Biological Weapons Improved Response Program BWIRP

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Biological Weapons Improved Response Program
(BWIRP) Acknowledgements Sue Skidmore BAH Jim
Church U.S. Army Soldier and Biological, Chemical
Command Aberdeen Proving Ground, Maryland
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Background
The Domestic Preparedness program was created
under the Nunn-Lugar-Domenici Legislation (PL
104-201) - National Defense Authorization Act
(FY1997), Title XIV Defense Against Weapons
of Mass Destruction
Under Section 1415 - The Secretary of Defense
shall develop and carry out a program for testing
and improving the responses of Federal, State and
local agencies to emergencies involving chemical
and biological weapons
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IRP Approach
WMD IP Initiatives First Responders
Chem/Bio Terrorism
Valid Solutions
Tough Problems
Improved Response Program
Workshops
Exercises
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BWIRP Overview

• Multi-year effort (April 1998)
• Multi-agency team
• 60 Responders, 5 Workshops
• Accomplishments
• Completed an assessment of the BW response
  problem
• Formulated an integrated approach to BW emergency
  response
• Identified gaps and improvements in response
  capabilities

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BWIRP Overview

• Workshops
• Identify critical response activities and gaps
• Identify and document best practical approaches
  to BW response
• Technical Investigations
• Explore possible solutions to technological/policy
  gaps
• Field Tests
• Validate and demonstrate BW response model
  component concepts

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BW Response Template and Key Decisions
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Modular Emergency Medical System (MEMS)

• The Modular Emergency Medical System (MEMS) was
  developed as a framework for organizing a
  communitys inherent medical resources to provide
  for an effective medical response following a BW
  terrorist attack
• MEMS is a framework that also provides for the
  rapid integration of mutual aid and federal
  response support effort
• Identifies recommended techniques for addressing
  special concerns of a BW incident

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Modular Emergency Medical System

• Activated by a city
• Augmented by volunteers, State and Federal assets

• Neighborhood Emergency
• Help Centers (NEHC)
• Expanded clinics
• - Triage, prophylaxis
• - Treatment information
• - Tracking, transportation

• Acute Care Centers (ACC)
• Satellite off of hospitals
• - Triage
• - Treatment
• - Supportive care

CC
Community Outreach - Treatment - Self help
at home - Communication link
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Purpose of the NEHC

• Directs BW patients away from the Emergency
  Department (ED)
• Allowing hospitals to remain open in some
  capacity
• Renders basic medical evaluation and triage
• Provides limited treatment, including
• stabilization care
• distribution of prophylactic medications
• self-help information

Designed to process 1000 patients / 24 hrs
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MEMS Development Process

• Working Group
• Created the basic idea of each component
• Medical experts who refined/developed the various
  concepts
• Computer Modeling
• Modeled with different scenarios, sizes, flow
  rates of arriving patients, number of patients,
  staffing levels and concept flexibilities
• Validation Panel
• Outside peer review by another group of medical
  experts

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MEMS Development (Cont)

• Field Test
• Used a National Guard medical unit (and
  others) to set up and run the NEHC
• Alternate Scenarios Working Group
• Could the NEHC concept work with agents other
  than Tularemia?
• ACC Validation Panels

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NEHC Patient Flow
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NEHC Staffing

• Total staff required 80 people (per shift)
• Key staff
• 3 Physicians
• 1 PA
• 1 Nurse Practitioner
• Other staff administration, housekeeping,
  volunteers, clerks, security

• 7 Nurses
• 3 Paramedics
• 6 EMTs

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NEHC Staffing
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Acute Care Center Patient Flow (ACC)
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Acute Care Center (Cont)

• The ACC is a 1000 bed temporary hospital ward
  in a non-hospital location
• Provides agent specific therapy and supportive
  care
• Designed for BW patients only
• Does not provide ventilators (or oxygen)
• Includes suggested sample admission orders and
  list of basic stock medications with rationale

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Acute Care Center Staffing (Cont)

• Suggested Staffing per 12 hour shift and 50 bed
  nursing subunit
• 1 MD
• 1 Physicians Assistant or Nurse Practitioner
• 6 RNs or mix of RNs and LPNs
• 4 nursing assistants
• 2 medical clerks
• 1 RT
• 1 Case Manager/Social Worker
• 2 housekeepers
• 2 patient transporters

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Community Outreach Mass Prophylaxis

• Primary purposes are to
• Disseminate information related to the BT
  incident
• Assess the affected community
• Enhance the distribution and dispensing of mass
  prophylaxis
• Secondary purpose in some cases may be to provide
  some type of patient care such as patient
  assessment and triage.

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Other Components

• Criminal and Epidemiological Investigations
• Law Enforcement Officers Guide
• Planning Guide For State and Local Communities

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Summary and Contact Information

• Visit our web site http//hld.sbccom.army.mil/dow
  nloads/ or http//hld.sbccom.army.mil/downloads/bw
  irp/
• Web site has copies of our completed reports and
  pamphlets
• Call Jim Church at 410-436-5686 for further
  questions

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Questions???