1. Bioterrorism Workbook and Decision Support: The Pittsburgh Matrix Michael Allswede, D.O. Section Chief Special Emergency Medical Response University of Pittsburgh Medical Center Health System

2. Pittsburgh Matrix Provide a decision support tool for hospitals and hospital systems preparing for or responding to bioterrorism events Provide a method of determining value for bioterrorism capability Guide funding for hospital capability development

3. Pittsburgh Matrix: Stratification of Tasks High Priority ModerateLow Priority Immediate Anthrax Protocols Education Programs Command Center Development Short Term Lab capacity Quarantine Protocols Special Lab Capability New Research Long Term Improve Mass Decon Standardization of Training Medical School Curriculum

4. The Pittsburgh Matrix: Medical Decision-Making Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002

5. Pathogen Rating Communicability/Quarantine Needs 0: Non-communicable/No Quarantine Example: Bot Toxin 1: Blood and Body Fluid/Universal PrecautionsExample: HIV Virus 2: Close Contact/Universal PrecautionsExample: Ebola Virus 3: Airborne/HEPA FiltrationExample: Variola Virus Effectiveness of Medical Treatment 0: Comfort Measures Only NeededExample: Salmonella 1: Highly Effective-Survival ProbableExample: Skin Anthrax 2: Improved Survival-Survival ImprovedExample: Yersinia Pestis 3. Ineffective-Survival Not ImprovedExample: Variola Virus Availability of Medical Treatment 0: Non-Pharmaceutical Treatment Example: Clear Liquid Diet 1: Multiple Available PharmaceuticalsExample: Ames Strains 2: Insufficient Local Supply Pharmaceutical Example: Bot Antitoxin 3: Obscure or Experimental PharmaceuticalsExample: Variola Vaccine Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002

6. Effects of Preparedness Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002 Better Technology System Prepared ness

7. Anthrax Aerosol Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002 Note: Numbers represent pathogen scores (Percentages) represent estimated mortality rates Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002

8. Variola Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002 Note: Numbers represent pathogen scores (Percentages) represent estimated mortality rates

9. Decision Support Tool Each Medical Asset can determine capacity levels based on daily census, surge disaster planning, and community outreach Timeline will be evident so a given box can be accessed Each box has Key Decisions and Key Resources enumerated in a logical response hierarchy

10. Resource Valuation Key Resources (capabilities) within each matrix box are accounted using UPMC Health System data Survivorship estimates yield value in dollars/lives saved for each matrix Key Resource

11. Pittsburgh Matrix: Work to do Complete methodological workbook for other medical facilities to follow Estimation of probability of a given attack occurrence EX: World events change the threshold and likelihood of each given attack Estimation of detection capability of a given attack EX: Syndromic detection is better for larger scale events

12. For More Information AHRQ-sponsored Workbook for Regional Bioterrorism Preparedness A collaborative effort between Research Triangle Institute, UPMC Health Systems, and Intermountain Health Care Available: September 30, 2003 Contact: Lucy Savitz at savitz@rti.org