Forensic Epidemiology in Law Enforcement and Public Health 2004 California Medical and Health Disaster Management Confe

1. Forensic Epidemiology in Law Enforcement and Public Health2004 California Medical and Health Disaster Management Conference Gregory Evans Institute for Bio-Security Saint Louis University School of Public Health

2. Botulism • Mode of Exposure • Inhalational • Food-borne • Clinical Features • Muscle paralysis • Respiratory failure • Treatment • Botulinum antitoxin • Supportive care

3. Consequence Management • Local and State Public Health Departments • Local Medical Care facilities • Support from Centers for Disease Control and Prevention

4. Observations from National Exercises • Local sources of supplies • identify reserve medical personnel • Number and types of treatment beds available • Number and type of medical and security personnel • Have hard copies of all material you might need

5. Observations from National Exercises • Types and amounts of medications needed • Algorithm for who will receive treatment • Source of nurses or respiratory therapists for ventilators • Determine auxiliary facilities for treating patients • Determine how hospital facilities can be maximized

6. Observations from National Exercises • Do not assume area hospitals will be able to take overload • Need content experts for most common bioterrorist agents

7. Differences Can Create Difficulties • Who’s in Charge? • Early Notification!

8. New Partners, New Paradigms • Security Clearances • Chain of Custody • Confidentiality Issues

9. Public Health and Law Enforcement Interviews • Much of the information both investigators need to obtain is the same • However, both investigators have unique perspectives/background/experience

10. Law Enforcement: Stop further food poisonings Control the panicking public Collect information to apprehend and convict the terrorists Public Health: Stop further food poisonings Coordinate treatment of victims Collect epidemiologic information that might prevent future attacks Public Health and Law Enforcement Goals Compared

11. Epidemiology • Originally, the study of epidemics • Outbreak is a more localized term for epidemic • Study of the factors that contribute to illness in individuals and communities, and how to reduce disease by altering those factors

12. Public Health Emergencies • Bioterrorism have focused attention on public health preparedness for emergencies • In the case of botulism poisoning, public health has moved from secondary responder to one of the primary responders

13. Local-State-Federal Relationships • Local health agencies • State health agencies • Federal agencies

14. Public Health ‘Police Powers’ • Inspect or close premises • Limit the movements of people (isolation, quarantine) • Require vaccination, testing, or treatment

15. Public Health ‘Police Powers’ • Seize, embargo, impound food and other hazardous substances, or stop their sale • Board planes, trains, buses, and ships as part of disease control • Review medical and hospital records • Interview whoever and whenever information is needed for investigation of a public health problem

16. How Do Infectious Diseases Spread? • Common source • Person-to-person • Vector-borne • Airborne

17. Steps in an Outbreak Investigation • Detect problem • Verify diagnosis • Confirm epidemic • Identify cases • Characterize data ® time / place / person • Take immediate control measures

18. Signs of an Intentional Outbreak • Cases of an extremely rare disease • Ordinary disease but out of season or area or with wrong mode of spread or other unusual characteristics • Cannot solve outbreak with usual techniques • Threats received • Group taking credit • Plausible accusations

19. Signs of an Intentional Outbreak • Victims attended a common event • Victims share a common workplace or other locale • A dissemination device is found • Victims live in same geographical area • Victims have recently traveled by common conveyance

20. For Additional Information www.bioterrorism.slu.edu