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

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

2. Acknowledgements This presentation, and the accompanying instructor’s 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 instructor’s guide. Patrick O’Carroll, 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

3. Emergency Response Planning

4. 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 agency’s bioterrorism response plan • Identify factors to consider and include in the development of a local emergency response plan

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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 State and Local Responders

11. 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 HAZMAT EMS FBI

12. 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

13. Incident Command SystemSome 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

14. Incident Command SystemSome Basic Principles • Modular organization (expands or contracts as required) • Common terminology • Common names/titles used for all personnel and equipment

15. Differences in Public Health and Law Enforcement Investigations Adapted from: Butler et al. EID, 2002

16. 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

17. 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

18. 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

19. 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

20. 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?

21. 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?

22. Workplace Emergency Response Plans • Workplace-specific emergency operations plan • Plan should include a bioterrorism component • Be familiar with your agency’s plan • Who activates it and when it might be activated • Your responsibilities • Evacuation plans • Communication procedures (i.e., phone tree/call-down roster)

23. 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 nation’s public health capacity and in developing a BT preparedness and response plan More on 1999 Initiative...

24. 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...

25. 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...

26. 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

27. 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 27

28. 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 28

29. Community PreparednessRole 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 29

30. Community PreparednessRole 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 30

31. 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.

32. 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

33. ResourcesNational Bioterrorism Web site: http://www.bt.cdc.gov • 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 (888) 246-2857 • National Domestic Preparedness Office: 1-202-324-9026 M-F 8am-5pm EST

34. 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 (206) 361-2881 • Washington State Emergency Management Division http://www.doh.wa.gov http://www.wa.gov/wsem/

35. 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: (206) 622-0460 • Eastern WA: (509) 747-5195 • Federal Emergency Management Agency (FEMA) • Incident Command System Self-study Course http://www.fema.gov http://training.fema.gov/EMIWeb/crslist.htm

36. 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