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Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.
City of ChicagoMayor Rahm Emanuel
Wczesne wykrywanie czynników biologicznych w warunkach polowych: studia przypadków w kontekście procesu
podejmowania decyzji w instytucjach zdrowia publicznego w sytuacji reagowania na przewidywane uwolnienie
niebezpiecznego środka biologicznego2014 Konferencja Epimilitaris w Rynie, Polska
Suzet M. McKinney, Doktor Zdrowia Publicznego, magister Zdrowia Publicznego,
Zastępca Komisarza Departamentu Zdrowia Publicznego w Chicago
Misja i zadania BioWatch
Misja− Zapewnić, utrzymywać i wspierać ciągłą możliwość
monitorowania zagrożenia bioaereozolem w wybranych obszarach metropolitarnych
Zadania− Wykrywanie i charakterystyka atak z użyciem broni
biologicznej przeciwko miastom naszego Narodu, high value assets and special events
− Zwiększyć i udoskonalić możliwość monitorowania zagrożenia bioareozolem i potencjał, jednocześnie ograniczając wydatki
− Dostarczać wskazówki i wsparcie agencjom federalnym, państwowym i lokalnym w zakresie zarządzania skutkami
− Zapewnienie interoperacyjności z innymi krajowymi systemami monitorowania zagrożeń bioaerozolem i
t i i t ż i
Asystent Sekretarza ds. Gotowości i Reakcji na Incydenty
Zarządzanie w sytuacjach kryzysowycht
Organy ochrony porządku
publicznego
Operacje polowe Agencja Ochrony Środowiska
Ministerstwo Obrony
Federalne Biuro Śledcze
Centra Kontroli i Prewencji Chorób
Tajna Służba Stanów Zjednoczonych
Laboratoria krajowe
BioWatch
Właściciele obiektów
Operacje zdrowia publicznego
Operacje laboratoryjne
Pierwsza linia reagowania
Partnerstwa BioWatch
Wykon awcy
Opis ćwiczeń
Ćwiczenia funkcjonalne– Sieć Metro w Chicago (CTA)– Scenariusz pod dachem– Skupienie się na pobieraniu próbek ze
środowiska– Forward Command– Informacja publiczna/ media
Scenariusz– Gęsto zaludniona przestrzeń miejska– Pozytywne wyniki wykrycia wąglika w dwóch
kolektorach
Maj 20 (22:00)– Maj 21 (04:30)
– Łączne Dowodzenie na posterunku forward command
– Etap I pobieranie próbek ze środowiska peronu metra
Lipiec 18 (09:00 –15:00)– Analiza laboratoryjna
próbek pobranych w ramach etapu I
– Zmiana harmonogramu ze względu na reakcję na grypę H1N1 w laboratorium w maju
Opis ćwiczeń
Ćwiczenia
Exercise conducted overnight; shut-down of downtown subway station
Four city blocks cordoned off for exercise play Unified command established Initial briefing at forward command post followed by
development of an Incident Action Plan (IAP) Mock press conferences Personnel decontamination Environmental sampling Sample transport Laboratory analysis
Lessons Learned After Action Report
– The potentially exposed population may have been too narrowly defined
– The media spokesperson communicated some inaccurate or unclear information at mock media briefings
– Laboratory-specific MOUs do not exist for surge support following a BioWatch event
Lessons Learned
Internal evaluations/observations– Members of the unified command (UC) were hard to
identify– Process for conducting coordinated criminal and
epidemiological investigations was unclear– Familiarity with radio use varied amongst responders
Exercise Overview Tabletop Exercise
Opportunity to asses target capabilities associated with the response to biological threats and to improve the management of the public health response to an anthrax incident across all levels of government
Target Capabilities tested– Communication– Emergency Public Safety and Security– Emergency Public Information and Warning– Critical Resource Logistics and Distribution– Mass Prophylaxis– Medical Supplies Management and Distribution
Participants
130 Participants (50 agencies)
Local representation− Law Enforcement (Chicago Police Department)− Fire/ Rescue (Chicago Fire Department)− Emergency Management (OEMC, CCDHSEM,
DCHSEM)− Public Health (CDPH, CCDPH, DCHD)− Other: Aviation, Environment − Hospitals (MCHC, IHA)
Participants
State representation– IL Department of Public Health– IL National Guard– IL Emergency Management Agency– IL Environmental Protection Agency
Federal representation– Office of Health Affairs– Department of Homeland Security– White House-Homeland Security Council– US DHHS– FEMA
Exercise Play
Facilitated Discussion
Lead representatives of various departments and agencies
3 Modules progressive phases of response– Initial response actions following a positive detection– Initial response actions– Continued response to a prolonged PH emergency
and recovery
Lessons Learned
Critical Resource Logistics and Distribution– Processes for managing and allocating resources
across region should be better defined– Should consider development of a regional SNS plan
for situations when multiple jurisdictions are impacted by an incident
– Laboratory capacities would be quickly overwhelmed
Mass Prophylaxis– Regional planning team to consider alternative
distribution methods would be beneficial– POD operations plans differ across the region
Lessons Learned
Medical Supplies Management & Distribution– Monitoring of supply usage and stockpile levels vary
across the region– Review of existing plans and consideration of regional
planning concepts for supply usage monitoring would be useful
Exercise Overview Multi-jurisdictional, multi-agency tabletop exercise
Provided an opportunity for participants from both jurisdictions to discuss regional coordination in response to an interstate biological incident
Objectives:– Explore effectiveness of notifications, maintenance of multi-agency/
multi-jurisdictional strategic coordination during a biological event– Discuss the types and frequency of critical information/intelligence
exchange– Examine joint strategies and resources necessary for the rapid and
effective collection, analysis, and interpretation of environmental sampling data and human/animal surveillance data
Core capabilities tested:– Environmental Response/Health and Safety– Intelligence and Information Sharing– Operational Communications– Operational Coordination – Planning– Public Health and Medical Services– Situational Assessment
Exercise Overview
Exercise Play
Facilitated discussion
Included key public health and emergency management officials from neighboring jurisdictions
Scenario involved a positive detection on an American holiday in a mid-size city during a summer festival attracting thousands of people from a neighboring large, urban city. The following day, 2 positive detections were made during a large fireworks display attracting millions of people in the large, urban city.
Operational Communications− Formalized interstate notification protocols will
enhance response operations in neighboring jurisdictions
Planning− Regional planning should be conducted to minimize
vast differences in response to field detection of biological threats in neighboring cities.
− Indoor detections create significant community and economic impacts that must be resolved
Lessons Learned
Operational Coordination− Regional ICS structures should be considered to
enhance interstate response efforts
Intelligence and Information Sharing– Protocols for efficient intelligence sharing between
fusion centers and partners should be clarified between neighboring jurisdictions
Environmental Response/Health and Safety− Availability of federal resources could be scarce due
to requests from multiple jurisdictions
Lessons Learned
Early-warning systems are critical in the ability to detect environmental occurrences of biologic threats
Exercise examples include three different scenarios of varying size, scale and scope
Some lessons learned in public health decision making were consistent across all three scenarios, despite size, scale or scope
Overall Findings
Most critical public health decisions are in the areas of:− Emergency Public Information and Warning− Notification of elected officials and other political
leaders− Management of healthcare notification vs. public
notification− Timeline for transition to all-hazard response plans− Considerations for joint criminal and epidemiological
investigations − Initiation of medical countermeasure distribution− Care and management of at-risk populations
Overall Findings
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