1. Introduction: CBRN for Public Health Bonnie Henry, MD, MPH, FRCPC Public health CBRN course

2. Course Faculty www.CEEP.ca Dr Daniel Kollek Dr Dan Cass Dr Brian Schwartz Dr Doug Sider Dr Chris Mackie Dr Bonnie Henry

3. Course Objectives (1) To understand the potential for a CBRN incident and how to assess local risk Describe the role of the health system, and public health, in preparedness, mitigation, response to and recovery from a CBRN incident

4. Course Objectives (2) To understand the roles of other organizations including police, fire and emergency medical services and emergency management in a CBRN incident To understand the Incident Management System and define and use a Public Health IMS model

5. Overview of Course Day 1 Precourse review Roles of Public Health CBRN introduction Review of provincial initiatives Disaster concepts Hazard Identification and Risk Analysis exercise Incident Management System

6. Overview of Course: Day 2 Focus on biological incidents and public health Personal Protective Equipment Mass vaccination/prophylaxis clinics Psychosocial support Rapid community needs assessment Crises communication

7. Public Health Roles Public Health Roles Early Detection Mass Patient Care Mass Immunization/Prophylaxis Epidemiologic investigation Communication Command and Control

8. Public Health Roles (2) Public Health Roles (2) Mass Fatality Management Evacuations/sheltering (humans and animals) Environmental Surety Community Recovery (rapid health risk assessment, mental health etc)

9. Precourse Review 1. Forms of anthrax include all of the following except: a.Neurological b.Cutaneous c.Gastrointestinal d.Pulmonary Answer: a 2. Appropriate Personal Protective Equipment to be worn while handling specimens suspicious for anthrax include: a.Surgical mask, Tyvek suit and goggles b.N95 mask, face shield, gloves, hat and boots c.Powered air purifying respirator, gown, gloves d.Surgical mask, eye protection, gloves, gown if necessary Answer: d

10. Precourse Review 3. Botulism is caused by: a.A neurotoxin produced by a spore that is ingested b.Septicemia caused by a gram negative bacillus c.A coronavirus d.Handling livestock Answer: a 4. Symptoms of botulinum poisoning include all of the following except: a.Visual disturbance b.Difficulty swallowing c.Paralysis on one side of the body d.Generalized weakness (hypotonia) in an infant Answer: c

11. Precourse Review 5. Which of the following statements is incorrect regarding Plague? a.Caused by a gram negative bacillus b.May cause fatal pulmonary infection c.Incision and drainage of buboes is the key to appropriate treatment d.May be passed from person to person via large droplets Answer: c 6. Appropriate management of pneumonic plague includes all of the following except: a.Droplet precautions until patient has completed 72 hours of antimicrobial therapy b.Doxycycline 100 mg. twice daily for post-exposure prophylaxis following confirmed or suspected bioterrorism exposure c.Post exposure vaccination d.sputum or tracheal aspirates for Gram’s, Wayson’s, and fluorescent antibody staining Answer: c

12. Precourse Review 7. An identified case of smallpox: a.Should be treated aggressively with antibiotics b.Is a public health emergency c.Should be assumed to be due to a failure of precautions at a BSL 4 laboratory d.Should be managed using droplet and contact precautions Answer: b 8. Post exposure to someone with smallpox, public health may require quarantine of contacts for what time period? a.7-19 days after last exposure b.1-21 days after last exposure c.1-17 days after last exposure d.Quarantine is not necessary after exposure to smallpox Answer: a

13. Precourse Review 9. Nerve Agents: a.Are more toxic in liquid form than in gaseous when released b.Stimulate acetylcholinesterase c.Result in tachycardia and large pupils d.Are lethal due to bronchorrhea and copious secretions Answer: d 10. Cyanide: a.Is almost impossible to obtain b.Works by inhibiting cellular aerobic respiration c.Is classified as a blister agent d.Produces tearing and salivation Answer: b

14. Precourse Review 11. Treatment for cyanide poisoning: a.Must be started within 2 hours of the exposure b.Is often extremely effective c.Has significant potential toxicity due to methemoglobinemia d.Includes decontamination with copious washing and dilution Answer: c 12. Which of the following is not a radiological/nuclear hazard? a.Alpha particle b.Beta particle c.Gamma ray d.Delta ray Answer: d

15. Precourse Review 13. When treating victims exposed to radiation, one must: a.Wear full protective equipment, including a level C air purifying respirator b.Stabilize and treat injuries first and foremost (wearing level D protection), as contamination of the health care worker is unlikely c.Decontaminate first; if the patient succumbs from their injuries they likely would have died from radiation sickness d.Not treat the patient until a formal dose assessment is performed Answer: b 14. With respect to Acute Radiation Sickness, which one of the following is true? a.If, in the first 6 hours after a suspected exposure, there are no symptoms of exposure serious ARS is unlikely b.Distance, time and administration of potassium iodide are the 3 most important factors in determining the level of illness c.The absorbed dose is measured in Curies d.The most serious manifestation is bone marrow stimulation Answer: a

16. Precourse Review 15. Potassium Iodide should not be used: a.In pregnant women b.In children or infants c.In persons situated more than 20 kilometres from an incident d.In a nuclear event involving I 131 Answer: c 16. What is the most effective way of protecting the public after a critical event? a.Assessment at hospital emergency departments b.Shelter in place and evacuation when necessary c.Mass administration of chelating agents d.Distribution of N95 respirators Answer: b

17. Questions?