America

has been

targeted

America

has been

attacked

America

has

suffered

Bioterrorism

A Nation Challenged

Domestic Preparedness

and Response

The Challenges of

Local /Federal Partnership

Comprehensive strategic assessment

of bioterrorism is required

Biothreat Assessment

Capability + Intent

Capability• “Loose bugs” readily available• The list of threat agents is formidable and

growing• Relatively inexpensive due to available

technologies for production and storage• Dissemination now more easily accomplished• Requisite knowledge and competency readily

available• “Dual use” technology makes it difficult to

identify clandestine R & D activities• Emergence of genetically engineered

bioagents

IntentNation/States, groups, and individuals of domestic and

international origins motivated by diverse political, social,

economic, religious, or criminal intent view the increased

availability of bioagents as an opportunity to wage asymmetric warfare

KnownIraqRussia

ProbableChinaIranNorth KoreaLibyaSyriaTaiwan

PossibleCubaEgyptIsrael

International Biological Weapons Programs

Source: Committee on Armed Services, House of Representatives. Special Inquiry into theChemical and Biological Threat. Countering the Chemical and Biological Weapons Threat inthe Post-Soviet World. Washington, D.C.: U.S. Government Printing Office; 23 Feb 1993.Report to the Congress.

Washington PostNovember 5, 2002

“The Bush Administration concludes that four nations

possess unsanctioned stockpiles of Smallpox virus.”

France, Iraq, North Korea and Russia

“two unnamed officials”

Zealots, extremists, and malicious

opportunists will not be constrained

by moral and ethical

considerations.

Bioterrorism

• Credible Threat

• Low Probability/High Consequence

Risk Assessment

Threat/Assets/Vulnerabilities Combinations

America is

Vulnerable

Deficienciesin

Planning and Preparation

Federal/Community Strategies were

Seriously Flawed

Domestic Preparedness Strategy

National StrategyFederal Response PlanTerrorism Incident Annex

Community StrategyEscalation of E.M.S. System Response

Federal Strategy Assumed:

• Coordination of Multiple Federal Agencies

• Appropriate Planning/Response

• Integration of Federal Family Into Community Response

• Department of Health & Human Services

• Department of Defense

• Department of Justice

• Federal Emergency Management Agency

Major Federal Response Initiatives

Community Strategy Assumed:

• Disaster Plan Exists

• Specific WMD Incident Plan Exists

• Realization of Needs and Losses

• Self Sufficiency

Unique characteristics of nuclear, chemical, and biological threats impose the need for a

unique defense doctrine for each threat category.

Adoption of a “holistic” doctrine for

biodefense remains elusive but vital

No Centralized Federal

Coordination

August 1998 Stakeholders Meeting - Issues for the Federal Government

• Identify single lead federal agencysingle lead federal agency to serve as a clearinghouseclearinghouse and coordinate the distribution of federal programs and guidance to state and local communities

• Identify single program and policy officesingle program and policy office to to integrate federal programsintegrate federal programs for terrorism-related assistance

U.S. RESPONSE TO CBW TERRORISM AND DOMESTIC PREPAREDNESS

Courtesy of the Center for Nonproliferation Studies/Monterey Institute of International Studies

The organizational framework of the national response

strategy is dysfunctional due to

excessive fragmentation which

has generated a combination of ill-

defined and overlapping

responsibilities.

No Authority Structure

Decays Federal Efforts

Undermines Federal Partnership

with State and Local Communities

No Authority Structure

Communication Issues

•Planning

•Response

Department of Homeland Security

HomelandSecurityDepartment

Bioterrorism Response “National Response”

Community Response First

Federal Response Follows

Improper Planning Models

Bioweapons present a far more complex problem than nuclear or

chemical weapons• Diversity of available biologic

agents • Diversity of vulnerable targets• Diversity of bioassault routes• Mimic natural epidemics• Insidious onset with latent period• Infective/contagious characteristics• Lethality • Prophylaxis and treatment issues

Chemical Decontaminaton Training ca. 1996

Jacksonville, North Carolina, USA

Strategic principles to enhance biodefense

capabilities•Faster diagnosis of bioattack saves lives

•Faster diagnosis accelerates the mobilization of treatment and containment actions

Points of effective biodefense interdiction

• Identification and excision of perpetrators/bioweapons before an incident

• Early alert and warning detection• Rapid medical diagnosis• Availability of suitable drugs and vaccines• Forensic and analytical tools for

attribution and retribution

Community Response

Triumvirate of:

• Health Care Professionals

• Health Care Facilities

• Public Health

First Responder community is

different.

Local civilian medical system is the critical human infrastructure

Health Care Professionals

• Minimal Involvement

• Unfocused Educational and Training Efforts

• Inadequate Funding

The Trinity of Local Response

HospitalsHospitalsPublic Public HealthHealth

RespondersResponders

Command & Command & ControlControl

Developing Objectives, Content, and Competencies for the Training of Emergency Medical Technicians,

Emergency Nurses, and Emergency Physicians to Care for Casualties

Resulting From Nuclear, Biological or Chemical (NBC) Incidents

METHODOLOGY

THE PROCESS

• Taskforce of individuals from key professional organizations

• Consensus development approach• Instructional design methodology

Analysis Design Development Implementation Evaluation

The analysis stage focused on defining the problem or concern thoroughly and understanding it sufficiently in order to

recommend appropriate solutions.• Audience• Content & Objectives• Proficiency Categories

Awareness Performance Planning• Barriers Undermine the acceptance & delivery of

effective WMD-related training

• Curricula and Course Review

RESULTS

• Audience

• Content Learning Objectives

• Barriers

• Curricula Reviews

• Recommended Strategies

RECOMMENDED STRATEGIES• Recommendations for

Integration• Recommendations for

Sustainment• Ensure Continuing

ProficienciesHow do we go about building training

that ensures that the levels of proficiencies desired can be met

within the accepted training models currently being used to educate the

target audience groups?

BARRIERSEMS PROVIDERS• No single source of authority• Excessive time• EMT curricula would have to expand• No “approve” body of content or curriculum

EMERGENCY PHYSICIANS• Curricula are full and time is limited• No “approve” body of content or curriculum• The need for training has not been broadly

articulated and emphasized• No advocates

EMERGENCY NURSES• Existing curriculum full• No “approve” body of content or curriculum• No formal acceptance exists

Minimal Integration of

Health Care Facilities

“The lack of integration of

health care facilities in the

overall community response is a

serious flaw in US national Strategy.”

Health Care Facilities

• Unfunded Mandates In A Time of Fiscal Constraints

• Concern of Contamination/Closure

• No Reimbursement Policy

• No Litigation Protection

Public Health System

remains fragile

Public Health SystemLacks:

• Trained Personnel

• Modern Technology

• Laboratory Capacity

• Sufficient Funding

Detection and Identification

Capabilities are Deficient

Primitive Surveillance Systems/Infrastructure

Medical Management

Capabilities are Deficient

Medical ManagementLacks:

• Vaccines for Prevention

• Antibiotics for Treatment

• Critical Supplies for Supportive Therapy

Federal Partnership with

Pharmaceutical Industry

will be of Benefit

Conclusions

The “Calculus of Risk” has changed dramatically with

the ready availability of

biologic agents suitable for

warfare

Unfortunately, no assurance is evident

that the federal response strategy can

provide proficient incident management

and crisis control against a bioincident.

The functional inadequacies posed by

the doctrinal vacuum and fragmented and uncoordinated organizational

responsibilities for biodefense constitute a

major source of vulnerability.

Disturbing inter-agency rivalries and a lack of

cross-agency awareness of the full spectrum of

the activities being undertaken make for

inefficient integration of biodefense activities.

Realistic simulation scenarios have

demonstrated that local response capabilities are ill-informed, poorly financed, not well trained or drilled, and not integrated into the

federal response system that will be inevitably introduced into any

bioincident.

Medical and public health responses to a bioweapons

attack are extremely complex requiring swift

interdiction by a plethora of local, state, and federal agencies in collaboration with an equally diverse

array of non-governmental organizations

Although the probability of a

bioattack is difficult to assess, the social

and political consequences of any

incident will be disproportionately

high.

Federal/State/Local Response Strategy

• Comprehensive/Appropriate

• Integrated

• Supported

Benefits of Comprehensive National Strategy:

• Deter Behavior

• Mitigate Consequences

• Prosecute Criminals