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Preparing for and Responding to Bioterrorism: Information for the Public Health Workforce. Acknowledgements. This presentation, and the accompanying instructor’s manual, were prepared by Jennifer Brennan Braden, MD, MPH, at the

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Preparing for and responding to bioterrorism information for the public health workforce

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


Acknowledgements

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


Emergency response planning

Emergency Response Planning


Emergency response planning learning objectives

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


Emergency response planning learning objectives1

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


Bioterrorism preparedness and response crisis and consequence management

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


Community preparedness a coordination of efforts

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


Local emergency response planning committees lepcs

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


National responders

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


State and local responders

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


The emergency response system

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


Incident command system definition

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


Incident command system some basic principles

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


Incident command system some basic principles1

Incident Command SystemSome Basic Principles

  • Modular organization (expands or contracts as required)

  • Common terminology

  • Common names/titles used for all personnel and equipment


Differences in public health and law enforcement investigations

Differences in Public Health and Law Enforcement Investigations

Adapted from: Butler et al. EID, 2002


Emergency operations plan

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


Emergency operations plan types of plans

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


Emergency operations plan state and local roles

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


Developing a local public health emergency operations plan

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


Legal issues to consider in planning for a health emergency

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?


Legal issues to consider in planning for a health emergency1

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?


Workplace emergency response plans

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)


National preparedness 1999 initiative

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...


National preparedness cdc activities

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...


National preparedness cdc activities cont

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...


National preparedness other dhhs activities

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


Community preparedness role of public health

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


Community preparedness role of public health1

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


Community preparedness role of public health2

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


Community preparedness role of public health3

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


Summary of key points

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.


Summary of key points1

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


Resources national

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


Resources washington state

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/


Resources emergency management

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


Resources emergency response planning

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


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