1. Paul Moyer, MS CT Response Coordinator Minnesota Department of Health Public Health Laboratory Division A Tiered Approach to All-Hazards Laboratory Testing of Unknown Environmental Samples

2. 2 Introduction Why Is Unknown Sample Testing Important? –Credible Threats Exist –Surveillance Why Is Testing at PHL Important? –Public Health Events –LRN Laboratories

3. 3 Objectives Describe a process for applying standardized procedures to non-standard events Illustrate the significance of notification and threat assessment pieces (Focus Areas working together) Discuss the advantages of a Bio/Chem/Rad tiered step analysis

4. 4 Background Anthrax 2001 –Specific Protocol –Letters Evolution to All-Hazards Approach –Specific Guidelines –Letters –Leaking Packages –Tainted Food/Water

5. 5 Background What the MDH plan IS –A Starting Point – Guidance –SOPs, Checklists, & Forms –Safety First What the MDH plan IS NOT –A Rote Protocol – Thinking IS Required –A Lab Only Effort – Partners Crucial –Rigid

6. 6 Safety Lab Safety Officer – IH BSL 3 Facility Limited Quantities Buddy + 1 System PPE

7. 7 Safety Chemical Splash Resistant Coveralls with Hood and Boots Chemical Resistant Sleeves Full Face APR: Dual Particualte/Organic Vapor Cartridges Outer Gloves: Nitrile Inner Gloves: Nitrile or Chemical Laminate

8. 8 What does Tiered Mean Expandable System Begins with Field Information/Tests Minimum Testing – Tier 1 Can Include: –Scenario/Submitter Directed Testing –Tier 2 Testing –Minimum Plus Testing

9. 9 Resource Management Anthrax Only Testing – Too Cold? All-Agent Testing – Too Hot? Tiered Testing – Just Right?

10. 10 Plan Strategy SOPs vs. SOGs Menu of Tests/Procedures Judgment – What makes sense Heres the Road Map

11. No Referenced SOP Decision Data / Information Additional Resource Process SOP Yes Open Sample SOP Receive Sample / Over-pack SOP Notificatio n SOP (Phase I) Minimum Testing + Additional Biological Staff Resource Call-Down Final Report SOP Process SOP Sections - Communications - QA / QC - Documentation - Safety - Analysis Rad Check Positive? Rad Check Positive? Results & Observation s Tier 2 Testing? Radiological Screen SOP Alert Radiation Response Team GC/MS, ICP/MS, Other CT Analytical SOPS LRN BT Analytical SOPS BT / CT Personnel Accept Sample? Document Sample Rejection No Yes Results Notificatio n SOP (Phase II) Prioritize Tier 1 Testing Informati on Results & Observation s Minimum Testing & Processing Setup No Documen t Minimum Testing + Additional Chemical Minimum Testing + Additional Toxin Minimum Testing + Viral Minimum Testing Or Documen t

12. 12 Plan Strategy BT, CT & REP* Teams On-Call Pairs (BT, CT-Rad) Cross - Trained on: –Threat Assessment –Sample Receiving – Chain-of-Custody –Sample Opening – Processing –Communications *Radiological Emergency Program

13. 13 Screening: Chemical vs. Biological Serial Analysis: –Rule Out Chemical Agents What about the Bio-Hazard? –Rule Out Biological Agents What about the Chemical Hazard? Parallel Analysis: –BT and CT-Rad Working Together –Broader Perspective / Depth of Knowledge –Use the Threat Assessment/Field Information

14. 14 Testing: Is It Hazardous? (…and If Not, What Is It?) ID and Confirm Rule Out Hazardous: –Radioactivity –Chemicals –Biological Agents Whats Left? Back to the Map

15. No Referenced SOP Decision Data / Information Additional Resource Process SOP Yes Open Sample SOP Receive Sample / Over-pack SOP Notificatio n SOP (Phase I) Minimum Testing + Additional Biological Staff Resource Call-Down Final Report SOP Process SOP Sections - Communications - QA / QC - Documentation - Safety - Analysis Rad Check Positive? Rad Check Positive? Results & Observation s Tier 2 Testing? Radiological Screen SOP Alert Radiation Response Team GC/MS, ICP/MS, Other CT Analytical SOPS LRN BT Analytical SOPS BT / CT Personnel Accept Sample? Document Sample Rejection No Yes Results Notificatio n SOP (Phase II) Prioritize Tier 1 Testing Informati on Results & Observation s Minimum Testing & Processing Setup No Documen t Minimum Testing + Additional Chemical Minimum Testing + Additional Toxin Minimum Testing + Viral Minimum Testing Or Documen t

16. 16 Key Pieces Notification Threat/Hazard Assessment Action Plan – Scenario Specific Minimum Testing – Tier 1 –Radiological –Chemical –Biological Advanced/LRN Testing – Tier 2

17. 17 Notification Incoming Request for Lab Analysis Internal Notification(s) –Hazard Assessment Response Coordinators (Focus Areas C & D) Unit Leaders –Management FYI Director Section Managers

18. 18 Notification External Notification(s) –Hazard Assessment MDH Epidemiology (Focus Area B) MDH Environmental Health Rep (Focus Area A) FBI WMD Coordinator CST –Management FYI MDH Health Protection Division Directors (All Focus Areas) Decision to Accept/Reject Sample

19. 19 Threat/Hazard Assessment Credible Threat? Excessive Hazard? –Fatalities –Explosives Suitable Request? –Public Health Threat? –Forensics?

20. 20 Event Action Plan – Scenario Specific Decisions By: –One Person –On-Call Pair –Group Decide To: –Test or Not Test –Test At What Level – Order Off the Menu –Assign Duties and Responsibilities

21. 21 Minimum Testing – Tier 1 Radiological Screen Chemical Characterization Biological Testing

22. 22 Minimum Testing – Tier 1 Radiological Screen –Inner Package / Sample –Geiger-Muller Counter (CPM) Alpha Beta Gamma Over-pack Previously Screened at Loading Dock

23. 23 Minimum Testing – Tier 1 Chemical Characterization –Papers: pH, M8, Oxidizer –Solubility: Water, Methylene Chloride –FTIR: HazmatID –Head Space Vial Aliquot (GC/MS)

24. 24 Minimum Testing – Tier 1 Biological Testing –Slides: Wet Mount, Gram Stain –RT-PCR –TRF –Cultures: BAP, Chocolate, Thio Broth

25. 25 Advanced/LRN Testing – Tier 2 Chemical –GC/MS – SVOC –ICP/MS – Metals –General/Bench Chemistry – Inorganic Biological –LRN Level B/C Agent Specific Protocols

26. 26 References Guidance on Initial Responses to a Suspicious Letter / Container With a Potential Biological Threat, FBI – DHS – HHS/CDC, 2004 Assessment of Methods for Handling Mixed-Threat Environmental Samples, NCEH – Battelle, 2004 Assessment of Protocols Involving Unknown Samples, NCEH – Battelle, 2004 Proposed Draft DHS Screening Protocol, 2005 (to augment/standardize existing assessments and field screening techniques)

27. 27 Contact Information Paul Moyer, MS Chemical Terrorism Response Coordinator 612-676-5245 Paul.moyer@health.state.mn.us

28. 28 Questions ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?? ? ? ? ? ? ?