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Using GroupSystems with Simulation to Validate Concepts for Municipal Response to

Terrorist Attacks with Biological Weapons

John Walther, Edgewood CB Center

Freeman Marvin, Decision Advantage

Susan Hayes, Litton-TASC

March 28, 2000

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Agenda

• First hour– BW Improved Response Program

– BW Response Template Validation

– Introduction to the Simulation Exercise

– NEHC Simulation Exercise

• Second hour– Use of GroupSystems in the NEHC Validation

– Introduction to the Simulation Exercise

– NEHC Simulation Exercise

– Questions and Answers

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Background

• PL 104-201 (National Defense Authorization Act for Fiscal Year 1997) initiated BW Improved Response Program

• Title XIV - Defense Against Weapons of Mass Destruction– “The Secretary of Defense shall develop and carry out a

program for testing and improving the responses of Federal, State and local agencies to emergencies involving biological weapons and related materials and emergencies involving chemical weapons and related materials.”

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Background

• BW IRP is a multi-year, multi-agency effort begun in April 1998

• BW IRP objectives:– complete an assessment of the BW response

problem– formulate an integrated approach to BW

emergency response – identify gaps and improvements in response

capabilities

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Template Development

• Series of five 3-day workshops during 1998– Day 1: tutorials / pre-selected topics– Day 2: presentation of a selected BW terrorist

attack scenario / develop response activities designed to mitigate the emerging consequences of the scenario

– Day 3: review and integrate the response template

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Attack Scenarios

• 5 potential BW scenarios were analyzed (covert release of BW agent)– Scenario #1: Francisella tularensis producing

1,100 casualties of which 380 were fatalities– Scenario #2: Staphylococcus Enterotoxin B in

combination with Fracisella tularensis producing 22,500 casualties, of which 10,000 were fatalities

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Attack Scenarios

– Scenario #3: Bacillus anthracis spores producing 126,000 casualties, of which 120,000 were fatalities

– Scenario #4: Venezuelan Equine Encephalitis (VEE) producing 1,300,000 casualties, of which 13,000 were fatalities

– Scenario #5: Rift Valley Fever on a cattle feed lot infecting 700,000 cattle and producing 48,000 human casualties, of which 250 were fatalities

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Typical Effects of Bio Agents

Biological agents can be disseminated as odorless, colorless aerosols that are highly lethal. Aerosolized agents are easily absorbed both through the respiratory system and mucous membranes (e.g., eyes). The onset of clinical symptoms may be rapid (within several minutes for toxins) or gradual (within a day to weeks) depending on the amount of exposure and constitution of the individual exposed. For example, typical symptoms for tularemia usually present within 3 to 6 days and include headache, fever, chest pain, stiff neck, and pneumonia. For higher concentration exposure or less resistant individuals, the symptoms may present earlier and be more acute. Individuals who eventually die typically suffer from cardiopulmonary failure. First-aid and treatment techniques include artificial respiration plus oxygen and administering fluids and antibiotics.

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Summary

• A BW terrorist event would primarily represent a public health catastrophic medical emergency.

• An organized, effective emergency response to a large BW attack involving a million or more people appears possible.

• The BW Response Template represents a flexible, integrated response system.

• Effective response to a major BW incident requires pre-planning before the event , and rapid implementation of the plan following an incident.

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BW Response Template Validation

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BW Response Template Components and Key Decisions

Results 1. Decide that unusual event has occurred

Continuous Surveillance

ActiveInvestigation

Medical SurveillanceExpanded

Medical Surveillance Continuous

Activate

Medical Diagnosis EpidemiologicalInvestigation

CriminalInvestigation

Results 2. Decide that major health event is occurring

3. Decide on potential cause and population at risk

4. Decide on medical prophylaxis and treatment measures

5. Decide on appropriate activation of modular emergency medical system and other appropriate response functions

Activate

Care of Casualtiesand Worried Well

Residual HazardAssessment andMitigation

Control Affected Area/Population - Physical Control - Public Information Control

FatalityManagement

Command and Control EOC

Resource Logistics and Support

Continuity ofInfrastructure

Family Support Services

Emergency Response

MedicalProphylaxis

Key Decisions

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AreaHospital

Acute Treatment/Triage

PrivateMD(s)

Treatment/Triage

Home

Modular Emergency Medical System

CasualtyRelocationUnit(s) - Non BW

Neighborhood

Emergency Help Center

Pharmaceuticals, Administration Patient Registration Patient Information

Transportation, Logistics

Clinic(s)Treatment/

Triage

Acute CareCenter(s)

Acute Treatment/Triage, Comfort

FatalityManagement

City Office of Emergency Management/Incident Command System

Communication and Coordination Link

Community Outreach(Door-to Door) andCitizen Mobilization

City Police& Fire

BW Patients & WW

lMCC

NEHC

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Key Validation Issues

• Rapid and large scale emergence of casualties

• Potential for high number of fatalities

• Effectiveness depends on ability to provide rapid response

• Standards of medical care

• Must minimize number of staff while ensuring adequate capacity

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Validation Approach

• Establish expected performance for the template component using models

• Conduct tests (live and simulated) and measure actual performance

• Compare expected and measured performances

• Recommend improvements to the template component

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Validation Models

Process Flowchart(Inspiratio

n)

Simulation

Models(Extend)

Multi-Criteria Decision Model

(Logical Decisions)

Decision Trees(DPL)

SME Interaction (GroupSystems)

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Desktop Exercise - Step-by-step critical review by subject matter expert panel

Simulation Exercise - Small group of responders simulating scenarios using networked computers

Live Exercise - Field exercise with actual responders and actors as casualties

Validation Protocols

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Introduction to the Simulation Exercise

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NEHC Simulation Exercise

• The goal of the exercise is to maximize MOE scores in a simulated BW attack

• Players represent the Medical Director and staff in each NEHC area

• Rules:1. Staff can be shifted between areas

2. Secondary triage policy can be changed

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Measures of Effectiveness

• Throughput

• Cycle time to ACC

• Cycle time to home

• Percent infected sent to ACC

• Percent non-infected sent home

• Reneging

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NEHC Players

• Medical Director (MD)

• Initial Triage

• Registration

• Secondary Triage

• Treatment and Stabilization

• Observation and Holding

• Discharge

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Rule 1: NEHC Staff Shifting• Initial Triage - EMT/Nurse

• Registration - Clerks and Volunteers

• Secondary Triage - EMT/Nurse and Volunteers

• Treatment and Stabilization - EMT/Nurse and Volunteers

• Observation and Holding - EMT/Nurse and Volunteers

• Discharge - Clerks and Volunteers

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Rule 2: Triage Policy Options

• Conservative– Send casualties showing any symptoms to the ACC

• Prudent– Send casualties showing multiple symptoms to the

ACC

• Efficient– Send only critical casualties to the ACC

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Scenario

• Day 0: Agent released

• Day 1 and 2: Local medical facilities overwhelmed

• Day 3: Public Health officials determine that an outbreak is in progress

• Day 4: NEHC opened

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Exercise Procedures

• Run simulation• Pause in 6-hour intervals• Review Status Board• Recommend staff changes to the MD• MD decides which changes to make to staff

and/or triage policy• Continue simulation