1. BIOTERRORISM PREPAREDNESS TRAINING SOCIAL WORKERS

2. Biological Agents of Highest Concern Smallpox Anthrax Plague Tularemia Botulism Viral Hemorrhagic Fevers

3. Types of Illnesses These Agents Can Cause “Flu-like” illness (fever, sweats, nausea) Cough and/or pneumonia Headache, confusion Skin ulcers (anthrax, tularemia, plague) Rashes (smallpox, viral hemorrhagic fevers) Paralysis (botulism)

4. Contagious Agents Person-to-Person Transmission Smallpox Plague Pneumonia Some Viral Hemorrhagic Fevers (Ebola)

5. Antibiotics, Antitoxin, or Immunization Antibiotics – Anthrax, Plague, Tularemia Antitoxin – Botulism Immunization – Smallpox, Anthrax, Some Viral Hemorrhagic Fevers

6. Decontamination – Category A Critical Agents Exposed persons – showering/washing thoroughly with soap & water adequate for most; bleach not necessary Facility & equipment – may not be necessary if contaminated with agents of short survival time; others may need bleach, sporacidal chemicals, incineration and/or sterilization in autoclave

7. Infection Control – Category A Critical Agents Standard precautions – all cases Airborne & contact precautions - smallpox, viral hemorrhagic fevers Droplet precautions – pneumonic plague

8. Infection Control Standard Precautions Disposable, non-sterile gloves Handwashing after glove removal Disposable gown/apron, face-shield if splashing anticipated Change protective gear between cases

9. Infection Control Contact Precautions Standard precautions plus Wear gloves & gown, change after contact with infectious material Dedicate non-critical patient care items to single patient or disinfect between patients

10. Infection Control Airborne Precautions Airborne Precautions Standard precautions plus Patient in negative air pressure room Wear respiratory protection (HEPA filter mask)

11. Infection Control Droplet Precautions Standard precautions plus Wear mask when within 6 feet of patient

12. Quarantine vs. Isolation Isolation: separation of a contagious person/group from other people to prevent spread of infection Quarantine: restrictions of activities or limitations of freedom of movement of those presumed exposed to communicable disease to prevent contact with those who have not been exposed

13. Emergency Operations Planning – 4 Components Preparedness – evaluate the risks/probabilities Response – how to deal with risks/probabilities Mitigation – how to minimize the effects or prevent reoccurrence of disaster Recovery – what would be needed to restore unmet needs/how to do this

14. Incident Command System System for organizing a response (based on the emergency operations plan) to an emergency after it occurs Common goal of stabilizing the incident: protecting life, property and environment

15. Incident Command System Directed by Incident Commander 4 Basic Functions Planning: determine what specifically needs to be done to handle the incident Operations: directs all resources to carry out the plan Logistics: provides the resources & all other services needed to support the plan Finance/Administration: monitors costs related to managing the incident

16. Severity of Response Dependent Upon Proximity to event (injured/bereaved) Intensely exposed (first responders) Displaced from home/work Loss of property Age (child/elderly) Special Needs (developmentally disabled/blind/cognitively impaired/etc) Culture

17. Severity of Response Dependent Upon Continued History of: Previous trauma Mental illness Substance Abuse Chronic Illness

18. Early Intervention Goal #1 Safety: Protect from further physical harm (remove from traumatic scene) See to basic needs (food, shelter, clothing, sanitation, sleep, medical care) Information dissemination

19. Early Intervention Goal #2 Function: Support to return to normal function (reduce stressors/reminders) Link to critical resources Reunite and keep families together Educate about responses to stressful or traumatic events

20. Early Intervention Goal #3 Action: Support to return to productive activity Redirect to constructive/helping tasks

21. Communication General Guidelines Tell the truth as it is known, when it is known Explain what is being done to deal with the situation Avoid withholding bad news or disturbing information Be forthright about what is not known Provide practical guidance Messages should be simple & straightforward

22. Self-Care Healthy lifestyle Self-regulation Positive coping skills (resilience) Stress management Education Emergency Preparedness Practice

23. Preparedness Training New Jersey State Division of Mental Health Training New Jersey Department of Homeland Security American Red Cross FEMA Disaster Mental Health Training NOVA (National Organization of Victims Advocacy) International Critical Incident Stress Foundation (ICISF) Religious organizations with disaster response groups Professional organizations

24. Summary of Key Points Most biological agents of concern produce initial non-specific or “flu-like” illness Standard precautions should be used with all patients following bioterrorism incident Reactions to a disaster will differ, but a structured response is necessary Care providers need to practice self-care Train for emergency preparedness