A MODEL RESPONSE TO
BIOTERRORISM: Pennsylvania
Region 13-WMD Task Force
J. David Piposzar, MPH
http://info.co.allegheny.pa.us/services/achd/
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• This lecture is one of series
produced by the Allegheny County
Health Department (PA), Bethlehem
Health Bureau (PA) and the City of
Elizabeth Department of Health &
Human Services (NJ).
• The organizers of this project are
scholars in the Northeast Regional
Public Health Leadership Institute,
Class of 2000. For information
contact: dcw01@health.state.ny.us
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• J. David Piposzar, MPH
– Emergency Management Coordinator,
Allegheny County Health Department
– Penn State University
• BS, Zoology
– University of Pittsburgh
• MPH, Graduate School of Public Health
• Delta Omega, National Public Health
Honorary
– Recipient of EPA Region III Partnership
Award for contributions to chemical
emergency preparedness and
prevention
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• Mr. Piposzar is a career public health employee
with 25 years of service in all aspects of public
health. He coordinates health department
emergency management functions with other
federal, state, county and municipal agencies.
He is a member of the Allegheny County
Emergency Planning Committee, where he chairs
the Medical and Health Subcommittee. He
authored a “Multi-hospital Emergency Medical
Plan for Hazardous Materials Emergencies” and
developed and implemented a nationally
recognized training program. His work has been
recognized by EPA, the Ford Foundation, and
Allegheny County government, among others.
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Learning Objectives
• Understand the factors
necessary to organize a
community to protect against
bioterrorism.
• Understand the basic threats
from bioterrorism.
• Understand how bioterrorism
events are diagnosed.
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Performance Objectives
• Begin organizing your community to
be able to respond to bioterrorism.
• Know what organizations and
agencies are necessary to respond
to bioterrorism at the local, state and
Federal level.
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PENNSYLVANIA-REGION 13
Metropolitan Medical Response
System
A Regional, System-Based Approach to
Mass Casualty &
Nuclear, Biological, and/or Chemical
(NBC)
Terrorism Preparedness
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PITTSBURGH
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Mission Objectives
1. Formalize regional mutual aid
agreements and plans.
2. Establish an interoperable
communication system.
3. Develop a specialized equipment pool.
4. Ensure specialized training is available.
5. Apply for grant funding.
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6. Foster networking and sharing of
information.
7. Develop criminal intelligence protocol’s
and procedures.
8. Deliver highly trained and equipped teams
of responders at the local and regional levels.
9. Ensure the highest level of Life Safety
response at a responsible cost to taxpayers.
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Funding
• $600,000
• $395,000
• $300,000
• $28,500
Metropolitan Medical
Response System
(MMRS)
MMRS-RISC TEAM
Project
Department of Justice
FEMA
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Committees
Policy
Communications / 9-1-1
Fire / Haz Mat
Medical / Health
Training
Law Enforcement
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MMRS Planning
Salt Lake City Minneapolis / St. Paul
Cleveland
St. Louis
Portland
Sacramento
Pittsburgh
Oakland
Long Beach
Tucson
Albuquerque
El Paso
Austin
Oklahoma City Fort WorthTulsa
Hampton
Roads
Charlotte
Nashville
New Orleans
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MMRS PLANNING

300+ individuals

87 organizations and

65 hospitals

Monthly meetings- 3rd Thursdays

E-mail network & secure web site
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Region 13 Plans
–Surveillance and notifications
–Mass immunization
–Mass Patient Care• RISC TEAM
• Pharmaceutical cache
–Mental Health
–Mass fatality management
–Environmental surety
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Types - Biological Agents
• Bacteria: Plague, Anthrax,
Tularemia
• Viruses: Smallpox, VEE, Viral
Hemorrhagic Fevers (Ebola)
• Toxins: Botulinum, Ricin, SEB
Anthrax - vegetated
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SURVEILLANCE- EARLY
RECOGNITION

Physicians and nurse gatekeepers

Infection control practitioners

Laboratories

Pharmacies

Veterinarians

Coroners/ medical examiners

911- Centers
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
EMS Regional Offices

Pittsburgh Poison Center

Police special protection
units/security details

USDA, FDA, food & water protection

Duty officers- PaDEP, EPA, PaDOH,
ACHD

School nurses

Employers
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Criminal Intelligence + Medical
Intelligence = Threat assessment
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Notifications to Health Officials
Reportable diseases
Unusual disease occurrences
Suspect cases- “syndromic” surveillance
Allegheny County Health Department
412-687-2243
Pa. Department of Health S.W District
412-565-5101
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Epidemiological Information
• Travel history
• Infectious
contacts
• Employment
history
• Activities over the
preceding 3 to 5
days
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Epidemiologic Clues
• Large epidemic with high illness and
death rate
• HIV(+) individuals may have first
susceptibility
• Respiratory symptoms predominate
• Infection non-endemic for region
• Multiple, simultaneous outbreaks
• Multi-drug-resistant pathogens
• Sick or dead animals of multiple
types
• Delivery vehicle or intelligence
information
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Public Health Concerns

Mass Immunization and Mass
Prophylaxis

Antibiotics

Antidotes

Vaccines

Acquisition & distribution methods
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Pharmaceutical Cache
– List of pharmaceuticals to provide care
for the first 24 hours of response to an
incident.
– Plans to store and replace “dated”
drugs through agreements with
distribution center.
– Plans to distribute & dispense
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Rx Cache
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Hospital Preparedness
• UPDATE HOSPITAL DISASTER PLANS:
– notification procedures
– lock-down procedures
– mass decontamination capability
– mass casualty triage capability
– PPE for staff
– pharmaceuticals and equipment
– medical staff training and recognition
– medical treatment protocols (adult &
pediatric)
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Integration with NDMS
National Disaster Medical System
• VA and Hospital affiliates
• Plan for forward movement of patients if
we are overwhelmed
• Plan to receive patients from other cities
if they are overwhelmed
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Mental Health Services
• Coordination with existing mental health
providers
• Counseling services for responders
• Counseling for victims, families, and
community
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Mortuary Services
• Based on existing mortuary services
• Mutual aid and federal D-Mort support
• Defining temporary morgue needs
• Enhancing PPE for morgue workers
• Special decontamination requirements
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Environmental Surety
• Protection of water and food supplies
• Plans and procedures to restore facilities
• Criteria for re-occupancy
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Communications
• Enhance communications among
agencies
• BMSI and Carnegie Mellon Research
Institute-secure web site
*
*
*
*
Hospital bed availability
Plans and procedures
Training materials
Response actions in real time
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REGIONAL INCIDENT
SUPPORT AND
COORDINATION TEAM
(RISC TEAM)
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Chart Title
REGION 13-EMA COORDINATORS
ADMINISTRATION
PERSONNEL
TRAINING
PLANNING
FINANCE
LOGISTICS
MEDICAL & HEALTH
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INCIDENT LOCATION
LOCAL RESOURCES EXPENDED
REQUEST REGION 13 ASSISTANCE
412-473-3000
OR RADIO
NOTIFICATION OF REGION 13 ENTITIES
911- ANSWERING POINTS
EMERGENCY MANAGEMENT AGENCIES
RISC TEAM
ACTIVATION
MUTUAL AID
ADJACENT JURISDICTION
RISC-COMMAND RESPONSE
LIAISON
STATE AND FEDERAL RESOURCES
RISC RESOURSES
(INCIDENT & LOCATION SPECIFIC)
DEPLOYMENT
SUPPORT SERVICES
RISC MEMBERS DEPLOYED
(REPORT TO STAGING POINT)
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Recommendations:
• SUPPORT DEVELOPMENT OF CRITICAL
SURVEILLANCE SYSTEMS
• HELP IDENTIFY PERSONNEL TO BUILD “
MEDICAL SURGE CAPACITIES”
• WORK QUIETLY AND EFFICIENTLY TO
MINIMIZE PUBLIC ANXIETIES OR FEAR
• MOBILIZE COMMUNITY RESOURCES
• SUPPORT TRAINING/EDUCATION OF
MEDICAL PERSONNEL
• ENHANCE COMMUNICATIONS &
PARTICIPATE IN PLANNING !
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