1. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS OFFICE OF PUBLIC HEALTH Public Health Preparedness And Response for Bioterrorism Presented by Madeline W. McAndrew State Public Health Official 5 February 2003 Building A Successful “Total Force” Response Capacity

2. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Keys to Building a Successful “Total Force” Response Capacity Command Control Coordination Communication Intelligence

3. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Public Health Awareness Ebola SmallpoxAIDS “Where do our weaknesses and vulnerabilities lie? The greatest of our war machines will not protect our forces against the deadly pathogen. Their stealth and precision surpass the complexity of human imagination. Their vectors are fully competent. Their tactics have been perfected over millennia. Their mission…invade and destroy the unsuspecting and unprotected.” Brian Blalock, Osan Air Base, Korea, 2001

4. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Securing the Homeland Public Health is integral to the National Security Strategy. Enhancing Security on the Homeland Environmental Health Initiatives Domestic Preparedness Against Weapons Mass Destruction

5. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE  Public Health is an intelligence gathering agency.  Information superiority is obtained via surveillance, collection and control of vital health statistics and parish specific disease information and trends. Intelligence

6. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE  Public Health is part of a national disease reporting and surveillance network. Centers for Disease Control and Prevention State and local laboratory network Hospital, EMS, physician, coroner, veterinarian disease reporting Intelligence

7. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Intelligence Local Law Enforcement Military/DoDFBI/DOJ Hospitals Public Health LaboratoriesVeterinarians LSP CDC/DHHS Law Enforcement Sensitive Criminal Investigation Security Clearance Criminal Surveillance Patient Sensitive Medical Investigation Controlled Access Disease Surveillance CROSSING THE GREAT DIVIDE Prevention and Deterrence Continuum is Intelligence Driven Coroners Intel Link

8. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Intelligence Emergency Management Public Health State Police Law Enforcement Sensitive Criminal Investigation Security Clearance Criminal Surveillance Patient Sensitive Medical Investigation Controlled Access Disease Surveillance Prevention and Deterrence Continuum is Intelligence Driven CROSS POLLINATION PARADIGM

9. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE State Public Health Official Public Health Assistant Secretary Madeline W. McAndrew Center for Health Promotion Information and Policy Center for Community Health Center for Preventive Health Infectious Disease Epi Laboratory Services Engineering/H2O Safety Sanitarian Services Environmental Epi Vital Records OPH Emergency Response CDC BT Grant DHH Communications OPH Human Resources DHH Emergency Response Center for Environmental Health HRSA/Hospital Grant Nursing Services Pharmacy Services Bureau of EMS Regional Offices TB Prevention & Control STD Services Immunization Services Administrative & Technical Public Health Incident Command Structure PIO C2 Plans Finance Ops

10. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE DOJ FEMA EPA CDC State Level Public Health Command and Control LSP HAZM AT Response Unit LOEP State EOC Louisiana State Police EOC DHH Emergency Response LANG 62 nd CST/WMD Dept. Environmental Quality MMRS DHH Secretary Isolation & Quarantine

11. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSEDiologicsOperatorPHVet TB/STDDirectors OPHLaboratoryDirector StateEpidemi-ologist EnvironEpiDirector ContractingOfficer DHHTeleComAgent ITDirector FinanceDirector DHHPurchasingAgent CHCenterDirector PPHICenterDirector OPHHumanResources PHCenterDirector ENVSCenterDirector HAN NPSCoordinator CDC BT Advisor BTDirector BTOperationsOfficer Public Health Assistant Secretary & OPH Medical Director DHH Public Affairs/PIO DHH Emergency Response OPH Legal Counsel LSP Officer LANG Officer LDHHSecretary CDC Liaison Metro City HD Liaison Public Health Emergency Operations Center and Incident Command PharmacyDirector Immuniza-tionsDirector NursingDirector EMSDirector VitalRecords PIO C2 Plans Finance Ops HNBC GIS Radio Com Runner Emergency Action Cell IT Support EOC Support Support

12. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Public Health Command and Control 8 6 4 3 C2 OPHC2C2 Regional PH C2 State PH C2 PH Headquarters State PH Lab 5 7 1 9 2

13. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Public Health Command and Control Expanded C2 OPH 7 8 6 5 4 2 3 1 9c2C2 Regional PH C2 State PH C2 Parish Health Unit State PH Lab

14. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Statewide Command and Control Network C2 LSP C2 DHH 5 4 1 A I C I D L 7 9 3 B CDC 8 2 C2 C2 LANG State EOC C2 C 6 B OPH C2 DEQ LHA/DRC C2 OPH MMRS C2 LSP LOEP

15. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Public Health “Total Force” Response Capacity 1 3 9 8 7 1 2 3 5 6 4 7 8 9 BAT CAT ERT C2 PIO CET 4 6 5 7 8 9 1 3 2 PAT 9 8 7 6 5 4 3 2 1 4 6 5 7 8 9 1 3 2 9 8 7 6 5 4 3 2 1 Communications/IT Immunization Teams Incident Response Teams Regional Command/Control Teams State Level PH Teams

16. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Regional Epidemiologist Disease Surveillance Spec. Regional Sanitarian Regional Nurse Public Health ER Coordinator Regional Administrator/C2 Regional Medical Director TEAM CHIEF Regional Engineer COMMET/IT Team Administrative Support Team Facility Manager/C2 ParishEOC OPHCCStateEOC Hospital ED Biological Aug. Teams (3) Immunization Teams (9x2) Pharmacy Teams (2) Public Affairs (2) Chemical Aug. Teams (2) Epidemic Surveillance Response Teams (2) Deployable Support Teams PH Nurse PH Sanitarian Disease Intervention Spec. Regional Public Health Command Center OPH Medical Director FBILSP LocalLaw NPS Regional Public Health Incident Response Team

17. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Public Health Clerk Public Health Nurse Immunization Consultant Immunization Consultant EMT Paramedic HRSA Hospital Nurse Public Health Clerk EMT Paramedic Public Health Nurse EMT Paramedic HRSA Hospital Nurse Regional Medical Director Regional Immunization Teams

18. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE ID Epidemiologist 1 ID Epi Supervisor ID Epidemiologist 1 Assistant State Epidemiologist State Epidemiologist State Health Officer State Health Officer DHH Emergency Resp. DHH Emergency Resp. ID Epidemiologist 1 ID Epi Supervisor ID Epidemiologist 1 TB Inter. Spec. STD Inter. Spec. State PH Official Admin Support OPH Medical Director Regional Medical Director Regional Incident Response Regional Medical Director Regional Incident Response DHH Public Info Officer State Level Epidemic Response Teams

19. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Env Epi Env Epi Physician Env Epi Supervisor Env Epi Env Epidemiologist Center Director Environmental Services State Health Officer/C2 State Health Officer/C2 DHH Emergency/Plans DHH Emergency/Plans Response Director State PH Official Admin Support OPH Medical Director Env Epi LSP HAZMAT Dept. Environmental Quality LSPEOC Regional Medical Director/C2 Regional Incident Response Team Dept. Environmental Quality DHH Public Info Officer StateEOC State Level Chemical Augmentation Team

20. OFFICE OF PUBLIC HEALTH…LEADERSHIP FOR THE 21 st CENTURY BIOTERRORISM PREPAREDNESS AND EMERGENCY RESPONSE Public Health Preparedness Challenges Preparedness and Readiness Education and Training Cultural Shift Integration and Cross Pollination Communication Gaps Risk Communication and Public Info Continued Funding