Presented at American College of Occupational and Environmental Health

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Goals and Benchmarks for Preparedness Planning A
systematic approach to valuation of preparedness

• Presented at American College of Occupational
  and Environmental Health
• Kansas City Mo, May 6, 2004
• Presented by Michael Allswede, DO
• Director, Strategic Medical Intelligence
• Center for Biosecurity at UPMC

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Research Funding

• AHRQ-Sponsored Workbook for Sharing Regional
  Bioterrorism Preparedness Tools
• RTI International IDS Research Network, Master
  Task Order, Contract 290-00-0018, Task 5
• The Agency for Healthcare Research and Quality
  (AHRQ)
• Research Partners RTI International UPMC
  Health System/University of Pittsburgh,
  Intermountain Health Care
• AHRQ Project Officer Sally Phillips, Ph.D., RN
• Award Period 9/2/02-9/30/04

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Research Team

• RTI International
• Lucy Savitz
• Linda Pucci
• Sonya Sutton
• Brandy Gainor
• Intermountain Health Care
• Jonathan Nebeker
• Brent James
• Michael Rawson
• IHC Clinical Expert Panel

• UPMC Health System/University of Pittsburgh
• Michael Allswede
• Samuel Watson
• Loren Roth
• UPMC Clinical Expert Panel
• External Consultant
• Frederick Reuter, CONSAD

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Research Objectives

• Develop a set of decision support tools to guide
  health care planners in rationally allocating
  resources for bioterrorism preparedness.
• UPMC Health System, Pittsburgh, PA
• Test the transportability of these tools.
• Intermountain Health Care, Salt Lake City, UT
• Document the planning process and tool
  application in a workbook.
• Distribute a limited number of workbooks to
  identified super users, studying application
  and tabulating frequently asked questions.
• Disseminate the final, refined workbook.

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UPMC Health System

• 19 Hospitals in Southwestern Pennsylvania
  centered at Pittsburgh
• 35,000 employees
• Medical Command and Control for City EMS and
  affiliated suburbs
• Largest Aeromedical Service in the Nation
• Affiliated University of Pittsburgh Schools of
• Medicine
• Public Health
• Nursing
• Dentistry

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Location of UPMC Health System Member Hospitals
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The Context for Rational Decision Making

• Provide an understanding of likely threats.
• Identify reasonable threat scenarios.
• Gather available clinical evidence.
• Synthesize information from multiple sources.

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Bioterrorism Elements

• Terrorist
• Victim
• Agent/Syndrome
• Interventions

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Optimal BT Planning

• Define the BT threat topography
• Assess potential victim load
• Define medical facility capacity
• Identify gaps and critical resources
• Assess the value of critical resources

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The Terrorist Test

• Political goals must be advanced by killing
  Americans
• Political conviction of the individuals must be
  serious enough to accept consequences of killing
  Americans
• Must possess knowledge and skills needed to
  store, plan, and execute a credible WMD attack

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Three Basic Threats

• International Transnational Groups
• State-supported, potentially exotic pathogens
• Population targeting
• Lone Wolf Individuals
• Limited by their access and abilities
• Wildcard targeting
• Domestic Groups
• Common pathogens
• Assassinations-Small volume targeting

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Pre-2001 BT Model
ICBM Missile Defense Model
CIA
NORAD Anti-ICBM
Civil Defense
National Disaster Response
Pre-Launch Intel
Launch
Detonation
Deaths
Recovery
Pre-2001 BT Model
Public Health Response
Disease Diagnosis
Bad Day
Symptoms develop in Population
Deaths Occur
Pre-Release Intel
Release
Recovery
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Center for Biosecurity Response Model
Pre-positioning Medical Assets
Surveillance of at risk populations
Law Enforcement Investigations
Syndromic Surveillance
Intelligence Sharing
Integrated Public Health-Medical Response
Symptoms develop in Population
Deaths Occur
Pre-Release Intel
Release
Recovery
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Stratification of Tasks
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UPMC Expenses
3.6 million to create the capability!
1 million per year to maintain and drill!
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What is the value of these endeavors?
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The Pittsburgh Matrix
Allswede, MP, Watson SJ., AHRQ Pittsburgh Matrix,
2002
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PM Hypotheses

• The primary drivers of survivorship in
  bioterrorism response are
• Victim load relative to available capacity
• Timeline of detection

• Timeline and capacity-victim load combinations
  can be used to value resources and assess
  critical gaps within a system.

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Supplemental Hypotheses
Better Technology
System Preparedness
Allswede, MP, Watson SJ., AHRQ Pittsburgh Matrix,
2002
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Pittsburgh Matrix Methodology

• Phase I
• Assess critical system assets
• Create pathogen specific scores and mortality
  data from existing historical data
• Estimate mortality in unknown vignettes from the
  known historical examples

• Phase II
• Enumerate key resources and key decisions
  resident in each matrix vignette
• Use UPMC key resources as template for cost
  estimations

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Scenarios
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Calculation of Scale
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Surge Capacity Beds
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UPMC Key Capabilities

• Command and Control Capability
• Terrorism Response Information Center (TRIC)
• Rapid Bed Capacity Assessment Tool
• Staff contact lists and broadcast technology
• Active ED case surveillance
• Corporate Command Center
• Bridge Teleconferencing
• Community Outreach

• BT Specific Capabilities
• HVAC Modifications-Quarantine System
• Personal Protective Equipment
• Infection Control Attire
• Staff training to OSHA standards
• Large volume decontamination
• Safety Link Briefings
• Real-Time Outbreak System (RODS)
• Antibiotic Stockpile
• Vaccination Clinic Preparations

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Anthrax Aerosol

• Aerosol of Bacillus Anthracis
• Mortality trends similar to 2001 US
• Exposure is the ID50 and Symptomatic Diagnosis
  is mid-prodrome
• Pre-Release refers to advanced warning of
  attack time and place

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Anthrax Aerosol
Allswede, MP, Watson SJ., AHRQ Pittsburgh Matrix,
2002
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Anthrax Survival Benefit
Allswede, MP, Watson SJ., AHRQ Pittsburgh Matrix,
2002
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Standardized Cost Capture Tool Examples
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Determination of Intervention Value

• Capability Clusters
• Command and Control
• Bioterrorism Specific
• Pathogen Specific
• High cost of resources suggests a Trauma Center
  Model
• Regional
• Municipal
• National

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Applications

• Guide policy decisions and inform allocation of
  ear marked government resources.
• Drive regional planning and partnering.
• Crisis decision support.
• Pre-event planning at the facility/system-level
• Forecasting needs resource allocation for
  specific risks
• Critical gap analysis
• Critical shortages identified per Matrix
  vignette,
• Triage of need for capabilities.

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Contacts

• Michael Allswede DO
• Center for Biosecurity at UPMC
• allswedemp_at_upmc.edu
• Lucy Savitz PhD
• Research Triangle Institute
• savitz_at_rti.org