15.11 Department of Health and Human Services 15.11.1 Agency for Healthcare Research and Quality 15.11.2 Centers for Disease Control and Prevention 15.11.3 Rapid Response and Advance Tec
Trang 1CHAPTER 15
SecurityMartha J Boss and Dennis W Day
CONTENTS
15.1 Security and Bioterrorism
15.1.1 Federal Response Plan
15.6 Federal Response of the United States
15.6.1 State and Local Outreach
15.6.2 Federal Response Teams and Exercises
15.6.3 Special Events
15.6.4 Bioterrorism Identification and Medical Response
15.7 U.S Department of Agriculture
15.7.1 Agricultural Research Service
15.7.2 Food Safety Inspection Service
15.7.3 Office of Crisis Planning and Management
15.8 Department of Commerce
15.8.1 National Institute of Standards and Technology
15.8.2 National Oceanic and Atmospheric Administration
15.8.3 National Telecommunications and Information Administration
15.8.4 U.S Patent and Trademark Office
15.8.5 Bureau of Export Administration
15.8.6 Critical Infrastructure Assurance Office
15.9 Department of Energy
15.10 Department of Defense
15.10.1 Defense Advanced Research Projects Agency (DARPA)
15.10.2 Joint Task Force for Civil Support
15.10.3 National Guard
15.10.4 U.S Army
Trang 215.11 Department of Health and Human Services
15.11.1 Agency for Healthcare Research and Quality
15.11.2 Centers for Disease Control and Prevention
15.11.3 Rapid Response and Advance Technology Laboratory
15.11.4 Laboratory Response Network for Bioterrorism
15.11.5 Health Alert Network
15.11.6 National Bioterrorism Response Training Plan
15.11.7 Food and Drug Administration
15.11.8 National Institutes of Health
15.11.9 National Institute for Occupational Safety and Health
15.11.10 Office of Emergency Preparedness
15.11.11 National Center for Environmental Health
15.12 Department of Justice (DOJ)
15.12.1 Federal Bureau of Investigation
15.12.2 Office of Justice Programs
15.13 Department of Transportation
15.13.1 Civil Aviation Security
15.13.2 Federal Aviation Administration Office of System Safety
15.13.3 Federal Transit Administration Safety and Security Office
15.13.4 Hazardous Materials Safety
15.13.5 National Response Center
15.13.6 Research and Special Programs Administration (RSPA) Office
of Pipeline Safety
15.13.7 U.S Coast Guard Marine Safety Center
15.14 Department of the Treasury
15.14.1 U.S Secret Service
15.15 Environmental Protection Agency
15.16 Federal Emergency Management Agency
15.16.1 Office of National Preparedness: Consequence Management
of WMD Attack
15.17 Office of Management and Budget Oversight of Terrorism Funding
15.18 Department of Veterans Affairs
15.18.1 Medical Supplies
15.19 Federal Working Groups
15.19.1 Collaborative Funding of Smallpox Research
15.19.2 Cooperative Work on Rapid Detection of Biological Agents in Animals,
Plants, and Food
15.19.3 Food Safety Surveillance Systems
15.19.4 Force Packages Response Team
15.19.5 Informal Working Group — Equipment Request Review
15.19.6 Interagency Board for Equipment Standardization and Interoperability15.19.7 National Medical Response Team Caches
15.19.8 National Disaster Medical System
15.19.9 National Pharmaceutical Stockpile Program
15.19.10 National Response Teams
15.19.11 Technical Support Working Group
15.19.12 Standing Agreements, Plans, and Programs
15.20 Sound Threat and Risk Assessments
15.21 Fragmentation
15.22 Biological Agent Threat Lists
15.23 Local Preparedness
Trang 315.23.1 Infectious Disease Surveillance System
15.23.2 Hospitals
15.24 Homeland Security
15.25 Identification of Biological Agents
15.26 Chemical and Biological Weapons Response Challenges
15.26.1 Generic Problems and Solutions
15.26.2 Problems and Solutions for Chemical and Biological Terrorist Events
15.27 NIOSH and CDC Personal Protective Equipment Recommendations
to assist in the decisions needed to integrate these responses Other countries may have similar methodologies; however, given that the United States responds to worldwide situations, coordination must occur with standing United States agencies and conceptual paradigms
15.1 SECURITY AND BIOTERRORISM
The report Bioterrorism: Federal Research and Preparedness Activities (U.S General ing Office (GAO)-01–915, Sept 28, 2001) report mandated by the Public Health Improvement Act
Account-of 2000 (P.L 106-505, sec 102) was presented October 5, 2001 This testimony was presented before the Subcommittee on Government Efficiency, Financial Management, and Intergovernmental Relations, Committee on Government Reform, House of Representatives The testimony described the following:
• Research and preparedness activities being undertaken by federal departments and agencies to manage the bioterrorist attack consequences
• Coordination of these activities
• Findings on the preparedness of state and local jurisdictions to respond to a bioterrorist attackBioterrorism is the threat or intentional release of biological agents (viruses, bacteria, or their toxins) for the purposes of influencing the conduct of government or intimidating or coercing a civilian population Federal departments and agencies are participating in a variety of research and preparedness activities, including:
• Improving the detection of biological agents
• Developing a national pharmaceuticals stockpile to treat disaster victims
Coordination among federal departments and agencies is fragmented Concerns are emerging about the preparedness of state and local jurisdictions, including:
• Insufficient state and local planning for response to terrorist events
• Inadequacies in the public health infrastructure
Trang 4• Lack of hospital participation in training on terrorism and emergency response planning
• Insufficient capabilities for treating mass casualties
• Lack of timely availability of medical teams and resources in an emergency
15.1.1 Federal Response Plan
In an emergency that required federal disaster assistance, federal departments and agencies would respond according to responsibilities outlined in the Federal Response Plan The Federal Response Plan, originally drafted in 1992 and updated in 1999, is authorized under the Robert T Stafford Disaster Relief and Emergency Assistance Act (Stafford Act; P.L 93–288, as amended) The plan outlines the planning assumptions, policies, operation concepts, organizational structures, and specific assignment of responsibilities to lead departments and agencies in providing federal assistance once the President has declared an emergency requiring federal assistance
15.1.2 Potential Attacks
Two types of attacks were discussed in the testimony:
• Weapons of mass destruction
• Biological agents — bioterrorism
A biological attack was considered unique in that detection time from the attack to initiation
of symptoms that alert to an attack may be several days During the delay interval, infection of others not immediately associated with the initial attack event may occur The initial and subsequent infections may also be misdiagnosed, leading to further spread and lack of effective governmental emergency response Consequently, in order to successfully respond, the following coordinated activities are required:
• Infectious disease surveillance
• Epidemiological investigation
• Laboratory identification of biological agents
• Distribution of antibiotics to large population segments to prevent the spread of an infectious disease
• Providing emergency medical services
• Continuing healthcare services delivery
• Managing mass fatalities
15.2 CRISIS AND CONSEQUENCE MANAGEMENT
Federal programs to prepare for and respond to chemical and biological terrorist attacks operate under an umbrella of various policies and contingency plans Federal policies on combating terrorism are laid out in a series of presidential directives and implementing guidance Federal response to terrorist attacks may overlap and run concurrently during the emergency response and are dependent upon the nature of the incident
15.2.1 Crisis Management
Efforts to stop a terrorist attack, arrest terrorists, and gather evidence for criminal prosecution are led by the Department of Justice, through the Federal Bureau of Investigation All federal agencies and departments, as needed, would support the Department of Justice and the Federal Bureau of Investigation on-scene commander
Trang 515.2.2 Consequence Management
Efforts to provide medical treatment and emergency services, evacuate people from dangerous areas, and restore government services are led by the Federal Emergency Management Agency in support of state and local authorities (Note: The federal government does not have primary responsibility for consequence management; state and local authorities do.)
15.3 CONTINGENCY PLANS
In a chemical or biological terrorist incident, the federal government would operate under one
or more contingency plans The U.S Government Interagency Domestic Terrorism Concept of Operations Plan establishes conceptual guidelines for:
• Assessing and monitoring a developing threat
• Notifying appropriate agencies concerning the nature of the threat
• Deploying necessary advisory and technical resources to assist the lead federal agency in facilitating interdepartmental coordination of crisis and consequence management activities
In the event that the President declares a national emergency, the Federal Emergency ment Agency would coordinate the federal response using a generic disaster contingency plan called the Federal Response Plan The Federal Response Plan is authorized by the Robert T Stafford Disaster Relief and Emergency Assistance Act (P.L 93–288, as amended) It provides a broad framework for coordinating the delivery of federal disaster assistance to state and local governments when an emergency overwhelms their ability to respond effectively and designates primary and supporting federal agencies for a variety of emergency support operations The Plan includes:
Manage-• Federal agency roles in consequence management during terrorist attacks
• Health and medical services
Several individual agencies have their own contingency plans or guidance specific to their activities
15.4 COORDINATION
In May 1998, the President established a National Coordinator within the National Security Council to better lead and coordinate these federal programs The position’s functions were never detailed in either an executive order or legislation Many of the overall leadership and coordination functions that the GAO has identified as critical were not given to the National Coordinator Several agencies performed interagency functions that the GAO believed would have been performed more appropriately above the level of individual agencies The interagency roles of these various agencies were not always clear and sometimes overlapped, which led to a fragmented approach The Department of Justice, the National Security Council, the Federal Bureau of Investigation, and the
Trang 6Federal Emergency Management Agency all had been developing or planning to develop potentially duplicative national strategies to combat terrorism.
The President announced the creation of an Office of Homeland Security on September 20,
2001, and specified its functions in Executive Order 13228 on October 8, 2001 These actions represent potentially significant steps toward improved coordination of federal activities and are generally consistent with recent recommendations Some questions that remain to be addressed include:
• How will this new office be structured?
• What authority will the director have?
• How can this effort be institutionalized and sustained over time?
15.5 EVENT PROBABILITY
The Federal Bureau of Investigation had identified the largest domestic threat to be the wolf terrorist, an individual who operates alone U.S intelligence agencies have reported an increased possibility that terrorists would use chemical or biological weapons in the next decade; however, terrorists would have to overcome significant technical and operational challenges to successfully produce and release chemical or biological agents of sufficient quality and quantity
lone-to kill or injure large numbers of people without substantial assistance from a foreign government sponsor
In most cases, specialized knowledge is required in the manufacturing process and in vising an effective delivery device for most chemical and nearly all biological agents that could be used in terrorist attacks Some of the required components of chemical agents and highly infective strains of biological agents are difficult to obtain Terrorists may have to overcome other obstacles
impro-to successfully launch an attack that would result in mass casualties, such as unfavorable
meteo-rological conditions and personal safety risks The term weapon of mass destruction (WMD)
generally refers to chemical, biological, radiological, or nuclear agents or weapons As clearly shown on September 11, a terrorist attack would not have to fit that definition to result in:
• Mass casualties
• Critical infrastructures destruction
• Economic losses
• Disruption of daily life nationwide
The attack increased the uncertainties regarding the threat, given that the attacks:
• Were conducted by a large group of conspirators rather than one individual
• Constituted long-planned coordinated efforts, showing a level of sophistication that may not have been anticipated by the Federal Bureau of Investigation
• Were implemented by individuals willing to commit suicide in the attacks, showing no concern for their own personal safety, which was considered one of the barriers to using chemical or biological agents
15.6 FEDERAL RESPONSE OF THE UNITED STATES
The preparedness efforts of federal departments and agencies have included:
• Increasing federal, state, and local response capabilities
• Developing response teams of medical professionals
Trang 7• Increasing availability of medical treatments
• Participating in and sponsoring terrorism response exercises
• Planning to aid victims and providing support during special events such as presidential rations, major political party conventions, and the Superbowl
inaugu-(Note: Presidential Decision Directive 62, issued May 22, 1998, created a category of special events
called National Security Special Events, which are events of such significance that they warrant greater federal planning and protection than other special events.)
15.6.1 State and Local Outreach
Several federal departments and agencies, such as the Federal Emergency Management Agency (FEMA) and the Centers for Disease Control and Prevention (CDC), have programs to increase the ability of state and local authorities to successfully respond to an emergency, including a bioterrorist attack These departments and agencies contribute to state and local jurisdictions by:
• Paying for equipment
• Developing emergency response plan elements
• Providing technical assistance
• Increasing communications capabilities
• Conducting training courses
15.6.2 Federal Response Teams and Exercises
Some federal departments and agencies have developed teams to directly respond to terrorist events and other emergencies Federally initiated bioterrorism response exercises have been con-ducted across the country
15.6.3 Special Events
Special events include presidential inaugurations, major political party conventions, and the Superbowl Federal departments and agencies also provide support at special events to improve response in case of an emergency Besides improving emergency response at the events, participa-tion by departments and agencies gives them valuable experience working together to develop and practice plans to combat terrorism
15.6.4 Bioterrorism Identification and Medical Response
Federal departments and agencies have also been increasing their own capacity to identify and deal with a bioterrorist incident For example, the CDC, U.S Department of Agriculture (USDA), and Food and Drug Administration (FDA) are:
• Improving surveillance methods for detecting disease outbreaks in humans and animals
• Establishing laboratory response networks to maintain state-of-the-art capabilities for biological agent identification and characterization of human clinical samples
Several agencies are involved in increasing the availability of medical supplies that could be used
in an emergency, including a bioterrorist attack The CDC’s National Pharmaceutical Stockpile contains pharmaceuticals, antidotes, and medical supplies that can be delivered anywhere in the United States within 12 hours of the decision to deploy The stockpile was deployed for the first time on September 11, 2001, in response to the terrorist attacks on New York City and Washington, D.C
Trang 8The GAO identified over 20 departments and agencies as having a role in preparing for or responding to the public health and medical consequences of a bioterrorist attack The potential redundancy of these federal efforts highlights the need for scrutiny In the GAO report on combating terrorism issued on September 20, 2001, the GAO recommended that the President, working closely with the Congress, consolidate some of the activities of DOJ’s Office of Justice Programs (OJP) under the Federal Emergency Management Agency (FEMA).
15.7 U.S DEPARTMENT OF AGRICULTURE 15.7.1 Agricultural Research Service
The Agricultural Research Service (ARS) is
• The principal in-house research agency of the USDA
• One of the four component agencies of the Research, Education, and Economics (REE) mission area
Congress first authorized federally supported agricultural research in the Organic Act of 1862, which established what is now the USDA That statute directed the Commissioner of Agriculture
to acquire and preserve in his department all information he could obtain by means of books and correspondence and by practical and scientific experiments The USDA’s agricultural research programs scope has been expanded and extended many times since the department was first created ARS has about 1200 research projects working at over 100 locations across the country and at 4 overseas laboratories The National Agricultural Library and the National Arboretum are also part
of Animal and Plant Health Inspection Service (APHIS), the mission of which is to protect America’s animal and plant resources by:
• Safeguarding resources from exotic invasive pests and diseases
• Monitoring and managing agricultural pests and diseases existing in the United States
• Resolving and managing trade issues related to animal or plant health
• Ensuring the humane care and treatment of animals
The APHIS mission is an integral part of the USDA’s efforts to provide the nation with safe and affordable food Without APHIS protecting America’s animal and plant resources from agri-cultural pests and diseases, threats to our food supply would be quite significant
Congress has passed several laws that give APHIS the authority to implement its protection mission APHIS employees are organized into five main operational divisions: Animal Care, International Services, Plant Protection and Quarantine, Veterinary Services, and Wildlife Services The principal legislative authorities of APHIS include the Organic Act of 1944, the Plant Protection Act (as contained in the Agricultural Risk Protection Act of 2000), Sections 12–14 of the Federal Meat Inspection Act, the Bureau of Animal Industry Act of 1884, the Tariff Act of 1930, the Animal Damage Control Act of 1931, the Animal Welfare Act of 1966, the Horse Protection Act of 1970, and the Virus–Serum–Toxin Act of 1913 Several laws authorize the collection of user fees for agricultural quarantine inspection and other APHIS services
15.7.2 Food Safety Inspection Service
The Food Safety Inspection Service (FSIS) inspects meat, poultry, and egg products and conducts strategic planning
Trang 915.7.3 Office of Crisis Planning and Management
The Office of Crisis Planning and Management (OCPM), under the Assistant Secretary for Administration, Office of the Secretary, serves as USDA’s focal point for coordinating national security, natural disaster, other emergencies, and agriculture-related international civil emergency planning and related activities, and acts as the primary USDA representative for antiterrorism activities Duties include:
• Coordinating with agencies and offices within the USDA to identify USDA intelligence ments and convey them to the intelligence community
require-• Organizing and distributing specialized intelligence reports to individual agencies and offices within the USDA
• Providing staff support for the USDA Counter-Terrorism Policy Council and the Director of OCPM who chairs the USDA Biosecurity Committee
• Serving as primary contact with the Federal Emergency Management Agency (FEMA) and all other federal departments and agencies having emergency responsibilities
• Establishing, maintaining, and managing emergency management policies and programs for the department to ensure that an emergency structure is in place to respond swiftly to a disaster or other crisis situation (the emergency structure is required to assess the impact of the disaster on food production, processing, and food distribution and to ensure that assistance programs are operating in the affected area)
• Coordinating USDA participation in disaster-related exercises and conducting training sessions for USDA State Emergency Boards
• Facilitating coordination of USDA agencies within the department and with other federal ments and organizations on matters concerning crisis planning and management
depart-• Managing the USDA’s critical situations emergency response effort, including its Continuity of Operations and Continuity of Government plans under Presidential Decision Directives (PDDs)
as well as the USDA Emergency Coordination Center management
15.8 DEPARTMENT OF COMMERCE 15.8.1 National Institute of Standards and Technology
The National Institute of Standards and Technology (NIST) is a nonregulatory federal agency within the U.S Commerce Department Technology Administration The mission of NIST is to develop and promote measurements, standards, and technology to enhance productivity, facilitate trade, and improve the quality of life Duties include:
• Conducting projects that support law enforcement, military operations, emergency services, airport and building security, cyber security, and efforts to develop new types of security technologies
• Developing cutting-edge science and technology infrastructure necessary to strengthen and guard America’s economic foundations and security capabilities
safe-• Conducting research that advances the nation’s technology infrastructure and is needed by U.S industry to continually improve products and services
The Advanced Technology Program accelerates the development of innovative technologies for broad national benefit by co-funding research and development partnerships with the private sector
15.8.2 National Oceanic and Atmospheric Administration
The National Oceanic and Atmospheric Administration (NOAA) improves technology and provides available backups in the event of power outages or security for technology operation centers
Trang 1015.8.3 National Telecommunications and Information Administration
The National Telecommunications and Information Administration (NTIA) provides spectrum management and telecommunications research capabilities and tests new technology applications for radiofrequency spectrum use
15.8.4 U.S Patent and Trademark Office
The U.S Patent and Trademark Office (PTO) improves patent and trademark quality and reduces dependency
15.8.5 Bureau of Export Administration
The Bureau of Export Administration (BXA) coordinates the Department of Commerce’s overall critical infrastructure protection and homeland security efforts
15.8.6 Critical Infrastructure Assurance Office
The Critical Infrastructure Assurance Office (CIAO) promotes federal initiatives and vate partnerships across industry sectors to protect the nation’s critical infrastructures and creates within CIAO the Homeland Security Information Technology and Evaluation Program to promote the coordinated information technology for homeland security purposes
• Failure to establish chemical and biological readiness as a medical priority in defense planning guidance (particularly for biological warfare)
• Complex assumptions required to predict casualties
• Poor data availability on affects of particular agents
• Disagreements among the military services about how quickly troops could actually be evacuated
• Pessimism that medical personnel could effectively treat substantial numbers of chemical and biological casualties
Trang 11Training, as well as testing and exercises, for chemical and biological casualties medical management remains limited Military services officials for medical planning maintain that spe-cialized training in the military is the appropriate way to address any need for additional medical
skills Courses are essentially voluntary (Note: The majority of uniformed medical personnel have
not completed any specialized military medical training for chemical and biological casualties Only the Army includes an introduction to chemical and biological casualty management in training required of medical personnel.) Medical personnel who have been trained may not be readily identified in the event of an emergency as tracking systems do not exist or are not currently functioning
Except for the Army’s Medic 2000 study (which found that the lowest proficiency scores among medics were for nuclear, biological, and chemical skills), the military services have not defined standards for treatment of chemical and biological casualties or tested the medical personnel proficiency, and no realistic field exercise of chemical or biological defense has been conducted The surgeons general from the military services have begun integrating chemical and a few biological scenarios into their medical exercises Only two joint military exercises planned since
1993 have included both medical support activities and chemical or biological warfare Key evaluations used to advise the President on readiness to implement the national security strategy have never set a scenario for the unified commanders requiring medical personnel to respond to the effects of weapons of mass destruction (WMD) Exercises involving medical support for chemical and biological casualties have been rare because of conflicting priorities encountered by both war fighters and medical personnel and because of difficulty and expense
1 The military services and joint staff should reach an agreement about which medical personnel are qualified to provide specific treatments These medical personnel should be validated by proficiency testing of the identified personnel to help further refine requirements for training and distribution of medical personnel across specialties
2 The military services should develop medical training requirements for chemical and biological contingencies, assess the training effectiveness with rigorous proficiency standards and tests, and track individual training and proficiency
3 The joint staff, commanders-in-chief, and the military services should increase chemical and biological exercises involving medical personnel to an extent commensurate with current chemical and biological threat assessments Given the threat of mass casualties, exercises should explore the extent of medical capabilities and the full consequences of scenarios that overwhelm them
15.10.1 Defense Advanced Research Projects Agency (DARPA)
The Defense Advanced Research Projects Agency (DARPA) develops imaginative, innovative, and often high-risk research ideas offering a significant technological impact that will go well beyond the normal evolutionary developmental approaches It pursues these ideas from the dem-onstration of technical feasibility through the development of prototype systems
15.10.2 Joint Task Force for Civil Support
The Joint Task Force for Civil Support plans and, when directed, commands and controls the DOD’s WMD and high-yield explosive consequence management capabilities in support of FEMA
15.10.3 National Guard
The National Guard manages response teams that would enter a contaminated area to gather samples for on-site evaluation
Trang 1215.10.4 U.S Army
The U.S Army maintains a repository of information about chemical and biological weapons and agents, detectors, and protection and decontamination equipment
15.11 DEPARTMENT OF HEALTH AND HUMAN SERVICES
The Department of Health and Human Services (HHS) coordinates federal assistance in response
to public health and medical care needs in an emergency The HHS could receive support from other agencies and organizations, such as DOD, USDA, and FEMA, to assist state and local jurisdictions
15.11.1 Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality examines clinical training and the ability of frontline medical staff to detect and respond to a bioterrorist threat It studies the use of information systems and decision support systems to enhance preparedness for medical care in the event of a bioterrorist event
15.11.2 Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC), under the Federal Response Plan, is the lead HHS agency providing assistance to state and local governments for these functions:
1 Health surveillance — Assist in establishing surveillance systems to monitor the general population
and special high-risk population segments; carry out field studies and investigations; monitor injury and disease patterns and potential disease outbreaks; and provide technical assistance and consul-tations on disease and injury prevention and precautions
2 Worker health and safety — Assist in monitoring health and well-being of emergency workers;
perform field investigations and studies; and provide technical assistance and consultation on worker health and safety measures and precautions
3 Radiological, chemical, and biological hazard consultation — Assess health and medical effects
of radiological, chemical, and biological exposures on the general population and on high-risk population groups; conduct field investigations, including collection and analysis of relevant samples; advise on protective actions related to direct human and animal exposure and on indirect exposure through radiologically, chemically, or biologically contaminated food, drugs, water sup-ply, and other media; and provide technical assistance and consultation on medical treatment and decontamination of radiologically, chemically, or biologically injured or contaminated victims
4 Public health and disease and injury prevention information — Transmit information to members
of the general public who are located in or near areas affected by a major disaster or emergency; assess the threat of vector-borne diseases following a major disaster or emergency; conduct field investigations, including the collection and laboratory analysis of relevant samples; provide vector control equipment and supplies; provide technical assistance and consultation on protective actions regarding vector-borne diseases; and provide technical assistance and consultation on medical treatment of victims of vector-borne diseases
In its FY2002–FY2006 Plan for Combating Bioterrorism, the HHS notes that potential sources for data on morbidity trends include:
• 911 emergency calls
• Reasons for emergency department visits
• Hospital bed usage
• Purchase of specific products at pharmacies
Trang 13The HHS is currently leading an effort to work with governmental and nongovernmental partners
to upgrade the nation’s public health infrastructure and capacities to respond to bioterrorism As part of this effort, several CDC centers, institutes, and offices work together in the agency’s Bioterrorism Preparedness and Response Program The principal priority of the CDC’s program is
to upgrade infrastructure and capacity to respond to a large-scale epidemic, regardless of whether
it is the result of a bioterrorist attack or a naturally occurring infectious disease outbreak The program was started in fiscal year 1999 and was tasked with building and enhancing national, state, and local capacity; developing a national pharmaceutical stockpile; and conducting several inde-pendent studies on bioterrorism
The CDC’s counter-bioterrorism activities are focused on building and expanding the public health infrastructure at the federal, state, and local levels In addition to preparing for a bioterrorist attack, these activities also prepare the agency to respond to other challenges, such as identifying and containing a naturally occurring emerging infectious disease
The CDC provides grants, technical support, and performance standards to support bioterrorism preparedness and response planning at the state and local levels It has worked with the Department
of Justice to complete a public health assessment tool, which is being used to determine the ability
of state and local public health agencies to respond to release of biological and chemical agents,
as well as other public health emergencies Ten states (Florida, Hawaii, Maine, Michigan, sota, Pennsylvania, Rhode Island, South Carolina, Utah, and Wisconsin) have completed the assessment and others are currently completing it
Minne-The CDC provides state and local grants, technical support, and performance standards to support bioterrorism preparedness through:
• Increasing staff, thus enhancing the capacity to detect the release of a biological agent or an emerging infectious disease
• Improving the communications infrastructure
• Preparing bioterrorism response plans
Research activities focus on detection, treatment, vaccination, and emergency response ment Rapid identification and confirmatory diagnosis of biological agents are critical to ensuring that prevention and treatment measures can be implemented quickly A Laboratory Response Network of federal, state, and local laboratories maintains state-of-the-art capabilities for biological agent identification and characterization of human clinical samples such as blood Technical assis-tance and training in identification techniques are provided to state and local public health labora-tories The CDC is upgrading its epidemiological and disease surveillance system to provide increased surveillance and epidemiological capacities before, during, and after special events Besides improving emergency response at these special events, the agency gains valuable experience
equip-in developequip-ing and practicequip-ing plans to combat terrorism
The CDC monitors unusual clusters of illnesses, such as influenza in June; although unusual clusters are not always a cause for concern, they can indicate a potential problem The CDC also provides increased surveillance of disease outbreaks in animals and improved surveillance methods for detecting disease outbreaks Communication capabilities are increased in order to improve the gathering and exchanging of information related to bioterrorist incidents According to the HHS, the epidemiological capacity at CDC needs to be improved A standard system of disease reporting would better enable CDC to:
• Monitor disease
• Track trends
• Intervene at the earliest sign of unusual or unexplained illness
Trang 1415.11.3 Rapid Response and Advance Technology Laboratory
The CDC operates a Rapid Response and Advance Technology Laboratory, which screens samples for the presence of suspicious biological agents and evaluates new technology and protocols for the detection of biological agents These technology assessments and protocols, as well as reagents and reference samples, are being shared with state and local public health laboratories Among the duties are:
• Developing and validating new diagnostic tests
• Creating agent-specific detection protocols
• Developing equipment performance standards
• Conducting research on smallpox and anthrax viruses and therapeutics
15.11.4 Laboratory Response Network for Bioterrorism
Research can provide testing of biological samples for detection and confirmation of biological agents Hospital and commercial laboratories that have state-of-the-art equipment and well-trained staff need to be added to this network to provide additional surge capacity Currently, 104 labora-tories are in the network The Laboratory Response Network (LRN) is building a multilevel network
of local, state and federal partners to prepare and respond to an act of terrorism Following are the designations for these partners:
• Level A — Community hospitals with diagnostic facilities equipped with reagents and assays screen samples collected by the FBI or local law enforcement agencies
• Level B — State health departments confirm sample credibility; a credible sample shifts to a Level
C center
• Level C — This level is designed for specific agents, such as plague, anthrax, or smallpox; from here, an identified sample moves to Level D labs, but if the FBI detects a credible threat (e.g., smallpox) the sample bypasses the first three tiers and shoots directly to Level D
• Level D — Much like forensic labs, this level of labs documents and files records in the event of
a court subpoena In one such facility, the SAS Air Sampler will be used to ensure that no aerosolized cross-contamination exists between laboratory areas The sampling plan design intent
is to ensure safety procedure work for quality control monitoring: (1) Begin with a clean laboratory with disinfected countertops, floors, and hoods; and (2) sample the air and repeat the disinfecting cycle until the site is clean and ready for the empirical test This protocol is designed to affirm whether the safety procedures work
The CDC is developing a crisis communications/media response curriculum for bioterrorism, as well as core capabilities guidelines to assist states and localities in their efforts to build compre-hensive anti-bioterrorism programs
15.11.5 Health Alert Network
The CDC is currently developing the Health Alert Network, which will support the key mation exchange over the Internet and provide a means to conduct distance training that could potentially reach a large segment of the public health community Currently, 13 states are connected
infor-to all of their local jurisdictions The CDC is directly connected infor-to groups such as the American Medical Association to reach healthcare providers
The CDC has described the Health Alert Network as a highway on which programs such as the National Electronic Disease Surveillance System (NEDSS) and the Epidemic Information Exchange (Epi-X) will run NEDSS is designed to facilitate the development of an integrated,
Trang 15coherent national system for public health surveillance Ultimately, it is meant to support the automated collection, transmission, and monitoring of disease data from multiple sources (for example, clinician’s offices and laboratories) from local to state health departments to the CDC Epi-X is a secure, Web-based exchange for public health officials to rapidly report and discuss disease outbreaks and other health events potentially related to bioterrorism as they are identified and investigated.
In collaboration with the Association of Public Health Laboratories and the Department of Defense, the CDC has started a secure Web-based network that allows state, local, and other public health laboratories access to guidelines for analyzing biological agents Authenticated users can order critical reagents necessary for performing laboratory sample analysis The network provides emergency contact information for state and local officials in the event of possible bioterrorism incidents and lists critical biological and chemical agents It provides summaries of state and local bioterrorism projects and contains general information about the CDC’s bioterrorism initiative The network also provides links to documents on bioterrorism preparedness and response Note that one aspect of this work is developing, testing, and implementing standards that will permit surveil-lance data from different systems to be easily shared During the West Nile virus outbreak, while
a secure electronic communication network was in place at the time of the initial outbreak, not all involved agencies and officials were capable of using this system at the same time Because the CDC’s laboratory was not linked to the New York State network, the New York State Department
of Health had to act as an intermediary in sharing the CDC’s laboratory test results with local health departments The CDC and New York State Department of Health laboratory databases were not linked to the database in New York City, and laboratory results consequently had to be manually entered there These problems slowed the investigation of the outbreak
15.11.6 National Bioterrorism Response Training Plan
The CDC is implementing the National Bioterrorism Response Training Plan This plan focuses
on preparing CDC officials to respond to bioterrorism and includes the development of exercises
to assess progress in achieving bioterrorism preparedness at the federal, state, and local levels
15.11.7 Food and Drug Administration
Duties of the Food and Drug Administration (FDA) include:
• Improving capabilities to identify and characterize foodborne pathogens
• Identifying biological agents using animal studies and microbiological surveillance
• Licensing of vaccines for anthrax and smallpox
• Determining procedures for allowing use of not-yet-approved drugs and specifying data needed for approval and labeling
15.11.8 National Institutes of Health
The National Institutes of Health (NIH) develops new therapies for smallpox virus and smallpox and bacterial antigen detection systems
15.11.9 National Institute for Occupational Safety and Health
The National Institute for Occupational Safety and Health (NIOSH) develops standards for respiratory protection equipment used against biological agents by firefighters, laboratory techni-cians, and other potentially affected workers
Trang 1615.11.10 Office of Emergency Preparedness
Duties of the Office of Emergency Preparedness (OEP) include:
• Developing and managing response teams that can provide support at the disaster site
• Overseeing a study on response systems
• Providing contracts to increase local emergency response capabilities, which involves entering into contracts to enhance medical response capability; the program includes a focus on response to bioterrorism, including early recognition, mass postexposure treatment and mass casualty care, and mass fatality management for local jurisdictions (fire, police, and emergency medical services; hospitals; public health agencies; and other services)
• Creating disaster medical assistance teams to provide medical treatment and assistance in the event
of an emergency; four of these teams (known as National Medical Response Teams) are specially trained and equipped to provide medical care to victims of WMD events, such as bioterrorist attacks
15.11.11 National Center for Environmental Health
The National Center for Environmental Health (NCEH) helps local, state, federal, and international agencies plan their responses to emergency situations It responds to requests for emergency and recovery assistance after technologic disasters and established and now maintains the national pharmaceutical stockpile, which is designed to ensure the rapid deployment of life-saving pharmaceuticals for treating victims of terrorist attacks It also provides technical support for public health activities during international emergencies, including civil strife, disasters, and famine
The NCEH provides a number of environmental health services that help other agencies, environmental health programs, and professionals better anticipate, identify, and respond to environmental problems and their consequences on human health NCEH’s services include helping to protect the public’s health within U.S national parks and on international cruise vessels that enter U.S ports, ensuring the health of the public and workers during disposal of chemical weapons and providing information and consultation on a wide range of environmental health issues
15.12 DEPARTMENT OF JUSTICE (DOJ) 15.12.1 Federal Bureau of Investigation
The Federal Bureau of Investigation (FBI) conducts work on detection and characterization of biological materials
15.12.2 Office of Justice Programs
The Office of Justice Programs (OJP) helps prepare state and local emergency responders by:
• Providing training, exercises, technical assistance, and equipment programs
• Assisting states in developing strategic plans, including funding for training, equipment acquisition, technical assistance, exercise planning, and execution to enhance state and local capabilities (for fire, law enforcement, emergency medical, and hazardous materials response services; hospitals; public health departments; and other services) to respond to terrorist incidents
• Developing a data collection tool to assist states in conducting their threat, risk, and needs assessments and in developing their preparedness strategy for terrorism, including bioterrorism
• Developing a biological agent detector