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How Ready Are Health Responders for Terrorist Attacks?. Lois M. Davis, Ph.D. June 26, 2003. How Prepared Local Health Responders Are for Terrorist Attacks Has Been an Ongoing Concern.

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how prepared local health responders are for terrorist attacks has been an ongoing concern
How Prepared Local Health Responders Are forTerrorist Attacks Has Been an Ongoing Concern
  • The June 2001 Dark Winter exercise—which simulated intentional release of smallpox in three U.S. cities—raised warning flags

“Dark Winter further demonstrated how poorly current organizational structures and capabilities fit with the management needs and operational requirements of an effective bioterrorism response. Responding to a bioterrorist attack will require new levels of partnership between public health and medicine, law enforcement, and intelligence. However, these communities have little past experience working together and vast differences in their professional cultures, missions, and needs.”

  • 9/11 attacks and anthrax attacks in Fall 2001 further called into question how prepared health responders were
today s focus
Today’s Focus
  • How prepared are local health responders for biological and chemical terrorism?
    • RAND nationwide surveys of state and local responders prior to 9/11 and at the one-year anniversary
    • Results of other survey efforts since 9/11: OIG/DHHS survey and GAO case studies
  • What role should the media play in informing the public health response to terrorism?
questions and answers
Questions and Answers

Questions

Answers

  • How prepared are local health responders for biological and chemical terrorism?
  • What role should the media play in informing the public health response to terrorism?
  • Preparedness efforts are improving since 9/11, but fundamental readiness concerns persist
prior to 9 11 only 1 3 of local public health departments had sops for biological attacks
Prior to 9/11, Only 1/3 of Local Public HealthDepartments Had SOPs for Biological Attacks

Have Response Plans or SOPs for . . .

. . .Biological Incidents

. . .Chemical Incidents

Local public health

27 (4)

25 (4)

Overall

Hospitals

32 (7)

54 (7)

32 (11)

Large

Metropolitan

Counties

36 (11)

69 (12)

40 (15)

24 (5)

26 (5)

Other

Counties

50 (8)

31 (7)

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Percent

Percent

prior to 9 11 only 1 3 of local public health departments had sops for biological attacks6
Prior to 9/11, Only 1/3 of Local Public HealthDepartments Had SOPs for Biological Attacks

Have Response Plans or SOPs for . . .

. . .Biological Incidents

. . .Chemical Incidents

Local public health

27 (4)

25 (4)

Overall

Hospitals

32 (7)

54 (7)

32 (11)

Large

Metropolitan

Counties

36 (11)

69 (12)

40 (15)

24 (5)

26 (5)

Other

Counties

50 (8)

31 (7)

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Percent

Percent

Slightly better for chemical attacks and among large

metropolitan counties

prior to 9 11 very few organizations had exercised their response plans for bioterrorism
Prior to 9/11, Very Few Organizations HadExercised Their Response Plans for Bioterrorism

Response Plans or SOPs Last Exercised for . . .

. . .Chemical Incidents

. . .Biological Incidents

Within

Past 12

Months

16 (6)

37 (9)

10 (5)

36 (9)

Local public health

Hospitals

19 (7)

9 (5)

Between

1–2 Years

Ago

27 (8)

7 (5)

18 (8)

20 (9)

2 or More

Years Ago

34 (14)

15 (7)

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Percent

Percent

prior to 9 11 very few organizations had exercised their response plans for bioterrorism8
Prior to 9/11, Very Few Organizations HadExercised Their Response Plans for Bioterrorism

Response Plans or SOPs Last Exercised for . . .

. . .Chemical Incidents

. . .Biological Incidents

Within

Past 12

Months

16 (6)

37 (9)

10 (5)

36 (9)

Local public health

Hospitals

19 (7)

9 (5)

Between

1–2 Years

Ago

27 (8)

7 (5)

18 (8)

20 (9)

2 or More

Years Ago

34 (14)

15 (7)

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Percent

Percent

Better for chemical attacks

prior to 9 11 only half of health organizations participated in wmd focused task forces
Prior to 9/11, Only Half of Health OrganizationsParticipated in WMD-Focused Task Forces

Interagency Disaster

Preparedness

Task Force

Exists in Region

Task Force Addresses

Planning for

WMD-Related

Incidents

Local public

health

61 (6)

53 (6)

Hospitals

Overall

76 (6)

53 (8)

77 (11)

Large

Metropolitan

Counties

73 (15)

90 (7)

88 (8)

50 (7)

59 (6)

Other

Counties

44 (9)

72 (7)

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Percent

Percent

other findings showed local health medical response to terrorism inadequately addressed
Other Findings Showed Local Health/Medical Response to Terrorism Inadequately Addressed
  • Surge capacity that may be required
  • Plans for communicating with other health providers, emergency responders, media, or the public
  • What role other responders, such as law enforcement, may play in the response to, or the investigation of, bioterrorist incidents
oig dhhs survey showed improvements in terrorism preparedness capabilities since 9 11
OIG/DHHS Survey Showed Improvements inTerrorism Preparedness Capabilities Since 9/11
  • OIG Study: Purposive sample of 12 states and 36 local health departments
  • All state health departments and nearly 89 percent of local ones were writing or had written bioterrorism response plan
  • Local health departments have begun to integrate public health preparedness activities with those of other emergency response organizations
  • Most local health departments reported belonging to terrorism-related task forces, working groups, or committees
gao case studies at sites in seven cities show similar improvements
GAO Case Studies at Sites in Seven Cities Show Similar Improvements
  • Most cities had undertaken steps to improve coordination among local response organizations
    • Hospitals and other organizations that had not been involved in local response planning increased participation
  • State/local jurisdictions/response organizations have begun to incorporate bioterrorism in overall plans
    • However, plans for regional coordination were lagging
  • Most states were in the process of undertaking assessments of capacity
    • Applying for DHHS funding helped states identify problems in bioterrorism preparedness and focus planning efforts
gao case studies at sites in seven cities show similar improvements13
GAO Case Studies at Sites in Seven Cities Show Similar Improvements
  • Most cities had undertaken steps to improve coordination among local response organizations
    • Hospitals and other organizations that had not been involved in local response planning increased participation
  • State/local jurisdictions/response organizations have begun to incorporate bioterrorism in overall plans
    • However, plans for regional coordination were lagging
  • Most states were in the process of undertaking assessments of capacity
    • Applying for DHHS funding helped states identify problems in bioterrorism preparedness and focus planning efforts

However, despite improvements, fundamental public health readiness issues remain

written comments from rand follow up survey highlight local health organizations concerns
Written Comments from RAND Follow-up Survey Highlight Local Health Organizations Concerns
  • “If additional funding is not provided to hospitals, the cost of WMD preparedness will be difficult if not impossible to meet.”
  • “We are a rural medical facility. Financial survival is difficult in the current climate. Funding is not available for training. . . .”
  • “Difficult to find balance between efforts for preparedness vs. other public health priorities in a shrinking resource environment.”
  • “Federal bioterrorism [funding] is just now resulting in ability to recruit and hire dedicated staff for bioterrorism preparedness.”
funding of bioterrorism preparedness activities remains a fundamental readiness concern
Funding of Bioterrorism Preparedness Activities Remains a Fundamental Readiness Concern
  • Post 9/11, federal funding for bioterrorism preparedness has increased, esp. for public health
  • However, wide variation across states in how funding is being allocated
    • Much of the focus is on capacity building and improving public health infrastructure
    • Some states are taking a comprehensive approach to include coordination, response planning, etc.
    • Degree to which funding will reach local level is a concern
    • Hospitals only now receiving bioterrorism funding in any substantial amounts (complex incentives for investing in preparedness)
    • Question of whether “supplantation” may occur in current fiscal crisis
workforce issues are another fundamental readiness concern
Workforce Issues Are Another Fundamental Readiness Concern
  • Health officials have cited workforce shortages as impediments that funding alone will not solve
    • Shortages of trained epidemiologists, lab personnel, and hospital personnel
    • Manpower shortages limiting ability to implement active surveillance systems
  • Health departments reluctant to hire new staff without guarantees of sustained federal (or state) funding
concern over effects of increasing focus on bioterrorism is also a fundamental issue
Concern Over Effects of Increasing Focus onBioterrorism Is Also a Fundamental Issue
  • Some public health officials fear overemphasis on bioterrorism to exclusion of other types of public health threats/emergencies
  • State and local health officials concerned that focus on bioterrorism may divert attention and resources from other public health functions and programs
    • Recent implementation of smallpox vaccination program
    • Forcing cutbacks in other basic health services, such as childhood immunizations and tuberculosis prevention
dhhs review of states bioterrorism plans also identified shortcomings
DHHS Review of States’ Bioterrorism Plans Also Identified Shortcomings
  • Some States’ workplans inadequately addressed coordination
    • With the Metropolitan Medical Response System (MMRS) cities
    • Between health departments and hospitals
    • With bordering states or countries
  • DHHS also requested priority be given to development of plans for
    • Receiving materials from the National Pharmaceutical Stockpile
    • Ensuring adequate surge capacity within hospital regions
    • Provisions be made for isolation rooms in hospital ERs
at most fundamental level is question of how to know how much readiness is enough
At Most Fundamental Level Is Question of “How to Know How Much Readiness Is Enough”
  • Current metrics for assessing how prepared a community really is for bioterrorism are inadequate
    • CDC’s list of critical benchmarks
    • DHS Advisory Council’s statewide template initiative
  • Need to go beyond these efforts to develop quantifiable performance measures and model of preparedness that:
    • DHS can use to assess how prepared U.S. is
    • Communities can use to assess local preparedness and inform resource allocation decisions
    • Individual health organizations can use to assess where they stand relative to their peers
questions and answers20
Questions and Answers

Questions

Answers

  • How prepared are local health responders for biological and chemical terrorism?
  • What role should the media play in informing the public health response to terrorism?
  • Preparedness efforts are improving since 9/11, but fundamental readiness concerns persist
  • Media can help with public education and provide input to communications plans being developed
communications with the media and public during 9 11 and anthrax attacks was poor
Communications with the Media and Public During 9/11 and Anthrax Attacks Was Poor
  • There was a problem of health officials not speaking with one voice
    • Spokespersons who contradicted guidance from public health officials
  • Public health officials appeared unresponsive to what citizens wanted to know
    • Individuals’ risk for contracting anthrax, need for antibiotics, etc.
  • Lack of coordination between local, state, and federal levels
evidence suggests such problems still exist after 9 11
Evidence Suggests Such Problems Still Exist After 9/11
  • DHHS review of state risk communications plans
    • Lacked sufficient details on communications with the public or media
    • Several did not identify public information officers
  • OIG survey found most health departments did not have complete risk communication plan for communicating with public and media
    • Only 25% of state health departments; 33% of local ones
evidence suggests such problems still exist after 9 1123
Evidence Suggests Such Problems Still Exist After 9/11
  • DHHS review of states’ risk communications plans
    • Lacked sufficient details on communications with the public or media
    • Several did not identify public information officers
  • OIG survey found most health departments did not have complete risk communication plan for communicating with public and media
    • Only 25% of state health departments; 33% of local ones

Health departments are working to rectify problems

and develop communications plans

improving communications about preparedness and response to bioterrorist incidents
Improving Communications About Preparednessand Response to Bioterrorist Incidents
  • Public health officials should undertake public education component in advance
    • Provide frank assessment of where jurisdictions stand on response planning, quarantine plans, evacuation plans, etc.
    • Media can play a role in educating the public
  • Media can help inform communications plans
    • Make public health officials aware of what media needs to know and is going to be asking during an event
    • Make them aware that there must be a “go-to” person among health officials to get information when an incident occurs . . . or will go elsewhere
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