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Bioterrorism
STATE TAKES STEPS TO PREPARE The terrorist attacks of September 11, 2001 and subsequent anthrax exposures have ignited a renewed commitment in the state of North Carolina to strengthen our readiness and our capacity to respond to a terrorist attack. Numerous local, state, and regional agencies are collaborating on multiple scenarios that exist now that the threat of terrorism is real. Specifically, four agencies have recently joined efforts to consider the treatment and response phase of a terrorist event. The agencies include the North Carolina Office of Emergency Medical Services (NCOEMS); the North Carolina Division of Emergency Management (NCEM); the North Carolina Division of Public Health - Epidemiology & Communicable Disease (NCPH); and the Special Operations Response Team (SORT). These agencies represent the management system responsible for coordinating a disaster response, ensuring that treatment and prevention strategies are implemented, as well as disease surveillance and medical preparedness. The goal of this effort is to assure our citizens that when a terrorist attack occurs in North Carolina, they will be able to get the medical care services they need to protect their health and prevent the further spread of disease. Priorities include enhancing disease monitoring and investigation systems, improving communication capabilities among health agencies and building the medical response capacity. The agencies have collaborated to develop the following tiered State Medical Response System (SMRS) plan: Type I (State Level). SORT is a private non-profit organization located in Winston-Salem, is a federally supported disaster medical team that responds nationwide. The Type I initiative will expand the equipment and personnel of SORT which will allow them to have a dedicated set of equipment for response to incidences in North Carolina if the federal committed resources are not available. To provide initial response to collapse structures, the state is supporting the development of Urban Search and Rescue (USAR) teams. The Type I teams will be trained and equipped in five communities that have existing capabilities. These teams will be trained and equipped to respond specifically to collapsed steel/concrete structures. Type II (Regional Level), will begin to address our hospital-based capabilities (medical surgical capabilities). Each county and hospital in North Carolina is currently included in at least one of seven Regional Advisory Committees or RACs. The plan envisions that the RACs will create a sub-committee to serve as the lead coordinating organizations across the state to serve as the conduit for information, training and medical mobilization in preparation for a terrorist event. To facilitate these efforts, each RAC's sub-committee will include the health directors from each of the counties included in its geographic area and representatives from local Emergency Medical Services (EMS) and Emergency Management. As proposed, a Type II response will initially involve the delivery of seven "mobile" packages (valued at approximately $96,000 a piece) to each of the seven lead hospitals within the RACs. These equipment trailers or shipping containers will be mobile. If any one RAC is not actively involved in a specific disaster event, the mobile package and allied-trained medical staff could then be relocated elsewhere to assist accordingly. The equipment inventory consists of personal protective equipment, decontamination materials, medications, etc. The Type II plan entails the lead RAC hospitals in identifying medical augmentation personnel at each hospital within their respective RAC areas to respond for as short term to respond to an incident with the mobile package, without taxing the medical resources within any one facility. Hospitals would be compensated through memorandums of agreement when activated by the State Emergency Operations Center for the expenses involved with hospital personnel responding to such disasters. The OEMS plans to convene with the seven RACs in the near future to discuss these plans. A regional approach through local lead health departments
located in strategic locations across North Carolina is being developed. Seven
Public Health Regional Bioterrorism Response Teams are to be co-located, to the
greatest extent possible, with the state Regional Response Teams (Hazmat) that
are currently operating across the state. Each Bioterrorism Team would be
responsible for a 14-25 county area. These teams will be focused on building
surveillance networks across North Carolina taping into the health care
community: hospitals, public health agencies, private medical clinics and
individual physicians. The seven teams will be hosted in the following local health departments: Buncombe, Mecklenburg, Guilford, Durham, Cumberland, Pitt, and New Hanover. The employees of these Teams will be employees of each respective local health department, but their focus will be regional (serving equally all of their respective counties). The State of North Carolina maintains six hazardous materials Regional Response Teams (RRTs). These highly trained and equipped teams are available to respond to emergencies involving hazardous materials, and can provide assessment, identification and mitigation services. These teams are local government resources, who enter into a contractual arrangement with the Division of Emergency Management to respond outside their jurisdiction. Teams are provided with a truck, equipment and logistical support. A seventh team is being developed in the Charlotte area. The USAR teams necessary for a Type II response will be developed in six regions. Two teams will be in the western part of the state, two teams in the central and two teams in the eastern part of the state. These USAR teams will be trained and equipped to respond to masonry and wood collapses. Type III (Local Level), employs another element of the SMRS and would consist of prehospital disaster teams, including Advanced Life Support providers, often the first line of defense. This will involve North Carolina purchasing and distributing, throughout the state, 90 highly mobile packages with basic personal protective equipment, decontamination equipment and medications. Although specific counties may want to purchase additional items, this assures at least a baseline-standardized package of materials across North Carolina, which can be moved to specific areas of high need. While the identification and distribution of necessary medical and decontamination materials, medications and personnel have been addressed, the extensive training needs for field personnel, the need to identify a methodology for reporting hospital bed status and development of response and contingency plans are essential. Moreover, it is clear public health will play a vital role in many terrorist scenarios. Therefore plans currently include the development of public health bioterrorist response teams. The latter would be comprised of individuals such as medical epidemiologists, lab technicians and disease investigation specialists who could assist in identifying, for example, the existence of a disease, those at risk, the need for quarantine, and so forth. While much of the tiered SMRS plan is still in the
developmental phase the agencies are quickly moving to outline a comprehensive
plan that will account for the need to develop and train regional medical teams.
This component will depend on the coordination of hospitals to efficiently meet
the increased health needs during a disaster and provide support for medical
teams with regards to equipment, medical supplies and trained personnel while
assuring clear command and control during a disaster. Current coordination of
medical activities during activation is through the existing Disaster Medical
Section as written in the existing State Emergency Operation Plan. ______________________________________
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