BIOTERRORISM: SOUTH CAROLINA RESPONDS

OBJECTIVES l To understand the response to a bioterrorist act through use of the unified incident command system l To describe the role and responsibility of each responding agency l To raise other issues that must be dealt with in planning a response to a bioterrorist act

l To best respond to the bioterrorist threat, our state is divided into local regions for an initial response. South Carolina eight regions l Federal and state resources are available when local resources are overwhelmed l Each region coordinates its response through a Unified Incident Command System using the nationwide template or guidelines of the National Incident Management System (NIMS)

l The NIMS guidelines provided a flexible framework to allow coordination and cooperation between involved agencies to develop policies and procedures prior to an incident. These are exercised and followed to ensure a safe and effective emergency response l All response agencies need to develop close working relationships and work together to save lives, preserve health, minimize panic and minimize disease impact

l To best manage an incident each jurisdiction must use a unified incident command system. l Each involved agency can have its own incident command system which is integrated with others. Hospitals use the Hospital Emergency Incident Command System (HEICS) l Each agency has its defined role and responsibilities

l In a bioterrorist attack, health agency personnel may need to interact with individuals from other response agencies l These may include: s Emergency Management Authority s Emergency Medical Services (EMS) s Mental Health agencies s Community Health Centers/Medical Offices s Law enforcement authority s Fire/Rescue s Volunteer community agencies s Medical examiner or coroner s Neighboring health jurisdictions(possibly in another state)

l In this section, the role and responsibility of each response agency will be presented l Each agency must coordinate with others in the planning for, response to, recovery from, and mitigation of a bioterrorist incident l It is important to note that functions assigned to each response agency may vary by jurisdiction

THE ROLE OF THE PUBLIC HEALTH DEPARTMENT l In a bioterrorist incident, public health is the lead agency l Provide support services and public health/medical services to include: s Activation of the Emergency Health Powers Act to deal with quarantine and isolation s Distribution of the Strategic National Stockpile (SNS) and dispensing vaccines and antibiotic prophylaxis s Environmental control (animal bites, wastewater, food services inspections, general sanitation)  Operate shelters for those with special needs

ROLE OF PUBLIC HEALTH s Disease surveillance, detection, and epidemiologic investigation s Ensure operational coordination in a mass casualty disaster response through an Emergency Operations Center (EOC) s Keep the public informed of available mass casualty assistance programs s Collect,compile, maintain and share all essential information s Provide laboratory support

THE ROLE OF HOSPITALS l Hospitals and usually with a one hospital taking the lead provide: s Emergency and definitive acute medical care s Isolate contagious individuals s Dispense medications and vaccines to staff and inpatients s Maintain safe and appropriate disposal of medical waste s Decontamination of victims and facilities as necessary s Train/Educate/Utilize volunteers

THE ROLE OF THE EMERGENCY MANAGEMENT AUTHORITY l Hosts the Emergency Operations Center (EOC) for the county l Has overall responsibility for coordination of the county response logistics including food, water, electricity, shelter and transportation l Mobilize and deploy assets during the crisis and in the recovery phase l Develops and maintains communication links and issues appropriate warnings to the public l Prepare for state and federal on-site assistance

THE ROLE OF EMERGENCY MEDICAL SERVICES l Is first on the scene and delivers initial triage of incident victims l Transports casualties l Augments hospital services

THE ROLE OF MENTAL HEALTH PROVIDERS l Coordinate and provide mental health crisis counseling to victims, staff, and the worried well l Make referrals as needed l Provide post-crisis mental health counseling

THE ROLE OF COMMUNITY HEALTH CENTERS AND MEDICAL OFFICES l Remain alert for initial cases of illness in their practice l Deliver outpatient ambulatory care to victims of a mass casualty disaster l Dispense medications and vaccines as needed l Provide triage to victims of a mass casualty event

THE ROLE OF THE LAW ENFORCEMENT AUTHORITY l Ensure the public safety l Facilitate response and recovery l Provide threat assessment, criminal investigation, forensics, and evidence processing. The site on an incident is a crime scene l Provide security and access control in and around the disaster site and at affected hospitals

THE ROLE OF FIRE/RESCUE +Evaluate the danger in a situation Responsible for hazardous materials management l Establish decontamination control in response to actual conditions l Perform search and rescue as needed

THE ROLE OF VOLUNTARY AGENCIES l Names of agencies may differ from county to county, but they are generally responsible for: s Support county relief efforts and provide shelters, feeding, blood supplies, emergency welfare or family support (Red Cross) s Support county relief efforts and provide warehouse support, feeding and/or emergency welfare support (Salvation Army)

MEDICAL EXAMINER OR CORONER l Involved in activities related to managing and processing incident related fatalities including: s Body recovery s Identification, pathology, autopsy, storage and forensics involving casualties s Decedent’s family assistance services

SOME IMPORTANT PLANNING CONSIDERATIONS l Each region must develop sufficient “surge capacity” including facilities, assets and staff to handle a very large number of casualties l Each region must develop a plan to recruit, credential, train and equip staff, as well as volunteers and retirees

PLANNING CONSIDERATIONS l Each region must develop a communication system for its response agencies to use when telephonic communication is not available l Each region must develop communication channels with the state and Federal governments l Each region must ensure the safety of its first responders and their families l If a region adjoins a neighboring state cross border issues need to be dealt with

PLANNING CONSIDERATIONS l Animal care issues need to be dealt with l Laboratory capabilities must be adequate l Special needs populations, e.g. non- English speakers, hearing and visually impaired and other disabled individuals must be planned for

CONCLUSION l As we have heard from our governing officials l It is not if we will be attacked, but when Will we be ready? Only time and our preparation will tell