1. North Carolina’s Role in Preparedness

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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,
ASM Sentinel Lab Procedures
Preparedness Workshops – 3x/year
Packaging and Shipping
Proficiency
Sentinel Laboratory Drills
CAP-LPX – Laboratory Exercise

8. 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

9. 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
If you already have a plan, perhaps there is additional useful information in this resource

10. 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

11. 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?

12. 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!

13. Preparedness Contact Information
NCSLPH Main Number
BTEP Unit
Main Line
BT Duty Phone (24/7)
BT Pager (24/7)
CT Unit
Main Line
CT Coordinator (cell)
Asst Coordinator (cell)

14. Resource links CDC: Laboratory Information for BT Emergencies
FDA: Main BT page
NCSLPH Web Site
NCSLPH Bioterrorism Home Page

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

16. Questions or comments? Contact: Barbie Page, MS, MT(ASCP)
Bioterrorism and Emerging Pathogens Unit