RTI International is a trade name of Research Triangle Institute

RTI International is a trade name of Research Triangle Institute

Public Health Preparedness: Roles and Contributions of a Not-for-Profit

Research Institute during a Tumultuous Period

Scott F. Wetterhall, MD, MPHSenior Program Director

Health Security and Systems Research

Health Security and Systems Research: Current Portfolio

Research on case definitions for BioSense program

Evaluation of BioSense Program

Community assessment of non-pharmaceutical interventions to prevent influenza

Training needs assessment of federal partners who may support quarantine efforts

Health Security and Systems Research: Current Portfolio (cont.)

Evaluation of the Medical Reserve Corps

Rapid response team for public health research on disasters

Focus of today’s talk:

Patient Tracking & Locating Model

Cyanide K/A/P among EMS providers

Poll Question

In disaster response, patient tracking and locating systems are:

A. Very important

B. Important

C. Moderately important

D. Not at all important

Activation of NDMS after Hurricane Katrina, September 2005

Role for Patient Tracking and Locating System

Identify persons in need

Locating missing persons

Allocating medical resources

Conducting public health interventions

Managing emergency shelters

Evacuating patients

Background on PTLocator

Agency for Healthcare Research and Quality (AHRQ) provides support

Conceived in 12/2004

Work began 08/2005

Review of extant products EMSystem

Ratheon

Dept. of Defense projects

Schematic of PTLocator

Current Version of PTL

Assumptions

Focus on identification of patient and location

Broad definition of patient/victim

System can serve at “national level” while also providing working model for “local” jurisdictions

Capabilities

Fully functional prototype accessible through Web

Manual Data Interface

Home Page of PTLocator

Screenshot of Data Entry Screen

Issues Facing Use of PTLocator

Data exchange across systems using XML—need for standards

Deployment during emergencies

Duplicate entries

HIPPA

Other privacy protections, esp. with public searches

AHRQ Companion Projects

Patient Tracking and & Locating Model

HAvBED hospital bed tracking system

Facility evacuation tool for estimating time and resources needed to evacuate a hospital

Cyanide Knowledge, Attitudes, andPractices among EMS providers

Poll Question

What is the highest risk of cyanide poisoning?

A. Fire

B. Industrial release

C. Release in transport

D. Terrorism

Multiple, heterogeneous sources of human exposure

Fire smoke

Intentional poisoning: terrorism, genocide, murder, suicide

Industrial release

Occupational injuries

Transportation mishaps

Ingestion of cyanogenic foods, drugs

Mass casualties likely in either unintentional or intentional poisonings

Effective remediation possible through adequate preparedness, including ability to provide empiric prehospital treatment rapidly

Cyanide Poisoning as a Public Health Issue

Cyanide Poisoning: Remediable Public Health Threat

Unlike toxicity associated with many other poisons,

cyanide poisoning can be effectively treated

Requires antidote and supportive care

Requires prompt intervention (within minutes to

hours) because of rapid progression of poisoning

Study Objectives

To assess cyanide awareness, preparedness, and practices of emergency medical service (EMS) providers in the U.S.

To assess cyanide antidote stocking practices among EMS providers in the U.S.

Methods

Design: Cross-sectional survey Questionnaire administered via the Internet, mail, or telephone

Sample: Target population: all advanced life support (ALS) emergency

providers working with fire departments in the U.S. Sample frame: 22,524 fire departments identified through US Fire

Administration’s National Fire Department Census Sample of 1,033 fire departments randomly selected from

sampling frame 832 ALS providers surveyed 507 evaluable surveys completed

Perceived Sources of Greatest Risk of Cyanide Exposure

Source of Greatest Risk

Percent respondents

Northeast

(n=91)

Midwest

(n=154)

South

(n=183)

West

(n=79)

Fire 40 42 43 37

Industrial Release 15 13 13 8

Release in Transport 39 40 42 48

Terrorism 6 5 3 7

Fire Smoke Viewed as Source

82 82 82 8286

35 3431

4035

20

40

60

80

100

Sample(n=507)

Northeast(n=91)

Midwest(n=154)

South(n=183)

West(n=79)

% R

esp

on

den

ts

Potential Source of Cyanide Exposure

Cyanide Exposure from Fire Smoke Is Likely or Very Likely in Their Service Area

Percent who view fire smoke as potential or likely source of cyanide exposure

Industrial Release Viewed as Source

Sample(n=507)

Northeast(n=91)

Midwest(n=154)

South(n=183)

West(n=79)

59

73

58 57

47

15 159

23

6

20

40

60

80

100

% R

esp

on

den

ts

Potential Source of Cyanide Exposure

Cyanide Exposure from Industrial Release Is Likely or Very Likely in Their Service Area

Percent who view industrial release as potential or likely source of cyanide exposure

Transport Viewed as Source

Sample(n=507)

Northeast(n=91)

Midwest(n=154)

South(n=183)

West(n=79)

% R

esp

on

den

ts

75 77

70

7874

27 26 27

34

1220

40

60

80

100

Potential Source of Cyanide Exposure

Cyanide Exposure from Transport Is Likely or Very Likely in Their Service Area

Responses did not differ as a function of estimated actual risk.

Percent who view transport as potential or likely source of cyanide exposure

Antidote Reported as Standard Treatment

14 13 11

24

15 13 15

7

20

40

60

80

100

% R

esp

on

den

ts When Cyanide Poisoning Is SuspectedWhen Cyanide Poisoning Is Confirmed

Northeast(n=91)

Midwest(n=154)

South(n=183)

West(n=79)

Percent reporting standard treatment for cyanide poisoning is antidote

Criteria for Estimating Likelihood of Cyanide Exposure

Fire-smoke injury rates per 100,000

No. CERCLIS (Superfund) sites

No. Au, Ag, Cu mines

No. EPA Toxic Release Inventory (TRI) facility counts (for select CN chemicals)

Max. amt. TRI select CN chemicals, in lbs.

Creation of Community Exposure Likelihood Variable

Strata Definition of Srata Percent Fire Departments in Final Frame

High Any CRITERIA = 3 49

Medium 2 or more CRITERIA = 2 28

Low All others 23

Estimated Cyanide Risk, United States,2005, by County

Estimated Cyanide Risk, United States,2005, by County

Cyanide Interest Level

Low Medium High

Cyanide Antidote Stocked

21

2823

1820

40

60

80

100

% R

esp

on

den

ts

Sample (n=507)

High-Risk Area

(n=111)

Medium-Risk Area

(n=147)

Low-Risk Area

(n=249)

2823

1820

40

60

80

100

% R

esp

on

den

ts

Sample (n=507)

High-Risk Area

(n=111)

Medium-Risk Area

(n=147)

Low-Risk Area

(n=249)

Percent reporting a cyanide antidote stocked on standard ALS vehicle

Importance of Stocking Antidote

1720

40

60

80

100%

Res

po

nd

ents

Sample (n=507)

High-Risk Area

(n=111)

Medium-Risk Area

(n=147)

Low-Risk Area

(n=249)

29

14 1420

40

60

80

100%

Res

po

nd

ents

Sample (n=507)

High-Risk Area

(n=111)

Medium-Risk Area

(n=147)

Low-Risk Area

(n=249)

Percent reporting cyanide antidote is very important, compared with other equipment carried on ambulances

Cyanide Antidote Kits Available

25.7

32.7

9.6

31.9

5

10

15

20

25

30

35

Mea

n N

um

ber

Ava

ilab

le

Sample (n=507)

High-Risk Area

(n=111)

Medium-Risk Area

(n=147)

Low-Risk Area

(n=249)

Mean number of cyanide antidote kits for prehospital use per 100,000 persons

Cyanide Study Conclusions

Fewer than half of EMS providers recognize fire smoke as the most likely source of CN exposure.

Only 15 percent report that an antidote is the standard treatment when cyanide poisoning is suspected.

Only 21 percent of ALS vehicles have cyanide antidote kits stocked.

There are only 25 antidote kits available per 100,000 persons, an inadequate number for a mass casualty event.

Closing Remarks

Working in public health preparedness at a not-for-profit institute:

Competitive, fast-paced environment

Mixture of investigator-initiated and contract work

Client satisfaction is high priority

Diverse activities—from software development to program evaluation to policy analysis

Multiple opportunities to make a difference

And finally…

Relationships Are Still the Key Ingredient for Success

Thank you

Scott F. Wetterhall, MD, MPH

swetterhall@rti.org