strategic medical intelligence - toxicology
TRANSCRIPT
Strategic Medical Intelligence
Michael Allswede DOFederal Bureau of Investigation
Pittsburgh
Terrorism Con Plan
“Crisis management is predominantly a law enforcement function and includes measures to identify, acquire and plan the use of resources needed to anticipate, prevent, and/or resolve a threat or action of terrorism. In a terrorist incident, a crisis management response may include traditional law enforcement missions such as intelligence, surveillance, tactical operations, negotiations, forensics, and investigations, as well as technical support missions such as agent identification, search, render safe procedures, transfer and disposal, and limited decontamination. In addition to traditional law enforcement missions, crisis management also includes assurance of public health and safety
Strategic Biological Weapons
Bioterrorism Elements
Terrorist VictimAgent/SyndromeInterventions
The Terrorist Test
Political goals must be advanced by killing of AmericansPolitical conviction of the individuals must be serious enough to accept consequences of killing AmericansMust possess knowledge and skills needed to store, plan, and execute a credible WMD attack
International Terrorism
Terrorist Stratification
International-TransnationalReligious or Nationalist MotivationsState supported
DomesticSpecific political agendaDefensive posture
“Lone Wolf”Ted Kaczynski
International-Transnational
Examples:Russian “Mob”Middle Eastern Groups“Red Army” FactionsIndependence MovementsRogue Nations
Capable of obtainingSignificant Funding and Expertise
International Terrorism
Domestic GroupsExmples:
“Christian Identity”American NaziKKK, CSA, Aryan NationsNational Alliance, Freemen, Michigan Militia
Defensive PostureWish to live an un-fettered lifeHave policy goals
Lone WolfSingle persons acting on their conscience
Ted KaczynskiLarry C Ford Theme oriented
“Leaderless Resistance”Timothy McVeighInspired by books or speechesRichard Butler of Hayden Lake ID
Victim SelectionNon-Targeted Population Attack
Gases or aerosols in open airWater ContaminationFood Supply interruption
TargetedSpecific Product ContaminationClosed Space releaseContact Contamination
PNC Park, Pittsburgh PA
Agent Selection
StealableNaturally OccurringEasy to ManufactureLimited Access
Bacillus Anthracis on Blood Agar
Three Threats Paradigms
International Transnational GroupsState-supported, potentially exotic pathogensPopulation targeting
“Lone Wolf” IndividualsLimited by their access and abilitiesWildcard targeting
Domestic GroupsCommon pathogensAssassinations-Small volume targeting
Pre-2001 BT Model ICBM Missile Defense Model
NORAD Anti-ICBM
Civil Defense
CIA National Disaster Response
Pre-Launch Intel Launch Detonation Deaths Recovery
Pre-2001 BT Model
Pre-Release Intel Release Symptoms develop in Population
Disease Diagnosis
Public Health
Response“Bad Day”
Deaths Occur Recovery
Proposed BT Model
Pre-Release Intel Release Symptoms develop in Population
Deaths Occur Recovery
Integrated Public Health-Medical ResponseIntelligence
Sharing
Syndromic Surveillance
Surveillance of at risk
populations
Pre-positioning Medical Assets
Law Enforcement Investigations
WARNING: Math and Science Ahead
The Pittsburgh Matrix
Above all
Resources
Augmented
Capacity
Surge
Capacity
Current
Capacity
Pre Release Release Symptom
Occurrence
Illness
Occurrence
Deaths/Epide
mic
Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002
PM Hypotheses
The primary drivers of survivorship in Bioterrorism response are:
Victim load relative to available capacityTimeline of Detection
Timeline and Capacity-Victim Load combinations can be used to value resources and assess critical gaps within a system
UPMC Costs of Care
0
200
400
600
800
1000
OfficeIn PtICU
Anthrax Survival Benefit
Above all
Resources 92% 80% 10%
Augmented
Capacity 100% 100% 84% 43%
Surge
Capacity 100% 100% 83% 50%
Current
Capacity 100% 100% 83% 50%
Pre Release Release Symptom
Occurrence
Illness
Occurrence
Deaths/Epide
mic
Allswede, MP, Watson SJ., AHRQ Pittsburgh Matrix, 2002
Supplemental Hypotheses
Better Technology
Triage of Resources
Augmented Capacity
Surge Capacity
Current Capacity
Pre Release Release Symptom Occurrence Illness Occurrence Epidemic
System Preparedness
Allswede, MP, Watson SJ., AHRQ Partnership for Quality, 2002
Homeland Security Analysis Critical Intervention Points
Critical Capabilities
Critical Resources
EMS-Medical Establishment, Nat. Lab. Response System
EMS-Medical Establishment, Public Health
Security Services
University R+DCIA, FBI, Analysts MMRS
Symptoms in Target
Deaths-Epidemic
Pre-event Intel
Release Illness in TargetDetectors,
Rads-existing
Chem-developing
Bio-R+D
Syndromic Surveillance
Medical Practitioners
Quarantine
Mass Treatment
Strat. Med. Intel
Interdiction
Medical Practioners
Lab Analysis
Bioterrorism Big Three
Public Health
PrivateMedicineLawEnforcement
Big Three Domains
Control of Population
Primary Treatment
Analysis and Advisement
Evidence Focus
Individual Victim focus
Population focus
Enforcement and Arrest
Primary Data Collection
Investigative Powers
Law Enforcement
Private Medicine
Public Health
Strategic Medical Intelligence Mandate
Provide Physician WMD advisement to regional MMRS-Public HealthDevelop/Implement Medical Monitoring of Target Groups Provide real-time patient analysisDevelop Intelligence-surveillance strategies
Strategic Medical Intel
Case Investigations
Targeted Surveillance
Legal IssuesMedical
Public HealthConLaw
Intelligence
Realtime Modeling
SWAT-WMD TrainingPersonal Safety
Strategic MitigationLocal Response
Interdiction
Macro IssuesStrategic Capabilities
Decision SupportInterdictionQuarantine
Mass Treatment
Community Response
Strategic Medical IntelligenceInstitute
Intelligence: Physician Advisement
Interpret WMD Threat InformationWMD Educational ProgrammingPhysician Consultations
MMRS, and SMIEMS PreparationsSpecial Resources
What Do We Look For?
Intelligence
Special liaison to “dual use” facilities in your areaReceive confidential concerns of area officials and citizensTransmit concerns to FBI for analysis and threat assessment
Intelligence: Sentinel Groups
PopulationsMass Transit CommutersDomestic Relations
Spousal, Inheritances, Minorities
Racial, Religious, EthnicPolitical
Right Wing/Left WingSpecial Interest
Abortion rights, Ecology, Fur TradeHomosexual, Alternative Lifestyles
ServicesMedical
Emergency, ID, Public Health, Police
SWAT, Investigative, HomicideEMS
Event Staff, Catchment areas
Special EventsElections, Polling PlacesSports EventsCivic EventsCultural Events
FederalATF, FBIJudges, OfficialsPresidential
VIP’s State, LocalOpposition LeadersLabor Leaders
City ServiceBus Drivers, Garbage CollectionCoroners
Intelligence: Pre-Event Indicators
Behavior ReportingRecruitment AttemptsRepressed, angry, PersonalityIdeaology of Concern
Suspicious EventsDigital-Hand-Arm AmputationsSudden Deaths in Healthy PeopleToxidromesUnusual Culture Reports
Reporting: Legal Basis
Similar to the MANDATED reporting of homocidal-suicidal ideation, and child abuse“Impaired Physician” reports by physicians is common because of risk to community
Interdiction
Prevention is more important than prosecution
Larry Wayne Harris Prosecution statues are not well defined by case law
Patriot Act
Interdiction: Calder Article Calculator
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9-108-97-86-75-64-53-42-31-20-1
Community Response: Analysis of Patients
Determine credibility of potential WMD eventsObtain needed law enforcement historical dataAssist incarcerated potential terrorist illness care and analysis
SMI’s Team Response to WMD
WMD EVENT
TRAINING
SYNDROMIC SURVEILLANCE
HUMAN INTEL
LIAISON LE/PH/HOSP
EXPERT ASSESSMENT/EVAL
LINK ANALYSIS INTERVIEW
ASSISTANCE
MONITOR TRENDS
LIAISON LE/PH/HOSP
INVESTIGATIVE ASSISTANCE
PRE-EVENT THREAT ASSESSMENT POST-EVENT
Pre-Event PlanningA highly contentious political rally is scheduled for your city.Law enforcement has been informed that credible threats of anthrax are possible.What should be the medical response?
Pre-Event Planning
Working with local planners, the rally attendance is estimatedMedical facilities are queried as to their bed counts, numbers of antibiotics, and available personnel to assess civic healthcare capacityAssess critical resource shortage and apply cost coefficient to estimate preparation costs.
Urban League, Pittsburgh, PA, 2003
Attended by President BushTargeted by Domestic and International Groups
SMI Process
Assess threats, credibility, avenues of attack to project victim distributionMonitor victims at likely healthcare facilitiesFirst case workup and firm detection without delay
Benefits of SMI
Formalized relationship with MMRS, State Police, and local Public Health authoritiesTrained and credentialed network of mutually supporting physicians familiar with law enforcement, emergency management, and communications
My Motto