District Response Plan Training January 24, 2002

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(No Transcript)
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ABSTRACT
The anthrax exposures via a letter to Capitol
Hill through the Brentwood Postal Facility in
Washington DC, necessitated the rapid deployment
of a mass treatment for postal workers and
others in the Washington metropolitan area.
Modification to the National Pharmaceutical
Stockpile (NPS) Use Plan facilitated this
medication distribution to over 15,000 persons
within a two week period. Incident management
was through the District of Columbia Department
of Health using an incident command
structure. Challenges encountered were seen in
four main areas (1) event management, (2)
dispensing of medications, (3) resources and (4)
communications. Each area presented overlapping
and confounding issues because of the uniqueness
of the Washington Capital Region.
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Overview of Presentation

• Discuss the Overall District Response Methodology
• Discuss how the District Responded to the Anthrax
  Attacks (October 2001 Present)
• Lessons Learned
• Next steps

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The Unique Challenges of District Government
Since we function as a city, County and State
with daily interactions with our citizens,
federal partners, neighboring states and
regional entities, our plans must include actions
and responsibilities for all parties involved.
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September 11, 2001 and the Anthrax Attacks
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INTRODUCTION

• Letter containing anthrax spores arrives on
  Capitol Hill via the Brentwood Postal Facility on
  October 15, 2001
• Initial suspected inhalation anthrax case
  admitted to a Virginia Hospital on October 19,
  2001. Initial death reported on October 21, 2001
• Mass prophylaxis begun on October 21, 2001
• Closure of Brentwood Postal Facility on October
  21, 2001
• Prophylactic antibiotics recommended by the DC
  DOH for all employees, contractors and visitors
  to non-public areas of Brentwood
• 5 confirmed cases from regional postal facilities

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DC Area Anthrax Locations
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The New District Response Plan

• Based on Incident Command System (ICS)
• Interoperability with Federal Response Plan (FRP)
• 15 Support Functions
• 10 Annexes (including Terrorism Annex)
• Coordinated delivery of assistance and resources
• Collaborated on by support and lead agencies and
  private industry
• Can be found online _at_ http//dcema.dc.gov
• Approved April 4, 2002
• Currently going 1st comprehensive update

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DRP Purpose and Highlights

• Strategic in Nature not tactical
• Outlines general roles and responsibilities
• Highlights Command and Control Structure (ICS and
  Unified Command)
• All-Hazards Approach
• Starting point for more-specific departmental
  Standard Operating Procedures (SOPs)

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What Is the District Response Plan (DRP)?
A framework that ensures that the District is
prepared to respond to the consequences of all
hazards.

• What Does the DRP Do?
• Describes the roles and responsibilities of
  District agencies for all hazards as well as the
  agencies relationships with federal and
  volunteer agencies that may support them should
  the situation warrant assistance.
• Unifies the efforts of organizations for a
  comprehensive approach to responding to a public
  emergency.

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What Does the DRP Do? cont

• Provides the mechanism for coordinated delivery
  of District assistance and resources to District
  citizens in a public emergency.
• Describes how federal assistance and resources
  will be coordinated with District resources in
  response to a public emergency.
• The DRP is structured after the Federal Response
  Plan (FRP) to provide interoperability with
  federal response agencies.

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What Are the General Concepts of Operation under
the DRP?

• The DRP adopts the principles of an existing
  national incident management system and the
  incident command system (ICS).
• The structure employs the principles of unified
  command where organizations operate in the
  Emergency Operations Center (EOC) with parallel
  and overlapping authorities.
• In the event a Presidential disaster declaration
  is issued, the DRP works in concert with the
  Federal Response Plan (FRP).

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What Are the 15 DRP ESFs?
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What is the Activation Process?
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PROPHYLAXIS DESIGN

• At risk population defined
• Time of exposure
• Work area
• Period of exposure
• Incident Command Structure utilized
• Single site selection
• Recently-closed DC General Hospital chosen to
  support the mission
• Prophylaxis choice
• The National Pharmaceutical Stockpile
• Multi-dose regimen
• Changing expert guidelines

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RESULTS

• Patient visits
• 17,759 patients seen at distribution center over
  a 2 week period (October 21- November 2, 2001)
• Medications distributed
• 497,880 capsules of doxycycline
• 160,160 tablets of ciprofloxacin
• Regimens used
• Initial 10 day supply
• 50 day supply
• 60 day supply
• DOH staff involved
• 300 people

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Lessons LearnedEVENT MANAGEMENT

• Invoke event management structure early
• Assume worst case. Scale down as required
• Define lead agency clearly
• Region in which event occurs should be lead
• Define key responsibilities
• Predefine if possible
• Coordinate cross- jurisdictional issues
• Fed. Government/CDC/Medical community/DC
  Government agencies/US Postal Service/Regional
  DOHs
• Record events for post event analysis

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Lessons Learned MEDICATION DISTRIBUTION

• Distribution site
• Identify and design layout in advance
• Pre-develop distribution protocols, especially
  patient education materials
• Privacy and confidentiality
• ID tracking of persons and medication doses (e.g.
  barcodes)
• Employees reluctant to disclose medical
  information
• Clinical evaluations often required in
  dispensing area
• Security

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PATIENT FLOW10-DAY
Pharmacy
Patient Ed
Patient Ed
Patient Departure
Patient Ed
Sick Room
Nursing Triage
Dispensing POD II
Patient Depart
Nurse Triage
POD I
POD II
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PATIENT FLOW 50/60 DAY
(Patient Materials Provided)
(Patient History Collected)
Nurse Triage
Patient Departure
Patient Arrival
Buses
Patient Ed
Dispensing
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Lessons LearnedRESOURCES

• Staff
• Determine required staff categories in advance
• Train for various scenarios and desired skill
  sets
• Transportation
• Dedicated transport vehicle for each site
• Telecommunications
• Intersite communications required
• Equip vital staff with two way pagers

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Lessons LearnedCOMMUNICATIONS

• Types of information
• Public (N.B. diversity)
• Healthcare providers
• Consequence management
• Internal
• Timeline for information
• Expedite approval process for release
• Call center necessary
• Dissemination of information
• Information specialist
• Use all available media
• Communicate regionally

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Public Health in a Changed WorldAnthrax in
Washington DC
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THE CHALLENGE

• October 15, 2001 anthrax laced letter arrives
  in Senate Office
• Oct. 18, 2001 press conference held in
  Brentwood postal facility
• Oct. 19, 2001 first patient presents with
  occupational inhalation anthrax
• Oct. 21, 2001 first postal worker dies.
  Brentwood closed

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THE RESPONSE

• Mass prophylaxis begun within 7 hours of
  positive confirmation
• 17,759 patients seen at DC site over 2 weeks
• 160,160 tabs Ciprofloxacin, 497,880 caps
  doxycycline
• Public Health corps medical/pharmacists deployed
  within 4 hrs.
• CDC team on site (gt100 members)
• Red Cross/Kaiser/local MD volunteers

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INCIDENT MANAGEMENT LESSONS

• Incident Command Structure
• Define lead agency, responsibilities
• Record events, costs
• Logistics
• Medicine distribution
• Site
• Privacy/confidentiality
• Clinical evaluations, mental health
• Security
• Resources
• Staff
• Transportation
• Telecommunications

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UNIVERSAL LESSONS

• Public Health is first responder in any terrorist
  event
• Only mechanisms that have been practiced can be
  relied on to work
• Always tell the truth, even when youre not sure
  what it is
• Providers are vital for ongoing surveillance
• Information sharing in real-time is more
  difficult than you think

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LESSONS FROM ANTHRAX

• Relationships are key
• Training is vital
• Communications are everything

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RELATIONSHIPS

• Only those already formed can be relied on
• Know the key players and their contact numbers
• Friends are better than plans
• Get to know the Feds!

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TRAINING

• Practice, Practice, Practice
• The hardest to reach and teach are the physicians
• The last to follow recommendations are the
  physicians

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COMMUNICATIONS

• Public remember diversity
• Clear calm direct
• Translators
• Valid credible spokesperson
• Providers
• Need real-time information
• Need hotline advice
• Need frequent updates and protocols
• Partners
• Local
• Regional

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CONCLUSION

• Hospitals require secure information system.
  Develop hotline for healthcare providers
• Produce protocols and action plan for various
  scenarios
• Coordinate levels of alertness with national
  color coding and with other agencies
• Staff training for all levels
• Communicate clearly at community level to
  reassure and assure response. Credible
  spokesperson

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CONCLUSION

• We have the ability and must develop the capacity
  to be ready
• We must provide trust, credibility, and honesty
• Plan Practice Review Plan - Practice

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Implementation of New HSAS System
Next Steps Implementing it at the local level
for DC Government, Citizens and Businesses
The Districts recommended actions for Residents
and businesses can be found at http//dcema.dc.go
v/info/threat.shtm
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For More Information please contact
The District of Columbia Emergency Management
Agency Steven Charvat, CEM 2000 14th Street,
NW Suite 800 Washington, DC 20009 USA Phone
[phone] FAX [phone] Email
steven.charvat_at_dc.gov www http//dcema.dc.gov