1. North Carolina’s Role in Preparedness

2. Objectives How you fit into the LRN Describe critical aspects of lab preparedness, surveillance and reporting, and response for bioterrorism Explain how clinical labs can access State PH Lab Access resources and training about response to bioterrorism

3. Laboratory Response Network Established in 1999 in response to Presidential Directive 39 which outlined national anti-terrorism policies and specific missions to federal agencies –CDC, FBI & APHL Mission –Enhance public health infrastructure –Integrate labs to create national & international network equipped to respond to acts of biological or chemical terrorism, emerging pathogens, etc.

4. Laboratory Response Network Sentinel Lab – Level A –Hospital, Health Departments, private and commercial labs Reference Labs – Level B/C –State, Local, Military, Federal and international labs National Labs – Level D –CDC, USARMIID, NMRC

5. Roles of the LRN Lab Reference service Specialized testing Direct services Environmental testing Rapid Testing Laboratory Improvement Applied research Disease identification and outbreak investigation Support of Surveillance and Epidemiology Investigations Emergency Preparedness and Response

6. All Laboratory Levels: Work Together As Members Of The National Laboratory Response Network for Bioterrorism Also Includes Department Of Defense, The Federal Bureau of Investigation, And Other Law Enforcement And Public Safety Agencies

7. Network Development Lab Assessment –Detailed Lab information via Sentinel Survey –Current Biosafety level and Clinical Scope Education –Online Training Resources (aphl.org) –Sentinel Lab Procedures (ASM) Training –Preparedness Workshop – 3x/year –Packaging and Shipping – 3x/year Proficiency –Sentinel Laboratory Drills –CAP-LPX – Laboratory Exercise

8. CAP LPX Preparedness Exercise Developed by CAP, CDC, and APHL Provide laboratories with opportunity to assess capabilities to detect pathogens of epidemiologic importance –Rule out and refer –Correct plan for notification –Packaging and Shipping –Handling of organisms

9. Current NC State Laboratory of Public Health

10. Anthrax in the US Mail - 2001 www.webofhope.com

11. Why is the Public Health Lab involved? Mandated by Congress Experience with Biological agents of concern and outbreak investigations Link between local lab level and CDC/federal agencies

12. The Role of NC State PH Lab Preparedness Unit Represent national Laboratory Response Network in state jurisdiction Conduct standardized LRN/CDC protocols Rule in or rule out presence of biologic agent Preserve forensic evidence for criminal investigation

13. Preparedness Contact Information SLPH Main # –919 733-7834 BTEP Unit –Main Line- 919-807-8765 –BT Pager (24/7)- 919-310-4243 –BT Duty Phone (24/7)- 919-807-8600 CT Unit –Main Line- 919-807-8771 –William Parks (cell) 919-602-2481 –Bernard Barrameda (cell) 919-710-5104

14. Clinical Laboratory Bioterrorism Readiness Plan http://www.asm.org/images/PSAB/BT_Rea diness.pdfhttp://www.asm.org/images/PSAB/BT_Rea diness.pdf American Society For Microbiology (ASM) provides a model for laboratories to use for developing a bioterrorism (BT) preparedness plan. Serves as an aid in the process of developing a specific plan for each institution.

15. Have A Plan 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

16. Questions to Answer 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?

17. Test Your Plan Annually Have a plan, test your plan, and keep it updated Provide training/in-service to your staff. Know whom to call Know chain of custody requirements Know shipping requirements

18. Bioterrorism Web Sites CDC: Laboratory Information for BT Emergencies –http://emergency.cdc.gov/bioterrorism/lab.asphttp://emergency.cdc.gov/bioterrorism/lab.asp CDC: Main BT homepage –http://www.bt.cdc.gov/http://www.bt.cdc.gov/ FDA: Main BT page –http://www.fda.gov/Drugs/EmergencyPreparedness/def ault.htmhttp://www.fda.gov/Drugs/EmergencyPreparedness/def ault.htm SLPH Web Site: –http://slph.state.nc.us/default.asphttp://slph.state.nc.us/default.asp

19. Conclusion The use of a biological or chemical agent for terrorism is a low probability event with very large, potentially devastating consequences BE PREPARED!

20. Course Pre-test Thank you for participating in North Carolina’s Role in Preparedness. The pre-test for the course is available at: http://www.quia.com/quiz/3062810.html http://www.quia.com/quiz/3062810.html

21. Questions or comments? Contact: Barbie Page, MS, MT(ASCP) Bioterrorism and Emerging Pathogens Unit Barbie.page@dhhs.nc.gov 252-714-0184