1. 1 Bioterrorism Presentation Sharon F. Grigsby, MBA Executive Director Bioterrorism Preparedness Program Public Health Department of Health Services County of Los Angeles

2. 2 The events of Fall 2001 Challenged Us All Our Sense of Invulnerability Our Self-Confidence Our Awareness of Public Infrastructure, and Our Definitions of First Responders

3. 3 Will the first response to a BT attack be this……

4. 4 …. or this?

5. 5 It’s more likely to look like this….

6. 6 …or this.

7. 7 Government Responds January 2002, President approves $1.1 billion for Bioterrorism Preparedness All fifty states, the territories and 4 major metropolitan areas receive funding

8. 8 HHS Funding Sources Centers for Disease Control and Prevention Focus on infectious disease control, public health needs Los Angeles, Chicago, New York, D.C. funded Los Angeles receives $24.6 million Health Resources and Services Administration Funding to States for Hospital Preparedness Los Angeles receives $3.6 million Office of Emergency Preparedness Funding provided for Metropolitan Medical Response Systems for 120 largest cities LA, Long Beach, Glendale funded in LA County

9. 9 CDC Funds Public Health for Bioterrorism, Emerging Infectious Diseases and other Public Health Emergencies Develop Comprehensive BT Plans Upgrade Disease Surveillance and Investigation Implement HASTEN with Health Providers Enhance Public Health Laboratory Capability Develop Risk Communication Capacity

10. 10 Lessons Learned from Anthrax Threats Inadequate internal communication system Need real time communication with most physicians Public communication strategy essential Full time central coordination essential

11. 11 Los Angeles County Public Health Threat Activities Pre-Sept 11 th 1999 CDC Funding of $800k Development of Epidemiology & Surveillance Capacity Development of Emergency Communications HASTEN Enhance Lab Capacity

12. 12 Being Prepared Education of medical community Education of public Training of special response teams Participation in exercises for different scenarios Development of communication systems Development of interagency protocols The Role of Public Health

13. 13 Initial Response to BT Induced Disease Early detection through surveillance/ rapid assessment of reports Mobilize laboratory Rapid confirmation of agent, site, initial at-risk population, prophylaxis and/or treatment Alert medical community, ERs, labs Implement disease specific plans (e.g. Smallpox) Determine resource needs and possible quarantine Coordinate with partner agencies (local/state/national) The Role of Public Health

14. 14 Continued Response to BT Induced Diseases Closely monitor communication network for new information Provide, accurate, timely information to public Continue epidemiologic investigation to refine at risk population Assess environmental contamination Provide or coordinate testing/ prophylaxis/ treatment to at-risk population Access biological stockpiles as necessary The Role of Public Health

15. 15 Large geographical area/mobile population real-time reporting & mapping applications Victims and/or those they infect may disperse before attack recognized communication strategy focusing on effective use of news media Victims may present at geographically dispersed medical offices and hospitals health provider/facility communication and reporting network BT Challenges in Los Angeles

16. 16 Early signs/symptoms nonspecific Provider education through multiple means Medical and laboratory communities not familiar with rare BT diseases establish syndromic surveillance provide training to increase awareness enhance collaboration between medical community and Public Health BT Challenges in Los Angeles

17. 17 CDC Public Health Bioterrorism Preparedness and Response Grant $24.6 million Six Focus Areas Planning Surveillance and Epidemiology Biological Laboratory Capacity Health Alert Network System Public Information and Risk Communication Training

18. 18 Jonathan E. Fielding, M.D., M.P.H. Director and Health Officer John F. Schunhoff, Ph.D. Chief of Operations -Surveillance -Bioterrorism -Community-wide Disease Reporting -Health Community Communications -Laboratory -Quarantine -Mass Immunization & Prophylaxis -Smallpox Plan Virginia Price Hastings Director John Celentano, M.D. Chief of Operations -Operational Medicine/Departmental -Disaster Coordination -Security -NPS Plan -Hospital Preparation for PPE/Decon Education/Training for Hospitals, First Responders Force Protection and Others -MMRS -DMAT and NMRT-West Teams -Coordination with Fire, Law and State and Federal Government Los Angeles County Department of Health Services Bioterrorism Response

19. 19 Assessment and Planning Assess existing public health preparedness status, including legal preparedness. Prepare Countywide response plan. Complete Regional response plan. Plan and implement exercises to test all aspects of response plans. Develop plan for National Pharmaceutical Stockpile use.

20. 20 Surveillance and Epidemiology Enhanced electronic disease surveillance Integrated Data Repository Establish and exercise mass prophylaxis plans Develop Epi Rapid Response Teams

21. 21 Enhanced Surveillance Activities Surveillance for influenza (data collected by state) ACD-Coroner Project Collaborating with the Office of the Coroner to monitor unexplained deaths Provides data on all non-trauma coroner’s cases to monitor for possible infectious causes. Animal illness/death surveillance (web-based) ED Syndromic Surveillance ReddiNet: CDC grant to explore adaptation for surveillance needs ED syndromic surveillance and rapid reporting pilot in 4 hospitals

22. 22 Laboratory Capacity Increase ability for rapid testing and identification of biological agents. Train local labs for bioterrorism preparedness. Increase availability of lab staff trained for bioterrorism. Relocate and renovate lab.

23. 23 Communications and Technology Develop systems for secure electronic exchange of public health information. Create mechanisms for broadcast messages and alert notifications. Improve communications technology: pagers, radios, satellite phones.

24. 24 Health Information and Risk Communications Develop public health bioterrorism messages for pre and post event use. Prepare materials in multiple languages. Train departmental spokespersons.

25. 25 Education and Training Assess public and staff needs for education on bioterrorism. Develop courses and curricula for bioterrorism preparedness. Develop partnerships with community stakeholders to disseminate information. Test effectiveness of educational programs and revise.

26. 26 Providing Information to the Public Bioterrorism website: www.labt.orgwww.labt.org 52,800 hits in since October 1, 2001 Health Info Line Over 1,200 calls in October and November 55% related to anthrax Community Presentations Over 200 since September 11, 2001 Brochures Over 35,000 distributed

27. 27 END