Supplement-Biological and Chemical Terrorism Strategic Plan for Preparedness and Response Recommendations of CDC Strategic Planning Workgroup (Excerpt)
>The Centers for Disease Control and Prevention's (CDC) strategic plan is based on the following five focus areas, with each area integrating training and research:
1. Preparedness and prevention.
Detection, diagnosis, and mitigation of illness and injury caused by biological and chemical terrorism is a complex process that involves numerous partners and activities. Meeting this challenge will require special emergency preparedness in all cities and states. CDC will provide public health guidelines, support, and technical assistance to local and state public health agencies as they develop coordinated preparedness plans and response protocols. CDC will also provide self-assessment tools for terrorism preparedness, including performance standards, attack simulations, and other exercises. In addition, CDC will encourage and support applied research to develop innovative tools and strategies to prevent or mitigate illness and injury caused by biological and chemical terrorism.
2. Detection and surveillance.
Early detection is essential for ensuring a prompt response to a biological or chemical attack, including the provision of prophylactic medicines, chemical antidotes, or vaccines. CDC will integrate surveillance for illness and injury resulting from biological and chemical terrorism into the U.S. disease surveillance systems, while developing new mechanisms for detecting, evaluating, and reporting suspicious events that might represent covert terrorist acts. As part of this effort, CDC and state and local health agencies will form partnerships with frontline medical personnel in hospital emergency departments, hospital care facilities, poison control centers, and other offices to enhance detection and reporting of unexplained injuries and illnesses as part of routine surveillance mechanisms for biological and chemical terrorism.
3. Diagnosis and characterization of biological and chemical agents.
CDC and its partners will create a multilevel laboratory response network for bioterrorism. That network will link clinical labs to public health agencies in all states, districts, territories, and selected cities and counties and high-tech facilities that can analyze biological agents. As part of this effort, CDC will transfer diagnostic technology to state health laboratories and others that will perform initial testing. CDC will also create an in-house rapid-response and advanced technology laboratory. The laboratory will provide around-the-clock diagnostic confirmatory and reference support for terrorism response teams. The network will include regional chemical laboratories for diagnosing human exposure to chemical agents and provide links with other departments (e.g., the U.S. Environmental Protection Agency, which is responsible for environmental sampling).
4. Response.
A comprehensive public health response to a biological or chemical terrorist event involves epidemiologic investigation, medical treatment, and prophylaxis for affected persons, and the initiation of disease prevention or environmental decontamination measures. CDC will assist state and local health agencies in developing resources and expertise for investigating unusual events and unexplained illnesses. In the event of a confirmed terrorist attack, CDC will coordinate with other federal agencies in accord with Presidential Decision Directive (PDD) 39. PDD 39 designates the Federal Bureau of Investigation as the lead agency for the crisis plan and charges the Federal Emergency Management Agency with ensuring that the federal response management is adequate to respond to the consequences of terrorism. If requested by a state health agency, CDC will deploy response teams to investigate unexplained or suspicious illnesses or unusual etiologic agents and provide on-site consultation regarding medical management and disease control. To ensure the availability, procurement, and delivery of medical supplies, devices, and equipment that might be needed to respond to terrorist-caused illness or injury, CDC will maintain a national pharmaceutical stockpile.
5. Communication systems.
U.S. preparedness to mitigate the public health consequences of biological and chemical terrorism depends on the coordinated activities of well-trained health care and public health personnel throughout the United States who have access to up-to-the-minute emergency information. Effective communication with the public through the news media also will be essential to limit terrorists' ability to induce public panic and disrupt daily life. During the next five years, CDC will work with state and local health agencies to develop:
• high-tech communication system that will support disease surveillance;
• rapid notification and information exchange regarding disease outbreaks that are possibly related to bioterrorism;
• dissemination of diagnostic results and emergency health information;
• coordination of emergency response activities.
Through this network and similar mechanisms, CDC will provide terrorism-related training to epidemiologists and laboratorians, emergency responders, emergency department personnel, and other frontline health care providers and health and safety personnel.
Recommendations
Implementing CDC's strategic preparedness and response plan by 2004 will ensure the following outcomes:
• U.S. public health agencies and health care providers will be prepared to mitigate illness and injuries that result from acts of biological and chemical terrorism.
• Public health surveillance for infectious diseases and injuries — including events that might indicate terrorist activity — will be timely and complete, and reporting of suspected terrorist events will be integrated with the evolving, comprehensive networks of the national public health surveillance system.
• The national laboratory response network for bioterrorism will be extended to include facilities in all 50 states. The network will include CDC's environmental health laboratory for chemical terrorism and four regional facilities.
• State and federal public health departments will be equipped with high-tech tools for rapid epidemiological investigation and control of suspected or confirmed acts of biological or chemical terrorism, and a designated stock of terrorism-related medical supplies will be available through a national pharmaceutical stockpile.
• A cadre of well-trained health care and public health workers will be available in every state. Their terrorism-related activities will be coordinated through a rapid and efficient communication system that links U.S. public health agencies and their partners.
Conclusion
Recent threats and use of biological and chemical agents against civilians have exposed U.S. vulnerability and highlighted the need to enhance our capacity to detect and control terrorist acts. The United States must be protected from an extensive range of critical and biological chemical agents, including some that have been developed and stockpiled for military use. Even without threat of war, investment in national defense ensures preparedness and acts as a deterrent against hostile acts. Similarly, investment in the public health system provides the best civil defense against bioterrorism. Tools developed in response to terrorist threats serve a dual purpose. They help detect rare or unusual disease outbreaks and industrial injuries that might resemble terrorist events in their unpredictability and ability to cause mass casualties (e.g., a pandemic influenza outbreak or a large-scale chemical spill). Terrorism-preparedness activities described in CDC's plan, including the development of a public health communication infrastructure, a multilevel network of diagnostic laboratories, and an integrated disease surveillance system, will improve our ability to rapidly investigate and control public health threats that emerge in the 21st century.
Source: Centers for Disease Control and Prevention, Atlanta.
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