Preparing for and Responding to Bioterrorism: Information for the Public Health Workforce

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Preparing for and Responding to Bioterrorism
Information for the Public Health Workforce
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Acknowledgements
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
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Emergency Response Planning
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Emergency 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

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Emergency 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

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Bioterrorism 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
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Community 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

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Local 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

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National 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

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State 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

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The 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
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Incident 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

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Incident 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

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Incident Command System Some Basic Principles

• Modular organization (expands or contracts as
  required)
• Common terminology
• Common names/titles used for all personnel and
  equipment

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Differences 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
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Emergency 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
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Emergency 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

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Emergency 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
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Developing 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
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Legal 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?

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Legal 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?

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Workplace 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)

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National 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...
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National 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...
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National 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...
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National PreparednessOther DHHS activities

• Medical Consequence Management HHS Office of
  Emergency Preparedness (OEP), expanding efforts
  to develop medical response capabilities at local
  and national levels

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Community 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

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Community 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

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Community 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
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Community 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

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Summary 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.

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Summary 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

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ResourcesNational

• 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 [phone]
• National Domestic Preparedness Office
• 1-202-324-9026 M-F 8am-5pm EST

Bioterrorism Web site http//www.bt.cdc.gov
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Resources 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
  [phone]
• Washington State Emergency Management Division

http//www.doh.wa.gov

• http//www.wa.gov/wsem/

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Resources 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
• [phone]
• Eastern WA [phone]
• Federal Emergency Management Agency (FEMA)
• Incident Command System Self-study Course

http//www.fema.gov
http//training.fema.gov/EMIWeb/crslist.htm
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Resources 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