C28-A-1 A MODEL RESPONSE TO BIOTERRORISM: Pennsylvania Region 13-WMD Task Force J. David Piposzar, MPH J. David Piposzar, MPH

C28-A-2 This lecture is one of series produced by the Allegheny County Health Department (PA), Bethlehem Health Bureau (PA) and the City of Elizabeth Department of Health & Human Services (NJ). The organizers of this project are scholars in the Northeast Regional Public Health Leadership Institute, Class of For information contact:

C28-A-3 J. David Piposzar, MPH – –Emergency Management Coordinator, Allegheny County Health Department – –Penn State University BS, Zoology – –University of Pittsburgh MPH, Graduate School of Public Health Delta Omega, National Public Health Honorary – –Recipient of EPA Region III Partnership Award for contributions to chemical emergency preparedness and prevention

C28-A-4 Mr. Piposzar is a career public health employee with 25 years of service in all aspects of public health. He coordinates health department emergency management functions with other federal, state, county and municipal agencies. He is a member of the Allegheny County Emergency Planning Committee, where he chairs the Medical and Health Subcommittee. He authored a “Multi-hospital Emergency Medical Plan for Hazardous Materials Emergencies” and developed and implemented a nationally recognized training program. His work has been recognized by EPA, the Ford Foundation, and Allegheny County government, among others.

C28-A-5 Learning Objectives Understand the factors necessary to organize a community to protect against bioterrorism. Understand the basic threats from bioterrorism. Understand how bioterrorism events are diagnosed.

C28-A-6 Performance Objectives Begin organizing your community to be able to respond to bioterrorism. Know what organizations and agencies are necessary to respond to bioterrorism at the local, state and Federal level.

C28-A-7 Metropolitan Medical Response System A Regional, System-Based Approach to Mass Casualty & Nuclear, Biological, and/or Chemical (NBC) Terrorism Preparedness PENNSYLVANIA-REGION 13

C28-A-8 PITTSBURGH

C28-A-9 Mission Objectives 1. Formalize regional mutual aid agreements and plans. 2. Establish an interoperable communication system. 3. Develop a specialized equipment pool. 4. Ensure specialized training is available. 5. Apply for grant funding.

C28-A Foster networking and sharing of information. 7. Develop criminal intelligence protocol’s and procedures. 8. Deliver highly trained and equipped teams of responders at the local and regional levels. 9. Ensure the highest level of Life Safety response at a responsible cost to taxpayers.

C28-A-11 Funding $600,000Metropolitan Medical Response System (MMRS) $395,000MMRS-RISC TEAM Project $300,000Department of Justice $28,500FEMA

C28-A-12 Committees Policy Communications / Fire / Haz Mat Medical / Health Training Law Enforcement

C28-A-13 MMRS Planning

C28-A-14  300+ individuals  87 organizations and  65 hospitals  Monthly meetings- 3rd Thursdays  network & secure web site MMRS PLANNING

C28-A-15 – – Surveillance and notifications – – Mass immunization – – Mass Patient Care- RISC TEAM Pharmaceutical cache – – Mental Health – – Mass fatality management – – Environmental surety Region 13 Plans

C28-A-16 Types - Biological Agents Bacteria: Plague, Anthrax, TularemiaBacteria: Plague, Anthrax, Tularemia Viruses: Smallpox, VEE, Viral Hemorrhagic Fevers (Ebola)Viruses: Smallpox, VEE, Viral Hemorrhagic Fevers (Ebola) Toxins: Botulinum, Ricin, SEBToxins: Botulinum, Ricin, SEB Anthrax - vegetated

C28-A-17 SURVEILLANCE- EARLY RECOGNITION Physicians and nurse gatekeepers Infection control practitioners Laboratories Pharmacies Veterinarians Coroners/ medical examiners 911- Centers

C28-A-18 EMS Regional Offices Pittsburgh Poison Center Police special protection units/security details USDA, FDA, food & water protection Duty officers- PaDEP, EPA, PaDOH, ACHD School nurses Employers

C28-A-19 Criminal Intelligence + Medical Intelligence = Threat assessment

C28-A-20 Notifications to Health Officials Reportable diseases Unusual disease occurrences Suspect cases- “syndromic” surveillance Allegheny County Health Department Pa. Department of Health S.W District

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C28-A-22 Epidemiological Information Travel history Infectious contacts Employment history Activities over the preceding 3 to 5 days

C28-A-23 Epidemiologic Clues Large epidemic with high illness and death rate HIV(+) individuals may have first susceptibility Respiratory symptoms predominate Infection non-endemic for region Multiple, simultaneous outbreaks Multi-drug-resistant pathogens Sick or dead animals of multiple types Delivery vehicle or intelligence information

C28-A-24 Public Health Concerns Mass Immunization and Mass Prophylaxis Antibiotics Antidotes Vaccines Acquisition & distribution methods

C28-A-25 –List of pharmaceuticals to provide care for the first 24 hours of response to an incident. –Plans to store and replace “dated” drugs through agreements with distribution center. –Plans to distribute & dispense Pharmaceutical Cache

C28-A-26 Rx Cache

C28-A-27 UPDATE HOSPITAL DISASTER PLANS: –notification procedures –lock-down procedures –mass decontamination capability –mass casualty triage capability –PPE for staff –pharmaceuticals and equipment –medical staff training and recognition –medical treatment protocols (adult & pediatric) Hospital Preparedness

C28-A-28 National Disaster Medical System VA and Hospital affiliates Plan for forward movement of patients if we are overwhelmed Plan to receive patients from other cities if they are overwhelmed Integration with NDMS

C28-A-29 Coordination with existing mental health providers Counseling services for responders Counseling for victims, families, and community Mental Health Services

C28-A-30 Based on existing mortuary services Mutual aid and federal D-Mort support Defining temporary morgue needs Enhancing PPE for morgue workers Special decontamination requirements Mortuary Services

C28-A-31 Protection of water and food supplies Plans and procedures to restore facilities Criteria for re-occupancy Environmental Surety

C28-A-32 Enhance communications among agencies BMSI and Carnegie Mellon Research Institute-secure web site *Hospital bed availability *Plans and procedures *Training materials *Response actions in real time Communications

C28-A-33 REGIONAL INCIDENT SUPPORT AND COORDINATION TEAM ( RISC TEAM)

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C28-A-36 Recommendations: SUPPORT DEVELOPMENT OF CRITICAL SURVEILLANCE SYSTEMS HELP IDENTIFY PERSONNEL TO BUILD “ MEDICAL SURGE CAPACITIES” WORK QUIETLY AND EFFICIENTLY TO MINIMIZE PUBLIC ANXIETIES OR FEAR MOBILIZE COMMUNITY RESOURCES SUPPORT TRAINING/EDUCATION OF MEDICAL PERSONNEL ENHANCE COMMUNICATIONS & PARTICIPATE IN PLANNING !