Wczesne wykrywanie czynników biologicznych w...

Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.

City of ChicagoMayor Rahm Emanuel

Wczesne wykrywanie czynników biologicznych w warunkach polowych: studia przypadków w kontekście procesu

podejmowania decyzji w instytucjach zdrowia publicznego w sytuacji reagowania na przewidywane uwolnienie

niebezpiecznego środka biologicznego2014 Konferencja Epimilitaris w Rynie, Polska

Suzet M. McKinney, Doktor Zdrowia Publicznego, magister Zdrowia Publicznego,

Zastępca Komisarza Departamentu Zdrowia Publicznego w Chicago

Misja i zadania BioWatch

Misja− Zapewnić, utrzymywać i wspierać ciągłą możliwość

monitorowania zagrożenia bioaereozolem w wybranych obszarach metropolitarnych

Zadania− Wykrywanie i charakterystyka atak z użyciem broni

biologicznej przeciwko miastom naszego Narodu, high value assets and special events

− Zwiększyć i udoskonalić możliwość monitorowania zagrożenia bioareozolem i potencjał, jednocześnie ograniczając wydatki

− Dostarczać wskazówki i wsparcie agencjom federalnym, państwowym i lokalnym w zakresie zarządzania skutkami

− Zapewnienie interoperacyjności z innymi krajowymi systemami monitorowania zagrożeń bioaerozolem i

t i i t ż i

Asystent Sekretarza ds. Gotowości i Reakcji na Incydenty

Zarządzanie w sytuacjach kryzysowycht

Organy ochrony porządku

publicznego

Operacje polowe Agencja Ochrony Środowiska

Ministerstwo Obrony

Federalne Biuro Śledcze

Centra Kontroli i Prewencji Chorób

Tajna Służba Stanów Zjednoczonych

Laboratoria krajowe

BioWatch

Właściciele obiektów

Operacje zdrowia publicznego

Operacje laboratoryjne

Pierwsza linia reagowania

Partnerstwa BioWatch

Wykon awcy

Ćwiczenia BioWatch w ChicagoMaj 2009

Opis ćwiczeń

Ćwiczenia funkcjonalne– Sieć Metro w Chicago (CTA)– Scenariusz pod dachem– Skupienie się na pobieraniu próbek ze

środowiska– Forward Command– Informacja publiczna/ media

Scenariusz– Gęsto zaludniona przestrzeń miejska– Pozytywne wyniki wykrycia wąglika w dwóch

kolektorach

Maj 20 (22:00)– Maj 21 (04:30)

– Łączne Dowodzenie na posterunku forward command

– Etap I pobieranie próbek ze środowiska peronu metra

Lipiec 18 (09:00 –15:00)– Analiza laboratoryjna

próbek pobranych w ramach etapu I

– Zmiana harmonogramu ze względu na reakcję na grypę H1N1 w laboratorium w maju

Opis ćwiczeń

Presenter

Presentation Notes

The exercise began at 10:00PM on May 20th and concluded at 4:30AM on May 21st. During this time, four city blocks were cordoned off for exercise play. The exercise began with a briefing at the forward command post followed by development of an incident action plan or IAP. BioWatch plans outlined that public health would take the lead during a biological incident. Immediately as the exercise started, I assumed the role of incident commander and remained in that position for the duration of the exercise. Twice during the exercise, between briefings at the forward command post, a mock press conference was held. At the first press conference, an initial briefing was given and this was followed by mock media posing questions to me, as the incident commander. The second mock press conference included briefings from me, the Chicago Transit Authority, and CDPH’s environmental health medical director. Shortly after the start of the exercise, sampling teams arrived on-scene from their designated staging area. Personnel decon was established, and teams suited up in PPE prior to entering the subway. Samples were taken from the track and mezzanine levels of the subway as well as the street level. All samples were completed in approximately an 1 hour and a half. The initial plan was to have the samples taken during the exercise immediately transported to the Illinois Department of Public Health Laboratory for analysis but due to the H1N1 influenza response, the lab portion of the exercise had to be rescheduled. When the lab was ready to complete the exercise, the samples taken during the exercise were mixed with 3 samples that were spiked with a non-pathogenic anthrax strain. The laboratory was able to distinguish all 3 spiked samples.

Ćwiczenia

Exercise conducted overnight; shut-down of downtown subway station

Four city blocks cordoned off for exercise play Unified command established Initial briefing at forward command post followed by

development of an Incident Action Plan (IAP) Mock press conferences Personnel decontamination Environmental sampling Sample transport Laboratory analysis

Presenter

Presentation Notes

Following the exercise, there was a brief hot wash with key players and CBED SPO evaluators. During the hot wash and subsequent meetings, a finalized After Action Report was completed and included lessons learned from the group as well as improvement planning for specific agencies. One lesson learned that came from the CBED SPO AAR was that the potentially exposed population may have been too narrowly defined. Since the subway in Chicago has shared airspace with an underground walkway and many significant buildings, the exposed population should have been expanded to include that population. A second lesson learned revolved around the details given during the mock media briefings. While the messages given were straightforward and clearly communicated, some of the details were not accurate. For example, the time of potential exposure was not accurately defined and symptoms should have been expanded to include influenza-like symptoms. A primary lesson learned from the laboratory portion of the exercise was that specific MOUs with other LRN laboratories are not established; while the laboratory understood what they would likely do in the event they were overwhelmed with BioWatch samples (clinical and/or environmental), a BioWatch-specific surge plan has not been outlined.

Lessons Learned After Action Report

– The potentially exposed population may have been too narrowly defined

– The media spokesperson communicated some inaccurate or unclear information at mock media briefings

– Laboratory-specific MOUs do not exist for surge support following a BioWatch event

Presenter

Presentation Notes

Following the exercise, there was a brief hot wash with key players and evaluators. During the hot wash and subsequent meetings, a finalized After Action Report was completed and included lessons learned from the group as well as improvement planning for specific agencies. One lesson learned that came from the AAR was that the potentially exposed population may have been too narrowly defined. Since the subway in Chicago has shared airspace with an underground walkway and many significant buildings, the exposed population should have been expanded to include that population. A second lesson learned revolved around the details given during the mock media briefings. While the messages given were straightforward and clearly communicated, some of the details were not accurate. For example, the time of potential exposure was not accurately defined and symptoms should have been expanded to include influenza-like symptoms. A primary lesson learned from the laboratory portion of the exercise was that specific MOUs with other LRN laboratories are not established; while the laboratory understood what they would likely do in the event they were overwhelmed with BioWatch samples (clinical and/or environmental), a BioWatch-specific surge plan has not been outlined.

Lessons Learned

Internal evaluations/observations– Members of the unified command (UC) were hard to

identify– Process for conducting coordinated criminal and

epidemiological investigations was unclear– Familiarity with radio use varied amongst responders

Presenter

Presentation Notes

During an internal evaluation of the exercise, further lessons learned were recognized. First, members of the unified command and their roles were hard to identify. It would be helpful to be able to clearly identify who the representative from each agency is as well as their role. Second, there seemed to be a lack of understanding of how to coordinate the epidemiological and criminal investigations. While these 2 investigations may have different objectives and data security issues (patient privacy vs evidence collection), the two disciplines are looking for essentially the same information. The third internal lesson learned was that it was unclear at times who had received radio training and the comfort level amongst responders for using the radios. Responders should develop a basic level of familiarity with radio in order to maintain constant and consistent communication.

Anthrax Response Exercise SeriesApril 2010

Exercise Overview Tabletop Exercise

Opportunity to asses target capabilities associated with the response to biological threats and to improve the management of the public health response to an anthrax incident across all levels of government

Target Capabilities tested– Communication– Emergency Public Safety and Security– Emergency Public Information and Warning– Critical Resource Logistics and Distribution– Mass Prophylaxis– Medical Supplies Management and Distribution

Participants

130 Participants (50 agencies)

Local representation− Law Enforcement (Chicago Police Department)− Fire/ Rescue (Chicago Fire Department)− Emergency Management (OEMC, CCDHSEM,

DCHSEM)− Public Health (CDPH, CCDPH, DCHD)− Other: Aviation, Environment − Hospitals (MCHC, IHA)

Participants

State representation– IL Department of Public Health– IL National Guard– IL Emergency Management Agency– IL Environmental Protection Agency

Federal representation– Office of Health Affairs– Department of Homeland Security– White House-Homeland Security Council– US DHHS– FEMA

Exercise Play

Facilitated Discussion

Lead representatives of various departments and agencies

3 Modules progressive phases of response– Initial response actions following a positive detection– Initial response actions– Continued response to a prolonged PH emergency

and recovery

Lessons Learned

Critical Resource Logistics and Distribution– Processes for managing and allocating resources

across region should be better defined– Should consider development of a regional SNS plan

for situations when multiple jurisdictions are impacted by an incident

– Laboratory capacities would be quickly overwhelmed

Mass Prophylaxis– Regional planning team to consider alternative

distribution methods would be beneficial– POD operations plans differ across the region

Lessons Learned

Medical Supplies Management & Distribution– Monitoring of supply usage and stockpile levels vary

across the region– Review of existing plans and consideration of regional

planning concepts for supply usage monitoring would be useful

Chicago-Milwaukee Regional BioWatch Exercise

August 2014

Exercise Overview Multi-jurisdictional, multi-agency tabletop exercise

Provided an opportunity for participants from both jurisdictions to discuss regional coordination in response to an interstate biological incident

Objectives:– Explore effectiveness of notifications, maintenance of multi-agency/

multi-jurisdictional strategic coordination during a biological event– Discuss the types and frequency of critical information/intelligence

exchange– Examine joint strategies and resources necessary for the rapid and

effective collection, analysis, and interpretation of environmental sampling data and human/animal surveillance data

Core capabilities tested:– Environmental Response/Health and Safety– Intelligence and Information Sharing– Operational Communications– Operational Coordination – Planning– Public Health and Medical Services– Situational Assessment

Exercise Overview

Exercise Play

Facilitated discussion

Included key public health and emergency management officials from neighboring jurisdictions

Scenario involved a positive detection on an American holiday in a mid-size city during a summer festival attracting thousands of people from a neighboring large, urban city. The following day, 2 positive detections were made during a large fireworks display attracting millions of people in the large, urban city.

Operational Communications− Formalized interstate notification protocols will

enhance response operations in neighboring jurisdictions

Planning− Regional planning should be conducted to minimize

vast differences in response to field detection of biological threats in neighboring cities.

− Indoor detections create significant community and economic impacts that must be resolved

Lessons Learned

Operational Coordination− Regional ICS structures should be considered to

enhance interstate response efforts

Intelligence and Information Sharing– Protocols for efficient intelligence sharing between

fusion centers and partners should be clarified between neighboring jurisdictions

Environmental Response/Health and Safety− Availability of federal resources could be scarce due

to requests from multiple jurisdictions

Lessons Learned

Early-warning systems are critical in the ability to detect environmental occurrences of biologic threats

Exercise examples include three different scenarios of varying size, scale and scope

Some lessons learned in public health decision making were consistent across all three scenarios, despite size, scale or scope

Overall Findings

Most critical public health decisions are in the areas of:− Emergency Public Information and Warning− Notification of elected officials and other political

leaders− Management of healthcare notification vs. public

notification− Timeline for transition to all-hazard response plans− Considerations for joint criminal and epidemiological

investigations − Initiation of medical countermeasure distribution− Care and management of at-risk populations

Overall Findings

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