Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor 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 biologicznego 2014 Konferencja Epimilitaris w Rynie, Polska Suzet M. McKinney, Doktor Zdrowia Publicznego, magister Zdrowia Publicznego, Zastępca Komisarza Departamentu Zdrowia Publicznego w Chicago
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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
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