emergency preparedness: the new public health politics november 1, 2006
Post on 20-Dec-2015
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TRANSCRIPT
Prepared for what
• Bioterrorism• Mass casualty events• Chemical emergencies• Natural Disasters and catastrophes• Radiation emergencies• Outbreaks
Why we have become concerned
• Oklahoma City Bombing• Y2K concerns• 9/11 Terrorist attack• 2001 Anthrax outbreaks• West Nile Virus spread• Increase in Hurricanes (Katrina, Ivan, Rita)• Salmonella poisoning cases in 2006• Potential for pandemic outbreaks• In Vegas, how well can we respond?
Important Policy Issues
• Distinguishing between international threats and regional preparedness
• Placing too much confidence in responding agencies– Federal, State, Local governments– Private, non-profit agencies (funding
opportunities)
• Question: Are we better prepared now than we were during the cold war?
• What does preparedness mean?
Government focused responses
• Prepare for low-probability, high consequence events
• Stockpiling supplies• Created cynical
public• Public believed that
terrorist threats likely, just not to them
All Hazards approach to Preparedness
• To be ready for all types of disasters
• Acceptance of approach increased after Katrina and Rita
• Pushed by Department of Homeland Security– www.ready.gov
What is All Hazard Expectation to Public?
• Resources at ready for food, water, medications, radio and staples, etc.
• Family plans prepared for meeting places, phone numbers, and reunification
• Knowledge of local and regional plans such as evacuation routes, shelter locations other government information– Note: In some cases, government does
not want to pre-issue this information
Historical perspective of civil defense preparedness
• During WWII, most Americans did not know where to go in case of attack (most gave it no thought)
• Early Cold War (1953) less than 10% were prepared and figure didn’t increase much after Cuban missile crisis
• Thawing of Cold War led to even less preparedness in terms of civil defense
Preparedness Today
• In natural disaster zones, most Americans report being prepared, though significant numbers (> 40% still are not).
• For terror disaster planning, most Americans are not prepared. Reflection of 5 years of no attacks?
Preparedness in the Health Care Facility
• During Rita and Katrina, most health facilities were prepared.
• Many still did not have access.– Louisiana Nursing
Home deaths– Hospital evacuation
problems hampered during Katrina
– Rita nursing home transportation deaths
Health Care and Preparedness
• Hospitals generally more prepared because of regular exercises
• Latest efforts for disaster preparedness involves other long term care facilities as in case of needed additional facilities
• Incorporation of mobile hospitals in case of mass casualties
• Adoption of distribution centers for Rx drugs in cases of pandemics
Bioterrorism
Definition from a Health Perspective:
The deliberate release into the civilian population of a natural or
altered disease-causing virus, bacteria or toxin
…for the purpose of causing illness, death or inculcating fear.
Bioterrorism• Disease causing
agents used by terrorists – Placed in foods– Released in the
air– Introduced
directly into the population through infected persons
– Vectors
Threat from Chemical Agents
• March, 1995 Tokyo Subway– Sarin nerve gas
attack in 5 subway stations, hit simultaneously during rush hour
– 11 killed– 5,500 injured– 60% suffered
PTSD
Terrorist threat for bioterrorism
• 1984 – Salmonella Poisoning, Oregon– 750+ ill
• Contamination of salad bars – Bhagwan Shree
Rajneesh religious group
– Attempt to affect a local election
• 1996 St. Paul Medical Center, Dallas
• Shigella dysenteriae 2
– Contamination of muffins and doughnuts by a 27-year old lab technician
– 13 of 45 lab workers ill
– 20 year prison sentence
Threats to Food
Bioterrorism Threat
1984 Botulinum
1972 Typhoid
00959085807570
March 1995 Sarin
12 Dead, 5500 Affected
November 1995Radioactive
Cesium
December 1995Ricin
June 1996
Uranium
1992 Cyanide
March 1995 Ricin
April 1995 Sarin
April-June 1995Cyanide,
Phosgene, Pepper Spray
February 1997 Chlorine
14 Injured,500 Evacuated
June 1994 Sarin
7 Dead,200 Injured
May 1995 Plague
April 1997 U2351984
Salmonella
1985 Cyanide
750+ ill
Anthrax Threat: 2001
• October 2001• FL, NY, Wash.
D.C., CT– 5 deaths from
inhalation anthrax, 6 people recovering
– 11 people recovering from cutaneous anthrax
– 42 exposures, no disease Photos: FBI
As of December 5, 2001
• International tourist destination– 35 million visitors
a year
• One airport• Tightly-clustered
high occupancy buildings
• Fast growth• Nuclear facilities
Las Vegas Risk Profile
Bioterrorism Threatvs. HAZMAT
• The U.S. is better prepared for a chemical than biological terrorism attack.
• A troubling fact given that biological weapons are relatively easy to produce. Source: Florida Today. Artist: Jeff Parker
Bioterrorism Threatvs. HAZMAT
• This problem will not blow up in one city and stay there –
• This is a problem that will move.
Challenges in Recognizing a Bioterrorism Event
• Delayed onset
• Wide dissemination of cases
• Rarity of the natural disease
• Surveillance
• Communication
• DiagnosisSource: Vanderbilt Medical Center
Bioterrorism Preparedness
• National – State – Local involvement
• Metropolitan Medical Response System– Expanded existing
emergency preparedness plans
– “All Hazards Planning” approach in Clark County
Metropolitan Medical Response System
• Hospital Response
• National Pharmaceutical Stockpile
• Casualty Collection Points
• Strike Teams
• Private/Public Partnerships
• Forward Movement of Patients Source: Las Vegas Sun 10/21/01
Key Players inOutbreak Management• Local
– “First Recognizers”– CCHD and OOE– Hospital/ Reference
Laboratories– OOE Health Alert System– School Officials– Media– Elected Officials
• National– Centers for
Disease Control and Prevention
• State– NSHD State Health
Officer– NSHD State
Epidemiologist– Nevada Public Health
Laboratory– NV Health Alert System– NSHD Health Protection
Services– NV DEM– NV Dept Agriculture– Governor & Press Office– Elected Officials
Public Health - Role and Responsibility
• Delegated powers and duties of local Health Officer – Control and
prevent the spread of communicable diseases that may occur within the jurisdiction
– Community health perspective
Public Health Role and Responsibility• Lead Agency in
Bioterrorist Event
• Bioterrorism Preparedness at CCHD– Health Alert
System– Surveillance– Training
Public Health Surveillance
• Ongoing collection of data
• Estimates magnitude of problem
• Detects epidemics
• Documents distribution & spread
• Monitors changes in infectious agents
• Allows timely response
Local EpidemiologySurveillance Systems
• Influenza sentinel site program
• Gastroenteritis sentinel site program
• Public complaints
• Lab reports
• Clinician reports
Figure 1: Comparison of GE Occurrence 2000 & 2001, Clark County
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
20 22 24 26 28 30 32 34 36 38 40 42 44 46 48
Week Number
2000 2001
Role of EpidemiologyBT Preparedness & Response
• Determine if what the clinician is reporting is unusual
• Investigate to:– Determine source and
extent of outbreak– ID the pathogen– Contact medical
community– Initiate control measures
Bioterrorism Event Notification Protocol
• Local Health Officer– Event Unusual?– Event Bioterrorism
NOTIFY
State Health Dept
CDC
FBI
Epidemiologic Surveillance Clues
• An unusual increase in the number of people seeking care– Postal Workers from NY, D.C., CT
– Right disease, wrong month
• Right disease, wrong host
Bubonic plague from Mt. Charleston February
Arthritis Children
Pandemic Flu Impact
1918 2001
World population 1.8 billion 5.9 billion
Transportation ships, railroad jets
Flu circles planet 4 months 4 days
Prevention masks, vaccines?disinfectants
Treatments bed rest, aspirin antivirals?
Estimated dead 20+ million 60 million?
Time Magazine
Top Five Reasons to Report
• Prompt containment of potential outbreaks
• Allows timely intervention
• Over reporting is better than under reporting
• Minimizes your workload for follow-up
• IT’S THE LAW!!!
All Nevada physicians, laboratories and other health care providers are required to report a case of or a suspected case of certain communicable diseases. Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Nevada.
Official CodeOf Nevada: 441A.225
Biologic Agents - Highest Concern• Bacillus anthracis –
Anthrax
• Francisella tularensis – Tularemia
• Clostridium botulinum - Botulism
• Viral hemorrhagic fevers (Ebola, Lassa)
• Variola major – Smallpox
• Yersinia pestis – Plague