BIOTERRORISM PREPAREDNESS FUNDING

Two primary funding efforts by the federal government have been instituted since 9/11 that have significantly shifted the focus of planning and preparedness in healthcare facilities to ensure improved response to bioterrorism or other disease-based mass-casualty events. These programs are described below.

National Bioterrorism Hospital-Preparedness Program

The Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) began in early 2002 to provide monies for public health departments to develop programs to upgrade the preparedness of the nation’s hospitals and for collaborating entities to respond to bioterrorism and deal with nonterrorist epidemics of rare diseases. The program focuses on identifying and implementing bioterrorism preparedness plans and protocols for hospitals and other participating healthcare entities (HRSA 2003). Grant awards were designed for the development and implementation of regional plans to improve the capacity of hospitals and their emergency departments, outpatient centers, EMS systems, and other collaborating healthcare entities to respond to incidents requiring mass immunization, treatment, isolation, and quarantine in the aftermath of bioterrorism or other outbreaks of infectious disease.

CDC Bioterrorism Cooperative Agreement

The Centers for Disease Control and Prevention (CDC) Bioterrorism Cooperative Agreement is a grant program designed to upgrade state and local public health jurisdictions’ preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies (CDC 2003). DHHS requires each state that receives funds to develop a statewide plan identifying how it will respond to a bioterrorism event and other outbreaks of infectious disease and also how it will strengthen core public health capacities in all relevant areas. The program initially identified the following six focus areas for improvement:

1.  Planning and readiness

2.  Surveillance and epidemiology

3.  Biological-laboratory capacity

4.  Communications and information technology

5.  Health information dissemination

6.  Education and training

Federal Guidelines and Legislation for Disaster Relief

Stafford Act. The 1993 Robert T.Stafford Disaster Relief and Emergency Assistance Act, as amended (Public Law 93–288), provides federal assistance to states to manage the consequences of domestic disasters by expediting the rendering of aid, assistance, and emergency services and the reconstruction and rehabilitation of devastated areas.

Weapons of Mass Destruction (WMD) Act of 1996. Title XIV of the Defense Against Weapons of Mass Destruction (Public Law 104–201), which became known as the WMD Act of 1996, provided funding for equipment and training for local first responders for the effective management of incidents involving WMD. The Department of Defense was charged with initiating the Domestic Preparedness Program in the nation’s 120 largest cities for training first responders, including healthcare facility personnel.

Bioterrorism Act. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, commonly called the Bioterrorism Act (Public Law 107–108), was designed to improve the ability of the United States to prevent, prepare for, and respond to bioterrorism and other public health emergencies. This law established the Office of Public Health Preparedness under the Department of Health and Human Services.

Homeland Security Act of 2002. The Department of Homeland Security (DHS) was created under the Homeland Security Act (Public Law 107–296). Many of the functions of different federal agencies were consolidated under a single department. The bill

§transferred the National Pharmaceutical Stockpile, later renamed the Strategic National Stockpile, to DHS, requiring DHS to consult with the Centers for Disease Control and Prevention (CDC) on administration of the program;

§transferred the Office of Emergency Response, which oversees the National Disaster Medical System, from the Department of Health and Human Services to DHS; and

§required CDC to establish the Bioterrorism Preparedness and Response Division.

Homeland Security Presidential Directives (HSPDs). Presidential directives designed to promulgate presidential decisions on homeland security matters are designated Homeland Security Presidential Directives.

§HSPD-5: Management of Domestic Incidents

§HSPD-6: Integration and Use of Screening Information

§HSPD-7: Critical Infrastructure Identification, Prioritization, and Protection

§HSPD-8: National Preparedness

CDC funding, through the state public health departments to the local community, is projected to continue for a number of years to ensure continuity of programs in public health. The regional or local coordinator is responsible for working with healthcare organizations to improve preparedness and response capability in each of the focus areas 

TRAINING ISSUES | Population

The purpose of an active training program designed around your disaster plan is to ensure every staff person and your resident population will react automatically and appropriately in an emergency or disaster situation. The staff must be familiar with the plan, understand their responsibilities within it, and be comfortable in carrying them out.

The best way to ensure staff and resident familiarity with the plan is to include them in its development. During a disaster, critical staff may become victims themselves. Overall understanding and cross-training is a good insurance policy against possible confusion and chaos. Turnover in staff also creates an ongoing need to constantly train staff and residents in disaster planning

One of the best ways to fine-tune staff training is through the use of in-house emergency drills and exercises and through participation in all community disaster drills and exercises. Emergency drills and exercises are an integral part of the preparedness phase of your crisis management program. They provide a mechanism to reveal planning strengths and weaknesses; identify resource shortfalls; improve internal and external coordination, collaboration, and communication; and clarify the roles and responsibilities of your staff during an emergency or disaster. They also provide an excellent opportunity to develop or improve your relationship with your local emergency organizations. 

SHELTERING ISSUES | Population

In some incidents, it may be wiser and safer to remain inside. To “shelter-in-place” means to make a shelter out of the place you are in. It is a way to make the building, or a portion of it, as safe as possible to protect your residents and your staff (CDC 2003). The decision to shelter-in-place or evacuate may be mandated or may be determined by the nature of the threat and the amount of time predicted before disaster strikes.

Public Shelters

It is unlikely that patients with special needs can be adequately cared for and monitored in hastily prepared shelters, randomly located and with untrained personnel, in the aftermath of a natural disaster. The best care for the frail elderly during such a crisis would be provided by a facility such as a long-term-care facility that already has in place the resources necessary for all aspects of proper care.

For the frail elderly to be sheltered successfully, their logistical, dietary, communications, staffing, and patient physical and psychiatric care needs must be addressed. None of these areas can be dismissed as trivial or unimportant. Whether concerned with the capacity to maintain climate control, nutritional requirements, adequate hydration, or communications in-house and outside, appropriate staffing is crucial in all areas when the safety and health status of the facility’s residents are at stake. This can be applied to other special populations when planning for any large-scale disaster situation.

To ensure adequate staffing to handle the regular population in addition to an influx of new patients, facilities must provide a host of services and benefits for employees as well as for families; everything from food and bedding to legal assistance should be available (Silverman et al. 1995). During crises that overwhelm resources, staffing will fall below desirable levels. To prepare for these contingencies, train all employees and equip them to aid in the basic care (such as feeding) of individuals who require assistance in their activities of daily living (Silverman et al. 1995).

Shelter-in-Place

Sheltering-in-place may be the only choice when there is little or no time to warn or evacuate residents and staff. Furthermore, it is the only proper protective action in situations such as a hazardous-materials spill or a tornado warning. Sheltering-in-place can have many advantages, including the following:

§  Immediate protection. Sheltering-in-place involves little time required after the warning, and it is less disruptive to residents.

§  Ideal life-support systems. The facility has food, water, sanitation, medicines, bedding, clean air, communications, and medically prepared surroundings.

§  Less staff burden. Sheltering-in-place requires considerably less emergency staff support than evacuation, without the transportation problems or need for additional security personnel.

MAAs for Evacuation

Establishing mutual-aid agreements, or informal arrangements when appropriate, for the staffing, equipment, and other resources you may need in a disaster will expedite facility response and recovery when disaster strikes.

If you are in a small community, an informal agreement to use a building as a temporary shelter for your facility residents may be sufficient. However, once moved, it is imperative that the residents are not disrupted unnecessarily or forced to encounter multiple moves. Transportation of residents during an evacuation may also be an informal arrangement with staff members, family or friends of residents, or other persons willing to help. It is a good idea to recruit more people and vehicles than you will actually need to ensure a sufficient number when the circumstances require evacuation of residents.

Formal agreements for the deployment or utilization of another jurisdiction’s or political subdivision’s staffing or equipment in an emergency or disaster situation, or MAAs.

To be effective, MAAs should

§  be in writing,

§  be reviewed by legal counsel,

§  be signed by responsible parties from all agencies involved,

§  define liability, and

§  detail the cost involved.

Other Contractual Agreements

Contracts and agreements can be used to ensure the provision of resources or services that go beyond immediate disaster-relief provisions. Contracted agreements should include the costs, estimated time to provide the service, and duration of the service contract. Examples of contracted services include emergency generators, cleanup and debris removal, food and water services, pharmaceutical supplies, medical and surgical supplies, and oxygen and special gases.

A projection of potential disaster resources should include a roster of specific resource providers or vendors, with current telephone numbers and multiple methods of emergency communication with suppliers. To expedite requests, the roster should also include the business name; location; contact name and title; phone, fax, and cell or beeper numbers; order number or item number of supplies most likely to be requested; and other pertinent information.