Paul Moyer, MS CT Response Coordinator Minnesota Department of Health

1. A Tiered Approach to All-Hazards Laboratory Testing of Unknown Environmental Samples Paul Moyer, MS CT Response Coordinator Minnesota Department of Health Public Health Laboratory Division

2. Introduction • Why Is Unknown Sample Testing Important? • “Credible” Threats Exist • Surveillance • Why Is Testing at PHL Important? • Public Health Events • LRN Laboratories

3. Objectives • Describe a process for applying standardized procedures to non-standard events • Illustrate the significance of notification and threat assessment pieces (“Focus Areas” working together) • Discuss the advantages of a Bio/Chem/Rad tiered step analysis

4. Background • Anthrax 2001 • Specific Protocol • Letters • Evolution to “All-Hazards” Approach • Specific Guidelines • Letters • Leaking Packages • Tainted Food/Water

5. Background • What the MDH plan “IS” • A Starting Point – Guidance • SOPs, Checklists, & Forms • Safety First • What the MDH plan “IS NOT” • A “Rote” Protocol – Thinking IS Required • A Lab Only Effort – Partners Crucial • Rigid

6. Safety • Lab Safety Officer – IH • BSL 3 Facility • Limited Quantities • Buddy + 1 System • PPE

7. Safety Full Face APR: Dual Particualte/Organic Vapor Cartridges Outer Gloves: Nitrile Chemical Resistant Sleeves Inner Gloves: Nitrile or Chemical Laminate Chemical Splash Resistant Coveralls with Hood and Boots

8. What does “Tiered” Mean • Expandable System • Begins with Field Information/“Tests” • Minimum Testing – Tier 1 • Can Include: • Scenario/Submitter Directed Testing • Tier 2 Testing • Minimum Plus Testing

9. Resource Management • Anthrax Only Testing – “Too Cold?” • All-Agent Testing – “Too Hot?” • Tiered Testing – “Just Right”?

10. Plan Strategy • SOPs vs. SOGs • “Menu” of Tests/Procedures • Judgment – “What makes sense” • Here’s the “Road Map”

11. Process SOP Notification SOP (Phase I) Process SOP Sections - Communications - QA / QC - Documentation - Safety - Analysis Referenced SOP Document Sample Rejection Accept Sample? Decision No Additional Resource Yes Receive Sample / Over-pack SOP Data / Information Results & Observations Document BT / CT Personnel Rad Check Positive? Yes LRN BT Analytical SOPS GC/MS, ICP/MS, Other CT Analytical SOPS No Final Report SOP Radiological Screen SOP Open Sample SOP Alert Radiation Response Team Staff Resource Call-Down Rad Check Positive? Results Notification SOP (Phase II) Yes No Yes No Minimum Testing & Processing Setup Tier 2 Testing? Minimum Testing Or Minimum Testing + Additional Biological Information Prioritize Tier 1 Testing Or Results & Observations Document Minimum Testing + Additional Chemical Or Minimum Testing + Additional Toxin Document Or Minimum Testing + Viral

12. Plan Strategy • BT, CT & REP* Teams • On-Call Pairs (BT, CT-Rad) • Cross - Trained on: • Threat Assessment • Sample Receiving – Chain-of-Custody • Sample Opening – Processing • Communications *Radiological Emergency Program

13. Screening: Chemical vs. Biological • Serial Analysis: • Rule Out Chemical Agents • What about the Bio-Hazard? • Rule Out Biological Agents • What about the Chemical Hazard? • Parallel Analysis: • BT and CT-Rad Working Together • Broader Perspective / Depth of Knowledge • Use the Threat Assessment/Field Information

14. Testing: Is It Hazardous? (…and If Not, What Is It?) • ID and Confirm • Rule Out Hazardous: • Radioactivity • Chemicals • Biological Agents • What’s Left? • Back to the “Map”

15. Process SOP Notification SOP (Phase I) Process SOP Sections - Communications - QA / QC - Documentation - Safety - Analysis Referenced SOP Document Sample Rejection Accept Sample? Decision No Additional Resource Yes Receive Sample / Over-pack SOP Data / Information Results & Observations Document BT / CT Personnel Rad Check Positive? Yes LRN BT Analytical SOPS GC/MS, ICP/MS, Other CT Analytical SOPS No Final Report SOP Radiological Screen SOP Open Sample SOP Alert Radiation Response Team Staff Resource Call-Down Rad Check Positive? Results Notification SOP (Phase II) Yes No Yes No Minimum Testing & Processing Setup Tier 2 Testing? Minimum Testing Or Minimum Testing + Additional Biological Information Prioritize Tier 1 Testing Or Results & Observations Document Minimum Testing + Additional Chemical Or Minimum Testing + Additional Toxin Document Or Minimum Testing + Viral

16. Key Pieces • Notification • Threat/Hazard Assessment • Action Plan – Scenario Specific • Minimum Testing – Tier 1 • Radiological • Chemical • Biological • Advanced/LRN Testing – Tier 2

17. Notification • Incoming Request for Lab Analysis • Internal Notification(s) • Hazard Assessment • Response Coordinators (Focus Areas C & D) • Unit Leaders • Management FYI • Director • Section Managers

18. Notification • External Notification(s) • Hazard Assessment • MDH Epidemiology (Focus Area B) • MDH Environmental Health Rep (Focus Area A) • FBI WMD Coordinator • CST • Management FYI • MDH Health Protection Division Directors (All Focus Areas) • Decision to Accept/Reject Sample

19. Threat/Hazard Assessment • Credible Threat? • Excessive Hazard? • Fatalities • Explosives • Suitable Request? • Public Health Threat? • Forensics?

20. Event Action Plan – Scenario Specific • Decisions By: • One Person • On-Call Pair • Group • Decide To: • Test or Not Test • Test At What Level – “Order Off the Menu” • Assign Duties and Responsibilities

21. Minimum Testing – Tier 1 • Radiological Screen • Chemical Characterization • Biological Testing

22. Minimum Testing – Tier 1 • Radiological Screen • Inner Package / Sample • Geiger-Muller Counter (CPM) • Alpha • Beta • Gamma • Over-pack Previously Screened at Loading Dock

23. Minimum Testing – Tier 1 • Chemical Characterization • Papers: pH, M8, Oxidizer • Solubility: Water, Methylene Chloride • FTIR: HazmatID • Head Space Vial Aliquot (GC/MS)

24. Minimum Testing – Tier 1 • Biological Testing • Slides: Wet Mount, Gram Stain • RT-PCR • TRF • Cultures: BAP, Chocolate, Thio Broth

25. Advanced/LRN Testing – Tier 2 • Chemical • GC/MS – SVOC • ICP/MS – Metals • General/Bench Chemistry – Inorganic • Biological • LRN Level B/C Agent Specific Protocols

26. References • Guidance on Initial Responses to a Suspicious Letter / Container With a Potential Biological Threat, FBI – DHS – HHS/CDC, 2004 • Assessment of Methods for Handling Mixed-Threat Environmental Samples, NCEH – Battelle, 2004 • Assessment of Protocols Involving Unknown Samples, NCEH – Battelle, 2004 • Proposed Draft DHS Screening Protocol, 2005 (to augment/standardize existing assessments and field screening techniques)

27. Contact Information Paul Moyer, MS Chemical Terrorism Response Coordinator 612-676-5245 Paul.moyer@health.state.mn.us

28. Questions ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?? ? ?