Anthrax Planning

Aerosolized anthrax has been a primary focus from the law enforcement side of bioterrorism for many years.  Additionally, it has also been a primary focus for the public health side of the issue, but for slightly different reasons.

As a weapon choice, anthrax makes sense; relatively easy to produce, relatively easy to deploy and not easily fixable.  It would also expend a great deal of response resources to control the actual exposure problem, much less the problem of community fear and demand for treatment regardless actual exposure.

Two recent articles articulate the Centers for Disease Control position and efforts: The addition of more and different countermeasures for anthrax exposure (http://www.cidrap.umn.edu/cidrap/content/bt/anthrax/news/sep1511anthrax.html) and a recommendation for testing or anthrax vaccine in pediatric individuals (http://www.cidrap.umn.edu/cidrap/content/bt/anthrax/news/sep2211anthrax.html).

Vaccine testing in the pediatric community will be problematic.  For the front line public health workers, it will be an invisible effort at some university setting.  What these issues do suggest, is the locality specific planning need to include three massive segments:

1.  The logistics only exercise of providing antibiotics to the area population within 48 hours.  For my service area, that population is a half million, including commuting workers, visitors and residents.  This will require an all out effort of the entire first responder community, any public health assets, state support and the Strategic National Stockpile assets.
2. The second phase will require additional concerted efforts.  If the epidemiological system can narrow the foci of exposure, those persons in the plume will require an additional 50 days of medication.  I can only assume that more rigorous medical screening for medication choice and management will be in place.  In any event, there will be a significant fatigue factor in the public health responders as demonstrated in the extended H1N1 campaign.
3. Last, when reviewing the article for potential pediatric testing, that the provision of anthrax vaccination will be provided to the population.  After an actual event, I suspect that vaccine uptake will be significant.  The issue on the public health effort will be based on demand for vaccine, priorities of the vaccination program versus day-to-day activities and if any additional personnel will be available.

Planning will continue. Key questions in our evaluation processes will orbit the human resources issues of staff, volunteers and those organizations that may be able to manage part of the problem on their own. 

Those first two days will be fast and loose with rules, medication volumes and methods.  After that, even with ten days to provide medication to the exposed group, it is my belief that more professional rigor will be in place.  Certainly for any vaccination program of long duration we will require significant nursing staff.  Extension into the Emergency Medical Services ranks for vaccinators will be difficult since there will continue to be accident and injuries.  Could active duty medical personnel be used?  Only of the significant laws are set aside.

The scope of the potential problem is not insurmountable.  The planning effort will and has already been demonstrated to provide support to daily activities in local health departments.

A guest entry by Teresa Blakeslee, the Medical Reserve Corps Coordinator for the district.

When Disaster Strikes…Are You Ready To Serve?

Don’t Wait, Affiliate!

When natural or human-caused disasters strike, people look for ways to contribute to the relief of the survivors. Many people have a strong psychological need to volunteer in a disaster. Does that sound like you? Are you ready to serve? Read on to see….

Volunteers who have not previously affiliated with a disaster response agency represent a tremendous resource for a community that’s been hit with a disaster. However when volunteers are well-coordinated through an organization such as the Medical Reserve Corps, everyone benefits.

Despite the best intentions of the spontaneous unaffiliated volunteer (SUV’s), your presence may compound, rather than alleviate, the problems in the disaster area. Why? You will have minimal access to food, water, shelter and medicine. SUV’s arriving on the scene will not have identification/clearance to enter a disaster zone to help. Some disasters may be the scene of crimes of desperation or the products of violent conflict, so you must also consider your personal security. Disease can spread quickly in disaster areas and you may need pre-treatment to avoid becoming ill.

You aren't emotionally prepared for the overwhelming stress of working in a disaster area and assisting disaster victims, and the long hours associated with response efforts. You may quickly succumb to your own emotional and physical limitations, and be part of the problem rather than the solution.

If you are not prepared to serve, join an organization such as the Medical Reserve Corps before the need is great. You will be provided free training and disaster exercises to help strengthen you to serve, help you learn to avoid your own distress on the scene, and help the overall operation through a structured response, ultimately being able to help victims recover more quickly.

If you have local knowledge or special skills, the Medical Reserve Corps has a way to incorporate you into their relief effort through pre-credentialing and pre-training for rapid response. Without this, you will wait at a volunteer reception center (VRC) to be processed for placement in the field behind those who have been pre-qualified.

Finally, it is likely you will want to help, and your help will be needed.

Visit http://www.vdh.virginia.gov/mrc/ to learn more about the Medical Reserve Corps who is seeking medical as well as support volunteers now to add to the ranks of a dedicated cadre of volunteers committed and in training to improving the health, safety, and resiliency of our communities!

Don’t Wait, Affiliate! Join today!

Radiation and the community....

One of the best tools for explaining radiation exposures and risk to our own staff was prepared secondary to the damage at Fukushima and although not inclusive, provides a level of perspective for folks.


There had been a great deal of opinions related to the Fukushima incident in the couple of months following the earthquake and tsunami. Like many folks, I had many questions. Unlike many, I could read the information coming from the blogosphere with a skeptical eye and a little more knowledge than the average citizen as a submarine corpsman (read that as health physics technician).

I dislike "worst case scenario" writing without identifying the story as such. The folks who articulated some facts and then extend the very loose logic into and end of the world story. I recently read a post by a physician who correctly stated that the International Commission on Radiation Protection determined that any radiation exposure can be dangerous. She then suggested (in very strong language) that the incidence of cancers will significantly increase. I think she is wrong to come to a conclusion without providing the reader good data (at least).

Many of the science writers for a wide variety on online do not put information in perspective for the reader. A person who is reading a great deal about the incident because they don't know, sees the headline "Radiation detected is 150 mSieverts...". They ask themselves, Is that a big number or a little number? And read the context.. The writer and the reader without the understanding that important information is missing: The range of detection, was it "on contact", at two feet etc. The writer should offer perspective. The inverse square law (http://en.wikipedia.org/wiki/Inverse-square_law) should be articulated to reader. "Double the distance and quarter the dose" would suffice to calm fears.

The Centers for Disease Control and Protections (CDC) has provided additional guidance for medical personnel, planners and the public (http://emergency.cdc.gov/radiation/). A great deal of this information and related activities will be of significant use to our public health colleagues who have not had exposure to the subjects. Those folks who are responsible for communities adjacent to the 104 nuclear power stations in the US are a bit better prepared since there are utility evaluations performed by FEMA every couple of years.

In any event, the district will continue to address radiation in concert with the other public health priorities.

Social Networking Integration

There are so many opportunities for the public and colleagues to access information. There have been a few places where we can provide multiple posts to the various social networking sites. Our objective within the realm of EP&R programs, is to provide passive access to information for general consumption.

The addition of Facebook, Twitter and perhaps blog feeds to the health district's web page looks like an option. We are also considering the addition of downloadable products to support the various programs. I hope that we can widget the blog onto the page and see how it goes....

Only a slight rant...

I suspect that many local planners are in a similar position; that the responsibility for the production of a specific document, policy or procedure is "owned" by someone else. A central office, a stakeholder in the planning process, or a jurisdiction can have a significant impact on the local planner. I have been applauded and chastised for the production of documents that are owned by another organization.

Sometimes, doing the work of others allows for the best ability to influence the process. It is more easy to sign a document and get a checkmark in the box, thus allowing the plan to move forward. In other situations, the development of conflict over turf actually produces a better or more timely result. Either way, I think the public we all serve wins.

Since I serve five jurisdictions, I volunteer to help the local jurisdiction planners by writing the health and medical annexes for their plans. With every iteration, those plans get closer and closer together, actually reflecting what the local health department can provide, what we can coordinate with central office staff or what we need a jurisdiction to provide.

Inorder for all of these things to occur. I believe local health department planners need to make sure that the jurisdictions see and feel the value of the health department planner. The professional relationship are very important. An emergency manager needs to trust the local health department....

Planning for the loss of the planner...

In discussions with the CDC consultants over the past few months, I was really disappointed that they wanted more and more details for an event, that by definition, occurs in an ambiguous environment. I had prepared a variety of plans that could aply nearly anywhere that would be convenient for the emergency managers and jurisdictional leadership; school gymnasiums, parking lots or empty strip malls. These general flow paths gave the assigned staff flexibility.

I know that many individual prefer more structure than I require in order to accomplish a task. This need for structure, although not what I need for the completion of response to the complex scenarios of the Cities Readiness Initiative, would prove difficult for some colleagues.

I have decided to address the issue as though I will never be present for an activity. For our seasonal and H1N1 campaigns I have appointed operations chiefs, and I will only provide consultation; they must move through the phases, make assignments and so on. It is a little painful for some, but others rise to the challenge.

A correction and explanation...

A colleague commented that the Project Public Health Ready has been an ongoing process for several years. This is a true statement, I should have clarified that the PPHR is a new effort here in Virginia where we intend to have all 35 health districts certified over the next three years.

I do believe that the PPHR effort will be a significant label for local health departments in the future. Any effort to document the quality of services provided by health departments is invaluable to the jurisdiction(s) served and the general public.