1. National Governors Association Policy Summit on Domestic Terrorism National Governors Association Policy Summit on Domestic Terrorism Tabletop Exercise Major Issue Recap

2. ! A clandestine meth lab was destroyed in a fire. ! The investigation revealed a biological laboratory. ! One individual was arrested at the scene; a second escaped and has not been apprehended. ! Several containers labeled “plague slurry” were discovered in the bio lab. The contents have not been confirmed. ! An interagency assessment has deemed the threat credible. Episode 1 Summary

3. Episode One Discussion Alert and Notification –FBI reports that we have a credible threat –State EM has not been asked for anything Public Health Surveillance –Concerned for outbreak, BUT is the Plague slurry real? –Health system is not familiar with Plague symptoms –Ramp up active surveillance and distribute diagnostic information Plan Activations –Governor, we do not have a (BT response) plan! –Call cabinet together and begin working through issues.

4. Episode One Discussion Continued Resource requirements –If Plague is real we will be short of antibiotics –Identify availability of antibiotics –Notify CDC of potential need for Antibiotics and support Status of investigations –FBI says credible threat and are in charge at site. –Whose in charge? Governor you are. –Make decisions based upon health recommendations and Task Force and Cabinet recommendations. Public Safety and Notification –No press interest at this time however we should develop public releases for use if required. –Notify the five major hospitals

5. Episode One Discussion Continued Control measures including quarantine –Governor has the authority based upon imminent emergency and emergency declaration. –Insufficient information to act on need for Quarantine Proclaiming of emergencies –No specific response to Governors question should I declare an emergency other than you have the authority Consequences ( mortality and morbidity) associated with a potential plague release –Plague is deadly contagious agent that usually effects animals or humans in third world countries. No Vaccines, antibiotics are the treatment. Must be administered early.

6. ! Queries of local hospitals identified unusual clusters, nearly all college students, with symptoms consistent with possible exposure to plague. The first patient admitted over the weekend has died. ! Y. pestis (plague) was detected in the containers and fire extinguishers. ! The van containing the dispersal device was in parking garage upwind from a dance club frequented by college students. ! The local media are reporting a possible bioterrorism attack, and are prepared to identify the agent as plague. ! National networks will air breaking news reports momentarily. Episode 2 Summary

7. Episode Two Discussion Plans for mass treatment and medication –Continue active surveillance –Provide clear guidance on symptoms and treatment –Establish hot line for information dissemination and victim identification –Establish treatment registry Healthcare system capacity –Potential for overload of health system –Supplemental health care resources may be required Federal supplemental assistance –CDC has been notified and assistance requested –FEMA and DHHS have been notified that supplemental health care assistance may be required

8. Episode Two Discussion Continued Emergency Authorities and Declarations –Governor has declared a State of Emergency Quarantine –No Quarantine of any area in the State –Recommend that all ill patients be initially isolated –Identify and treat persons who were in close proximity to release Public Safety and announcements –Governor will give a coordinated press conference –Press representative fears this is late –Press secretary forms Joint Information Center –Release credible and detailed factual information often –Inform the public concerning the risk and who is at risk

9. Episode Two Discussion Continued Direction and control of local and State and Federal response –State EOC and EOP are activated. –Emergency operations staff are also working on recovery planning and associated issues Impact on animal populations. –No input this section. Potential for disease transmission Joint information Management –State press Secretary continues frequent press releases in coordination with health officials. Spokesperson available around the clock 24/7.

10. ! Gotham, New Aberdeen and the nation are dealing with the consequences of a successful bioterrorism attack. ! Surrounding counties, states and a host of countries are monitoring the incident and have taken precautionary steps. ! Problems are occurring in the mass treatment and medication of those potentially exposed to the plague. ! The number of victims now appears to be relatively small, and is confined in great part to University of New Aberdeen students. Episode 3 Summary

11. Episode Three Discussion Implementation of mass treatment and medication –Need to send a consistent coordinated interagency message on medical treatment –Persons who are coughing should be isolated and treated –Continue to administer prophylaxis as required to patients and exposed individuals. Healthcare system capacity –Stressed at 72 hours –Lack of surge capability at local level is evident Federal supplemental assistance. –Federal agency liaison are in the State EOC –CDC providing stockpile

12. Episode three Discussion Continued Quarantine –Reserve the right but no quarantine –Continue isolation of ill patients –Continue hot line and information on risk and symptoms Public safety and safety announcements –Continue joint information bulletins on public health issues and status of the response and recovery. –Ensure multi-language public information is available. Direction and control of local State and Federal Resources –FEMA CDC and other key Federal players have liaison personnel in state EOC. – Consider utilization of Civil Support Teams. –Consider use of National Guard to support state and Local Police

13. Episode three Discussion Continued Impact on animal populations and potential long-term consequences –Consider quarantine of specific animals –Implement vector control for rodents and fleas –Implement Joint information management on animal population at risk, symptoms and recommended actions Recovery –Who pays and how much will be paid by FEMA under a Presidential Emergency Declaration –Coverage for extra-ordinary costs to private hospitals? –Ensure close Federal, State and Local Public health coordination and communication

14. Closing Comments Major issues: –1. An adequate infrastructure for planning is critical and a current exercised bio-plan is essential. –2. A viable communication and Public Information plan is critical –3. A competent and informed surveillance system is essential for timely decision making and response –4. Need greater coordination between the law enforcement and public health. –5. The Governor has sufficient authorities to lead and manage his resources for a public health emergency

15. Closing Comments Continued 6. The systems will have to respond to biological health crisis regardless of a terrorism component. –Robust health systems ( with surge capability) are essential to manage mass fatalities and long term health care recovery 7. Don’t forget that the Joint Task Force for Civil support is a Federal asset. 8. DHHS reminds you that Federal assistance is only a phone call away. Call early.

19. National Governors Association A Policy Summit On Domestic Terrorism Tabletop Exercise Major Issues Recap