Bioterrorism Response Research Articles

Effects of a mobile-based bioterrorism response program among clinical nurses: A quasi-experimental study

BackgroundTo respond to unstable international security and the outbreak of new infectious diseases, clinical nurses should be equipped with bioterrorism response competencies. ObjectivesThis study developed a mobile-based bioterrorism response program for clinical nurses and examined its effectiveness on their knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies. DesignA quasi-experimental study design was used. SettingGeneral or tertiary general hospitals in South Korea were considered. ParticipantsParticipants were 45 clinical nurses (23 in the experimental group and 22 in the control). MethodsThe mobile-based bioterrorism response program was conducted over three weeks in 10 sessions (total of 300 min). The knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies were compared between two groups using paired t-test, and Wilcoxon signed ranks test. Satisfaction with the program was measured in the experimental group. ResultsUpon completion of the mobile-based bioterrorism response program, the experimental group showed significant increases in knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies. ConclusionsThe mobile-based bioterrorism response program is expected to contribute to better preparedness for bioterrorism response systems in clinical practice. In addition, this program is expected to be of valuable use in bioterrorism education for nursing students as well as other healthcare professionals involved in bioterrorism response.

EMS and Bioterrorism Response

Introduction:Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats.Method:This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey.Results:Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. Provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment.Conclusion:To effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Predictors of bioterrorism preparedness among clinical nurses: A cross-sectional study

BackgroundBioterrorism is terrorism that causes death, injury, or illness by the intentional release of viruses, bacteria, fungi, or toxins. Bioterrorism cannot be prevented; therefore, having the ability to recognize and respond to the consequences of infection caused by biological agents is imperative. This study aimed to examine the level of bioterrorism preparedness and identify the influencing factors of bioterrorism preparedness among nurses, who are early responders to bioterrorism. MethodsThis study had a predictive correlational study design. It surveyed 245 clinical nurses currently working in general hospitals. We used a structured questionnaire consisting of items about general characteristics, knowledge about bioterrorism, awareness of bioterrorism risk, perception of institutional bioterrorism preparedness, attitude toward bioterrorism, and bioterrorism preparedness. The collected data were analyzed using descriptive statistics and by performing a t-test, chi-square test, analysis of variance, post-hoc test, correlational analysis, and regression analysis. ResultsBioterrorism preparedness was significantly positively correlated with the perception of institutional and frontline bioterrorism preparedness and attitude toward bioterrorism. It was also significantly influenced by sex, undergraduate bioterrorism education, employee bioterrorism education, perception of governmental bioterrorism preparedness, and attitude toward bioterrorism. The greatest predictors of bioterrorism preparedness were attitude toward bioterrorism, perception of institutional bioterrorism preparedness, and undergraduate bioterrorism education, which explained 39 % of the variance of bioterrorism preparedness. ConclusionThis study found that clinical nurses' awareness and attitude toward bioterrorism are important factors in their bioterrorism preparedness and that attention to and education about bioterrorism are crucial to enhance clinical nurses' bioterrorism preparedness. Continued research is needed to establish a bioterrorism response system and relevant educational programs.

Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response.

SummaryThis report provides CDC recommendations to U.S. health care providers regarding treatment, pre-exposure prophylaxis, and postexposure prophylaxis of plague. Yersinia pestis, the bacterium that causes plague, leads to naturally occurring disease in the United States and other regions worldwide and is recognized as a potential bioterrorism weapon. A bioweapon attack with Y. pestis could potentially infect thousands, requiring rapid and informed decision making by clinicians and public health agencies. The U.S. government stockpiles a variety of medical countermeasures to mitigate the effects of a bioterrorism attack (e.g., antimicrobials, antitoxins, and vaccines) for which the 21st Century Cures Act mandates the development of evidence-based guidelines on appropriate use. Guidelines for treatment and postexposure prophylaxis of plague were published in 2000 by a nongovernmental work group; since then, new human clinical data, animal study data, and U.S. Food and Drug Administration approvals of additional countermeasures have become available. To develop a comprehensive set of updated guidelines, CDC conducted a series of systematic literature reviews on human treatment of plague and other relevant topics to collect a broad evidence base for the recommendations in this report. Evidence from CDC reviews and additional sources were presented to subject matter experts during a series of forums. CDC considered individual expert input while developing these guidelines, which provide recommended best practices for treatment and prophylaxis of human plague for both naturally occurring disease and following a bioterrorism attack. The guidelines do not include information on diagnostic testing, triage decisions, or logistics involved in dispensing medical countermeasures. Clinicians and public health officials can use these guidelines to prepare their organizations, hospitals, and communities to respond to a plague mass-casualty event and as a guide for treating patients affected by plague.

코로나-19 팬데믹이 생물테러 대응체계에 주는 함의

본 연구의 목적은 코로나-19로 수많은 사망자와 확진자 발생으로 전혀 다른 삶의 패턴으로 변화되고 있는 상황에서 테러단체나 북한이 코로나-19와 유사한 세균이나 바이러스 등 생물학 무기를 이용한 생물테러의 가능성에 대하여 군사안보 측면에서 대비하고자 질적 연구를 진행하였다. 연구결과 첫째, 전통적·비전통적 안보위협에 대비한 포괄적인 안보체계 구축이 필요하고 이를 위해 법과 규정 등 제도의 정비, 중단없는 control tower 역할을 위한 지휘통제시스템 구축 등이 요구되었으며, 둘째, 생물테러 시 초기 피해 및 확산방지를 위한 개인 방호물자의 확보와 주기적인 대피 및 방호훈련을 해야 하며, 셋째, 생물테러에 이용할 가능성이 있는 세균이나 바이러스의 물질과 시설에 대한 경계 및 방호대책 강구, 북한의 생물학 능력 및 생물학 무기에 대한 재판단과 위협의 우선순위를 고려한 대비책 강구, 백신과 치료제 확보가 요구되었다. 결론적으로 군사적 약자인 테러단체나 적이 인명 살상 및 사회 혼란 등의 목적 달성을 위해 팬데믹 상황에 편승하여 생물테러나 세균전 도발에 대한 대비방안을 제시했다는 측면에서 매우 의미 있는 연구라 할 수 있다.

Evaluating the Effectiveness of a Full-Scale Exercise of Epidemiologic Capacity for Bioterrorism Response

Abstract Introduction In May 2016, the Texas Department of State Health Services Public Health Region 7, in partnership with the local health departments in their region, designed and conducted a full-scale exercise (FSE) with a real-time epidemiologic phase leading to full-scale medical countermeasures distribution. Methods The exercise was designed to be a plausible scenario with a biologic agent that occurs naturally in Texas, Bacillus anthracis, and align with the Homeland Security Exercise and Evaluation Program (HSEEP) recommendations. After Action Reports (AAR) were reviewed and key informant interviews were conducted and content analyzed for themes through inductive coding. Results Themes identified include: benefits to exercising epidemiology’s role in public health preparedness; identification of gaps in real-time communication between public health and epidemiology; need to incorporate epidemiology into future exercises; importance of exercising realistic epidemiology scenarios in real-time; and identification of strengths and weakness in exercise coordination and logistics. Conclusion There is value in exercising epidemiology capabilities in real-time and in an operational full-scale context. Fully incorporating epidemiology into public health emergency preparedness exercises is one way to strengthen the relationship between these two disciplines and ensure well-coordinated rapid responses to public health threats.

The Development of a Bioterrorism Response, A Guideline for Citizens in Korea

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Public Policy in the Age of Weapons of Mass Hysteria: On the Decision to Vaccinate: Evaluating Risks and Benefits

Fifteen years after 9/11, and after 80 billion dollars has been spent on biodefense, we still don’t have a sure-fire way to deal with surprise epidemics. Ebola was just a test – and we failed. Miserably. This is the first in a series of articles that examines the propriety of our policy regarding pandemic projections and prioritization of research. I first examine the hype that generated our bio-terrorism response before evaluating the technological feasibility for using a bio-terrorist weapon, (exemplified by smallpox) as conceived in various published reports and war-games. While theoretically, in the laboratory – a nickel’s worth of anthrax or smallpox can do untold damage – the challenge is deployment. Microbiologists and virologists may be adept and creating designer microbes with a license to kill – but getting it from the lab to the victim’s target organ is a challenge – complicated by weather conditions, security constraints and engineering obstacles inherent in deployment technology. So, while if you are a rogue state, it might be nice to have a miniature nuclear war-head – without the missile to deploy it – all you have is a photo-op for a magazine cover. Understanding the terrorist mind and objectives is a necessary component to bio-terrorism preparedness, and one that seems to be lacking in our current governmental set-up. It appears the response is being led by compartmentalized scientists without ample training in understanding the criminal mind, or engineering (deployment) technology.The second part of the article is a risk-benefit analysis, evaluating the value of mass vaccination (for smallpox), comparing risks of the vaccine, likelihood of harm and the competitive need for other vaccines. I suggests a framework for evaluating the likelihood of a bio-weapons, and its detection. I further compare the response with West Nile disease, in terms of likely harm and efforts deployed to address it. Finally I suggest some engineering techniques as “first aid” measures, should an indoor terrorist attack occur.

Bioterrorism and Local Agency Preparedness: Results from an Experimental Study in Risk Communication

Abstract This article examines data collected from a panel of 43 local, state, and Federal emergency response professionals and public officials in Pueblo, Colorado who participated in a 6-month risk communication experiment simulating the remediation of simultaneous bioterrorist attacks involving anthrax and Foot and Mouth Disease. Participant responses to the scenario presented in real-time indicated that local and state government agency personnel with responsibility for public health emergency management are not necessarily familiar with best practices developed from major incidents. Findings also indicate that information related to bioterrorism response should be provided to agencies that do not normally work in public health but that would be involved in responding to a biological agent event.

Rapid Detection Method for Bacillus anthracis Using a Combination of Multiplexed Real-Time PCR and Pyrosequencing and Its Application for Food Biodefense

Bacillus anthracis, the causative agent of anthrax, has the capacity to form highly resilient spores as part of its life cycle. The potential for the dissemination of these spores using food as a vehicle is a huge public health concern and, hence, requires the development of a foodborne bioterrorism response approach. In this work, we address a critical gap in food biodefense by presenting a novel, combined, sequential method involving the use of real-time PCR and pyrosequencing for the rapid, specific detection of B. anthracis spores in three food matrices: milk, apple juice, and bottled water. The food samples were experimentally inoculated with 40 CFU ml-1, and DNA was extracted from the spores and analyzed after immunomagnetic separation. Applying the combination of multiplex real-time PCR and pyrosequencing, we successfully detected the presence of targets on both of the virulence plasmids and the chromosome. The results showed that DNA amplicons generated from a five-target multiplexed real-time PCR detection using biotin-labeled primers can be used for single-plex pyrosequencing detection. The combined use of multiplexed real-time PCR and pyrosequencing is a novel, rapid detection method for B. anthracis from food and provides a tool for accurate, quantitative identification with potential biodefense applications.

Harmonization of European Laboratory Response Networks by Implementing CWA 15793: Use of a Gap Analysis and an “Insider” Exercise as Tools

Laboratory response networks (LRNs) have been established for security reasons in several countries including the Netherlands, France, and Sweden. LRNs function in these countries as a preparedness measure for a coordinated diagnostic response capability in case of a bioterrorism incident or other biocrimes. Generally, these LRNs are organized on a national level. The EU project AniBioThreat has identified the need for an integrated European LRN to strengthen preparedness against animal bioterrorism. One task of the AniBioThreat project is to suggest a plan to implement laboratory biorisk management CWA 15793:2011 (CWA 15793), a management system built on the principle of continual improvement through the Plan-Do-Check-Act (PDCA) cycle. The implementation of CWA 15793 can facilitate trust and credibility in a future European LRN and is an assurance that the work done at the laboratories is performed in a structured way with continuous improvements. As a first step, a gap analysis was performed to establish the current compliance status of biosafety and laboratory biosecurity management with CWA 15793 in 5 AniBioThreat partner institutes in France (ANSES), the Netherlands (CVI and RIVM), and Sweden (SMI and SVA). All 5 partners are national and/or international laboratory reference institutes in the field of public or animal health and possess high-containment laboratories and animal facilities. The gap analysis showed that the participating institutes already have robust biorisk management programs in place, but several gaps were identified that need to be addressed. Despite differences between the participating institutes in their compliance status, these variations are not significant. Biorisk management exercises also have been identified as a useful tool to control compliance status and thereby implementation of CWA 15793. An exercise concerning an insider threat and loss of a biological agent was performed at SVA in the AniBioThreat project to evaluate implementation of the contingency plans and as an activity in the implementation process of CWA 15793. The outcome of the exercise was perceived as very useful, and improvements to enhance biorisk preparedness were identified. Gap analyses and exercises are important, useful activities to facilitate implementation of CWA 15793. The PDCA cycle will enforce a structured way to work, with continual improvements concerning biorisk management activities. Based on the activities in the AniBioThreat project, the following requirements are suggested to promote implementation: support from the top management of the organizations, knowledge about CWA 15793, a compliance audit checklist and gap analysis, training and exercises, networking in LRNs and other networks, and interinstitutional audits. Implementation of CWA 15793 at each institute would strengthen the European animal bioterrorism response capabilities by establishing a well-prepared LRN.

Rapid detection and identification of Bacillus anthracis in food using pyrosequencing technology

The development of advanced methodologies for the detection of Bacillus anthracis has been evolving rapidly since the release of the anthrax spores in the mail in 2001. Recent advances in detection and identification techniques could prove to be an essential component in the defense against biological attacks. Sequence based such as pyrosequencing, which has the capability to determine short DNA stretches in real-time using biotinylated PCR amplicons, has potential biodefense applications. Using markers from the virulence plasmids (pXO1 and pXO2) and chromosomal regions, we have demonstrated the power of this technology in the rapid, specific and sensitive detection of B. anthracis spores in food matrices including milk, juice, bottled water, and processed meat. The combined use of immunomagnetic separation and pyrosequencing showed positive detection when liquid foods (bottled water, milk, juice), and processed meat were experimentally inoculated with 6CFU/mL and 6CFU/g, respectively, without an enrichment step. Pyrosequencing is completed in about 60min (following PCR amplification) and yields accurate and reliable results with an added layer of confidence. The entire assay (from sample preparation to sequencing information) can be completed in about 7.5h. A typical run on food samples yielded 67–80bp reads with 94–100% identity to the expected sequence. This sequence based approach is a novel application for the detection of anthrax spores in food with potential application in foodborne bioterrorism response and biodefense involving the use of anthrax spores.

Crowd evacuation simulation for bioterrorism in micro-spatial environments based on virtual geographic environments

Urban management requires assessing bioterrorism response in micro-spatial environments, modeling potential attacks and carrying out efficient risk assessment. This paper presents the method of crowd evacuation simulation for bioterrorism in micro-spatial environments using the basic theory of Virtual Geographic Environments (VGE), combined with pathogen diffusion and crowd simulation modeling techniques. A framework of evacuation simulation was presented in this paper and the key technologies to implement the framework, including grid-based spatial data environment, agent-based individual model, and the method of associated individual behavior with spatial environment were also proposed to simulating crowd behaviors in bioterrorism. Taking the Olympic Park station of the Beijing Metro Line 8 as a typical study area, a crowd evacuation simulation prototype system was developed and a quasi-experiment using three different scenarios was conducted. The prototype system can be used to demonstrate some emergent individual behaviors in bioterrorism, such as competitive, queuing, and herding. Details can be obtained at each computation step (e.g., the number of people in subway station, the region of population, the geo-location of individual, the exposed population in polluted areas) with the prototype system. In the experiments, the number of people exposed is constantly increasing with the gradually increase of contaminant area as time pass. And different scenes were appeared for the different way of deal with bioterrorism. With the experiment, the number of people affected and the relevant parameters under various bioterrorism scenarios can be estimated, which can support rapid and efficient emergency decision-making for bioterrorism prevention.

Immediate Feedback on Accuracy and Performance: The Effects of Wireless Technology on Food Safety Tracking at a Distribution Center

The effects of wireless ring scanners, which provided immediate auditory and visual feedback, were evaluated to increase the performance and accuracy of order selectors at a meat distribution center. The scanners not only increased performance and accuracy compared to paper pick sheets, but were also instrumental in immediate and accurate data capture and tracking in compliance with the Public Health Security Bioterrorism Preparedness and Response Act (BTA) of 2002. The intervention, which required minimal training, successfully accelerated key operational processes and compliance with food safety mandates. The implications for Organizational Behavior Management practitioners are discussed.

Q Fever: Single-Point Source Outbreak With High Attack Rates and Massive Numbers of Undetected Infections Across an Entire Region

In early 2009, a dairy-goat annex care farm in South Limburg, the Netherlands, reported 220 Coxiella burnetii-related abortions in 450 pregnant goats. These preceded human cases and occurred in a region that was Q-fever free before 2009, providing a unique quasi-experimental setting for investigating regional transmission patterns associated with a Q-fever point source. Index-farm residents/employees, visitors, and their household contacts were traced and screened for C. burnetii. Distribution of community cases was analysed using a geographic information system. True incidence, including undetected infections, was estimated regionwide by seroprevalence in a pre- versus postoutbreak sample, and near-farm by immunoglobulin M seroprevalence in a municipal population sample. Environmental bacterial load was repeatedly measured in surface and aerosol samples. Serological attack rate was 92% (24/26) in index-farm residents/employees, 56% (28/50) in visitors, and 50% (7/14) in household contacts, and the clinical attack rate (ie, the proportion of persons seropositive for acute infection who also had clinical illness) was ≥ 80%. Notified symptomatic community cases (n = 253) were scattered downwind from the index farm, following a significant exposure-response gradient. Observed incidence ranged from 6.3% (0-1 km) to 0.1% (4-5 km), and remained high beyond. True incidence of infections was estimated at 2.9% regionwide, extrapolating to 8941 infections; estimated near-farm incidence was 12%. Coxiella burnetii load was high on-farm (2009), and lower off-farm (2009-2010). Linking a single dairy-goat farm to a human Q-fever cluster, we show widespread transmission, massive numbers of undetected infections, and high attack rates on- and off-farm, even beyond a 5-km high-risk zone. Our investigation may serve as an essential case study for risk assessment in public health and related fields such as bioterrorism response and preparedness.

Immunomagnetic capture of Bacillus anthracis spores from food.

Food is a vulnerable target for potential bioterrorist attacks; therefore, a critical mitigation strategy is needed for the rapid concentration and detection of biothreat agents from food matrices. Magnetic beads offer a unique advantage in that they have a large surface area for efficient capture of bacteria. We have demonstrated the efficient capture and concentration of Bacillus anthracis (Sterne) spores using immunomagnetic beads for a potential food application. Magnetic beads from three different sources, with varying sizes and surface chemistries, were functionalized with monoclonal antibodies and polyclonal antibodies from commercial sources and used to capture and concentrate anthrax spores from spiked food matrices, including milk, apple juice, bagged salad, processed meat, and bottled water. The results indicated that the Pathatrix beads were more effective in the binding and capture of anthrax spores than the other two bead types investigated. Furthermore, it was observed that the use of polyclonal antibodies resulted in a more efficient recovery of anthrax spores than the use of monoclonal antibodies. Three different magnetic capture methods, inversion, the Pathatrix Auto system, and the new i CropTheBug system, were investigated. The i CropTheBug system yielded a much higher recovery of spores than the Pathatrix Auto system. Spore recoveries ranged from 80 to 100% for the i CropTheBug system when using pure spore preparations, whereas the Pathatrix Auto system had recoveries from 20 to 30%. Spore capture from food samples inoculated at a level of 1 CFU/ml resulted in 80 to 100% capture for milk, bottled water, and juice samples and 60 to 80% for processed meat and bagged salad when using the i CropTheBug system. This efficient capture of anthrax spores at very low concentrations without enrichment has the potential to enhance the sensitivity of downstream detection technologies and will be a useful method in a foodborne bioterrorism response.

보건관련 교수들의 생물테러 교육현황에 관한 연구 -응급구조학, 임상병리학과 기타 보건관련학교수를 대상으로-

바이러스, 세균, 곰팡이, 독소 등을 이용한 생물테러는 사회불안을 일으키고 사람들에게 치명적인 병을 일으킨다. 2001년 911테러를 겪으면서 생물테러 대비에 대한 중요성이 강조되고 있다. 따라서, 보건관련 종사자들은 이런 생물테러 발생이 있을 때 주도적인 역할을 하는 사람들이다. 본 연구의 목적은 보건관련 교수들에게 설문을 통해 생물테러 교육현황에 대해 알아보고자 하는데 있다. 보건관련 대학에서 학생들에게 생물테러 대비에 대한 교육을 실시하여 향후 언제 발생할지 모르는 생물테러에 대한 대비와 대처능력을 갖게 하는 것이 중요하다. 보건관련 대학에서 학생들에게 생물테러 대비에 대한 교육을 실시하여 향후 언제 발생할지 모르는 생물테러에 대한 대비와 대처능력을 갖게 하는 것이 중요하다. 연구는 2007년 3월 10일부터 6월 10일까지 3달간 우편설문조사로 진행되었다. 응급구조학과 23개교, 임상병리학과 25개교, 기타 보건관련학과에도 우편으로 설문을 배포하였다. 응급구조학과, 임상병리학과, 기타 보건관련 교수들의 97.6%에서 생물테러 교육 경험이 없었다고 응답하였다. 생물테러 교육의 내용으로 비상사태 및 재난의 정의와 특성, 테러 및 생물테러의 정의, 생물테러의 역사, 생물테러의 일반적 특성, 생물테러 가능병원체의 종류, 대비, 체계적 대응, 의학적 대응이다. 이상의 결과를 바탕으로 생물테러 교육과정을 개발하여 재난 대비 교육을 실시하고자 한다. A bioterrorism attack(BT) attack is the deliberate release of viruses, bacteria, fungi, and toxins used to cause illness or death in people, animal, and plants. Therefore, the healthcare workers are those who will take the main role in BT outbreak situations. The purpose of this study is to investigate current status of education for BT preparedness and response in health-related colleges. It is important to provide the BT preparedness and response to the health-allied students in case of unexpected BT outbreak. The questionnaires were collected from March 10 to June 10 in 2007 via mai l. Approximately 97.6% of the health-related professors answered that they had no experience of bioterrorism education. The contents of the bioterrorism curricula should contain the followings : definition and characteristics of the emergency and disaster, definition of bioterrorism, history of bioterrorism, general characteristics of bioterrorism, etiological agents of bioterrorism, bioterrorism response, systematic response, and medical response. Through these data, we will develop the disaster and bioterrorism preparedness curricula.

Logistics modelling: Improving resource management and public information strategies in Florida

One of the most time-sensitive and logistically-challenging emergency response operations today is to provide mass prophylaxis to every man, woman and child in a community within 48 hours of a bioterrorism attack. To meet this challenge, federal, state and local public health departments in the USA have joined forces to develop, test and execute large-scale bioterrorism response plans. This preparedness and response effort is funded through the US Centers for Disease Control and Prevention’s Cities Readiness Initiative, a programme dedicated to providing oral antibiotics to an entire population within 48 hours of a weaponised inhalation anthrax attack. This paper will demonstrate how the State of Florida used a logistics modelling tool to improve its CRI mass prophylaxis plans. Special focus will be on how logistics modelling strengthened Florida’s resource management policies and validated its public information strategies.

(A33) Application of the Modular Emergency Medical System (MEMS) for Community Response to All-Hazards Public Health Emergencies

The Modular Emergency Medical System (MEMS) is a flexible and scalable model for community-based response to all catastrophic emergencies. This paper highlights the development of MEMS at the local and regional levels, including training exercises to demonstrate MEMS capabilities, implementation strategies, and its role in the H1N1 response and vaccination clinics. The MEMS was introduced in 2002 as a bioterrorism response by the US Army Edgewood Biological and Chemical Command (ECBC). All-hazards MEMS, as part of a Regional Response System (RRS), was developed by the New England Center for Emergency Preparedness (NECEP) working with state and federal partners. The MEMS presents a modular response framework to mobilize communities and local resources to meet the medical surge demands during a catastrophic event. The modular components of MEMS empower a community-based response to catastrophic emergencies. The Neighborhood Emergency Help Center (NEHC) provides triage and initial treatment, or can function as a point for dispensing prophylaxis medications or vaccinations. During a medical surge, the Acute Care Center (ACC) moves non-critical patients outside of the hospital setting, creating more space for critical care patients. The Community Outreach (CO) module supports casualties recovering in their own homes, under quarantine, and other home-care support. The Casualty Transportation System (CTS) operates between MEMS components, patients' homes and outside of the affected area, meeting all transfer needs. The Medical Control Center (MCC) and Multi-Agency Coordinating Entity (MACE) provide command, control, and coordination of community emergency medical services (EMS), hospital, and public health response assets. Local, regional, and statewide exercises have demonstrated the capabilities of MEMS in Northern New England. The MEMS system, specifically with the MACE concept, was used in New Hampshire during the 2009 H1N1 event. These proven implementation strategies will assist local communities in developing and refining all-hazards response plans.

Recent Advances in the Prevention of Bioterrorism Attacks

Since the September 2001 attacks on the World Trade Center and other locations in the United States, a primary concern for the global community has been to heighten homeland security and thereby prevent terrorist attacks. Additional attacks following the tragedy in 2001 across the world included mailed envelopes containing viable Bacillus anthracis or Anthrax spores that caused 5 deaths in the US. As a countermeasure to bioterrorism attacks, the US implemented the “Public Health Security and Bioterrorism Preparedness and Response Act� in 2002. This was recently strengthened by the passing of the “Food Safety Modernization Act� of 2010. Both laws are intended to provide resources to oversight agencies for tighter regulation and control of food entering and being distributed in the US. It raises the question to what degree a nation can prepare for a potential bioterrorism attack on the food supply. The Centers for Disease Control and Prevention (CDC) have identified several biotoxins that could be used for dispersion. Many of these agents are listed in categories A (including anthrax, botulism, smallpox, and the plague) and B (including strains of Salmonella and Escherichia, Cholera, and Ricin) of the CDC list of potential bioterrorism agents that can be dispersed with relative ease and result in high morbidity and mortality rates. A major concern is the preparedness of public health authorities and the timeliness of the response and recognition of an actual incident. A recent risk analysis of the response to a bioterrorism incident involving Salmonella or Escherichia bacteria concluded that it would take between 3-5 days and at least 2 confirmed cases to detect and contain the source.