2. Development of Models for Emergency Preparedness: Personal Protective Equipment, Decontamination, Isolation/Quarantine, and Laboratory Capacity Bettina M. Stopford R.N. Director Public Health and Medical Emergency Preparedness Homeland Security Support Operations Science Applications International Corporation McLean, VA

3. Project Overview & Goals AHRQ Bioterrorism Initiative AHRQ Bioterrorism Initiative  To examine current evidence-based best practices and present them in an operationally pertinent format for the end user. Review research and obtain key stakeholder input 4 topic areas: Review research and obtain key stakeholder input 4 topic areas:  To assess, identify, measure, and prepare guidelines and models for evidence-based, best-demonstrated practices  Identify research gaps, shortfalls and future needs  Identify health care-focused enhancements to the existing automated exercise and assessment program scenarios, (AEAS).

4. Methodology Open-source literature research Open-source literature research Government/industry regulation reviews Government/industry regulation reviews Subject matter expert interviews Subject matter expert interviews Stakeholder review of draft document and models Stakeholder review of draft document and models Stakeholder conference Stakeholder conference

5. Stakeholders Broad spectrum of Federal, State, local, academic, civilian, military, regulatory, operations, and clinical subject matter experts Broad spectrum of Federal, State, local, academic, civilian, military, regulatory, operations, and clinical subject matter experts JCAHO, OSHA, NIOSH, DHS ODP, HHS, CDC, SBCCOM, ATSDR, ENA, ACEP, AHA, ANA, APIC, ABSA, ASHE, ASTM, IACP, IAFC, IAEMT, DoD, APHL, NDMS, ASHRM, HRSA, USAMRIID, Risk Management, Law, Universities, public health, medical, nursing, bioethics, laboratory and hazardous materials professionals, among others JCAHO, OSHA, NIOSH, DHS ODP, HHS, CDC, SBCCOM, ATSDR, ENA, ACEP, AHA, ANA, APIC, ABSA, ASHE, ASTM, IACP, IAFC, IAEMT, DoD, APHL, NDMS, ASHRM, HRSA, USAMRIID, Risk Management, Law, Universities, public health, medical, nursing, bioethics, laboratory and hazardous materials professionals, among others

6. Goals of Model Development Create operational planning user tool Create operational planning user tool Evidence-based, best-demonstrated practices Evidence-based, best-demonstrated practicesResults: Four sets of guidelines/models developed Four sets of guidelines/models developed One electronic, interactive model for review One electronic, interactive model for review

7. Guideline Questions for Model Adaptability: Is the best practice suitable for use in any region? Adaptability: Is the best practice suitable for use in any region? Throughput: How many victims of a WMD attack will the best practice aid? Throughput: How many victims of a WMD attack will the best practice aid? Cost: How much will it cost regions to implement the best practice? Cost: How much will it cost regions to implement the best practice? Operational Impact: What are the operational considerations of implementing best practice? Operational Impact: What are the operational considerations of implementing best practice? Training: What level of training does this best practice require? Training: What level of training does this best practice require?

8. Guideline Questions for Model Resources: Does the practice build on existing practices/infrastructure? Are there available resources to implement the practices? Resources: Does the practice build on existing practices/infrastructure? Are there available resources to implement the practices? Morbidity and Mortality: What impact will this practice have on saving lives? Morbidity and Mortality: What impact will this practice have on saving lives? Evidence-based Practice vs. Theory: Is there a body of professional research supporting this practice or is it theoretical? Evidence-based Practice vs. Theory: Is there a body of professional research supporting this practice or is it theoretical? Regulatory Compliance: Does the practice comply with existing regulations or does it require a regulatory change? Regulatory Compliance: Does the practice comply with existing regulations or does it require a regulatory change?

9. Personal Protective Equipment (PPE) Distinguish between a contaminated patient event vs. an infectious patient event Distinguish between a contaminated patient event vs. an infectious patient event PPE choice for an infectious patient/agent is determined by infection control guidelines PPE choice for an infectious patient/agent is determined by infection control guidelines PPE choice for a contaminated patient is guided by new OSHA standards PPE choice for a contaminated patient is guided by new OSHA standards PPE should be selected based on the results of a community-based hazards vulnerability analysis (HVA) that should reveal credible threats, as well a role (such as EMS vs. facility based) PPE should be selected based on the results of a community-based hazards vulnerability analysis (HVA) that should reveal credible threats, as well a role (such as EMS vs. facility based)

10. Isolation/Quarantine Best practices model for plan development includes the following components: Best practices model for plan development includes the following components:  Hazards Vulnerability Analysis  Review of existing community action plans  Gap analysis  Establish isolation barriers  Designated isolation/quarantine facilities

11. Isolation/Quarantine Best practices model for plan development includes the following components: Ease in fiscal restraints Ease in fiscal restraints Technology use Technology use Legal and regulatory authority Legal and regulatory authority Surge capacity Surge capacity Mobile medical units Mobile medical units Training and education Training and education Active, early surveillance Active, early surveillance Reporting incentives Reporting incentives Increased Epi capacity Increased Epi capacity Rapid ID, isolation, notification Rapid ID, isolation, notification

12. Laboratory Capacity Laboratories will play a critical role in the response to any BT event Laboratories will play a critical role in the response to any BT event Ensuring a practiced, streamlined system is paramount to achieve maximum laboratory surge capacity Ensuring a practiced, streamlined system is paramount to achieve maximum laboratory surge capacity Timeliness, accuracy and security of lab diagnostics will have a direct impact on containment, mitigation and clinical treatment Timeliness, accuracy and security of lab diagnostics will have a direct impact on containment, mitigation and clinical treatment Laboratory surge capacity issues must be addressed at local, State and national levels Laboratory surge capacity issues must be addressed at local, State and national levels Three elements of containment determine BioSafety (BSL) level Three elements of containment determine BioSafety (BSL) level  Laboratory practices and techniques, safety equipment, and facility design

13. Decontamination A spiral development approach is required to build a community or region’s capacity A spiral development approach is required to build a community or region’s capacity Decontamination should be fully integrated into Planning Organization Equipment Training and Exercises (POETE) Decontamination should be fully integrated into Planning Organization Equipment Training and Exercises (POETE) Decontamination best practices were quantified in an interactive emergency planning Decontamination best practices were quantified in an interactive emergency planning

14. RESEARCHPRACTICE