“Preparing Our Communities”

1® BDLS is a registered trademark of the American Medical Association® BDLS is a registered trademark of the American Medical AssociationV 2.9 04/07V 2.9 04/07

®®

““Preparing Our Communities”Preparing Our Communities”

Welcome!Welcome!

2V 2.9 04/07V 2.9 04/07

Faculty DisclosureFaculty Disclosure

• For Continuing Medical Education (CME) purposes as required by For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) and other continuing the American Medical Association (AMA) and other continuing education credit authorizing organizations:education credit authorizing organizations:– In order to assure the highest quality of CME programming, the AMA In order to assure the highest quality of CME programming, the AMA

requires that faculty disclose any information relating to a conflict of requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an interest or potential conflict of interest prior to the start of an educational activity. educational activity.

– The teaching faculty for the BDLS course offered today have no The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off label usage during disclose. Nor will there be any discussion of off label usage during this course. this course.

3® BDLS is a registered trademark of the American Medical Association® BDLS is a registered trademark of the American Medical AssociationV 2.9 04/07V 2.9 04/07

®®

Public Health Public Health Aspects of DisastersAspects of Disasters

Chapter 8Chapter 8

4V 2.9 04/07V 2.9 04/07

Faculty DisclosureFaculty Disclosure

• For Continuing Medical Education (CME) purposes as For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) required by the American Medical Association (AMA) and other continuing education credit authorizing and other continuing education credit authorizing organizations:organizations:– In order to assure the highest quality of CME programming, In order to assure the highest quality of CME programming,

the AMA requires that faculty disclose any information relating the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to to a conflict of interest or potential conflict of interest prior to the start of an educational activity. the start of an educational activity.

– The teaching faculty for the BDLS course offered today have The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off interest to disclose. Nor will there be any discussion of off label usage during this course. label usage during this course.

5V 2.9 04/07V 2.9 04/07

ObjectivesObjectives

• Define Public Health.Define Public Health.• Discuss the Goals of a Public Health System.Discuss the Goals of a Public Health System.• Describe the Public Health role in an emergency.Describe the Public Health role in an emergency.• Identify the disaster planning phases.Identify the disaster planning phases.• Discuss emergency public health measures.Discuss emergency public health measures.• Discuss Federal, State, and Local Powers and jurisdictional Discuss Federal, State, and Local Powers and jurisdictional

issues, and licensing requirements regarding disaster response.issues, and licensing requirements regarding disaster response.• Define the roles in an Incident Command System.Define the roles in an Incident Command System.• Identify the key elements of a communications strategy.Identify the key elements of a communications strategy.• Discuss the 1918 Influenza epidemic as a model for pandemic flu Discuss the 1918 Influenza epidemic as a model for pandemic flu

preparedness.preparedness.• Discuss the public health response to Bioterrorism.Discuss the public health response to Bioterrorism.

6V 2.9 04/07V 2.9 04/07

The Public Health SystemThe Public Health System

- an Overview- an Overview

7V 2.9 04/07V 2.9 04/07

What is public health?What is public health?

• Health services concerned with threats Health services concerned with threats to the overall health of a community to the overall health of a community based on population health analysis. based on population health analysis.

• Generally includes:Generally includes:– surveillance and control of infectious surveillance and control of infectious

diseasedisease– promotion of healthy behaviors among promotion of healthy behaviors among

members of the community. members of the community.

• An effort organized by society to An effort organized by society to protect,protect, promote, and restorepromote, and restore the people’s health the people’s health during a disaster.during a disaster.

8V 2.9 04/07V 2.9 04/07

The fundamental obligations of agencies The fundamental obligations of agencies

responsible for public health are to:responsible for public health are to:

• Prevent epidemics and the spread of disease; Prevent epidemics and the spread of disease; • Protect against environmental hazards; Protect against environmental hazards; • Prevent injuries; Prevent injuries; • Promote and encourage healthy behaviors and mental Promote and encourage healthy behaviors and mental

health; health; • Respond to disasters and assist communities in Respond to disasters and assist communities in

recovery; and recovery; and • Assure the quality and accessibility of health servicesAssure the quality and accessibility of health services

- - Especially for those who are effected by Especially for those who are effected by disasters disasters but are not casualties themselves. but are not casualties themselves.

9V 2.9 04/07V 2.9 04/07


Goals:Goals:

• Identify health risks in the community; Identify health risks in the community; • Maintain a safe and healthful environment; Maintain a safe and healthful environment; • Detect, investigate, and prevent the spread of Detect, investigate, and prevent the spread of

disease; disease; • Promote healthy lifestyles; Promote healthy lifestyles; • Perform and report epidemiology studiesPerform and report epidemiology studies

– The study of factors affecting the health and illness of The study of factors affecting the health and illness of populations that serves as the foundation and logic of populations that serves as the foundation and logic of interventions made in the interest of public health and interventions made in the interest of public health and preventive medicine.preventive medicine.

10V 2.9 04/07V 2.9 04/07


Essential Public Health Services:Essential Public Health Services:

• Monitor health status of the populationMonitor health status of the population• Investigate health problems and hazardsInvestigate health problems and hazards• Develop policies and plans for responding to Develop policies and plans for responding to

emergenciesemergencies• Health surveillance and epidemiological investigations.Health surveillance and epidemiological investigations.• Enforce public health and safety laws and regulationsEnforce public health and safety laws and regulations• Provide health services during a public health Provide health services during a public health

emergencyemergency• Assure a competent workforce to respond to public Assure a competent workforce to respond to public

health emergencieshealth emergencies• Evaluate health services for public health emergenciesEvaluate health services for public health emergencies

11V 2.9 04/07V 2.9 04/07


Core Functions:Core Functions:

• Prevent epidemics and spread of diseasePrevent epidemics and spread of disease• Protect against environmental hazardsProtect against environmental hazards• Prevent injuryPrevent injury• Promote healthy behaviors and mental healthPromote healthy behaviors and mental health• Respond to disasters and assist communities in Respond to disasters and assist communities in

recovery recovery • Assure quality and accessibility of health Assure quality and accessibility of health

servicesservices

12V 2.9 04/07V 2.9 04/07

Public Health Surveillance and Public Health Surveillance and Epidemiological InvestigationEpidemiological Investigation

Basic Requirements to implement a surveillance Basic Requirements to implement a surveillance system:system:

• Trained personnel** Trained personnel**

– The key to this is adequate personnel who are properly trained.The key to this is adequate personnel who are properly trained.• Reporting systemsReporting systems• Laboratory capacityLaboratory capacity

– There must be a standardized method for data collection.There must be a standardized method for data collection.• Communication linksCommunication links• Legal frameworkLegal framework• Health care facilitiesHealth care facilities

13V 2.9 04/07V 2.9 04/07

Outbreak ResponseOutbreak Response

• Specimen Tracking/Cycle Time ReductionSpecimen Tracking/Cycle Time Reduction• Expanded Surveillance/FieldExpanded Surveillance/Field• Response Assignments and Tracking Response Assignments and Tracking • Public Health and Clinical Capacity Public Health and Clinical Capacity • Alerting Cascades/Worker Force AvailabilityAlerting Cascades/Worker Force Availability• Stockpile Supplies (locations, types)Stockpile Supplies (locations, types)• Notifications (Public Health and other Officials)Notifications (Public Health and other Officials)

14V 2.9 04/07V 2.9 04/07

Public Health and Disaster PlanningPublic Health and Disaster Planning

Disaster Planning Phases:

• Predisaster or Warning Phase– To be useful, you must be ready– To be ready, you must be trained– To be trained, you must plan ahead

• Interdisaster Phase• Impact Phase• Emergency Relief Phase• Reconstruction or Rehabilitation Phase

15V 2.9 04/07V 2.9 04/07

Public Health and Disaster PlanningPublic Health and Disaster Planning

Plans unique to regional and local resources and needsPlans unique to regional and local resources and needs

Planning objectives:Planning objectives:

• Hazard vulnerability analysisHazard vulnerability analysis• Emergency response planEmergency response plan• Mitigation activities (prepare)Mitigation activities (prepare)• Implement response planImplement response plan• Mobilize resources for recoveryMobilize resources for recovery

16V 2.9 04/07V 2.9 04/07

Public Health Management of Public Health Management of DisastersDisasters

• Environmental HealthEnvironmental Health

• Communicable Disease ControlCommunicable Disease Control– Emergency public health measuresEmergency public health measures

• Quarantine- state’s “police powers”Quarantine- state’s “police powers”• Isolation, vaccination/prophylaxisIsolation, vaccination/prophylaxis• Seizure of propertySeizure of property• Travel restrictionTravel restriction• Disposal of corpsesDisposal of corpses

• Mental Health ServicesMental Health Services

17V 2.9 04/07V 2.9 04/07

Public Health LawsPublic Health Laws

Public Health Emergency LawPublic Health Emergency Law

18V 2.9 04/07V 2.9 04/07

State and Local Powers State and Local Powers

• 1010thth Amendment Amendment– The powers not delegated to the United States by the The powers not delegated to the United States by the

Constitution, nor prohibited by it to the States, are Constitution, nor prohibited by it to the States, are reserved for the States respectively, or to the people. reserved for the States respectively, or to the people.

• NEMACNEMACNational Emergency Management Assistance National Emergency Management Assistance

Compact Compact • Public Health LawsPublic Health Laws

– Model State Emergency Health Powers Act Model State Emergency Health Powers Act (MSEHPA)(MSEHPA)

• Declaration of a Public Health EmergencyDeclaration of a Public Health Emergency• Public Health PowersPublic Health Powers

19V 2.9 04/07V 2.9 04/07

Public Health Disaster ResponsePublic Health Disaster Response

StateState

Broad ResponsibilitiesBroad Responsibilities– State Public Health PersonnelState Public Health Personnel– State HospitalsState Hospitals– State Police/State EMSState Police/State EMS– National Guard called up by the GovernorNational Guard called up by the Governor

FundingFunding– State tax revenuesState tax revenues– Federal grants and contractsFederal grants and contracts

20V 2.9 04/07V 2.9 04/07

QuarantineQuarantine

A collective action for the common good

Public good Individual liberties

Paramount to meet needs of individuals infected and exposed

21V 2.9 04/07V 2.9 04/07


LocalLocal• Frontline of public healthFrontline of public health

– Local Public Health PersonnelLocal Public Health Personnel– Municipal HospitalsMunicipal Hospitals– Police/Fire/EMSPolice/Fire/EMS

• ResponsibilitiesResponsibilities• FundingFunding

– Local taxesLocal taxes

– State and federal grantsState and federal grants

22V 2.9 04/07V 2.9 04/07

Federal Disaster Assistance ProcessFederal Disaster Assistance Process

• Stafford ActStafford Act– Authorizes the president to direct ANY federal Authorizes the president to direct ANY federal

resource for assistanceresource for assistance• Federal Response Plan (FRP)Federal Response Plan (FRP)

– Provides for Coordination and Lead Roles Among Provides for Coordination and Lead Roles Among Federal AgenciesFederal Agencies

• Activation of the FRPActivation of the FRP– Federal Emergency Management Agency (FEMA)Federal Emergency Management Agency (FEMA)– Emergency Support Functions (ESFs)Emergency Support Functions (ESFs)

• Department of Homeland SecurityDepartment of Homeland Security– Initial National Response Plan (NRP)Initial National Response Plan (NRP)– National Incident Management System (NIMS)National Incident Management System (NIMS)– National Disaster Medical System (NDMS)National Disaster Medical System (NDMS)

23V 2.9 04/07V 2.9 04/07


• Federal Employees-Full Time and SurgeFederal Employees-Full Time and Surge– Public Health ServicePublic Health Service– National Disaster Medical System (NDMS)National Disaster Medical System (NDMS)– Department of Veterans Affairs (VA)Department of Veterans Affairs (VA)– Environmental Protection Agency (EPA)Environmental Protection Agency (EPA)– Department of Defense/ ArmyDepartment of Defense/ Army– National Guard (if Federalized)National Guard (if Federalized)

24V 2.9 04/07V 2.9 04/07

Public Health ServicePublic Health Service

Public Health Service Commissioned Corps

and Reserve Corps

– Federal employees in other jobs – “activated” for response to public health threats.

– Deployed through HHS.

25V 2.9 04/07V 2.9 04/07

National Disaster Medical System (NDMS)

• Federal, state and local health professionalsFederal, state and local health professionals• Includes medical (DMAT), nursing (NNRT), veterinary Includes medical (DMAT), nursing (NNRT), veterinary

(VMAT), mortuary (DMORT) & pharmacy (NPRT)(VMAT), mortuary (DMORT) & pharmacy (NPRT)• Trained/equipped for catastrophic health eventsTrained/equipped for catastrophic health events• When activated, become “intermittent” federal employeesWhen activated, become “intermittent” federal employees• Hired “in accordance with civil service laws”Hired “in accordance with civil service laws”• Activated through DHS/FEMAActivated through DHS/FEMA

26V 2.9 04/07V 2.9 04/07

Department of Veterans Affairs

Under Authority from the Stafford Act:Under Authority from the Stafford Act:

• VA hospital facilities and personnel can be directed to VA hospital facilities and personnel can be directed to assist state and local emergency response efforts.assist state and local emergency response efforts.– Provide for Medical Emergency Preparedness Centers.Provide for Medical Emergency Preparedness Centers.– Provide hospital care and medical services in an Provide hospital care and medical services in an

emergency or disaster.emergency or disaster.

27V 2.9 04/07V 2.9 04/07

Environmental Protection AgencyEnvironmental Protection Agency

• Specialized chem/enviro response teamsSpecialized chem/enviro response teams• CERCLA/Superfund authority provides for long term CERCLA/Superfund authority provides for long term

cleanupcleanup• Activated through National Response PlanActivated through National Response Plan• Emergency Support FunctionsEmergency Support Functions• requested through either FEMA/DHS or can act requested through either FEMA/DHS or can act

independently under its Environmental Protection independently under its Environmental Protection AuthorityAuthority

28V 2.9 04/07V 2.9 04/07

Department of Defense (DoD)Department of Defense (DoD)

• Major DoD deployments in emergencyMajor DoD deployments in emergency• Situations coordinated through DHS/FEMASituations coordinated through DHS/FEMA• DoD maintains liaisons with DHS/FEMA to assist in DoD maintains liaisons with DHS/FEMA to assist in

identifying military assets to assist in major disasters identifying military assets to assist in major disasters and emergenciesand emergencies

29V 2.9 04/07V 2.9 04/07

Emergency Response To Terrorism: Emergency Response To Terrorism:

All sites will be characterized by multiple overlapping, All sites will be characterized by multiple overlapping, simultaneous investigationssimultaneous investigations

• Clinical (Finding Cases)Clinical (Finding Cases)• Epidemiologic (Disease Tracking)Epidemiologic (Disease Tracking)• Forensic (Crime/Attribution investigation)Forensic (Crime/Attribution investigation)• Environmental (worker safety/clean up)Environmental (worker safety/clean up)• Linked to broader National effortLinked to broader National effort

30V 2.9 04/07V 2.9 04/07

The National Response PlanThe National Response Plan

Establishes a comprehensive Establishes a comprehensive all-hazards approachall-hazards approach to enhance the ability to enhance the abilityof the United States to:of the United States to:

• Save lives and protect the health and safety of the public, responders, Save lives and protect the health and safety of the public, responders, and recovery workers; and recovery workers;

• Ensure security of the homeland; Ensure security of the homeland; • Prevent an imminent incident, including acts of terrorism, from Prevent an imminent incident, including acts of terrorism, from

occurring; occurring; • Protect and restore critical infrastructure and key resources; Protect and restore critical infrastructure and key resources; • Conduct law enforcement investigations to resolve the incident, Conduct law enforcement investigations to resolve the incident,

apprehend the perpetrators, and collect and preserve evidence for apprehend the perpetrators, and collect and preserve evidence for prosecution and/or attribution; prosecution and/or attribution;

• Protect property and mitigate damages and impacts to individuals, Protect property and mitigate damages and impacts to individuals, communities, and the environment; and communities, and the environment; and

• Facilitate recovery of individuals, families, businesses, governments, Facilitate recovery of individuals, families, businesses, governments, and the environment.and the environment.

31V 2.9 04/07V 2.9 04/07

Practice of Medicine During Practice of Medicine During DisastersDisasters

• Jurisdictional IssuesJurisdictional Issues– A Federal Employee (full-time or temporary) licensed in any state is A Federal Employee (full-time or temporary) licensed in any state is

permitted to practice medicine in any other state.permitted to practice medicine in any other state.• Licensure and Liability of Medical VolunteersLicensure and Liability of Medical Volunteers

– Subject to mutual aid agreements, Interstate Compacts, and individual Subject to mutual aid agreements, Interstate Compacts, and individual State laws.State laws.

– NRP and Most state agencies have a Volunteer Management Annex NRP and Most state agencies have a Volunteer Management Annex covering verification of skills, licensing, privileges and credentialing for out covering verification of skills, licensing, privileges and credentialing for out of state volunteers.of state volunteers.

• Good Samaritan StatutesGood Samaritan Statutes– Provisions/liability exposure varies by state.Provisions/liability exposure varies by state.– Very low liability exposure: Volunteers, government employees.Very low liability exposure: Volunteers, government employees.– Liability: persons receiving compensation - not government employees.Liability: persons receiving compensation - not government employees.

• Compensation for Emergency CareCompensation for Emergency Care– The federal government is responsible for workers’ compensation, and The federal government is responsible for workers’ compensation, and

salaries of its employees.salaries of its employees.– When mutual aid agreements are enacted, compensation provisions are When mutual aid agreements are enacted, compensation provisions are

includedincluded..

32V 2.9 04/07V 2.9 04/07

Jurisdictional IssuesJurisdictional Issues

State and federal emergencies declaredState and federal emergencies declared

• • Joint Field Office establishedJoint Field Office established

– – Principal Federal OfficialPrincipal Federal Official

– – Federal and State Coordinating OfficersFederal and State Coordinating Officers• HHS coordinating all federal health response actionsHHS coordinating all federal health response actions• under ESF 8under ESF 8• State health counterpart coordinating state health State health counterpart coordinating state health

response actionsresponse actions

– – NOTE: Onsite Incident Commander NOTE: Onsite Incident Commander retains retains authority – has system to obtain authority – has system to obtain resourcesresources

33V 2.9 04/07V 2.9 04/07

Licensure IssuesLicensure Issues

• – If a “person” is licensed in responding state, the person “shall be deemed” licensed in requesting state.

• – Unless requesting governor orders otherwise.

34V 2.9 04/07V 2.9 04/07

Liability During Disaster ResponseLiability During Disaster Response

Liability is limited:Liability is limited:– Most states limit liability for actions in emergencies Most states limit liability for actions in emergencies

to gross negligence or willful misconduct.to gross negligence or willful misconduct.

Federal law preempts state laws.Federal law preempts state laws.

No liability for volunteer of any non-governmentalNo liability for volunteer of any non-governmental

organization or government if:organization or government if:

– – Work performed within volunteer’s scope of dutiesWork performed within volunteer’s scope of duties

– – Volunteer is properly licensedVolunteer is properly licensed

– – Volunteer had no criminal or willful misconductVolunteer had no criminal or willful misconduct

35V 2.9 04/07V 2.9 04/07

Minimizing Liability Example:State Good Samaritan Laws – Florida

• A person is not liable for civil damages arising out of care or treatment, in emergency situations, including declared emergencies– IF care is provided…– “gratuitously” and “in good faith”– “without objection” of the injured victim or victims

thereof, acting “as an ordinary reasonably prudent person would have acted under the same or similar circumstances”

• Protection also extended for actions coordinated with organized emergency management teams and agencies.

36V 2.9 04/07V 2.9 04/07

Model Emergency Powers ActModel Emergency Powers Act

Allows:Allows:

““Public health authority may waive any and all licensingPublic health authority may waive any and all licensing

requirements, permits, or fees required by the State Coderequirements, permits, or fees required by the State Code

and applicable orders, rules or regulations for health and applicable orders, rules or regulations for health care care

providers from other jurisdictions.”providers from other jurisdictions.”

37V 2.9 04/07V 2.9 04/07

Protecting Privacy of Disaster Protecting Privacy of Disaster VictimsVictims

HIPAA:HIPAA:

Disclosure for Public Health ActivitiesDisclosure for Public Health Activities. [xix] The Privacy Rule permits the. [xix] The Privacy Rule permits thedisclosure of PHI to facilitate public health activity:disclosure of PHI to facilitate public health activity:

– (1) “preventing or controlling disease, injury, or disability, (1) “preventing or controlling disease, injury, or disability, including, but not limited to, the reporting of disease, injury, vital including, but not limited to, the reporting of disease, injury, vital events such as birth or death, and the conduct of public health events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health surveillance, public health investigations, and public health interventions;”interventions;”

– (2) to notify individuals “who may have been exposed to a (2) to notify individuals “who may have been exposed to a communicable disease or may otherwise be at risk of contracting communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the covered entity or public or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such person as health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or necessary in the conduct of a public health intervention or investigation.investigation.

38V 2.9 04/07V 2.9 04/07

Incident Command SystemIncident Command System

• A management system used to organize emergency A management system used to organize emergency response.response.

• Offers a scalable response to an emergency (incident) Offers a scalable response to an emergency (incident) of any magnitudeof any magnitude

• Provides a common framework within which people Provides a common framework within which people can work together.can work together.

• Eliminates the "who's in charge" problem.Eliminates the "who's in charge" problem.

39V 2.9 04/07V 2.9 04/07


• Incident CommanderIncident Commander (IC) (IC) – the single person in charge the single person in charge

• Finance Section ChiefFinance Section Chief– tracking incident related costs, personnel records, tracking incident related costs, personnel records,

requisitions, and administrating procurement contracts requisitions, and administrating procurement contracts required by Logistics.required by Logistics.

• Logistics Section ChiefLogistics Section Chief – providing all resources, services, and support required providing all resources, services, and support required

by the incident.by the incident.• Operations Section ChiefOperations Section Chief

– directing all actions to meet the incident objectives.directing all actions to meet the incident objectives.

40V 2.9 04/07V 2.9 04/07


• Planning Section ChiefPlanning Section Chief – collection and display of incident information, primarily collection and display of incident information, primarily

consisting of the status of all resources and overall status of consisting of the status of all resources and overall status of the incident.the incident.

• Public Information OfficerPublic Information Officer – serves as the conduit for information to internal and external serves as the conduit for information to internal and external

stakeholders, including the media or other organizations stakeholders, including the media or other organizations seeking information directly from the incident or event.seeking information directly from the incident or event.

• Safety OfficerSafety Officer– monitors safety conditions and develops measures for monitors safety conditions and develops measures for

assuring the safety of all assigned personnel.assuring the safety of all assigned personnel.

• Liaison OfficerLiaison Officer – serves as the primary contact for supporting agencies serves as the primary contact for supporting agencies

assisting at an incident.assisting at an incident.

41V 2.9 04/07V 2.9 04/07

Emergency Communication and Public Emergency Communication and Public Information SystemsInformation Systems

• Cellular communicationsCellular communications• Amateur Ham Radio OperatorsAmateur Ham Radio Operators• Internet-based communications and other Internet-based communications and other

computer resourcescomputer resources– CDC Health Alert Network (HAN)CDC Health Alert Network (HAN)– GISGIS– PDAsPDAs

42V 2.9 04/07V 2.9 04/07

Key Elements of a Key Elements of a Communications StrategyCommunications Strategy

• Respond quickly and accuratelyRespond quickly and accurately• Identify a primary person to be the “voice” of the Identify a primary person to be the “voice” of the

agency or organization agency or organization • Tell the truth but resist giving every detailTell the truth but resist giving every detail• The face that is shown to the media must be one of The face that is shown to the media must be one of

concern and compassion concern and compassion • Appreciate the role and efforts of the media in Appreciate the role and efforts of the media in

emergency management.emergency management.

43V 2.9 04/07V 2.9 04/07

Public Health ModelsPublic Health Models

Influenza 1918-1919Influenza 1918-1919• 20 Million Deaths Worldwide20 Million Deaths Worldwide• ““Undiscovered virus” at the timeUndiscovered virus” at the time• Mass casualty in health facilities (needs exceeded Mass casualty in health facilities (needs exceeded

resources)resources)

Pandemic Flu 2006-2007Pandemic Flu 2006-2007• The assumptions, based largely on the 1918 influenza The assumptions, based largely on the 1918 influenza

epidemic, are being used throughout the federal epidemic, are being used throughout the federal government to define a severe case scenario for a government to define a severe case scenario for a

pandemic flu outbreak.pandemic flu outbreak.

44V 2.9 04/07V 2.9 04/07

45V 2.9 04/07V 2.9 04/07

• WHO global (Human) surveillance network WHO global (Human) surveillance network

– ~112 sites in 80 countries to detect “new” flu~112 sites in 80 countries to detect “new” flu– Major Collaborating CentersMajor Collaborating Centers

• Atlanta, London, Melbourne, TokyoAtlanta, London, Melbourne, Tokyo

• Animal Surveillance (e.g., Birds, others)Animal Surveillance (e.g., Birds, others)

• Strategic Readiness Concerns Strategic Readiness Concerns

• Early detection – Immunization – Clinical SurgeEarly detection – Immunization – Clinical Surge

“Global” Influenza Surveillance

46V 2.9 04/07V 2.9 04/07

BioterrorismBioterrorism

• The intentional use of infectious agents, or The intentional use of infectious agents, or germs, to cause illness.germs, to cause illness.

• Made a national priority. Made a national priority. • The federal The federal Centers for Disease Control and Centers for Disease Control and

PreventionPrevention has worked with state and local has worked with state and local health departments to identify and to respond health departments to identify and to respond to bioterrorism for several years. to bioterrorism for several years.

• The public health response to bioterrorism The public health response to bioterrorism includes medications, medical supplies, and if includes medications, medical supplies, and if necessary, vaccines to protect an affected necessary, vaccines to protect an affected community. community.

47V 2.9 04/07V 2.9 04/07

The Bioterrorism Act of 2002The Bioterrorism Act of 2002

• The events of Sept. 11, 2001, reinforced The events of Sept. 11, 2001, reinforced the need to enhance the security of the the need to enhance the security of the United States. United States.

• Congress responded by passing the Congress responded by passing the Public Health Security and Bioterrorism Public Health Security and Bioterrorism Preparedness and Response Act of 2002.Preparedness and Response Act of 2002.

• President Bush signed it into law June President Bush signed it into law June 12, 2002. 12, 2002.

48V 2.9 04/07V 2.9 04/07

Public Health Response to Public Health Response to BioterrorismBioterrorism

• Requires communication and coordination Requires communication and coordination with first responders and law enforcement with first responders and law enforcement officials. officials.

• State and local health departments should State and local health departments should work with these groups to ensure that local work with these groups to ensure that local disaster preparedness plans address disaster preparedness plans address bioterrorism.bioterrorism.

• Planning for Response to Threats Planning for Response to Threats – define the roles of each agency, including define the roles of each agency, including

protection of first responders;protection of first responders;– groups should be tested through simulations. groups should be tested through simulations.

49V 2.9 04/07V 2.9 04/07

Bioterrorism JurisdictionBioterrorism Jurisdiction

• FBI has jurisdiction for bioterrorism response but FBI has jurisdiction for bioterrorism response but recognizes the need to conduct epidemiologic recognizes the need to conduct epidemiologic investigations, define at-risk groups, and rapidly investigations, define at-risk groups, and rapidly implement potentially life-saving medical and public implement potentially life-saving medical and public health responses.health responses.– When bioterrorism alleging use of anthrax or other agents When bioterrorism alleging use of anthrax or other agents

occurs, the local emergency response system should be occurs, the local emergency response system should be activated by dialing 911 in most communities; in communities activated by dialing 911 in most communities; in communities without 911 systems, local law enforcement authorities should without 911 systems, local law enforcement authorities should be notified.be notified.

– Police, fire, emergency medical services (EMS), and hazardous Police, fire, emergency medical services (EMS), and hazardous materials units (HAZMAT) (i.e., first responders) will respond materials units (HAZMAT) (i.e., first responders) will respond sent to the scene; sent to the scene;

– The local FBI field office and local and state public health The local FBI field office and local and state public health authorities also should be notified. authorities also should be notified.

50V 2.9 04/07V 2.9 04/07

Bioterrorism PlanningBioterrorism Planning

The Anthrax ModelThe Anthrax Model

• Anthrax is an acute infectious disease caused by the Anthrax is an acute infectious disease caused by the spore-forming bacterium spore-forming bacterium B. anthracisB. anthracis. .

• It occurs most frequently as an epizootic or enzootic It occurs most frequently as an epizootic or enzootic disease of herbivores (e.g., cattle, goats, and sheep), disease of herbivores (e.g., cattle, goats, and sheep), which acquire spores from direct contact with which acquire spores from direct contact with contaminated soil. contaminated soil.

• Humans usually become infected through contact with Humans usually become infected through contact with or ingestion or inhalation of or ingestion or inhalation of B. anthracisB. anthracis spores from spores from infected animals or their products (e.g., goat hair). infected animals or their products (e.g., goat hair).

• Human-to-human transmission has not been Human-to-human transmission has not been documented.documented.

51V 2.9 04/07V 2.9 04/07

Public Health Response to Public Health Response to BioterrorismBioterrorism

• Although all the threats alleging use of anthrax Although all the threats alleging use of anthrax described in this report were hoaxes, they described in this report were hoaxes, they demonstrate settings where bioterrorism can occur demonstrate settings where bioterrorism can occur and the potential public health impact.and the potential public health impact.

• These threats required prompt action by health, law These threats required prompt action by health, law enforcement, and laboratory personnel. enforcement, and laboratory personnel.

• Coordination and communication across agencies are Coordination and communication across agencies are necessary to protect the public and first responders necessary to protect the public and first responders from credible biologic warfare and bioterrorism agents from credible biologic warfare and bioterrorism agents

such as anthrax.such as anthrax.

52V 2.9 04/07V 2.9 04/07

Bioterrorism ResponseBioterrorism Response

• FBI will coordinate the collection of evidence FBI will coordinate the collection of evidence (e.g., letters, packages, or air-handling system (e.g., letters, packages, or air-handling system samples) and deliver materials to an FBI or US samples) and deliver materials to an FBI or US Department of Defense laboratory for testing. Department of Defense laboratory for testing.

• To guide decision-making, test results To guide decision-making, test results identifying identifying B. anthracisB. anthracis should be available as should be available as soon as possible, at least within 24-48 hours. soon as possible, at least within 24-48 hours. – Efforts are under way to assess and enhance the Efforts are under way to assess and enhance the

capabilities of state and local health department capabilities of state and local health department laboratories to fulfill the need for rapid analysis.laboratories to fulfill the need for rapid analysis.

– Planning for laboratory testing should be part of Planning for laboratory testing should be part of bioterrorism preparedness by state and local public bioterrorism preparedness by state and local public health, law enforcement, and first responder health, law enforcement, and first responder authorities in consultation with federal officials authorities in consultation with federal officials

53V 2.9 04/07V 2.9 04/07


• Public health officials, working with law enforcement Public health officials, working with law enforcement and first response personnel, should determine the and first response personnel, should determine the need for decontamination and postexposure need for decontamination and postexposure prophylaxis. prophylaxis.

• In most of the recent hoaxes purporting anthrax In most of the recent hoaxes purporting anthrax exposure, immediate postexposure decontamination exposure, immediate postexposure decontamination and prophylaxis have not been indicated because of and prophylaxis have not been indicated because of the lack of credibility of the threat. the lack of credibility of the threat.

• Public health officials should collect contact Public health officials should collect contact information for potentially exposed persons for information for potentially exposed persons for notification of laboratory results or other follow-up. notification of laboratory results or other follow-up.

• Potentially exposed persons should be given Potentially exposed persons should be given information about the signs and symptoms of illnesses information about the signs and symptoms of illnesses associated with the biologic agent and about whom to associated with the biologic agent and about whom to contact and where to go should they develop illness. contact and where to go should they develop illness.

54V 2.9 04/07V 2.9 04/07


Recommendations for Postexposure Prophylaxis Recommendations for Postexposure Prophylaxis • Postexposure prophylaxis for exposure to Postexposure prophylaxis for exposure to B. B.

anthracisanthracis consists of chemoprophylaxis and consists of chemoprophylaxis and vaccination vaccination

• Oral fluoroquinolones are the drugs of choice Oral fluoroquinolones are the drugs of choice for adults, including pregnant women for adults, including pregnant women – If fluoroquinolones are not available or are If fluoroquinolones are not available or are

contraindicated, doxycycline is acceptable. contraindicated, doxycycline is acceptable. – Prophylaxis should continue until B. anthracis Prophylaxis should continue until B. anthracis

exposure has been excluded. exposure has been excluded.

55V 2.9 04/07V 2.9 04/07


Decontamination:Decontamination:• If decontamination is appropriate, persons should remove their If decontamination is appropriate, persons should remove their

clothing and personal effects, place all items in plastic bags, and clothing and personal effects, place all items in plastic bags, and shower using copious quantities of soap and water.shower using copious quantities of soap and water.– Plastic bags with personal effects should be labeled clearly Plastic bags with personal effects should be labeled clearly

with the owner's name, contact telephone number, and with the owner's name, contact telephone number, and inventory of the bag's contents. inventory of the bag's contents.

– Personal items may be kept as evidence in a criminal trial or Personal items may be kept as evidence in a criminal trial or returned to the owner if the threat is unsubstantiated. returned to the owner if the threat is unsubstantiated.

• For incidents involving possibly contaminated letters, the For incidents involving possibly contaminated letters, the environment in direct contact with the letter or its contents environment in direct contact with the letter or its contents should be decontaminated with a 0.5% hypochlorite solution (i.e., should be decontaminated with a 0.5% hypochlorite solution (i.e., one part household bleach to 10 parts water) following a crime one part household bleach to 10 parts water) following a crime scene investigation. scene investigation. – Personal effects may be decontaminated similarly.Personal effects may be decontaminated similarly.

56V 2.9 04/07V 2.9 04/07


• CDC and other offices in the US Department of Health CDC and other offices in the US Department of Health and Human Services are working with state and local and Human Services are working with state and local health departments, federal agencies, and health departments, federal agencies, and nongovernmental organizations to improve the public nongovernmental organizations to improve the public health capacity to address bioterrorism and develop health capacity to address bioterrorism and develop locality-specific response plans. locality-specific response plans.

• CDC also can assist public health officials with CDC also can assist public health officials with decision-making if a threat occurs alleging the use of a decision-making if a threat occurs alleging the use of a biologic agent. biologic agent.

57V 2.9 04/07V 2.9 04/07

Thank You!Thank You!

Questions?Questions?

Documents

“Preparing Our Communities”