National Governors Association

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National Governors AssociationPolicy Summit on
Domestic Terrorism
Tabletop Exercise Major Issue Recap
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Episode 1 Summary

• A clandestine meth lab was destroyed in a fire.
• The investigation revealed a biological
  laboratory.
• One individual was arrested at the scene a
  second escaped and has not been apprehended.
• Several containers labeled plague slurry were
  discovered in the bio lab. The contents have not
  been confirmed.
• An interagency assessment has deemed the threat
  credible.

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Episode One Discussion

• Alert and Notification
• FBI reports that we have a credible threat
• State EM has not been asked for anything
• Public Health Surveillance
• Concerned for outbreak, BUT is the Plague slurry
  real?
• Health system is not familiar with Plague
  symptoms
• Ramp up active surveillance and distribute
  diagnostic information
• Plan Activations
• Governor, we do not have a (BT response) plan!
• Call cabinet together and begin working through
  issues.

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Episode One Discussion Continued

• Resource requirements
• If Plague is real we will be short of antibiotics
• Identify availability of antibiotics
• Notify CDC of potential need for Antibiotics and
  support
• Status of investigations
• FBI says credible threat and are in charge at
  site.
• Whose in charge? Governor you are.
• Make decisions based upon health recommendations
  and Task Force and Cabinet recommendations.
• Public Safety and Notification
• No press interest at this time however we should
  develop public releases for use if required.
• Notify the five major hospitals

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Episode One Discussion Continued

• Control measures including quarantine
• Governor has the authority based upon imminent
  emergency and emergency declaration.
• Insufficient information to act on need for
  Quarantine
• Proclaiming of emergencies
• No specific response to Governors question should
  I declare an emergency other than you have the
  authority
• Consequences ( mortality and morbidity)
  associated with a potential plague release
• Plague is deadly contagious agent that usually
  effects animals or humans in third world
  countries. No Vaccines, antibiotics are the
  treatment. Must be administered early.

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Episode 2 Summary

• Queries of local hospitals identified unusual
  clusters, nearly all college students, with
  symptoms consistent with possible exposure to
  plague. The first patient admitted over the
  weekend has died.
• Y. pestis (plague) was detected in the
  containers and fire extinguishers.
• The van containing the dispersal device was in
  parking garage upwind from a dance club
  frequented by college students.
• The local media are reporting a possible
  bioterrorism attack, and are prepared to identify
  the agent as plague.
• National networks will air breaking news reports
  momentarily.

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Episode Two Discussion

• Plans for mass treatment and medication
• Continue active surveillance
• Provide clear guidance on symptoms and treatment
• Establish hot line for information dissemination
  and victim identification
• Establish treatment registry
• Healthcare system capacity
• Potential for overload of health system
• Supplemental health care resources may be
  required
• Federal supplemental assistance
• CDC has been notified and assistance requested
• FEMA and DHHS have been notified that
  supplemental health care assistance may be
  required

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Episode Two Discussion Continued

• Emergency Authorities and Declarations
• Governor has declared a State of Emergency
• Quarantine
• No Quarantine of any area in the State
• Recommend that all ill patients be initially
  isolated
• Identify and treat persons who were in close
  proximity to release
• Public Safety and announcements
• Governor will give a coordinated press conference
• Press representative fears this is late
• Press secretary forms Joint Information Center
• Release credible and detailed factual information
  often
• Inform the public concerning the risk and who is
  at risk

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Episode Two Discussion Continued

• Direction and control of local and State and
  Federal response
• State EOC and EOP are activated.
• Emergency operations staff are also working on
  recovery planning and associated issues
• Impact on animal populations.
• No input this section. Potential for disease
  transmission
• Joint information Management
• State press Secretary continues frequent press
  releases in coordination with health officials.
  Spokesperson available around the clock 24/7.

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Episode 3 Summary

• Gotham, New Aberdeen and the nation are dealing
  with the consequences of a successful
  bioterrorism attack.
• Surrounding counties, states and a host of
  countries are monitoring the incident and have
  taken precautionary steps.
• Problems are occurring in the mass treatment and
  medication of those potentially exposed to the
  plague.
• The number of victims now appears to be
  relatively small, and is confined in great part
  to University of New Aberdeen students.

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Episode Three Discussion

• Implementation of mass treatment and medication
• Need to send a consistent coordinated interagency
  message on medical treatment
• Persons who are coughing should be isolated and
  treated
• Continue to administer prophylaxis as required to
  patients and exposed individuals.
• Healthcare system capacity
• Stressed at 72 hours
• Lack of surge capability at local level is
  evident
• Federal supplemental assistance.
• Federal agency liaison are in the State EOC
• CDC providing stockpile

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Episode three Discussion Continued

• Quarantine
• Reserve the right but no quarantine
• Continue isolation of ill patients
• Continue hot line and information on risk and
  symptoms
• Public safety and safety announcements
• Continue joint information bulletins on public
  health issues and status of the response and
  recovery.
• Ensure multi-language public information is
  available.
• Direction and control of local State and Federal
  Resources
• FEMA CDC and other key Federal players have
  liaison personnel in state EOC.
• Consider utilization of Civil Support Teams.
• Consider use of National Guard to support state
  and Local Police

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Episode three Discussion Continued

• Impact on animal populations and potential
  long-term consequences
• Consider quarantine of specific animals
• Implement vector control for rodents and fleas
• Implement Joint information management on animal
  population at risk, symptoms and recommended
  actions
• Recovery
• Who pays and how much will be paid by FEMA under
  a Presidential Emergency Declaration
• Coverage for extra-ordinary costs to private
  hospitals?
• Ensure close Federal, State and Local Public
  health coordination and communication

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Closing Comments

• Major issues
• 1. An adequate infrastructure for planning is
  critical and a current exercised bio-plan is
  essential.
• 2. A viable communication and Public Information
  plan is critical
• 3. A competent and informed surveillance system
  is essential for timely decision making and
  response
• 4. Need greater coordination between the law
  enforcement and public health.
• 5. The Governor has sufficient authorities to
  lead and manage his resources for a public health
  emergency

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Closing Comments Continued

• 6. The systems will have to respond to
  biological health crisis regardless of a
  terrorism component.
• Robust health systems ( with surge capability)
  are essential to manage mass fatalities and long
  term health care recovery
• 7. Dont forget that the Joint Task Force for
  Civil support is a Federal asset.
• 8. DHHS reminds you that Federal assistance is
  only a phone call away. Call early.

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National Governors Association

• A Policy Summit On Domestic Terrorism
• Tabletop Exercise
• Major Issues Recap