North Carolina’s Role in Preparedness

Objectives What is the Laboratory Response Network? What aspects serve to strengthen NC’s network? Describe the benefit in utilizing the CAP LPX proficiency exercise. Describe critical aspects of a lab preparedness plan. Explain how clinical labs can contact NCSLPH Preparedness Units – BTEP and CT. Access resources and training about response to bioterrorism

Laboratory Response Network Founding partners of the LRN: CDC, FBI & APHL The LRN was established in 1999 in response to Presidential Directive 39 which outlined national anti-terrorism policies and assigned specific missions to federal departments and agencies. The objective was to ensure an effective laboratory response to bioterrorism by helping to improve the nation's public health laboratory infrastructure. Mission - The LRN and its partners will develop, maintain and strengthen an integrated national and international network of laboratories that can respond quickly to needs for rapid testing, timely notification and secure reporting of results associated with acts of biological or chemical terrorism and other high priority public health emergencies.

What does this integrated national and international network look like? Tiered structure National labs: CDC USAMRIID Reference labs: 150+ labs nationally - state and local public health, federal, military, veterinary, food and water testing, and environmental as well as international labs in Canada, the United Kingdom, Australia, Mexico and South Korea Sentinel labs (25,000 estimated): Hospital laboratories Commercial laboratories Private laboratories

Why are Public Health Labs involved? Mandated by Congress for state labs to support local BT response Experience with biological agents of concern and outbreak investigations Link between local lab level and CDC/federal agencies Preserves forensic evidence for criminal investigations NCSLPH serves as a reference lab representing national LRN in state jurisdiction

NCSLPH as an LRN Reference Lab provides: Reference services Specialized testing Environmental testing Rapid Testing Laboratory Improvement Applied research Disease identification and outbreak investigation Support of Surveillance and Epidemiology Investigations Emergency Preparedness and Response

Network Development We strive to maintain and strengthen NC’s laboratory network with our sentinel labs through: Lab Assessment Obtaining detailed information about our sentinel labs through Sentinel Surveys and outreach visits Having knowledge of Current Biosafety level and Clinical Scope of Practice Education and Training Online Training Resources (aphl.org, www.cdc.gov/labtraining) ASM Sentinel Lab Procedures Preparedness Workshops – 3x/year Packaging and Shipping Proficiency Sentinel Laboratory Drills CAP-LPX – Laboratory Exercise

CAP LPX Preparedness Exercise What is the CAP LPX? An ungraded proficiency developed by CAP, CDC, and APHL CAP LPX is a great way for sentinel labs to practice the skills and ability to detect possible agents of bioterrorism Rule out and refer Handling of organisms Correct plan for notification Packaging and Shipping

Clinical Laboratory Bioterrorism Readiness or Preparedness Plan Does your laboratory have a written plan of action? American Society For Microbiology (ASM) provides a fillable template for laboratories to use in developing a bioterrorism (BT) readiness plan Serves as an aid in the process of developing a specific plan for your laboratory should you encounter a specimen where testing is needed http://www.asm.org/images/PSAB/BT_Readiness.pdf If you already have a plan, perhaps there is additional useful information in this resource

Components of A Preparedness Plan for Your Laboratory Purpose Contact Protocol and Chain of Communication Laboratory Response Network Responsibilities of the Clinical Laboratory Sentinel Level Laboratory Guidelines Packaging and Shipping Instructions Information Checklist Handling of Possible BT agents Policy Sign-off List Training Sign-off List Therapy of BT agents Appendix

What to Consider When Creating Your Plan What is the biosafety level of my lab? Is my lab active in the LRN? Where is the nearest higher level lab? What guidelines should be followed to package and ship biological agents? Whom should I call? Test your plan at least annually Keep it updated Provide training/in-service to your staff Know chain of custody requirements Know shipping requirements Who has a BT plan?

Conclusion IT IS ALWAYS BEST TO BE PREPARED! The use of a biological or chemical agent for terrorism is a low probability event with very large, potentially devastating consequences IT IS ALWAYS BEST TO BE PREPARED!

Preparedness Contact Information NCSLPH Main Number 919-733-7834 BTEP Unit Main Line- 919-807-8765 BT Duty Phone (24/7)- 919-807-8600 BT Pager (24/7)- 919-310-4243 CT Unit Main Line- 919-807-8771 CT Coordinator (cell) 919-602-2481 Asst Coordinator (cell) 919-323-1301

Resource links CDC: Laboratory Information for BT Emergencies http://emergency.cdc.gov/bioterrorism/lab.asp FDA: Main BT page http://www.fda.gov/EmergencyPreparedness/default.htm NCSLPH Web Site http://slph.state.nc.us/default.asp NCSLPH Bioterrorism Home Page http://slph.state.nc.us/bioterrorism/default.asp

Course Pre-test Thank you for participating in North Carolina’s Role in Preparedness. The pre-test for the course is available at: http://www.quia.com/quiz/3062810.html Our pre-test is designed to assess BT knowledge; not all answers were provided in this powerpoint.

Questions or comments? Contact: Barbie Page, MS, MT(ASCP) Bioterrorism and Emerging Pathogens Unit Barbie.page@dhhs.nc.gov 252-714-0184