy Assumed

• Disaster Plan Exists
• Specific WMD Incident Plan Exists
• Realization of Needs and Losses
• Self Sufficiency

26
(No Transcript)
27
Unique characteristics of nuclear, chemical, and
biological threats impose the need for a unique
defense doctrine for each threat category.
28
Adoption of a holistic doctrine for biodefense
remains elusive but vital
29

• No Centralized Federal Coordination

30
August 1998 Stakeholders Meeting - Issues for the
Federal Government

• Identify single lead federal agency to serve as a
  clearinghouse and coordinate the distribution of
  federal programs and guidance to state and local
  communities
• Identify single program and policy office to
  integrate federal programs for terrorism-related
  assistance

31
U.S. RESPONSE TO CBW TERRORISM AND DOMESTIC
PREPAREDNESS
Courtesy of the Center for Nonproliferation
Studies/Monterey Institute of International
Studies
32
The organizational framework of the national
response strategy is dysfunctional due to
excessive fragmentation which has generated a
combination of ill-defined and overlapping
responsibilities.
33
No Authority Structure

• Decays Federal Efforts
• Undermines Federal Partnership
• with State and Local Communities

34
No Authority Structure

• Communication Issues
• Planning
• Response

35
(No Transcript)
36
Department of Homeland Security
37
(No Transcript)
38
(No Transcript)
39
HomelandSecurityDepartment
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
Bioterrorism Response National Response

• Community Response First
• Federal Response Follows

46

• Improper Planning Models

47
Bioweapons present a far more complex problem
than nuclear or chemical weapons

• Diversity of available biologic agents
• Diversity of vulnerable targets
• Diversity of bioassault routes
• Mimic natural epidemics
• Insidious onset with latent period
• Infective/contagious characteristics
• Lethality
• Prophylaxis and treatment issues

48
(No Transcript)
49
Chemical Decontaminaton Training ca. 1996
Jacksonville, North Carolina, USA
50
Strategic principles to enhance biodefense
capabilities

• Faster diagnosis of bioattack saves lives
• Faster diagnosis accelerates the mobilization of
  treatment and containment actions

51
Points of effective biodefense interdiction

• Identification and excision of perpetrators/biowea
  pons before an incident
• Early alert and warning detection
• Rapid medical diagnosis
• Availability of suitable drugs and vaccines
• Forensic and analytical tools for attribution and
  retribution

52
Community ResponseTriumvirate of

• Health Care Professionals
• Health Care Facilities
• Public Health

53
First Responder community is different.Local
civilian medical system is the critical human
infrastructure
54
Health Care Professionals

• Minimal Involvement
• Unfocused Educational and Training Efforts
• Inadequate Funding

55
The Trinity of Local Response
Responders
Command Control
Public Health
Hospitals
56
Developing Objectives, Content, and Competencies
for the Training of Emergency Medical
Technicians, Emergency Nurses, and Emergency
Physicians to Care for Casualties Resulting From
Nuclear, Biological or Chemical (NBC) Incidents
57
METHODOLOGY

• THE PROCESS
• Taskforce of individuals from key professional
  organizations
• Consensus development approach
• Instructional design methodology
• Analysis
• Design
• Development
• Implementation
• Evaluation

58
The analysis stage focused on defining the
problem or concern thoroughly and understanding
it sufficiently in order to recommend appropriate
solutions.

• Audience
• Content Objectives
• Proficiency Categories
• Awareness
• Performance
• Planning

• Barriers
• Undermine the acceptance delivery of effective
  WMD-related training

• Curricula and Course Review

59
RESULTS

• Audience
• Content Learning Objectives
• Barriers
• Curricula Reviews
• Recommended Strategies

60
RECOMMENDED STRATEGIES

• Recommendations for Integration
• Recommendations for Sustainment
• Ensure Continuing Proficiencies

How do we go about building training that ensures
that the levels of proficiencies desired can be
met within the accepted training models currently
being used to educate the target audience groups?
61
BARRIERS

• EMS PROVIDERS
• No single source of authority
• Excessive time
• EMT curricula would have to expand
• No approve body of content or curriculum
• EMERGENCY PHYSICIANS
• Curricula are full and time is limited
• No approve body of content or curriculum
• The need for training has not been broadly
  articulated and emphasized
• No advocates
• EMERGENCY NURSES
• Existing curriculum full
• No approve body of content or curriculum
• No formal acceptance exists

62
Minimal Integration of Health Care Facilities
63
The lack of integration of health care
facilities in the overall community response is a
serious flaw in US national Strategy.
64
Health Care Facilities

• Unfunded Mandates In A Time of Fiscal Constraints
• Concern of Contamination/Closure
• No Reimbursement Policy
• No Litigation Protection

65
(No Transcript)
66
Public Health System remains fragile
67
Public Health SystemLacks

• Trained Personnel
• Modern Technology
• Laboratory Capacity
• Sufficient Funding

68
Detection and Identification Capabilities are
Deficient
69

• Primitive Surveillance Systems/Infrastructure

70
(No Transcript)
71
Medical Management Capabilities are Deficient
72
Medical ManagementLacks

• Vaccines for Prevention
• Antibiotics for Treatment
• Critical Supplies for Supportive Therapy

73
Federal Partnership withPharmaceutical Industry
will be of Benefit
74
Conclusions
75
The Calculus of Risk has changed dramatically
with the ready availability of biologic agents
suitable for warfare
76
Unfortunately, no assurance is evident that the
federal response strategy can provide proficient
incident management and crisis control against a
bioincident.
77
The functional inadequacies posed by the
doctrinal vacuum and fragmented and uncoordinated
organizational responsibilities for biodefense
constitute a major source of vulnerability.
78
Disturbing inter-agency rivalries and a lack of
cross-agency awareness of the full spectrum of
the activities being undertaken make for
inefficient integration of biodefense activities.
79
Realistic simulation scenarios have demonstrated
that local response capabilities are
ill-informed, poorly financed, not well trained
or drilled, and not integrated into the federal
response system that will be inevitably
introduced into any bioincident.
80
Medical and public health responses to a
bioweapons attack are extremely complex requiring
swift interdiction by a plethora of local, state,
and federal agencies in collaboration with an
equally diverse array of non-governmental
organizations
81
Although the probability of a bioattack is
difficult to assess, the social and political
consequences of any incident will be
disproportionately high.
82
(No Transcript)
83
Federal/State/Local Response Strategy

• Comprehensive/Appropriate
• Integrated
• Supported

84
Benefits of Comprehensive National Strategy

• Deter Behavior
• Mitigate Consequences
• Prosecute Criminals

85
(No Transcript)