Paul Moyer, MS CT Response Coordinator Minnesota Department of Health Public Health Laboratory Division A Tiered Approach to All-Hazards Laboratory Testing.

Paul Moyer, MS

CT Response Coordinator

Minnesota Department of Health

Public Health Laboratory Division

A Tiered Approach to All-Hazards Laboratory Testing of Unknown

Environmental Samples

2

Introduction

Why Is Unknown Sample Testing Important?– “Credible” Threats Exist– Surveillance

Why Is Testing at PHL Important?– Public Health Events– LRN Laboratories

3

Objectives

Describe a process for applying standardized procedures to non-standard events

Illustrate the significance of notification and threat assessment pieces (“Focus Areas” working together)

Discuss the advantages of a Bio/Chem/Rad tiered step analysis

4

Background

Anthrax 2001– Specific Protocol– Letters

Evolution to “All-Hazards” Approach– Specific Guidelines– Letters– Leaking Packages– Tainted Food/Water

5

Background

What the MDH plan “IS”– A Starting Point – Guidance– SOPs, Checklists, & Forms– Safety First

What the MDH plan “IS NOT”– A “Rote” Protocol – Thinking IS Required– A Lab Only Effort – Partners Crucial– Rigid

6

Safety

Lab Safety Officer – IHBSL 3 FacilityLimited QuantitiesBuddy + 1 SystemPPE

7

Safety

Chemical Splash Resistant Coveralls with

Hood and Boots

Chemical Resistant Sleeves

Full Face APR: Dual Particualte/Organic Vapor Cartridges

Outer Gloves:Nitrile

Inner Gloves: Nitrile or Chemical Laminate

8

What does “Tiered” Mean

Expandable SystemBegins with Field Information/“Tests”Minimum Testing – Tier 1 Can Include:

– Scenario/Submitter Directed Testing– Tier 2 Testing– Minimum Plus Testing

9

Resource Management

Anthrax Only Testing – “Too Cold?”

All-Agent Testing – “Too Hot?”

Tiered Testing – “Just Right”?

10

Plan Strategy

SOPs vs. SOGs

“Menu” of Tests/Procedures

Judgment – “What makes sense”

Here’s the “Road Map”

No

No

Referenced SOP

Decision

Data / Information

Additional Resource

Process SOP

Yes

Yes

Yes

OpenSample

SOP

Receive Sample /

Over-packSOP

Notification

SOP(Phase I)

Minimum Testing + Additional Biological

Staff Resource Call-Down

Final ReportSOP

Process SOP Sections- Communications- QA / QC- Documentation- Safety - Analysis

Rad Check

Positive?

Rad Check

Positive?

Results & Observation

s

Tier 2Testing?

Radiological ScreenSOP

Alert RadiationResponse

Team

GC/MS, ICP/MS,

OtherCT Analytical

SOPS

LRNBT Analytical

SOPS

BT / CT Personnel

AcceptSample?

DocumentSample

Rejection

No

Yes

ResultsNotificatio

nSOP

(Phase II)

Prioritize Tier 1

Testing

Information

Results & Observation

s

Minimum Testing &

ProcessingSetup

No

Document

Minimum Testing + Additional Chemical

Minimum Testing + Additional Toxin

Minimum Testing+ Viral

Minimum Testing

Or

Or

Or

Or

Document

Document

12

Plan Strategy

BT, CT & REP* TeamsOn-Call Pairs (BT, CT-Rad)Cross - Trained on:

– Threat Assessment– Sample Receiving – Chain-of-Custody– Sample Opening – Processing– Communications

*Radiological Emergency Program

13

Screening: Chemical vs. Biological

Serial Analysis:– Rule Out Chemical Agents

• What about the Bio-Hazard?

– Rule Out Biological Agents• What about the Chemical Hazard?

Parallel Analysis:– BT and CT-Rad Working Together– Broader Perspective / Depth of Knowledge– Use the Threat Assessment/Field Information

14

Testing: Is It Hazardous? (…and If Not, What Is It?)

ID and ConfirmRule Out Hazardous:

– Radioactivity– Chemicals– Biological Agents

What’s Left? Back to the “Map”

No

No

Referenced SOP

Decision

Data / Information

Additional Resource

Process SOP

Yes

Yes

Yes

OpenSample

SOP

Receive Sample /

Over-packSOP

Notification

SOP(Phase I)

Minimum Testing + Additional Biological

Staff Resource Call-Down

Final ReportSOP

Process SOP Sections- Communications- QA / QC- Documentation- Safety - Analysis

Rad Check

Positive?

Rad Check

Positive?

Results & Observation

s

Tier 2Testing?

Radiological ScreenSOP

Alert RadiationResponse

Team

GC/MS, ICP/MS,

OtherCT Analytical

SOPS

LRNBT Analytical

SOPS

BT / CT Personnel

AcceptSample?

DocumentSample

Rejection

No

Yes

ResultsNotificatio

nSOP

(Phase II)

Prioritize Tier 1

Testing

Information

Results & Observation

s

Minimum Testing &

ProcessingSetup

No

Document

Minimum Testing + Additional Chemical

Minimum Testing + Additional Toxin

Minimum Testing+ Viral

Minimum Testing

Or

Or

Or

Or

Document

Document

16

Key Pieces

NotificationThreat/Hazard AssessmentAction Plan – Scenario SpecificMinimum Testing – Tier 1

– Radiological– Chemical– Biological

Advanced/LRN Testing – Tier 2

17

Notification

Incoming Request for Lab Analysis Internal Notification(s)

– Hazard Assessment• Response Coordinators (Focus Areas C & D)• Unit Leaders

– Management FYI• Director• Section Managers

18

Notification

External Notification(s)– Hazard Assessment

• MDH Epidemiology (Focus Area B)• MDH Environmental Health Rep (Focus Area A)• FBI WMD Coordinator• CST

– Management FYI• MDH Health Protection Division Directors (All Focus

Areas)

Decision to Accept/Reject Sample

19

Threat/Hazard Assessment

Credible Threat?

Excessive Hazard?– Fatalities– Explosives

Suitable Request?– Public Health Threat?– Forensics?

20

Event Action Plan – Scenario Specific

Decisions By:– One Person– On-Call Pair– Group

Decide To:– Test or Not Test– Test At What Level – “Order Off the Menu”– Assign Duties and Responsibilities

21

Minimum Testing – Tier 1

Radiological Screen

Chemical Characterization

Biological Testing

22

Minimum Testing – Tier 1

Radiological Screen– Inner Package / Sample– Geiger-Muller Counter (CPM)

• Alpha• Beta• Gamma

Over-pack Previously Screened at Loading Dock

23

Minimum Testing – Tier 1

Chemical Characterization– Papers: pH, M8, Oxidizer– Solubility: Water, Methylene Chloride– FTIR: HazmatID– Head Space Vial Aliquot (GC/MS)

24

Minimum Testing – Tier 1

Biological Testing– Slides: Wet Mount, Gram Stain– RT-PCR– TRF– Cultures: BAP, Chocolate, Thio Broth

25

Advanced/LRN Testing – Tier 2

Chemical– GC/MS – SVOC– ICP/MS – Metals – General/Bench Chemistry – Inorganic

Biological– LRN Level B/C Agent Specific Protocols

26

References

Guidance on Initial Responses to a Suspicious Letter / Container With a Potential Biological Threat, FBI – DHS – HHS/CDC, 2004

Assessment of Methods for Handling Mixed-Threat Environmental Samples, NCEH – Battelle, 2004

Assessment of Protocols Involving Unknown Samples, NCEH – Battelle, 2004

Proposed Draft DHS Screening Protocol, 2005 (to augment/standardize existing assessments and field screening techniques)

27

Contact Information

Paul Moyer, MS Chemical Terrorism Response Coordinator

612-676-5245

Paul.moyer@health.state.mn.us

28

Questions

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