National Health System Initiatives for Terrorism

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National Health System Initiatives for Terrorism

• Dave Teeter, PharmD
• 2004 NDMS Conference
• Dallas, TX
• dsteeter1_at_aol.com

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Session Objectives

• List and explain the purpose and funding
  structure of various Federal grant programs for
  health system preparedness and response to acts
  of terrorism.
• Cite examples of local health system coordination
  structures and processes.

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Session Objectives

• Discuss the role(s) of community hospitals in
  these programs.
• Explain approaches for community bioterrorism
  surveillance systems and mass prophylaxis.
• List findings from the disaster research that
  apply to these topics.

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Session Objectives

• Identify problem areas and formulate resolution.
• Participation is encouraged.

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Public Perception of Disasters

• Wont happen.
• Wellat least not to me.
• It wont be that bad.
• The heck with it. There is nothing I can do.
• Could these views create problems for you in
  developing the bioterrorism response plan for
  your hospital?

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Disaster Research

• Convergence
• responders, victims and goods
• Improvisation
• Role abandonment

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Disaster Research

• Will there be problems with coordination and
  communication?
• Will the media show up?
• Will people panic?
• Will there be looting?

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Are we all in the same boat?
Beds
Staff
Patients
206,000
4.1 M
53,200
2.9 M
21,000
185,000
FY 95
FY 01
FY 01
FY 95
FY 95
FY 01
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Local Structure

• Within the facility
• Disaster committee
• Related committees?
• Community
• MMRS (Metropolitan Medical Response System)
• LEPC (Local Emergency Planning Committee)

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Local Structure

• Organizations
• Hospital associations, professional associations,
  local Task Forces, county / state Emergency
  Management, Department of Health
• Other structure within your community / state?

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Federal Money

• MMRS
• HRSA grants
• CDC grants

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Surveillance

• What is the routine reporting chain for
  infectious diseases?
• Could this put us behind the power curve
  following a covert release of biological agent?

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Bioterrorism Surveillance

• Syndromic models
• Pre-diagnostic surveillance
• ICD-9-CM
• Goal to detect outbreaks through aberrant
  patterns
• Still might be the astute clinician

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Secure Communications

• Epi-X (Epidemic Information Exchange)
• CDC December 2000
• Secure web-based communication among CDC, state /
  local health departments, poison control centers
  and other public health professionals
• Postings discussions

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Pharmaceuticals for the first 24-48 hours

• What have you learned from surveys of community
  and hospital pharmacies?
• Have pharmacies in your area coordinated with
  their prime vendors?

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Pharmaceutical Stockpiling

• Models
• None
• Individual facility
• Hospital helping hospital
• City / county (within and outside MMRS)
• Federal
• Regardless integrate with local community

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Timeline for disaster response
Incident
Victims
Local EMS
State
Federal
Days
Minutes
Minutes
Hours/Day
Federal assets in disasters with warning or high
profile events.
Federal assets in disasters without warning.
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SNS - Local Issues

• When will you see it?
• Push packages vendor-managed inventory
• Where will the SNS arrive (air/land)?
• State responsible once the SNS arrives
• Site(s) for distribution
• Repackaging machines, private companies
• Manpower students, technicians
• Tracking/documentation

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Unique Pharmaceuticals

• Some, usually under IND, are available only
  through DOD or CDC
• Anthrax vaccine
• Smallpox vaccine
• VIG
• Botulinum antitoxin other than trivalent

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Mass Prophylaxis

• Your communitys plan
• Will patients coming to hospital(s) - via either
  plan or on their own?
• Getting supplies and manpower to location(s)
• Security

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Mass Prophylaxis

• Caring for your staff
• Mass screening and counseling
• Documentation, reimbursement and other issues
  that give you a headache

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References

• Your state / county DOH
• www.
• cdc.gov and hrsa.gov
• aha.org
• va.gov/emshg and dhhs.gov
• usamriid.army.mil
• naccho.org