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HSE420Module6Chapter11Slides.pptxBiosecurity & Bioterrorism: Containing and Preventing Biological Threats
Chapter 11
Response at the State and Local Level
Learning Objectives
Discuss the roles and responsibilities of various key agencies in response to a biological event.
Discuss the need for command and coordination systems in the event of a biological attack.
Describe the importance of the National Incident Management System and the Incident Command System.
Discuss the roles of key federal agencies and officials when it comes to response to a biological event at the local level.
Discuss life safety issues for responders attending to the scene of a biological event.
Discuss considerations and describe methods for biosampling.
Describe outbreak containment measures employed by public health.
Key Terminology
Area Command
Contact tracing
Incident Command System
National Incident Management System
Surveillance
Unified Command
Response to Disease Outbreak
Local and state activities affect our ability to respond effectively to natural or intentional disease outbreaks
Responsibility for disease prevention and outbreak investigation falls on public health agencies
Responsibility for medical management of illness caused by disease rests with the medical systems of our communities
Investigational and prosecutorial aspects of intentional acts with disease threat falls into the hands of federal law enforcement officials
Responsibility for all hazards preparedness and resource allocations falls onto the shoulders of emergency managers
Recognition: Surveillance
State and local pubic health systems depend mostly on the surveillance capabilities of hospitals and local primary care providers.
Whether a disease outbreak occurs naturally or due to the intentional release of a harmful biological agent, much of the initial response will occur at the local level, particularly at hospitals and their emergency departments.
Hospital personnel will be some of the first healthcare workers with the opportunity to identify an infectious disease outbreak or a bioterrorist event.
The same circumstances that place these medical professionals in an optimal position to recognize the onset of an outbreak also places them at greatest risk from the disease event itself.
Systems Integration
Public health departments need to have disease surveillance systems and epidemiologists to detect clusters of suspicious symptoms or diseases in order to facilitate early detection of disease and treatment of victims.
Laboratories need to have adequate capacity and necessary staff to test clinical and environmental samples in order to identify an agent promptly so that proper treatment can be started and reduce spreading of infectious diseases.
All organizations involved in the response must be able to communicate easily with one another as events unfold and critical information is acquired, especially in a large-scale infectious disease outbreak.
Surveillance
Surveillance can be defined as ongoing systematic collection, collation, analysis and interpretation of data and the dissemination of information to those who need to know for action to be taken.
Effective communicable disease control relies on an effective surveillance and response system that promotes better coordination and integration of surveillance functions (WHO, 2007).
Surveillance is a continuous and systematic process consisting of three primary activities:
collection of relevant data for a specified population, time period, and/or geographic area;
accurate analysis of data; and
rapid dissemination of interpreted data.
Types of Surveillance
Passive disease surveillance refers to the receipt of reports of infections/disease from physicians, laboratories, and other health professionals required to submit to submit reports required by public health statute
Active disease surveillance is guided by public health statute in each state and refers to the routine gathering of data in an effect to identify cases. This type of surveillance can be seasonal or initiated by a mass casualty event that has resulted in an increased numbers of individuals or potential cohorts presenting with similar symptoms or illnesses
Syndromic Surveillance has been used for early detection of outbreaks, to follow the size, spread, and tempo of outbreaks, to monitor disease trends, and to provide reassurance that an outbreak has not occurred. Syndromic surveillance systems seek to use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks
Command & Coordination
National Incident Management System (NIMS)
National Response Plan (NRP)
National Response Framework (NRF)
Incident Command System (ICS)
Hospital Incident Command System (HICS)
Public Health Incident Command System (PHICS)
The Incident Command System
Command
Operations
Planning
Logistics
Finance/
Admin
Intelligence
Critical Thinking
The 2001 Amerithrax incident did not create a large pool of casualties (five deaths out of 22 total cases), which supports the argument that an intentional biological release is a low-consequence event from a medical perspective, therefore not requiring significant mitigation activities. On the other hand, significant resources are now deployed to prevent and provide early detection of another similar attack. Is the main objective to minimize the medical consequences in another attack or is it an attempt to restore confidence in the government’s ability to protect the American public?
Unified Command
MCI will require Unified Command
An important element in multi-jurisdictional or multi-agency domestic incident management
Provides guidelines to enable agencies with different legal, geographic, and functional responsibilities to coordinate, plan, and interact effectively
Overcomes much of the inefficiency and duplication of effort that can occur when agencies from different functional and geographic jurisdictions, or agencies at different levels of government, operate without a common system or organizational framework.
HHS leads ESF 8 in a UC structure
Area Command
Activated only if necessary
Depends on the complexity of the incident and span-of- control considerations
Established either to oversee the management of multiple incidents that are being handled by separate ICS organizations or to oversee the management of a very large incident that involves multiple ICS organizations
Does not have operational responsibilities
Area Command (continued)
Sets overall agency incident-related priorities
Allocates critical resources according to established priorities
Ensures that incidents are managed properly
Ensures effective communications
Ensures that incident management objectives are met and do not conflict with each other or with agency policies
Identifies critical resource needs and reports them to the Emergency Operations Centers
Ensures that short-term emergency recovery is coordinated to assist in the transition to full recovery operations
Provides for personnel accountability and a safe operating environment
Role of Federal Agencies at a WMD Incident
The Secretary of DHS is the Principal Federal Official (PFO) for domestic incident management.
The Secretary of DHS is responsible for coordinating federal operations within the United States to prepare for, respond to, and recover from terrorist attacks, major disasters, and other emergencies.
The Attorney General has lead responsibility for criminal investigations of terrorist acts or terrorist threats by individuals or groups inside the U.S., or directed at U.S. institutions abroad, where such acts are within the federal criminal jurisdiction of the U.S. (DHS, Homeland Security Presidential Directive-5).
The Federal Bureau of Investigation (FBI), under the authority of the Attorney General, handles all crime scenes where a terrorist act involving a WMD has occurred.
Department of Justice Assets
Critical Incident Response Group (CIRG)
Evidence Response Team (ERT)
FBI Field Offices
FBI WMD Coordinator – one assigned to each state
Joint Terrorism Task Force (JTTF)
FBI has five Rapid Deployment Teams
FBI Hazardous Materials Response Unit (HMRU)
Department of Health and Human Services (HHS)
Centers for Disease Control and Prevention (CDC) - develops strategies for public health aspects of an emergency; two key roles are disease surveillance and disease investigation.
Office of Preparedness and Response maintains responsibility for the National Disaster Medical System (NDMS).
Disaster Medical Assistance Teams (DMAT)
a resource to support local, regional, and state requirements; however, they can be federalized to provide interstate aid
can be rapidly deployed to disaster sites to help identify, track, and process fatalities at a CBRNE event
Disaster Mortuary Response Teams (DMORT)
Critical Thinking.
The National Response Framework (NRF) incorporates best practices and procedures from incident management disciplines—homeland security, emergency management, law enforcement, firefighting, public works, public health, responder and recovery worker health and safety, emergency medical services, and the private sector—and integrates them into a unified structure. It forms the basis of how the federal government coordinates with state, local, and tribal governments and the private sector during incidents. Following a biological incident (act of bioterrorism, biocrime, or major outbreak), assistance will come from various federal agencies under the NRF, depending on the scope of the incident. How big a footprint will federal agencies have in a community? What impact do they have on an operation even after the event has been through all incident phases?
Response: Safety
Responder personal protection is defined in 29 CFR, Part 1910.120
When wearing PPE, responders should always use the buddy system
Any plan involving a biological hazard should be based on relevant safety recommendations by the CDC
Need for decontamination and for treatment of all first responders with antibiotics or other medications should be decided in consultation with local public health authorities
Appropriate Level of PPE
Responders should use a NIOSH-approved, pressure-demand SCBA in conjunction with a Level A protective suit in responding to a suspected biological incident where any of the following information is unknown or the event is uncontrolled:
the type of airborne agent
the dissemination method
if dissemination via an aerosol-generating device is still occurring or it has stopped but there is no information on the duration of dissemination, or what the exposure concentration might be.
Actions within the Hot Zone
Responders may use a Level B protective suit with an exposed or enclosed NIOSH- approved pressure-demand SCBA if the situation can be defined in which:
the suspected biological aerosol is no longer being generated
other conditions may present a splash hazard
Image courtesy of US DOD
Level C Posture
Responders may use a full face-piece respirator with a P100 filter or powered air-purifying respirator (PAPR) with high efficiency particulate air (HEPA) filters when it can be determined that:
an aerosol-generating device was not used to create high airborne concentration
dissemination was by a letter or package that can be easily bagged
Image courtesy of US DOD
Decontamination
Decontamination of protective equipment and clothing is an important precaution to make sure that any particles that might have settled on the outside of protective equipment are removed before taking off gear
Decontamination sequences currently used for hazardous material emergencies should be used as appropriate for the level of protection employed
Equipment can be decontaminated using soap and water, and 0.5% hypochlorite solution (one part household bleach to 9 parts water)
Image courtesy of US DOD, Armed Forces Press Service
Decontamination Process
Wet down the person; this allows the biological material (contamination) to adhere to clothing and skin, thus reducing the airborne hazard and the potential for ingestion and/or inhalation.
Strip contaminated clothing.
Flush the victim with a large amount of water, using soap if available, to remove any remaining contamination from skin and hair. Do not use bleach solutions to decontaminate skin surfaces.
Cover for protection and modesty.
Sampling & Detection
Biological agents pose new challenges to both law enforcement and public health officials
In the past, law enforcement and public health officials conducted separate and independent investigations.
A biological attack requires a high level of cooperation between these two disciplines to achieve their respective objectives:
identifying the biological agent
preventing the spread of the disease
preventing public panic
apprehending those responsible.
Image courtesy of US DOD
Evidence Collection & Preservation
With biocrimes, responders may be called upon to collect and preserve microbial forensic evidence
If evidence is not collected, degrades, or is contaminated during collection, handling, transport, or storage, the downstream characterization and attribution analyses may be compromised
Image courtesy of US DOD
ASTM Two-Step Procedure
E 2458 is a two-step procedure that is performed after an initial risk assessment is conducted and a visible powder is deemed a credible biological threat
Method A - covers the bulk collection and packaging of the suspicious visible powders from solid nonporous (hard) surfaces. Bulk samples are collected and transported in a manner that permits public health and safety, and law enforcement agencies to obtain uncompromised samples for confirmatory analysis and forensic testing
Method B - covers swab sampling of residual suspicious powders for presumptive on-site biological screening
Response: Containment
Contact Tracing
Isolation
Quarantine
Voluntary Q
Group Q
Community Q - Cordon Sanitaire
Zoonotic Connection? Involve animal health officials
Medical Surge – tough for a medical system that is already at capacity!
Critical Thinking.
At first, quarantine sounds like a prudent measure for public health officials to use during an outbreak. However, large-scale quarantine comes with many requirements and responsibilities. If a public health official is going to confine people to a location, the city or state must provide for their needs. Also, if a public health official is going to mandate them to remain under control, that mandate must be enforced. Is deadly force an acceptable method of enforcing quarantine? Does a law enforcement officer have the authority to shoot someone who is fleeing from a quarantine barrier? Would images such as these undermine a community official’s authority or ability to quell fear? What about the kinder and gentler measure of social distancing programs? Can we count on the public to limit their contact with others?
Discussion Questions
Following a biological incident, how big a footprint will federal agencies have in your community?
What impact do they have on an operation even after the event has been through all incident phases?
Where does the National Response Framework (NRF) fit into all this?
What is the difference between Unified Command and Area Command?
Chapter Summary
Surveillance will be the key to triggering a response
Consequences of a biological incident are potentially complex and are likely to result in a convergence of state and federal government agencies upon the scene of the incident
Convergence – numerous federal agencies will converge upon the affected area
Command, Coordination and Communication will present huge challenges
Response plans must consider safety and containment
Sampling and evidence handling will be problematic
