Case Studies in Public Health Decision Making in Response to

Case Studies in Public Health Decision Making in Response to

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 biologicznego
2014 Konferencja Epimilitaris w Rynie, Polska
Suzet M. McKinney, Doktor Zdrowia Publicznego, magister Zdrowia
Publicznego,
Zastępca Komisarza Departamentu Zdrowia Publicznego w Chicago
City of Chicago
Mayor Rahm Emanuel
Chicago Department of Public Health
Commissioner Bechara Choucair, M.D.
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
Partnerstwa BioWatch
Operacje polowe
Operacje
laboratoryjne
Agencja Ochrony
Środowiska
Ministerstwo Obrony
Operacje zdrowia
publicznego
Federalne Biuro Śledcze
Zarządzanie w
sytuacjach
kryzysowycht
Centra Kontroli i
Prewencji Chorób
Organy ochrony
porządku
publicznego
Asystent Sekretarza
ds. Gotowości i
Reakcji na Incydenty
Pierwsza linia
reagowania
Tajna Służba Stanów
Zjednoczonych
Właściciele
obiektów
Wykon
awcy
Laboratoria krajowe
BioWatch
Ćwiczenia BioWatch w Chicago
Maj 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
Opis ćwiczeń
 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
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
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
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
Anthrax Response Exercise Series
April 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
Exercise Overview
 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 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.
Lessons Learned
 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
Overall Findings
 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
@ChiPublicHealth
facebook.com/ChicagoPublicHealth
312.747.9884
[email protected]
www.CityofChicago.org/Health