Ivan C.A. Walks, M.D. Ivan Walks and Associates, LLC

1. “Anticipating and Defending Against Bioterrorism in our Diverse Healthcare Environments” Planning for and Responding to Threats to the U.S. Homeland October 29, 2004 Ivan C.A. Walks, M.D. Ivan Walks and Associates, LLC “Invest in Health: Improve the Quality of Life”

2. The “Preparedness” Era • Framework for Comprehensive Crisis Planning, Response and Recovery/ CONTINUITY • Developing and Supporting Healthcare Leadership in “Public” Health • Assessing and Accessing Community Resources / Addressing Challenges “Invest in Health: Improve the Quality of Life”

3. “The Public” - M I P S • Hx of conventional terror attacks (Israeli Ministry of Health 2002) Psych vs Physical response as high as 10:1 • Some non-conventional terror scenarios project mass psychogenic or sociogenic illness consistent with a contagious epidemic (Bartholomew 2002) “Invest in Health: Improve the Quality of Life”

4. MIPS and the Terrorism Response • Bioterrorism 1900 – 2001 (Regis – 2001) • 66% Hoax, 21% Failed, 13% Materialized • 24% in USA with <10 deaths • $Billions in response • Little focused on depression and anxiety • Emergency decontamination equipment and negative pressure isolation rooms focus vs. mental health infrastructure “Invest in Health: Improve the Quality of Life”

5. Communicating in a Crisis: Risk Communication Guidelines for Public Officials - HHS, SAMHSA 2002 • Risk Communication: An interactive process of exchange of information and opinion among individuals, groups and institutions; often involves multiple messages about the nature of risk or expressing concerns, opinions or reactions to risk messages or to legal and institutional arrangements for risk management • First Do No Harm: “ASSESS THE ENVIROMMENT” Crisis + heightened public emotions + limited access to facts + rumor, gossip, speculation, assumption and interference = an unstable information environment “Invest in Health: Improve the Quality of Life”

6. Relevant “Public (s)” • Culturally, Ethnically and Linguistically Diverse • Physically and Psychologically Diverse • Physiologically Diverse (ethnopsychopharmacology) • Financially, Socially and Historically Diverse • Literacy / Health Literacy “Invest in Health: Improve the Quality of Life”

7. Hallmark Psychosocial Events The Baltimore Sun, 09/12/01 “Invest in Health: Improve the Quality of Life”

8. Information Dissemination Information sharing with the public • The public needs accurate and timely information they can trust • A core repository is needed for the most up-to-date information • A unified message throughout the region • Must have everyone on the same page • Avoid unnecessary confusion and fear “Invest in Health: Improve the Quality of Life”

9. Diverse Public / Diverse Media “Invest in Health: Improve the Quality of Life”

10. Cross-Jurisdictional System Design, Procurement and Operation:inclusive, multi-system, multi-level • All stakeholders represented in Disaster Preparedness, “All Hazards” planning • Research – epidemiology and interventions • Service / Treatment Resources – “Formulary” • Data: Gathering and Dissemination • “Cultural Quality” Based Assessment – measure - value, efficiency, “Invest in Health: Improve the Quality of Life”

11. Non-Terrorist Incidents • West Nile, Flu, Weather • 2003 Unattended Mercury spill - high school and homes evacuated • 2004 Lead in drinking water supply • 2004 Flu Shots • What are the technical, political/policy challenges? • Lessons? “Invest in Health: Improve the Quality of Life”

12. World Trade Center Terrorist Attack:Air Quality Concerns - Then and Now The Baltimore Sun, 09/12/01

13. Accountable Preparedness, Response and Recovery/Continuity • Housing, feeding and “safety” of responders • Dual use incident management tools • Cost accounting, planning, training, logistics, resource inventory management and tracking, and cost recovery preparedness via “Scenarios Training” • Secure Information and Knowledge Management “Invest in Health: Improve the Quality of Life”

14. Bioterror-Preparedness Challenges • Syndromic Surveillance labor intensive • Incident and Communicable disease reporting to DOHs not timely and consistent • Manual exchange of information within and among organizations • Information technologies used within disease-specific registries and program areas are not interoperable • New funding leading to additional “stovepipes”. “Invest in Health: Improve the Quality of Life”

15. Healthcare Intelligence ADSS Objectives • Electronic linkage among stakeholder organization systems; Alerting system; GIS capability • Real-time or “near real-time” digital data flow • Computer-aided statistical analysis and reporting • Infectious and communicable disease decision support • Centralized data repository provides access to data from multiple sources “Invest in Health: Improve the Quality of Life”

16. Take Home Lessons • “Fail to Plan, Plan to Fail” • Flexible Implementation • Relationships Matter • Psychosociocultural Community Diversity • Cross-Jurisdiction, Multi-agency Coordination • Informed, Caring, Careful, Redundant Leadership • Credible, Real-time Reporting • Tell the Public‘s’ the Truth & in Plain Talk - (Cultural Competence) • When Things Speed Up, Slow Down “Invest in Health: Improve the Quality of Life”