IntroductionThe U.S. Department of Homeland Security’s Top Officials Three Exercise (TOPOFF 3) is a Congressionally mandated exercise designed to strengthen the nation’s capacity to prevent, prepare for, respond to, and recover from large-scale terrorist attacks involving weapons of mass destruction (WMDs).1

The TOPOFF 3 Exercise Program, the most comprehensive terrorism response exercise ever conducted in the United States.1

The Full-Scale Exercise took place April 4–8, 2005.

Union County, New Jersey was highlighted during this the exercise in 2005. The scenario revolved around an outbreak of pneumonic plague as a result of a deliberate terrorist event.

This poster explores lessons learned while participating in, and conducting a mass prophylaxis exercise during

TOP OFFICALS 3.

MethodsConducted mass prophylaxis exercise during TOP OFFICALS 3 (TOP OFF 3). The exercise scenario was an outbreak of pneumonic plague as a result of a terrorist incident in Union County, New Jersey.

Community members were recruited to participate as victims / role players for one Point of Dispensing (POD) location. Participants represented the general population, special needs populations including those with visual and hearing impairments, youth, elderly, and diverse racial/ethnic backgrounds. The objectives were to prophylax participants within a limited timeframe and communicate health messages.

AcknowledgmentsWe thank the first responders, volunteers of the exercise, and all who participated during the exercise.

Pictures courtesy of the Union County Office of Public Information, Jim Lowney, photographer.

Results

Overall, communication needs were met among participants.

Challenges encountered included:

Parental consent issues regarding medication for children without parents or guardians present.

Victim / role players refused medication and or had medication restrictions.

Isolation and Quarantine issues at POD.

Translators were made available for diverse language needs.

Signs were made for the hearing impaired, however official sign language interpreters were not readily available.

Materials were available in English and Spanish only.

Video about pneumonic plague was developed, however due to POD configuration information was difficult to comprehend.

ConclusionsMeeting the needs of Union County’s diverse population is challenging during times of emergency.

The exercise provided the conduit to enhance public health infrastructure by building relationships with the local emergency services agencies, finding resources including language interpreters and other health information resources.

Further exploration is needed to develop a plan providing health related materials for diverse racial and ethnic populations, as well as the deaf and blind populations during times of emergency or disaster.

As world events continue to remain unstable, relationships with emergency services agencies need to be developed and maintained. Protecting the public’s health will be dependent on resources, assistance and volunteer’s being readily available and trained prior to an event.

Lessons Learned: Conducting a Mass Prophylaxis Exercise in Union County, New Jersey during TOP OFFICALS 3a Michelle Kennedy, MPH, CHES, b Roberta Swenson-Milano, MPH, b Denise Santiago, MS, MA

a Office of Research and Sponsored Programs, Rutgers University, New Brunswick, New Jerseyb Union County, New Jersey Office of Emergency Management, LINCS Agency, Westfield, New Jersey

Literature cited1 The State Department of homeland Security, www.dhs.gov, Accessed on

August 17, 2006.Fig. 1. Volunteers were recruited to “play” act the role of community members exposed to Pneumonic Plague. Here role players are entering the POD facility to receive antibiotics.

Fig. 2. Some role players were required to be “quarantined.” Quarantine orders posed public health and risk communication challenges during the exercise.

Fig. 3. Volunteer played the role of a pregnant woman seeking medical consult during the exercise to see if antibiotics were safe to take during advanced pregnancy.

Fig. 4. Signs in English and Spanish helped volunteers navigate the Point of Dispensing (POD).

For further informationPlease contact rm2@njlincs.net or go to the Union County LINCS website for further information and related projects at www.ucnj.org/lincs

Key Health Education Messages

What is the plague? Plague is a disease caused by a bacteria There are 3 forms of plague:

1. Bubonic affects the lymph nodes 2. Septicemic affects the blood3. 3. Pneumonic affects the lungs: public health officials believe that Pneumonic affects the lungs: public health officials believe that

in a biological attack, the pneumonic form would be seen.in a biological attack, the pneumonic form would be seen.

What are the symptoms of the plague? Fever Headache Weakness Rapidly developing pneumonia Chest pain Cough: Sometimes watery or bloody mucus Nausea, vomiting, and/or abdominal pain may also occur Symptoms usually surface between 1 and 6 days after exposure

How is the plague transmitted?

Pneumonic plague is transmitted from person to person through coughing, and/or sneezing from an infected person who is in close contact, which is defined as between 3 to 6 feet.

Aerosol release and persons exposed breathe in bacteria.

Is there treatment for the plague? Yes. Antibiotics should be taken within 24 hours of symptoms.

How can exposed persons avoid becoming sick or help reduce the spread of the plague? Seek treatment as soon as possible through a medical provider. Cover nose or mouth with tissue or surgical mask.

Where can I go for more information? Your local health department:

www.state.nj.us/health/lh/directory/lhdselectcounty.htm http://nj.gov/health/plague Toll free hotline for New Jersey: 866-234-0964

Media Challenges

Rumor control Misinformation Artificiality of the exercise

Communication Methods E-mail Public Information Officers and Spokespersons Press Releases Television

Prior to the event, relationships and communication Prior to the event, relationships and communication among emergency responders significantly aided among emergency responders significantly aided

in the response during the exercise.in the response during the exercise.