Public health response to bioterrorism
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The Centers for Disease Control and Prevention (CDC) defines bioterrorism as "the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants” (Centers for Disease Control and Prevention [CDC], 2007, p. 1). This presentation will cover the initiation, process and roles of agencies in Multnomah County, Oregon and their relationships with international, national and state agencies. The role of the public health department in relation to bioterrorism will also be explored.
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Public health response to bioterrorism
- 1. By: Tosin Ola, RN, BSN
- 2. Category A: Highest risk Category C: Emerging Can be easily spread Threats Result in high death rates Are easily available Might cause public panic Are easily produced and and social disruption spread Require special action for Have potential for high public health preparedness morbidity and mortality rates and major health Category B impact. Moderately easy to spread Result in moderate illness rates and low death rates Require enhanced disease monitoring
- 3. SARS-like virus Severe Acute Respiratory Syndrome Spread through droplet transmission Category A threat
- 4. Multnomah County County Sheriff and Police Emergency Operation Departments Center (EOC) Help to coordinate Are the first notified transportation of equipment and individuals Decide what agencies to contact Coordinate safe evacuation if necessary Act as chief coordinator between all agencies Disseminate information to the public
- 5. Emergency Medical 9-1-1 Communications Technicians (EMTs) system Provide initial medical Facilitate communication services to victims between agencies Provide transportation to Reverse 911 calls in case of hospital for treatment evacuations Coordinate care with local Help disseminate hospitals information to the public Can dispatch emergency personnel in case of another suspected outbreak
- 6. Reduce exposure to SARS Conduct investigations Conduct ongoing public Order isolations health information and Order quarantines education campaign Ensure staff safety Update website Provide adequate Clinician/staff education treatment Use media outlets Determine needs Strategic National Stockpile Request resources/order supplies Establish mobile staff, facilities and points of distribution
- 7. Oregon Health Region 911 call placed to local Media outlets alerted 1 Health/Medical agency for public awareness Coordination Center HMCC City of Portland Emergency Oregon State Emergency Operations Center Emergency Coordination Center EOC notified Management OSEM ECC for field support County Sheriff , First Hospital Command National Incident Responders and Centers for local Management System Police Department hospitals NIMS notified Multnomah County Global Outbreak Alert Multnomah County Health Department and Response Incident Command Incident Command Network and WHO Center is created initiated are notified
- 8. National Incident Management System (NIMS) FEMA DHS Environmental Protection Agency (EPA) EMAC Strategic National Stockpile (SNS)
- 9. Federal Bureau of Investigation (FBI) American Red Cross and other relief agencies Food and water Shelter Safety
- 10. Multi-layered All requests and orders for supplies were filled and transported to the right locations The EOC and HMCC were located in the same building but on different floors. Everyone knew where the command center was Situational reports were received from all hospitals and the field
- 11. Lack of communication between the different command centers and staff Several leaders do not know what other agencies are responsible for Lack of system wide numbering/abbreviation protocol that allows tracking of orders Not enough staff training with computer system that was used Hospital capacity was not fully utilized Backup communications were not used
- 12. Prepare Respond Recover Rebuild For more information on disaster preparedness, visit http://ready.gov
- 13. American Red Cross (2007). The federal charter of the American Red Cross. Retrieved May 30, 2009, from http://www.redcross.org/museum/history/charter.asp Centers for Disease Control and Prevention (2005). Basic information about SARS. Retrieved May 27, 2008, from http://www.cdc.gov/ncidod/sars/factsheet.htm Centers for Disease Control and Prevention (2007). Bioterrorism Overview. Retrieved May 27, 2009, from http://www.bt.cdc.gov/bioterrorism/overview.asp Gerberding, J. L., Hughes, J. M., & Koplan, J. P. (2002). Bioterrorism preparedness and response: clinicians and public health agencies as essential partners . Journal of the American Medical Association, 287, 898-900. Getty Images (2009). Healthcare images. Retrieved May 28, 2009, from http://gettyimages.com Multnomah County Health Department (2006, July). Public health emergency response plan. Retrieved from Multnomah County Health Department Website: http://www.co.multnomah.or.us/health/emergprep/plans.shtml
- 14. Multnomah County Health Department. (2009, February 4). SARS attacks inter-relationships after action report (Emergency Preparedness and Incident Command System). Portland, OR: Multnomah County United States Department of Homeland Security (2008). About the National Incident Management System (NIMS). Retrieved May 29, 2009, from http://www.fema.gov/emergency/nims/AboutNIMS.shtm United States Environmental Protection Agency (2007). Interstate mutual aid and assistance: EMAC tips for the water sector. Retrieved May 28, 2009, from http://www.epa.gov/safewater/watersecurity/pubs/fs_watersecurity_emac_tips.pdf Ursano, R. J. (2005). Preparedness for SARS, influenza and bioterrorism. Psychiatry Services, 56(1), 76-79. World Health Organization (n.d.). Frequently asked questions regarding the deliberate use of biological agents and chemicals as weapons. Retrieved May 28, 2009, from http://www.who.int/csr/delibepidemics/faqbioagents/en/
Notas del editor
- The Centers for Disease Control and Prevention (CDC) defines bioterrorism as "the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants” (Centers for Disease Control and Prevention [CDC], 2007, p. 1). This presentation will cover the initiation, process and roles of agencies in Multnomah County, Oregon and their relationships with international, national and state agencies. The role of the public health department in relation to bioterrorism will also be explored. For the purpose of this presentation, Severe Acute Respiratory Syndrome (SARS) will be investigated as a possible bio-terrorism threat, although the process can be applied to other respiratory contracted flu pandemics like the H1N1 virus, viral hemorrhagic flu, or water and food contamination threats.
- Bioterrorism agents can be separated into three categories. Category A: These high-priority agents include organisms or toxins that pose the highest risk to the public and national security and require special action for public health preparedness (CDC, ¶ 11). This is due to the reasons listed above. Examples are Anthrax, Botulism, Ebola, Bubonic plague, and viral hemorrhagic fever (Gerberding, Hughes, & Koplan, 2002, p. 898).Category B: These agents are the second highest priority since they are moderately easy to spread, and result in moderate illness rates and low death rates (CDC, 2007, p. 1). Examples are Brucellosis, water supply threats, food safety threats, ricin (Gerberding et al., p. 898). Category C: These include emerging pathogens that could be engineered for mass spread in the future because they are easily available, are easily produced and spread and have potential for high morbidity and mortality rates and major health impact (CDC, 2007, p. 1).
- Severe acute respiratory syndrome (SARS) was initially onlyone of many infectious diseases, but by late 2002 it had turnedinto a new and global epidemic with the potential of becominga pandemic of overwhelming proportions (Ursano, 2005, p. 76). SARS is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003 (Centers for Disease Control and Prevention [CDC], 2005, ¶ 1). Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained (CDC). The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes (Ursano). Children, infants and the elderly are most vulnerable to fatalities from respiratory related bioterrorism (Multnomah County Health Department [MCHD], 2006).
- It is important to emphasize that in Oregon, countiesare directly responsible for protecting the public’s health (Multnomah County Health Department [MCHD], 2006, p. 5). The first agencies that respond to local threats in the area are listed above and in the following slide with their roles and responsibilities during a crises situation.
- The 9-1-1 communications system plays a vital role in the bioterrorism and disaster response of Multnomah county. Most populations are educated that in case of emergency 9-1-1 is the first thing to call. This system helps to coordinate emergency care between the fire department, EMTs, police department as well as reverse 911 calls to encourage families to safe evacuation in case of emergencies (MCHD, 2006).
- The county health department has very specific roles as outlined in the strategic plan (MCHD, 2006). They are:Reduce exposure to SARS byConducting investigations – Identify disease agent and extent of spreadOrdering isolations – Reduce the exposure of infection to a minimum number of persons Ordering quarantines – Reduce the exposure of potentially exposed persons to others Ensure safety of staff and access to personal protective equipment and supplies Provide adequate treatment (MCHD, 2006).Determine needs – Establish course of action Request resources – Order local supplies or SNS delivery Establish points of distribution (PODs) – Set-up and staff facilities as neededConduct ongoing public health information and education campaign (MCHD, 2006).Update websiteClinician/staff educationUse media outlets and statements to alert the population
- The chain of response in Multnomah county to bio-terrorism is shown above. Each member agency has a responsibility to initiate the department and activating the response team as well as communicating and collaborating with other agencies until resolution of the problem (MCHD, 2006). If the bioterrorism cannot be contained by local agencies; state, regional, national and international organizations are called in to assist with the efforts (CDC, 2007). All outbreaks of bioterrorism and infectious disease, whether natural or deliberate, would quickly be detected by the Global Outbreak Alert and Response Network, which continually monitors reports and rumors of disease events around the world (World Health Organization [WHO], n.d., ¶ 4). After validity of a problem has been ascertained, the World Health Organization dispatches a team to investigate and assist with the crises within 24 hours from notification (WHO).
- The EOC notifies the National Incident Management System (NIMS) of bioterrorism. NIMS then implements protocols with federal agencies. As a sub-division of the Department of Homeland Security and the Federal Emergency Management Agency, NIMS helps to collaborate on the national and international spectrum for full crises management (United States Department of Homeland Security [DHS], 2008, ¶ 2).If there is suspected water contamination, the Environmental Protection Agency initiates the Emergency Management Assistance Compact; a mechanism whereby drinking water and wastewater utilities can provide interstate (between states) mutual aid and assistance during times of emergency (United States Environmental Protection Agency [EPA], 2007, p. 1).When a public health emergency requires large quantities of pharmaceuticals, vaccines, and/or medical supplies, that are in excess of the local and state resources, EOC in consultation with the public health office, may request activation of the Strategic National Stockpile (SNS) to supplement existing community resources (MCHD, 2006, p. 11).
- Where terrorism is suspected, the FBI leads the law enforcement investigation, and security may be needed to preserve evidence (Gerberding et al., 2002). The city and township agencies, security staff, sheriff’s office, Oregon state police, National Guard, volunteers and the county health department all have a responsibility to secure the scene, gather and protect evidence (MCHD, 2006, chap. 14). The American Red Cross and other relief agencies are available to provide food, shelter and water for victims of bioterrorism and disasters (American Red Cross, 2007). This includes safety, food and shelter for both large and small animals affected by disasters (ARC, 2007).
- The response plan is multi-layered, with several agencies responding in the event of bio-terrorism or natural disaster (Multnomah County Health Department [MCHD], 2009, p. 3). During the bioterrorism drill, all the reports, orders and supplies where received as well as situational reports from all hospitals and from the field. The command center was centrally located and all parties involved knew how to get in contact with the command center (MCHD).
- The weaknesses of the strategic plan were outlined for future development in the Post Drill Action Report. Recurrent drills, staff training and improvement of protocols and policies can prevent these problems from happening again in the future, especially during a real crises event (MCHD, 2009).
- The possibility of public health emergencies arising in the United States concerns many people in the wake of recent hurricanes, tsunamis, acts of terrorism, and the threat of pandemic influenza (WHO, n.d., ¶ 14). Though some people feel it is impossible to be prepared for unexpected events, the truth is that taking preparedness actions helps people deal with disasters of all sorts much more effectively when they do occur (Gerberding et al., 2002, p. 90). The four steps of disaster management are pictured above. Nurses, community health leaders and first responders should all be aware of the strategic plans in their communities (CDC, 2008). The public health department is integral in the management and education of the population during a biological crises. Although each agency has a defined role, all function, respond and collaborate together during bioterrorism and natural disasters to recover from the incident and rebuild the community affected.