Preparing for and Responding to Bioterrorism: Information for Primary Care Clinicians

Northwest Center for Public Health PracticeUniversity of Washington School of Public Health and Community Medicine, July 2002

Preparing for and Responding to Preparing for and Responding to Bioterrorism: Information for Bioterrorism: Information for

Primary Care CliniciansPrimary Care Clinicians

UW Northwest Center for Public Health Practice

Acknowledgements Acknowledgements Acknowledgements Acknowledgements

This presentation, and the accompanying instructor’s manual (current as of 7/02), were prepared by Jennifer Brennan Braden, MD, MPH, at the Northwest Center for Public Health Practice in Seattle, WA, and Jeff Duchin, MD with Public Health – Seattle & King County and the Division of Allergy & Infectious Diseases, University of WA, for thepurpose of educating primary care clinicians in relevant aspects of bioterrorism preparedness and response. Instructors are encouragedto 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 The Centers for Disease Control and PreventionProject Coordinator

Judith YarrowHealth Policy & Analysis, University of WADesign and Editing

Jane Koehler, DVM, MPHCommunicable Disease Control, Epidemiology and Immunization section, Public Health - Seattle & King County

Ed Walker, MD; University of WADepartment of Psychiatry


Bioterrorism Preparedness Bioterrorism Preparedness and Response and Response

Bioterrorism Preparedness Bioterrorism Preparedness and Response and Response

CDC


Bioterrorism Preparedness & ResponseBioterrorism Preparedness & Response Learning ObjectivesLearning Objectives


Be familiar with:Be familiar with:

The role of the clinician in bioterrorism The role of the clinician in bioterrorism preparedness and response preparedness and response

The roles of local and national agencies The roles of local and national agencies involved in bioterrorism preparedness and involved in bioterrorism preparedness and responseresponse

Be familiar with:Be familiar with:

The role of the clinician in bioterrorism The role of the clinician in bioterrorism preparedness and response preparedness and response

The roles of local and national agencies The roles of local and national agencies involved in bioterrorism preparedness and involved in bioterrorism preparedness and responseresponse




Be familiar with: Be familiar with:

The purpose and functions of the Health The purpose and functions of the Health Alert Network (HAN) and the National Alert Network (HAN) and the National Pharmaceutical Stockpile (NPS)Pharmaceutical Stockpile (NPS)

How to contact the appropriate local agency How to contact the appropriate local agency to report potential bioterrorism or other to report potential bioterrorism or other public health concerns public health concerns

Be familiar with: Be familiar with:

The purpose and functions of the Health The purpose and functions of the Health Alert Network (HAN) and the National Alert Network (HAN) and the National Pharmaceutical Stockpile (NPS)Pharmaceutical Stockpile (NPS)

How to contact the appropriate local agency How to contact the appropriate local agency to report potential bioterrorism or other to report potential bioterrorism or other public health concerns public health concerns


Bioterrorism Preparedness & ResponseBioterrorism Preparedness & ResponseCrisis & Consequence ManagementCrisis & Consequence Management

Bioterrorism Preparedness & ResponseBioterrorism Preparedness & ResponseCrisis & Consequence ManagementCrisis & Consequence Management

Crisis management: law enforcement response Crisis management: law enforcement response to terrorist acts to terrorist acts Local, state, federal law-enforcement agenciesLocal, state, federal law-enforcement agencies

Consequence management: response to the Consequence management: response to the disaster focusing on the alleviation of damage, disaster focusing on the alleviation of damage, loss, hardship, or sufferingloss, hardship, or suffering Public health, medical, & emergency mgt personnelPublic health, medical, & emergency mgt personnel Falls under ESF-8 (public health) of Federal Disaster Falls under ESF-8 (public health) of Federal Disaster

Response PlanResponse Plan

Crisis management: law enforcement response Crisis management: law enforcement response to terrorist acts to terrorist acts Local, state, federal law-enforcement agenciesLocal, state, federal law-enforcement agencies

Consequence management: response to the Consequence management: response to the disaster focusing on the alleviation of damage, disaster focusing on the alleviation of damage, loss, hardship, or sufferingloss, hardship, or suffering Public health, medical, & emergency mgt personnelPublic health, medical, & emergency mgt personnel Falls under ESF-8 (public health) of Federal Disaster Falls under ESF-8 (public health) of Federal Disaster

Response PlanResponse Plan PDD-39

This link will take you away from the educational site

http://www.fas.org/irp/offdocs/pdd39.htm

National RespondersNational RespondersNational RespondersNational Responders

Health and Human Health and Human Services (HHS)Services (HHS)

Centers for Disease Centers for Disease Control and Prevention Control and Prevention (CDC)(CDC)

Federal Emergency Federal Emergency Management Agency Management Agency (FEMA)(FEMA)

FBIFBI Environmental Environmental

Protection Agency Protection Agency (EPA)(EPA)

Department of Department of AgricultureAgriculture

Department of DefenseDepartment of Defense

Health and Human Health and Human Services (HHS)Services (HHS)

Centers for Disease Centers for Disease Control and Prevention Control and Prevention (CDC)(CDC)

Federal Emergency Federal Emergency Management Agency Management Agency (FEMA)(FEMA)

FBIFBI Environmental Environmental

Protection Agency Protection Agency (EPA)(EPA)

Department of Department of AgricultureAgriculture

Department of DefenseDepartment of Defense

State and Local RespondersState and Local RespondersState and Local RespondersState and Local Responders

Health care providers & Health care providers & facilities facilities

Local and state health Local and state health departments departments

Emergency Emergency management agencies management agencies

Search & Rescue, Search & Rescue, EMS, & HAZMAT EMS, & HAZMAT teamsteams

Volunteers Volunteers

Health care providers & Health care providers & facilities facilities

Local and state health Local and state health departments departments

Emergency Emergency management agencies management agencies

Search & Rescue, Search & Rescue, EMS, & HAZMAT EMS, & HAZMAT teamsteams

Volunteers Volunteers

Law enforcement, Law enforcement, National GuardNational Guard

State emergency State emergency management agencymanagement agency

Political leadersPolitical leaders Community service Community service

organizationsorganizations

Law enforcement, Law enforcement, National GuardNational Guard

State emergency State emergency management agencymanagement agency

Political leadersPolitical leaders Community service Community service

organizationsorganizations


National PreparednessNational Preparedness1999 Initiative 1999 Initiative

National PreparednessNational Preparedness1999 Initiative 1999 Initiative

National Bioterrorism Preparedness and National Bioterrorism Preparedness and Response Initiative Response Initiative 1999 DHHS Initiative to prepare the nation to 1999 DHHS Initiative to prepare the nation to

respond to potential BT activityrespond to potential BT activity CDC designated lead in upgrading nation’s CDC designated lead in upgrading nation’s

public health capacity and in developing a BT public health capacity and in developing a BT preparedness & response planpreparedness & response plan

National Bioterrorism Preparedness and National Bioterrorism Preparedness and Response Initiative Response Initiative 1999 DHHS Initiative to prepare the nation to 1999 DHHS Initiative to prepare the nation to

respond to potential BT activityrespond to potential BT activity CDC designated lead in upgrading nation’s CDC designated lead in upgrading nation’s

public health capacity and in developing a BT public health capacity and in developing a BT preparedness & response planpreparedness & response plan

More on 1999 Initiative...This link will take you away from the educational site

http://www.bt.cdc.gov/documents/RegMeetingSlides/Overview.pdf


National PreparednessNational PreparednessCDC Activities CDC Activities

National PreparednessNational PreparednessCDC Activities CDC Activities

CDC bioterrorism preparedness & response CDC bioterrorism preparedness & response activities activities Preparedness and preventionPreparedness and prevention Detection and surveillanceDetection and surveillance Diagnosis and characterization of biological Diagnosis and characterization of biological

and chemical agentsand chemical agents ResponseResponse

CDC bioterrorism preparedness & response CDC bioterrorism preparedness & response activities activities Preparedness and preventionPreparedness and prevention Detection and surveillanceDetection and surveillance Diagnosis and characterization of biological Diagnosis and characterization of biological

and chemical agentsand chemical agents ResponseResponse

More on CDC program...



National PreparednessNational PreparednessCDC Activities, cont. CDC Activities, cont.

National PreparednessNational PreparednessCDC Activities, cont. CDC Activities, cont.

CDC bioterrorism preparedness & response CDC bioterrorism preparedness & response activities activities Education and trainingEducation and training Improved communication systems –Improved communication systems – HAN, HAN,

LRNLRN National Pharmaceutical StockpileNational Pharmaceutical Stockpile

CDC bioterrorism preparedness & response CDC bioterrorism preparedness & response activities activities Education and trainingEducation and training Improved communication systems –Improved communication systems – HAN, HAN,

LRNLRN National Pharmaceutical StockpileNational Pharmaceutical Stockpile


National PreparednessNational PreparednessOther DHHS activitiesOther DHHS activities

National PreparednessNational PreparednessOther DHHS activitiesOther DHHS activities

Medical Consequence ManagementMedical Consequence Management: HHS : HHS

Office of Emergency Preparedness (OEP), Office of Emergency Preparedness (OEP),

expanding efforts to develop medical response expanding efforts to develop medical response

capabilities at local and national levelscapabilities at local and national levels

Medical Consequence ManagementMedical Consequence Management: HHS : HHS

Office of Emergency Preparedness (OEP), Office of Emergency Preparedness (OEP),

expanding efforts to develop medical response expanding efforts to develop medical response

capabilities at local and national levelscapabilities at local and national levels

National Pharmaceutical StockpileNational Pharmaceutical StockpilePurposePurpose

National Pharmaceutical StockpileNational Pharmaceutical StockpilePurposePurpose

Provides resources to respond to both biological Provides resources to respond to both biological and chemical attacksand chemical attacks

Requested by governorRequested by governor

Managed by the Centers for Disease Control Managed by the Centers for Disease Control and Prevention and Prevention

Provides resources to respond to both biological Provides resources to respond to both biological and chemical attacksand chemical attacks

Requested by governorRequested by governor

Managed by the Centers for Disease Control Managed by the Centers for Disease Control and Prevention and Prevention

More on NPS...


National Pharmaceutical StockpileNational Pharmaceutical StockpilePush PackagesPush Packages


12-hour “Push Packages” in cargo-sized 12-hour “Push Packages” in cargo-sized containers weighing approximately 37 tons eachcontainers weighing approximately 37 tons each

Located around the country at strategic Located around the country at strategic locationslocations

Held in environmentally controlled and secured Held in environmentally controlled and secured warehouseswarehouses

Can reach its destination within 12 hours of Can reach its destination within 12 hours of being requestedbeing requested

12-hour “Push Packages” in cargo-sized 12-hour “Push Packages” in cargo-sized containers weighing approximately 37 tons eachcontainers weighing approximately 37 tons each

Located around the country at strategic Located around the country at strategic locationslocations

Held in environmentally controlled and secured Held in environmentally controlled and secured warehouseswarehouses

Can reach its destination within 12 hours of Can reach its destination within 12 hours of being requestedbeing requested



Contain color-coded inventoryContain color-coded inventory

Pharmaceuticals - stock rotated before Pharmaceuticals - stock rotated before expirationexpiration

IV supplies, airway supplies, ventilatorsIV supplies, airway supplies, ventilators

Bandages & personal protective equipmentBandages & personal protective equipment

Contain color-coded inventoryContain color-coded inventory

Pharmaceuticals - stock rotated before Pharmaceuticals - stock rotated before expirationexpiration

IV supplies, airway supplies, ventilatorsIV supplies, airway supplies, ventilators

Bandages & personal protective equipmentBandages & personal protective equipment



Materials pre-packaged for immediate Materials pre-packaged for immediate dispensingdispensing

Support staff will accompany the packageSupport staff will accompany the package

Receiving state responsible for logistics of Receiving state responsible for logistics of repackaging and distributionrepackaging and distribution

Materials pre-packaged for immediate Materials pre-packaged for immediate dispensingdispensing

Support staff will accompany the packageSupport staff will accompany the package

Receiving state responsible for logistics of Receiving state responsible for logistics of repackaging and distributionrepackaging and distribution

National Pharmaceutical StockpileNational Pharmaceutical StockpileVendor-Managed InventoryVendor-Managed Inventory

National Pharmaceutical StockpileNational Pharmaceutical StockpileVendor-Managed InventoryVendor-Managed Inventory

Agreements with pharmaceutical manufacturers Agreements with pharmaceutical manufacturers to make large stocks available on demandto make large stocks available on demand

Shipped to arrive within 24-36 hours after Shipped to arrive within 24-36 hours after requestedrequested

VA hospitals have an agreement with CDC to VA hospitals have an agreement with CDC to assist in the procurement & maintenance of assist in the procurement & maintenance of NPS NPS

Agreements with pharmaceutical manufacturers Agreements with pharmaceutical manufacturers to make large stocks available on demandto make large stocks available on demand

Shipped to arrive within 24-36 hours after Shipped to arrive within 24-36 hours after requestedrequested

VA hospitals have an agreement with CDC to VA hospitals have an agreement with CDC to assist in the procurement & maintenance of assist in the procurement & maintenance of NPS NPS


Health Alert Network Health Alert Network DefinitionDefinition

Health Alert Network Health Alert Network DefinitionDefinition

A nationwide, integrated information and communications system designed to: Ensure communications capacity at all local

and state health departments Ensure capacity to receive distance-learning

offerings from CDC, et al. Ensure capacity to broadcast and receive

health alerts at every level

A nationwide, integrated information and communications system designed to: Ensure communications capacity at all local

and state health departments Ensure capacity to receive distance-learning

offerings from CDC, et al. Ensure capacity to broadcast and receive

health alerts at every level

More on HAN...This link will take you away from the educational site


Health Alert Network Health Alert Network How It Works How It Works

Health Alert Network Health Alert Network How It Works How It Works

Links local health departments to one another Links local health departments to one another and to other organizations critical for and to other organizations critical for preparedness and response: preparedness and response: Community first-responders Community first-responders Hospital and private laboratories Hospital and private laboratories State health departmentsState health departments CDCCDC Other federal agenciesOther federal agencies

Links local health departments to one another Links local health departments to one another and to other organizations critical for and to other organizations critical for preparedness and response: preparedness and response: Community first-responders Community first-responders Hospital and private laboratories Hospital and private laboratories State health departmentsState health departments CDCCDC Other federal agenciesOther federal agencies


Health Alert NetworkHealth Alert Network National Electronic Disease Surveillance National Electronic Disease Surveillance

Health Alert NetworkHealth Alert Network National Electronic Disease Surveillance National Electronic Disease Surveillance

Information system “highway” for the National Information system “highway” for the National Electronic Disease Surveillance System Electronic Disease Surveillance System (NEDSS)(NEDSS) NEDSS supports automated collection and NEDSS supports automated collection and

transmission of disease reports from transmission of disease reports from clinicians’ offices, laboratories, & hospitals to clinicians’ offices, laboratories, & hospitals to local & state health departments and CDC local & state health departments and CDC

Information system “highway” for the National Information system “highway” for the National Electronic Disease Surveillance System Electronic Disease Surveillance System (NEDSS)(NEDSS) NEDSS supports automated collection and NEDSS supports automated collection and

transmission of disease reports from transmission of disease reports from clinicians’ offices, laboratories, & hospitals to clinicians’ offices, laboratories, & hospitals to local & state health departments and CDC local & state health departments and CDC

Community PreparednessCommunity PreparednessA Coordination of EffortsA Coordination of Efforts

Community PreparednessCommunity PreparednessA Coordination of EffortsA Coordination of Efforts

Partnerships between public health and:Partnerships between public health and: Clinicians and health care facilities Clinicians and health care facilities Public safety: law enforcement, fire, HAZMAT Public safety: law enforcement, fire, HAZMAT Emergency management Emergency management

Coordinate response across agencies at the Coordinate response across agencies at the local, state, and federal levels local, state, and federal levels

Partnerships between public health and:Partnerships between public health and: Clinicians and health care facilities Clinicians and health care facilities Public safety: law enforcement, fire, HAZMAT Public safety: law enforcement, fire, HAZMAT Emergency management Emergency management

Coordinate response across agencies at the Coordinate response across agencies at the local, state, and federal levels local, state, and federal levels

Community PreparednessCommunity PreparednessKnow Whom to ContactKnow Whom to Contact

Community PreparednessCommunity PreparednessKnow Whom to ContactKnow Whom to Contact

Know how to activate the biological disaster Know how to activate the biological disaster response plan in your practice setting response plan in your practice setting Who’s in charge?Who’s in charge? Communication Communication

Know the 24/7 contact number for your local Know the 24/7 contact number for your local health department health department

Know how to activate the biological disaster Know how to activate the biological disaster response plan in your practice setting response plan in your practice setting Who’s in charge?Who’s in charge? Communication Communication

Know the 24/7 contact number for your local Know the 24/7 contact number for your local health department health department

Community PreparednessCommunity Preparedness Role of Public Health Role of Public Health


Coordinate preparedness & response activities Coordinate preparedness & response activities Requires collaboration with medical Requires collaboration with medical

professionals, first responders, and other professionals, first responders, and other partners partners

Provide information to health professionals, Provide information to health professionals, government leaders, and the publicgovernment leaders, and the public

Coordinate preparedness & response activities Coordinate preparedness & response activities Requires collaboration with medical Requires collaboration with medical

professionals, first responders, and other professionals, first responders, and other partners partners

Provide information to health professionals, Provide information to health professionals, government leaders, and the publicgovernment leaders, and the public



Detection and evaluation of biological disasterDetection and evaluation of biological disaster Requires robust surveillance, epidemiology, and Requires robust surveillance, epidemiology, and

disease investigation infrastructure disease investigation infrastructure plusplus new new detection methodsdetection methods

Facilitate medical management of exposed Facilitate medical management of exposed personspersons Provide information on diagnosis, treatment, Provide information on diagnosis, treatment,

prophylaxis, and infection control issuesprophylaxis, and infection control issues

Detection and evaluation of biological disasterDetection and evaluation of biological disaster Requires robust surveillance, epidemiology, and Requires robust surveillance, epidemiology, and

disease investigation infrastructure disease investigation infrastructure plusplus new new detection methodsdetection methods

Facilitate medical management of exposed Facilitate medical management of exposed personspersons Provide information on diagnosis, treatment, Provide information on diagnosis, treatment,

prophylaxis, and infection control issuesprophylaxis, and infection control issues



Coordinate and engage state and federal Coordinate and engage state and federal resourcesresources

Education, training, and informationEducation, training, and information

Surveillance, disease case and outbreak Surveillance, disease case and outbreak investigationinvestigation

Coordinate and engage state and federal Coordinate and engage state and federal resourcesresources

Education, training, and informationEducation, training, and information

Surveillance, disease case and outbreak Surveillance, disease case and outbreak investigationinvestigation



Inventory and address deficiencies in regional Inventory and address deficiencies in regional resourcesresources

Hospital response capacity/preparednessHospital response capacity/preparedness

EMS/first responder capacity/preparednessEMS/first responder capacity/preparedness

Mass treatment and prophylaxisMass treatment and prophylaxis

Mortuary capacity/preparednessMortuary capacity/preparedness

Law enforcement/securityLaw enforcement/security

Inventory and address deficiencies in regional Inventory and address deficiencies in regional resourcesresources

Hospital response capacity/preparednessHospital response capacity/preparedness

EMS/first responder capacity/preparednessEMS/first responder capacity/preparedness

Mass treatment and prophylaxisMass treatment and prophylaxis

Mortuary capacity/preparednessMortuary capacity/preparedness

Law enforcement/securityLaw enforcement/security

Bioterrorism Preparedness & Response Bioterrorism Preparedness & Response Role of the Clinician as “First Responder”Role of the Clinician as “First Responder”


Prompt recognition, evaluation, and management Prompt recognition, evaluation, and management of suspicious cases of suspicious cases Recognize clinical presentations consistent Recognize clinical presentations consistent

with potential BT agents with potential BT agents Be familiar with the “epidemiological clues” Be familiar with the “epidemiological clues”

Requires thorough, targeted history Requires thorough, targeted history Occupation, travel, contacts, recent Occupation, travel, contacts, recent

“exposures,” threats“exposures,” threats Differentiating the “worried well” from the illDifferentiating the “worried well” from the ill

Prompt recognition, evaluation, and management Prompt recognition, evaluation, and management of suspicious cases of suspicious cases Recognize clinical presentations consistent Recognize clinical presentations consistent

with potential BT agents with potential BT agents Be familiar with the “epidemiological clues” Be familiar with the “epidemiological clues”

Requires thorough, targeted history Requires thorough, targeted history Occupation, travel, contacts, recent Occupation, travel, contacts, recent

“exposures,” threats“exposures,” threats Differentiating the “worried well” from the illDifferentiating the “worried well” from the ill



Prompt recognition, evaluation, and management Prompt recognition, evaluation, and management of suspicious cases, continuedof suspicious cases, continued Know how to access current resources and Know how to access current resources and

information on infection control, treatment, and information on infection control, treatment, and post-exposure prophylaxispost-exposure prophylaxis

Local and state public health, CDCLocal and state public health, CDC Infectious disease consultants, hospital Infectious disease consultants, hospital

epidemiologist, or infection control epidemiologist, or infection control professionalsprofessionals

Be familiar with procedures for obtaining & Be familiar with procedures for obtaining & submitting clinical specimens for testing by submitting clinical specimens for testing by clinical & health dept labsclinical & health dept labs

Prompt recognition, evaluation, and management Prompt recognition, evaluation, and management of suspicious cases, continuedof suspicious cases, continued Know how to access current resources and Know how to access current resources and

information on infection control, treatment, and information on infection control, treatment, and post-exposure prophylaxispost-exposure prophylaxis

Local and state public health, CDCLocal and state public health, CDC Infectious disease consultants, hospital Infectious disease consultants, hospital

epidemiologist, or infection control epidemiologist, or infection control professionalsprofessionals

Be familiar with procedures for obtaining & Be familiar with procedures for obtaining & submitting clinical specimens for testing by submitting clinical specimens for testing by clinical & health dept labsclinical & health dept labs




Report confirmed or suspicious cases to public Report confirmed or suspicious cases to public health health Be familiar with 24/7 reporting procedures for Be familiar with 24/7 reporting procedures for

suspected cases or potential outbreaksuspected cases or potential outbreak Know how to engage local emergency Know how to engage local emergency

respondersresponders Be familiar with the disaster response plan for Be familiar with the disaster response plan for

your hospital or practice settingyour hospital or practice setting Know the immunization status and eligibility of Know the immunization status and eligibility of

your staff for vaccine preventable diseasesyour staff for vaccine preventable diseases

Report confirmed or suspicious cases to public Report confirmed or suspicious cases to public health health Be familiar with 24/7 reporting procedures for Be familiar with 24/7 reporting procedures for

suspected cases or potential outbreaksuspected cases or potential outbreak Know how to engage local emergency Know how to engage local emergency

respondersresponders Be familiar with the disaster response plan for Be familiar with the disaster response plan for

your hospital or practice settingyour hospital or practice setting Know the immunization status and eligibility of Know the immunization status and eligibility of

your staff for vaccine preventable diseasesyour staff for vaccine preventable diseases


Bioterrorism Preparedness & Response Bioterrorism Preparedness & Response Role of the Clinician - Preparedness PlanningRole of the Clinician - Preparedness Planning


Long-term consequence management and Long-term consequence management and remediationremediation Identify and manage late-onset cases Identify and manage late-onset cases Monitor for and manage adverse effects of Monitor for and manage adverse effects of

treatment or prophylaxistreatment or prophylaxis Identify and manage psychological sequelae Identify and manage psychological sequelae

Be familiar with local procedures for evaluation Be familiar with local procedures for evaluation of suspicious substances (“white powder”): role of suspicious substances (“white powder”): role of law enforcement & public healthof law enforcement & public health

Long-term consequence management and Long-term consequence management and remediationremediation Identify and manage late-onset cases Identify and manage late-onset cases Monitor for and manage adverse effects of Monitor for and manage adverse effects of

treatment or prophylaxistreatment or prophylaxis Identify and manage psychological sequelae Identify and manage psychological sequelae

Be familiar with local procedures for evaluation Be familiar with local procedures for evaluation of suspicious substances (“white powder”): role of suspicious substances (“white powder”): role of law enforcement & public healthof law enforcement & public health




Participate in preparedness planningParticipate in preparedness planning

Identify resources needed for biological mass Identify resources needed for biological mass casualty event casualty event

Medical, nursing, other professional, and Medical, nursing, other professional, and support staffsupport staff

Antibiotics and other pharmaceuticalsAntibiotics and other pharmaceuticals

Supplies for mass treatment/vaccinationSupplies for mass treatment/vaccination

Ventilators and related respiratory support Ventilators and related respiratory support equipmentequipment

Participate in preparedness planningParticipate in preparedness planning

Identify resources needed for biological mass Identify resources needed for biological mass casualty event casualty event

Medical, nursing, other professional, and Medical, nursing, other professional, and support staffsupport staff

Antibiotics and other pharmaceuticalsAntibiotics and other pharmaceuticals

Supplies for mass treatment/vaccinationSupplies for mass treatment/vaccination

Ventilators and related respiratory support Ventilators and related respiratory support equipmentequipment




Identify resources needed for biological mass Identify resources needed for biological mass casualty event, continuedcasualty event, continued

Hospital ICU and isolation bedsHospital ICU and isolation beds

Mental health resourcesMental health resources

Post-mortem management Post-mortem management

Triage, security and crowd control Triage, security and crowd control

Communication – internal, external, public Communication – internal, external, public relations/media relations/media

Identify resources needed for biological mass Identify resources needed for biological mass casualty event, continuedcasualty event, continued

Hospital ICU and isolation bedsHospital ICU and isolation beds

Mental health resourcesMental health resources

Post-mortem management Post-mortem management

Triage, security and crowd control Triage, security and crowd control

Communication – internal, external, public Communication – internal, external, public relations/media relations/media


Bioterrorism Preparedness and Response Bioterrorism Preparedness and Response Role of the ClinicianRole of the Clinician

Bioterrorism Preparedness and Response Bioterrorism Preparedness and Response Role of the ClinicianRole of the Clinician

To report a potential BT incident or threat in King To report a potential BT incident or threat in King CountyCounty Notify Public Health – Seattle & King County: Notify Public Health – Seattle & King County:

206-296-4774 (24hr number)206-296-4774 (24hr number) If no one available, call the Washington State If no one available, call the Washington State

Department of Health: 1-877-539-4344Department of Health: 1-877-539-4344 Notify your hospital epidemiologist or infection Notify your hospital epidemiologist or infection

control practitioner control practitioner Notify other partners as identified on your Notify other partners as identified on your

facility’s biological disaster response planfacility’s biological disaster response plan Consider activating your site disaster Consider activating your site disaster

response plan response plan

To report a potential BT incident or threat in King To report a potential BT incident or threat in King CountyCounty Notify Public Health – Seattle & King County: Notify Public Health – Seattle & King County:

206-296-4774 (24hr number)206-296-4774 (24hr number) If no one available, call the Washington State If no one available, call the Washington State

Department of Health: 1-877-539-4344Department of Health: 1-877-539-4344 Notify your hospital epidemiologist or infection Notify your hospital epidemiologist or infection

control practitioner control practitioner Notify other partners as identified on your Notify other partners as identified on your

facility’s biological disaster response planfacility’s biological disaster response plan Consider activating your site disaster Consider activating your site disaster

response plan response plan


Hoaxes and Evaluation of Hoaxes and Evaluation of Suspicious PowdersSuspicious Powders

Hoaxes and Evaluation of Hoaxes and Evaluation of Suspicious PowdersSuspicious Powders

If a suspicious package or substance is If a suspicious package or substance is receivedreceived Cover package/substance (do not try to clean Cover package/substance (do not try to clean

up any spilled contents)up any spilled contents) Leave the room and close the doorLeave the room and close the door Turn off air conditioning system Turn off air conditioning system Wash hands with soap & water Wash hands with soap & water Report to local law enforcement (call 911)Report to local law enforcement (call 911) Notify building security Notify building security

If a suspicious package or substance is If a suspicious package or substance is receivedreceived Cover package/substance (do not try to clean Cover package/substance (do not try to clean

up any spilled contents)up any spilled contents) Leave the room and close the doorLeave the room and close the door Turn off air conditioning system Turn off air conditioning system Wash hands with soap & water Wash hands with soap & water Report to local law enforcement (call 911)Report to local law enforcement (call 911) Notify building security Notify building security


Hoaxes and Evaluation of Hoaxes and Evaluation of Suspicious Powders, cont.Suspicious Powders, cont.Hoaxes and Evaluation of Hoaxes and Evaluation of Suspicious Powders, cont.Suspicious Powders, cont.

Additional steps to take, if exposed to a Additional steps to take, if exposed to a suspicious powder or substancesuspicious powder or substance Remove contaminated clothing & place in Remove contaminated clothing & place in

plastic bag or other sealed containerplastic bag or other sealed container Shower with soap & water (bleach is not Shower with soap & water (bleach is not

necessary) necessary) Contact local health jurisdictionContact local health jurisdiction

Symptom monitoring and/or prophylaxis Symptom monitoring and/or prophylaxis may be needed for others in the room/areamay be needed for others in the room/area

Additional steps to take, if exposed to a Additional steps to take, if exposed to a suspicious powder or substancesuspicious powder or substance Remove contaminated clothing & place in Remove contaminated clothing & place in

plastic bag or other sealed containerplastic bag or other sealed container Shower with soap & water (bleach is not Shower with soap & water (bleach is not

necessary) necessary) Contact local health jurisdictionContact local health jurisdiction

Symptom monitoring and/or prophylaxis Symptom monitoring and/or prophylaxis may be needed for others in the room/areamay be needed for others in the room/area


Bioterrorism Preparedness and Response Bioterrorism Preparedness and Response Summary of Key PointsSummary of Key Points


BT preparedness and response requires BT preparedness and response requires coordination between clinicians, public health, coordination between clinicians, public health, emergency first responders, and law emergency first responders, and law enforcement.enforcement.

BT preparedness and response requires BT preparedness and response requires coordination between clinicians, public health, coordination between clinicians, public health, emergency first responders, and law emergency first responders, and law enforcement.enforcement.




BT preparedness for clinicians involvesBT preparedness for clinicians involves Ability to recognize unusual clinical Ability to recognize unusual clinical

presentations and clusters of casespresentations and clusters of cases Knowledge of diagnosis and management of Knowledge of diagnosis and management of

diseases of BT origindiseases of BT origin Awareness of their health care facility or Awareness of their health care facility or

practice’s disaster response planpractice’s disaster response plan Knowledge of disease reporting Knowledge of disease reporting

requirements, and how and when to contact requirements, and how and when to contact local public health authoritieslocal public health authorities

BT preparedness for clinicians involvesBT preparedness for clinicians involves Ability to recognize unusual clinical Ability to recognize unusual clinical

presentations and clusters of casespresentations and clusters of cases Knowledge of diagnosis and management of Knowledge of diagnosis and management of

diseases of BT origindiseases of BT origin Awareness of their health care facility or Awareness of their health care facility or

practice’s disaster response planpractice’s disaster response plan Knowledge of disease reporting Knowledge of disease reporting

requirements, and how and when to contact requirements, and how and when to contact local public health authoritieslocal public health authorities


ResourcesResourcesNationalNational

ResourcesResourcesNationalNational

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

Emergency Preparedness & Response Emergency Preparedness & Response branch 24-hour notification telephone branch 24-hour notification telephone number: (770) 488-7100number: (770) 488-7100 CDC Public Inquiry HotlinesCDC Public Inquiry Hotlines

English (888) 246-2675English (888) 246-2675Español (888) 246-2857Español (888) 246-2857

National Domestic Preparedness Office: National Domestic Preparedness Office: (202) 324-9026 M-F 8am-5pm EST(202) 324-9026 M-F 8am-5pm EST

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

Emergency Preparedness & Response Emergency Preparedness & Response branch 24-hour notification telephone branch 24-hour notification telephone number: (770) 488-7100number: (770) 488-7100 CDC Public Inquiry HotlinesCDC Public Inquiry Hotlines

English (888) 246-2675English (888) 246-2675Español (888) 246-2857Español (888) 246-2857

National Domestic Preparedness Office: National Domestic Preparedness Office: (202) 324-9026 M-F 8am-5pm EST(202) 324-9026 M-F 8am-5pm EST

Bioterrorism Web site: http://www.bt.cdc.govBioterrorism Web site: http://www.bt.cdc.govStrategic Plan for Preparedness & Response MMWR 49(RR-4)

These links will take you away from the educational site


Resources Resources Washington StateWashington State Resources Resources Washington StateWashington State

Washington State Department of HealthWashington State Department of Health

Communicable Disease EpidemiologyCommunicable Disease Epidemiology (206) 361-2914 (206) 361-2914 1-877-539-43441-877-539-4344 - - 24-hour emergency 24-hour emergency

numbernumber Julie Wicklund, BT Surveillance Julie Wicklund, BT Surveillance

Epidemiologist (206) 361-2881Epidemiologist (206) 361-2881 Washington State Emergency Management

Division

Washington State Department of HealthWashington State Department of Health

Communicable Disease EpidemiologyCommunicable Disease Epidemiology (206) 361-2914 (206) 361-2914 1-877-539-43441-877-539-4344 - - 24-hour emergency 24-hour emergency

numbernumber Julie Wicklund, BT Surveillance Julie Wicklund, BT Surveillance

Epidemiologist (206) 361-2881Epidemiologist (206) 361-2881 Washington State Emergency Management

Division http://www.wa.gov/wsem/

http://www.doh.wa.gov



ResourcesResourcesLocal Local

ResourcesResourcesLocal Local

Public Health – Seattle & King CountyPublic Health – Seattle & King County

To report illness or discuss suspicious To report illness or discuss suspicious substances (206) 296-4774 (24 hr)substances (206) 296-4774 (24 hr)

Public Health – Seattle & King CountyPublic Health – Seattle & King County

To report illness or discuss suspicious To report illness or discuss suspicious substances (206) 296-4774 (24 hr)substances (206) 296-4774 (24 hr)

http://www.metrokc.gov/health/bioterrorism



Resources Resources Emergency ManagementEmergency Management

Resources Resources Emergency ManagementEmergency Management

State Emergency Management duty officer State Emergency Management duty officer (800)258-5990 (800)258-5990

Regional Emergency Coordinator,Region X Regional Emergency Coordinator,Region X (206) 615-2266(206) 615-2266

FBIFBI Western WA and after hrs, Statewide: Western WA and after hrs, Statewide:

(206) 622-0460 (206) 622-0460 Eastern WA: (509) 747-5195Eastern WA: (509) 747-5195

Federal Emergency Management Agency Federal Emergency Management Agency (FEMA)(FEMA) - includes links to - includes links to emergency management courses emergency management courses

State Emergency Management duty officer State Emergency Management duty officer (800)258-5990 (800)258-5990

Regional Emergency Coordinator,Region X Regional Emergency Coordinator,Region X (206) 615-2266(206) 615-2266

FBIFBI Western WA and after hrs, Statewide: Western WA and after hrs, Statewide:

(206) 622-0460 (206) 622-0460 Eastern WA: (509) 747-5195Eastern WA: (509) 747-5195

Federal Emergency Management Agency Federal Emergency Management Agency (FEMA)(FEMA) - includes links to - includes links to emergency management courses emergency management courses

http://www.fema.govhttp://www.fema.gov



Resources Resources Health Care Facility PreparednessHealth Care Facility Preparedness

Resources Resources Health Care Facility PreparednessHealth Care Facility Preparedness

American Hospital Association Disaster American Hospital Association Disaster Readiness siteReadiness site

Association of Professionals in Infection Control Association of Professionals in Infection Control and Epidemiology (APIC) and Epidemiology (APIC)

APIC & CDC BT readiness plan template for APIC & CDC BT readiness plan template for health care facilitieshealth care facilities

American Hospital Association Disaster American Hospital Association Disaster Readiness siteReadiness site

Association of Professionals in Infection Control Association of Professionals in Infection Control and Epidemiology (APIC) and Epidemiology (APIC)

APIC & CDC BT readiness plan template for APIC & CDC BT readiness plan template for health care facilitieshealth care facilities

http://www.aha.org/Emergency/EmIndex.asphttp://www.aha.org/Emergency/EmIndex.asp

http://www.cdc.gov/ncidod/hip/Bio/13apr99APIC-CDCBioterrorism.PDFhttp://www.cdc.gov/ncidod/hip/Bio/13apr99APIC-CDCBioterrorism.PDF

http://www.apic.org



In Case of An Event…In Case of An Event…Web Sites with Up-to-Date Information and Web Sites with Up-to-Date Information and

InstructionsInstructions



Centers for Disease Control and Prevention Centers for Disease Control and Prevention

Saint Louis University, CSB & EISaint Louis University, CSB & EI

WA State Local Health Departments/DistrictsWA State Local Health Departments/Districts

Level A Lab Protocols: Presumptive Agent IDLevel A Lab Protocols: Presumptive Agent ID

Centers for Disease Control and Prevention Centers for Disease Control and Prevention

Saint Louis University, CSB & EISaint Louis University, CSB & EI

WA State Local Health Departments/DistrictsWA State Local Health Departments/Districts

Level A Lab Protocols: Presumptive Agent IDLevel A Lab Protocols: Presumptive Agent ID

http://www.bt.cdc.gov/EmContact/index.asphttp://www.bt.cdc.gov/EmContact/index.asp

http://bioterrorism.slu.edu/hotline.htmhttp://bioterrorism.slu.edu/hotline.htm

http://www.bt.cdc.gov/LabIssues/index.asphttp://www.bt.cdc.gov/LabIssues/index.asp

http://www.doh.wa.gov/LHJMap/LHJMap.htmhttp://www.doh.wa.gov/LHJMap/LHJMap.htm







FBI Terrorism Web PageFBI Terrorism Web Page

WA State Emergency Mgt Division – Hazard Analysis WA State Emergency Mgt Division – Hazard Analysis UpdateUpdate

Mail Security Mail Security

Links to your state health departmentLinks to your state health department

NIOSH – Worker Safety and Use of PPE NIOSH – Worker Safety and Use of PPE

FBI Terrorism Web PageFBI Terrorism Web Page

WA State Emergency Mgt Division – Hazard Analysis WA State Emergency Mgt Division – Hazard Analysis UpdateUpdate

Mail Security Mail Security

Links to your state health departmentLinks to your state health department

NIOSH – Worker Safety and Use of PPE NIOSH – Worker Safety and Use of PPE

http://www.fbi.gov/terrorism/terrorism.htmhttp://www.fbi.gov/terrorism/terrorism.htm

http://www.usps.com/news/2001/press/serviceupdates.htmhttp://www.usps.com/news/2001/press/serviceupdates.htm

http://www.cdc.gov/niosh/emres01.htmlhttp://www.cdc.gov/niosh/emres01.html

http://www.wa.gov/wsemhttp://www.wa.gov/wsem

http://www.astho.org/state.htmlhttp://www.astho.org/state.html


Preparing for and Responding to Bioterrorism: Information for Primary Care Clinicians

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Transcript of Preparing for and Responding to Bioterrorism: Information for Primary Care Clinicians