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Pup biologic warfare
This document discusses hospital preparedness for epidemics and emerging infectious diseases. It begins by outlining the objectives of identifying fundamentals of a hospital preparedness and response plan. It then discusses various biological hazards like anthrax, SARS, avian flu, etc. It emphasizes the importance of personal protective equipment and decontamination areas for first responders. It categorizes biological agents into categories A, B and C based on their priority and describes examples under each category. Finally, it discusses the history and revisions of the International Health Regulations to enhance global health security.
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Pup biologic warfare
- 1. L 11 Epidemicsand Emerging Infections 1 Epidemics and Emerging Infections Hospital Preparedness for Emergencies
- 2. Wars of theFuture: Biological Warfare and Chemical Weapons Teodoro Herbosa MD FPCS Department of Emergency Medicine College of Medicine University of the Philippines, Manila
- 3. L 11 Epidemicsand Emerging Infections 3 Objective Identify the fundamentals of a hospital preparedness and response plan for epidemics. Upon completion of this unit, you will be able to:
- 4. L 11 Epidemicsand Emerging Infections 4 Biological Hazards ❑ “Terrorism” / Anthrax ❑ SARS ❑ Avian Flu ❑ Dengue ❑ MERSCoV ❑ Ebola Vulnerability emerging to infectious diseases
- 5. L 11 Epidemicsand Emerging Infections 5 Biological Hazards Tartars used plague- infected corpses in Kaffa, 1346.
- 6. L 11 Epidemicsand Emerging Infections 6 Influenza Pandemic Nurses work in the Red Cross rooms of Seattle, WA with “influenza masks” on their faces. December 1918 (Courtesy of the National Archives, 165-WW-269B-10)
- 7. L 11 Epidemicsand Emerging Infections 7 Basic Dictum Safety First!
- 8. L 11 Epidemicsand Emerging Infections 8 Biological Event ❑ Bacterial agents ▪ Anthrax, Brucellosis, Yersinea pestis (Plague) & Cholera , Salmonella ❑ Viruses ▪ Smallpox, Hemorrhagic Fever Virus ❑ Biological product ▪ Botulinum toxin, Endotoxins, Mycotoxin, SEB, ricin,
- 9. L 11 Epidemicsand Emerging Infections 9 Smallpox – Bangladesh, 1976 A child stricken by smallpox is relatively cured but his health is still threatened by malnutrition and secondary infection. (Courtesy of the National Archives, 76-845)
- 10. L 11 Epidemicsand Emerging Infections 10 Biological Event ❑ Infection borne through air, food and water ❑ Incubation period - delay from time of exposure until clinical symptoms arise ❑ Extensive exposure may occur before the primary event is appreciated.
- 11. L 11 Epidemicsand Emerging Infections 11 Rare Diseases can be Overseen Rare color photo of Baby with smallpox. National Archive film footage from Vietnam (RG-428- NPC-38594)
- 12. L 11 Epidemicsand Emerging Infections 12 Biological Event ❑ Delivered with conventional explosives ❑ Emergency care, decontamination is necessary (outside the hospital) ❑ Personnel must be trained in patient decontamination
- 13. L 11 Epidemicsand Emerging Infections 13 Decontamination Area ❑ Storage for decontamination equipment and supplies ❑ Decontamination area - cooled to reduce the heat load on personnel caused by their protective equipment ❑ The decontamination site has 3 zones: ▪ Hot zone – incoming casualties ▪ Warm zone – decontamination area ▪ Cold zone – triage and transport
- 14. L 11 Epidemicsand Emerging Infections 14 Contamination reduction (warm) zone Support (cold) zone Exclusion (hot) zone wind CORRIDOR amp Access control points Crowd control line Decontamina tion line Hot line
- 15. L 11 Epidemicsand Emerging Infections 15 Decontamination Area ❑ First responders and medical personnel SHOULD PROTECT THEMSELVES ❑ Personal Protective Equipment (PPE) ▪ Protect eyes, lungs and skin
- 16. L 11 Epidemicsand Emerging Infections 16 Decontamination Area Storage for decontamination equipment and supplies Decontamination area ❑ cooled to reduce the heat load on personnel caused by their protective equipment
- 17. L 11 Epidemicsand Emerging Infections 17 Decontamination Area
- 18. L 11 Epidemicsand Emerging Infections 18 Hot zone Support zone Decontamination zone Patients No special protective gear hazmat teams with proper protective gear gross contaminates removed here remove victim’s contaminated clothing wash & final rinse/soap & shampoo wash & rinse clean stretcher & blankets
- 19. L 11 Epidemicsand Emerging Infections 19 Decontamination Area
- 20. L 11 Epidemicsand Emerging Infections 20 Decontamination Area ❑ First responders (decontamination) protect themselves through PPE. ❑ Personal Protective Equipment (PPE) respiratory equipment ❑ Garments and barrier material
- 21. L 11 Epidemicsand Emerging Infections 21 Decontamination Area ❑ Maximum protection is achieved through use of positive pressure respirators and total body encapsulation. ❑ Surgical mask and a pair of latex gloves provide minimum protection
- 22. L 11 Epidemicsand Emerging Infections 22 Decontamination Area
- 23. L 11 Epidemicsand Emerging Infections 23 Personal Protective Equipment Red Cross workers of Boston, MA removing bundles of masks for American Soldiers from a table where other women are busily engaged in making them. March 1919. (Courtesy of the National Archives, 165- WW-269B-37)
- 24. L 11 Epidemicsand Emerging Infections 24 Medical Response ❑ Pandemic ▪ large number of casualties with similar symptoms ▪ dissemination device ▪ receipt of a warning ▪ hospital may receive untreated casualties directly from the site Emergency Hospital at Brookline, MA to care for influenza cases. October 1918
- 25. L 11 Epidemicsand Emerging Infections 25 Medical Response First responders and medical personnel SHOULD PROTECT THEMSELVES September 11
- 26. L 11 Epidemicsand Emerging Infections 26 Medical Response Why is the level of Epidemic preparedness so critical? ❑ Because the consequences of not being prepared are so catastrophic Smallpox Vaccine
- 27. L 11 Epidemicsand Emerging Infections 27 Category A The public health systems and primary health-care providers must be prepared to address varied biological agents, including pathogens that are rarely seen. High- priority agents include organisms that pose a risk to national security because they – ❑ can be easily disseminated or transmitted person-to-person; ❑ cause high mortality, with potential for major public health impact; ❑ might cause public panic and social disruption; and ❑ require special action for public health preparedness.
- 28. L 11 Epidemicsand Emerging Infections 28 Category A Agents Include: ❑ Variola major (Smallpox): ❑ Bacillus anthracis (Anthrax); ❑ Yersinia pestis (Plague); ❑ Clostridium botulinium toxin (Botulism); ❑ Francisella tullarensis (Tularemia);
- 29. L 11 Epidemicsand Emerging Infections 29 Category A Agents Include: ❑ Filoviruses - Ebola Hemorrhagic Fever; - Marburg Hemorrhagic Fever; and ❑ Arenaviruses - Lassa (Lassa Fever) - Junin (Argentine Hemorrhagic Fever) related viruses.
- 30. L 11 Epidemicsand Emerging Infections 30 Category B Second-highest priority agents: ❑ moderately easy to disseminate ❑ cause moderate morbidity and low mortality ❑ require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance
- 31. L 11 Epidemicsand Emerging Infections 31 Category B agents include: ❑ Coxiella burnetti (Q fever) ❑ Brucella species (Brucellosis) ❑ Burkholderia mallei (Glanders) ❑ Alphaviruses ▪ Venezuelan encephalomyelitis ▪ Eastern and Western equine encephalomyelitis ❑ Rich toxin from Ricinus communis (castor beans) ❑ Epsilon toxin of Clostridium perfringens ❑ Staphylococcus enterotoxin B
- 32. L 11 Epidemicsand Emerging Infections 32 Category B A subset of List B agents include pathogens that are food or waterborne. These pathogens include, but are not limited to: ▪ Salmonella species ▪ Shigella dysenteriae ▪ Escherichia coli O157:H7 ▪ Vibrio cholerae ▪ Cryptosporidium parvum
- 33. L 11 Epidemicsand Emerging Infections 33 Category C Third-highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of: ❑ availability ❑ ease of production and dissemination ❑ potential for high morbidity and mortality due to major health impacts
- 34. L 11 Epidemicsand Emerging Infections 34 Category C agents include: ❑ Nipah virus ❑ Hantaviruses ❑ Tickbone hemorrhagic fever viruses ❑ Tickbone encephalitis viruses ❑ Yellow fever ❑ Multi-drug resistant tuberculosis
- 35. L 11 Epidemicsand Emerging Infections 35 Category C Preparedness for List C agents requires ongoing research to improve disease detection, diagnosis, treatment and prevention. Linking bio-terrorism preparedness efforts with ongoing disease surveillance and outbreak response activities as defined in CDC’s emerging infectious disease strategy is imperative.
- 36. L 11 Epidemicsand Emerging Infections 36 ❑ Cholera epidemic, Europe 1830 - 1847 intensive infectious disease diplomacy multilateral cooperation; First International Sanitary Conference, Paris 1851 ❑ 1948 WHO Constitution ❑ 1951 WHO adopted International Sanitary Regulations ❑ International Health Regulations, 1969 History of the IHR
- 37. L 11 Epidemicsand Emerging Infections 37 IHR (1969) to monitor and control six serious infectious diseases: Cholera, Plague, Yellow fever, Smallpox, Relapsing fever and Typhus IHR (1969) - Cholera, Plague and Yellow fever remain of concern WHO must be informed History of the IHR
- 38. L 11 Epidemicsand Emerging Infections 38 1990's resurgence of epidemics Cholera - South America Plague - India Emergence of infectious agents Ebola (48th World Health Assembly, 1995 revision of IHR, May 2001) WHA 54.14, Global health security: epidemic alert and response History of the IHR
- 39. L 11 Epidemicsand Emerging Infections 39 May 2003 resolution WHA56.28 Revision of IHR IGWG sessions in Nov 2004 and Feb/ May 2005 58th World Health Assembly adopted IHR (2005) 23 May 2005 resolution WHA58.3. History of the IHR
- 40. L 11 Epidemicsand Emerging Infections 40 International Health Regulations of 2005, Article 5-1 Surveillance Declaration of Policies • urges Member States to develop, strengthen and maintain as soon as possible, but no later than five years from entry into force of these regulations, and the capacity to detect, assess, notify and report events in accordance with these regulations.
- 41. L 11 Epidemicsand Emerging Infections 41DOH – CHD, REGIONAL EPIDEMIOLOGY and SURVEILLANCE UNIT (RESU) Priority Diseases/Syndromes And Conditions Targeted For Surveillance Category I (Immediately Notifiable) 1. Acute Flaccid Paralysis 2. Adverse Event Following Immunization (AEFI) 3. Anthrax 4. Human Avian Influenza 5. Measles 6. Meningococcal Disease 7. Neonatal Tetanus 8. Paralytic Shellfish Poisoning 9. Rabies 1.Severe Acute Respiratory Syndrome (SARS) Category II (Weekly Notifiable) 1. Acute Bloody Diarrhea 2. Acute Encephalitis Syndrome 3. Acute Hemorrhagic Fever Syndrome 4. Acute Viral Hepatitis 5. Bacterial Meningitis 6. Cholera 7. Dengue 8. Diphtheria 9. Influenza-like Illness 10. Leptospirosis 11. Malaria 12. Non-neonatal Tetanus 13. Pertussis •Typhoid and Paratyphoid Fever
- 42. L 11 Epidemicsand Emerging Infections 42 Medical Response First responders must take care that they don't become victims themselves.
- 43. L 11 Epidemicsand Emerging Infections 43 Medical Response A 1995 NBC exercise in New York City determined the first 100 emergency responders to arrive on scene 'killed' ❑ not adequately prepared or trained to deal with this incident Los Angeles exercise ❑ doctors admitting that 'victims' have seriously contaminated hospitals
- 44. L 11 Epidemicsand Emerging Infections 44 Why is the level of epidemic preparedness so critical? Because the consequences of not being prepared are so catastrophic!
- 45. L 10 ComplexEmergencies 45 Terrorism ❑ ‘War Within Borders’ ❑ Asia - a nesting place for terrorism and lead member of the globe in terrorism ❑ Afghanistan ➔ Japan ❑ Vulnerability of non-involved population ❑ Unclear end-point for termination of further, recurrent acts
- 46. L 10 ComplexEmergencies 46 Weapons of Mass Destruction (WMD) ❑ In warfare for 2500 years ❑ Biological - Tartars used plague-infected corpses in Kaffa in 1346. ❑ Modern warfare (1915) - Chlorine gas ❑ Nuclear bombs - Hiroshima and Nagasaki, 1945. ❑ Nerve and vesicant agents against Iran ❑ Cyanide against the Kurds
- 47. L 10 ComplexEmergencies 47 Nuclear Agents ❑ Nuclear detonation through conventional explosives ❑ Activation of Radioactive material ❑ Dissemination through ▪ Food ▪ Water ▪ Direct environmental spread
- 48. L 10 ComplexEmergencies 48 Injury Profile – Nuclear Agents ❑ Thermal injury - burns ❑ Eye injuries - blindness due to blast flash ❑ Ear injuries - deafness rupture of ear drums ❑ Penetrating wounds/orthopedic injuries/head injuries
- 49. L 10 ComplexEmergencies 49 Radiation Sickness ❑ Irradiation injuries do not make the patient radioactive! ❑ Decontamination before transport ❑ Removal of all clothing ❑ Tepid bathing of skin surface
- 50. L 10 ComplexEmergencies 50 Biological agents ❑ Infectious disease or toxin that can be used in bioterrorism or biological warfare ❑ Viruses, microorganisms (bacteria and fungi) and their associated toxins ❑ Can be delivered with conventional explosives, air, food and water
- 51. L 10 ComplexEmergencies 51 ❑ Incubation period: delay in time of exposure until clinical symptoms ❑ Some are rapidly fatal ❑ Others are severely incapacitating ❑ Extensive exposure may occur before the primary event is revealed Biological Agents
- 52. L 10 ComplexEmergencies 52 Biological agents ❑ Bacteria - Anthrax, Brucellosis, Plague & Cholera ❑ Viruses - smallpox / hemorrhagic fever ❑ Biological products - Botulinum toxin, endotoxins, mycotoxin
- 53. L 10 ComplexEmergencies 53 Anthrax ❑
- 54. L 10 ComplexEmergencies 54 Plague ❑ Bubonic Plague – Enlarged Lymph nodes ❑ “Black Death” – Peripheral gangrene
- 55. L 10 ComplexEmergencies 55 Smallpox ❑
- 56. L 10 ComplexEmergencies 56 Chemical Agents Chlorine gas dispersion during World War I
- 57. L 10 ComplexEmergencies 57 ❑ About 70 chemicals are documented in history as WMD which include: Chlorine, Phosgene, Cyanide and Vesicants (‘Nitrogen Mustard’) ❑ Exposure may not be revealed until chemical injuries are recognized ❑ On-site decontamination Chemical Agents
- 58. L 10 ComplexEmergencies 58 Nerve Gas (Sarin Gas Attack - Japan) ❑ Sarin - fluorinated phosphinate ❑ Similar to Insecticide - malathion ❑ Attacks the nervous system
- 59. L 10 ComplexEmergencies 59 NBC incident – Characteristics ❑ Mass casualties with similar symptoms ❑ Dissemination device ❑ Receipt of warning ❑ Hospital may receive untreated casualties direct from the site ❑ Rescue personnel could become victims due to unavailability of information Fill in the Blank
- 60. L 10 ComplexEmergencies 60 Hospital Preparedness for NBC Events ❑ Management system for mass NBC casualties ❑ HAZMAT suits and PPE for staff ❑ Education of staff and community regarding local and regional risks ❑ Training in patient decontamination Fill in the Blank
- 61. L 10 ComplexEmergencies 61 Decontamination Protocols ❑ Patients could arrive at hospital prior to decontamination ❑ Risk to health care professionals who would subsequently require decontamination. ❑ Designated Decontamination areas in the Hospital Fill in the Blank
- 62. L 10 ComplexEmergencies 62 Review of Objectives As a result of this session, you should be able to: ❑ Describe the characteristics and challenges of Complex Disasters. ❑ Identify the salient features of NBC incidents and the response required. ❑ Outline major health effects and hospital preparedness for complex disasters.
- 63. L 11 Epidemicsand Emerging Infections 63 Summary ❑ Epidemics pose challenges for medical personnel. ❑ Preparedness for an appropriate hospital response activated is essential, while ensuring the safety of personnel. ❑ EMS may not provide the most effective and immediate medical response. ❑ Successful outcome of the medical care requires adequate preparedness.
- 64. L 11 Epidemicsand Emerging Infections 64 Summary ❑ Planning, disciplined & coordinated behavior by personnel, mobilization ability, availability of medical resources, and communication are essential in effective care. Continue…
- 65. L 11 Epidemicsand Emerging Infections 65 Objectives ❑ Identify the fundamentals of a hospital preparedness and response plan for epidemics. Upon completion of this unit you will be able to:
- 66. L 11 Epidemicsand Emerging Infections 66 Exercise ❑ What resources does your hospital have which can be applied to a CBR incident? ❑ What training is required for EM personnel in order to mount a safe and effective hospital response to a CBR incident? ❑ With what other agencies should the hospital be conducting joint CBR exercises?
- 67. L 11 Epidemicsand Emerging Infections 67 ❑ With whom should the hospital coordinate regularly on CBR issues? ❑ Who should be represented on your hospital’s CBR functional preparedness committee? Exercise Continue…