North Carolina’s Role in Preparedness A Brief Overview

Objectives What is the Laboratory Response Network? Why are public health labs involved? Describe the benefit in utilizing the CAP LPX proficiency exercise. Describe aspects of a written lab preparedness plan. Access contact information for NCSLPH Preparedness Units – BTEP and CT. Access resources on bioterrorism.

Laboratory Response Network The LRN was established in 1999 in response to Presidential Directive 39 which outlined national anti-terrorism policies and assigned specific missions to federal departments and agencies. The founding partners of the LRN are CDC, FBI & APHL The mission was to develop, maintain and strengthen an integrated national and international network of laboratories that can respond quickly to needs for rapid testing, timely notification and secure reporting of results associated with acts of biological or chemical terrorism and other high priority public health emergencies.

What does this integrated national and international network look like? Tiered structure National labs: CDC USAMRIID Reference labs: 150+ labs nationally - state and local public health, federal, military, veterinary, food and water testing, and environmental as well as international labs in Canada, the United Kingdom, Australia, Mexico and South Korea Sentinel labs (25,000 estimated): Hospital laboratories Commercial laboratories Private laboratories

Why are Public Health Labs involved? Mandated by Congress for state labs to support local BT response Experience with biological agents of concern and outbreak investigations Link between local lab level and CDC/federal agencies Preserves forensic evidence for criminal investigations NCSLPH serves as an LRN reference lab representing national LRN in state jurisdiction

NCSLPH as an LRN Reference Lab provides: Reference services Specialized testing Environmental testing Rapid Testing Laboratory Improvement Applied research Disease identification and outbreak investigation Support of Surveillance and Epidemiology Investigations Emergency Preparedness and Response

We strive to maintain and strengthen NC’s laboratory network with our sentinel labs through: Lab Assessment Obtaining detailed information about our sentinel labs through Sentinel Surveys and Outreach Visits Having knowledge of Current Biosafety level and Clinical Scope of Practice Education and Training Online Training Resources (aphl.org, www.cdc.gov/labtraining) ASM Sentinel Lab Procedures Preparedness Workshops – 3x/year Packaging and Shipping Workshops Proficiency Sentinel Laboratory Drills CAP-LPX – Laboratory Exercise

CAP LPX Preparedness Exercise What is the CAP LPX? An ungraded proficiency developed by CAP, CDC, and APHL CAP LPX is a great way for sentinel labs to practice the skills and ability to detect possible agents of bioterrorism Rule out and refer Handling of organisms Correct plan for notification Packaging and Shipping For more info: https://estore.cap.org/OA_HTML/xxCAPibeCCtpItmDspRte.jsp?section=10475&i tem=566755&sitex=10020:22372:US

Clinical Laboratory Bioterrorism Readiness or Preparedness Plan Does your laboratory have a written plan of action that is specific to the laboratory? American Society For Microbiology (ASM) provides a fillable template for laboratories to use in developing a bioterrorism (BT) readiness plan Serves as an aid in the process of developing a specific plan for your laboratory should you encounter a specimen where testing is needed Available at: https://www.asm.org/ASM/media/Policy-and- Advocacy/LRN/Sentinel%20Files/BT-Readiness.pdf If you already have a plan, perhaps you will find additional information in this resource

Components of A Preparedness Plan for Your Laboratory Purpose Contact Protocol and Chain of Communication Laboratory Response Network Responsibilities of the Clinical Laboratory Sentinel Level Laboratory Guidelines Packaging and Shipping Instructions Information Checklist Handling of Possible BT agents Policy Sign-off List Training Sign-off List Therapy of BT agents

What to Consider When Creating Your Plan What is the biosafety level of my lab? Is my lab active in the LRN? Where is the nearest higher level lab? What guidelines should be followed to package and ship biological agents? Whom should I call? Testing your plan at least annually Keep it updated Provide training/in-service to your staff Know chain of custody requirements Know shipping requirements Who has a BT plan?

Conclusion The use of a biological or chemical agent for terrorism is a low probability event with very large, potentially devastating consequences IT IS ALWAYS BEST TO BE PREPARED!

Preparedness Contact Information NCSLPH Main Number 919-733-7834 BTEP Unit Main Line- 919-807-8765 BT Duty Phone (24/7)- 919-807-8600 BT Pager (24/7)- 919-310-4243 CT Unit Main Line- 919-807-8771 CT Coordinator (cell) 919-602-2481 Asst Coordinator (cell) 919-323-1301

Resource links CDC: Laboratory Information for BT Emergencies https://emergency.cdc.gov/bioterrorism/lab.asp FDA: Main BT page https://www.fda.gov/EmergencyPreparedness/default.htm NCSLPH Web Site https://slph.ncpublichealth.com/default.asp NCSLPH Bioterrorism Home Page https://slph.ncpublichealth.com/bioterrorism/default.asp

Course Pre-test Thank you for participating in North Carolina’s Role in Preparedness. The pre-test for the course is available at: http://www.quia.com/quiz/3062810.html Our pre-test is designed to assess general BT knowledge; not all answers were provided in this powerpoint.

Barbie Page, MS, MT(ASCP) Bioterrorism and Emerging Pathogens Unit Questions or comments? Contact: Barbie Page, MS, MT(ASCP) Bioterrorism and Emerging Pathogens Unit Barbie.page@dhhs.nc.gov 252-714-0184