During a bioterrorist event, health-care professionals urgently need to be able both to protect themselves from disease and to prevent its spread. They also need laboratory support for identifying infectious agents or contaminants. This report presents extensive information and detailed best-practice models to respond to these needs.
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Chapter 1. Introduction
Appendix A. Subject Matter Interview Questions and Experts
Chapter 2. Personal Protective Equipment
Appendix A. References and Bibliography
Appendix B. Emergency Medical Services PPE Model
Appendix C. Healthcare Facility PPE Model
Chapter 3. Decontamination
Appendix A. References and Bibliography
Appendix B. Mass Casualty Patient Decontamination Model
Appendix C. Model for Mass Casualty Decontamination Planning
Chapter 4. Isolation/Quarantine
Appendix A. References and Bibliography
Appendix B. Isolation and Quarantine Best Practices Model for Plan Development
Chapter 5. Laboratory Capacity
Appendix A. References and Bibliography
Appendix B. Model for Laboratory Capacity and Bioterrorism Response Planning
Appendix C. Checklist for the Preliminary Triage of Unknown Environmental Samples
Acronyms and Abbreviations
This section summarizes the purpose of this project and provides background on the Agency for Healthcare Research and Quality (AHRQ) Bioterrorism Initiative.
A biological or other WMD event could result in many casualties presenting themselves in a variety of clinical settings, including emergency rooms, physicians' offices, and walk-in clinics. To reasonably accommodate these casualties, health-care professionals need training and tools to help them recognize and diagnose diseases caused by biological weapons, recognize toxidromes indicative of chemical exposure, inform public health authorities, and treat patients. Health professionals also need access to the most appropriate protection for themselves and to prevent the spread of disease and the ability to address surge capacity issues, including laboratory services, regionally.
Under Congressional direction, AHRQ, within the U.S. Department of Health and Human Services (HHS), is providing support for assessing and improving the U.S. health-care system's capacity to respond to possible incidents of bioterrorism. This initiative, which focuses on clinical preparedness of health-care providers and health-care systems, is part of a broad effort by HHS and other Federal agencies directed toward potential instances of bioterrorism. AHRQ's Bioterrorism Initiative is examining the clinical training and ability of front-line medical staff—including primary care providers, emergency departments, and hospitals—to detect and respond to a bioterrorist threat.
The Bioterrorism Initiative is consistent with AHRQ's overall research goals of supporting improvement in health outcomes, strengthening quality measurement and improvement, and identifying strategies to improve health-care access, foster appropriate use of the health-care system, and reduce unnecessary expenditures.
In the first task order of the Bioterrorism Initiative, AHRQ supported research on the use of information and decision support systems to enhance clinical preparedness in the event of a bioterrorist threat and to assess and improve links between the health system, local and State public health departments, and emergency preparedness units.
AHRQ's Bioterrorism Initiative provides Models for Emergency Preparedness in the subject areas of personal protective equipment, decontamination, isolation/quarantine, and laboratory capacity for the medical, public health, and emergency preparedness systems in an effort to improve detection and response to a bioterrorist event. The primary objective of this task order is to assess and prepare guidelines and models for evidence-based, best-demonstrated practices.
Current literature has been assessed to address the subject areas of this task order in the medical and public health emergency preparedness arena, including health-care professional practices, the public health infrastructure, and emergency preparedness. In general, the assessment focused on identifying and measuring evidence-based, best-demonstrated practice models that have been used effectively to improve the guidelines for use of personal protective equipment, decontamination, isolation/quarantine, and laboratory capacity.
This assessment will consider strategies to enhance regional preparedness guidelines and a resource approach for a bioterrorism and WMD response. While the initial statement of work addressed only the threat of bioterrorism, authors found it difficult to ignore the overlapping full spectrum threats of chemical and radiological events, and as such, addressed these areas in the decontamination and personal protective equipment sections.
As described in the AHRQ-approved work plan, the Science Applications International Corporation (SAIC) team examined open source publications and interviewed Federal, State and local stakeholders representing a broad spectrum of regulatory, professional, government, and private agencies and organizations. The goal was to summarize current evidence-based, best demonstrated practices relating to preparedness for healthcare professionals in the topics of personal protective equipment, decontamination, isolation/quarantine and laboratory capacity. Gaps and shortfalls would be identified, as well as future research and development needs. A series of questions was posed to frame the best demonstrated practices, and a summary was developed in the form of guidelines and models for use in all-hazards planning.
SAIC conducted this research referencing professional literature, with a focus on literature published in the last 5 years, with each subject area assigned to subject-matter experts (SMEs) in bioterrorism and infectious diseases, emergency medicine/nursing, hazardous materials, emergency management, environmental engineering, and public health (Chapter 1, Appendix A). Further, SAIC engaged SMEs from a variety of government, military, academia, non-profit, and commercial organizations to broaden the research agenda. SAIC also considered related research activities sponsored by AHRQ and other government agencies as additional sources of information, maintaining close contact with AHRQ's Task Order Officer (TOO) for the duration of the project.
SAIC assessed current literature in the medical and public health arenas to address the subject areas of personal protective equipment, decontamination, isolation/quarantine, and laboratory capacity. The goal was to prepare guidelines for evidence-based, best-demonstrated practices in an effort to improve detection and response to a bioterrorist or other WMD event. Open-source literature resources included MEDLINE®/PubMed®, MedJournals, LexisNexis®, MDLinx, MedWorld, MedWeb, Medic8®, Oxford Journals, BioMedNet, and eMedicine®, as well as publications from collegiate and medical libraries.
In assessing the subject areas, SAIC followed the relevant requirements and/or guidelines from the following agencies and organizations: AHRQ, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Occupational Safety and Health Administration (OSHA), National Fire Protection Association (NFPA), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), U.S. Army Soldier and Biological Chemical Command (SBCCOM), Agency for Toxic Substances and Disease Registry (ATSDR), and professional associations, including Emergency Nurses Association (ENA), American College of Emergency Physicians (ACEP), American Hospital Association (AHA), American Medical Association (AMA), American Nurses Association (ANA), Association for Professionals in Infection Control and Epidemiology (APIC), American Biological Safety Association (ABSA), American Society for Healthcare Engineering (ASHE), American Society for Testing and Materials (ASTM), and others.
Sections are designed to present evidence-based best practices, shortfalls, gaps, research and development recommendations, and guidelines extracted from the research summaries and stakeholder interviews. Each section has appendices with stakeholder rosters, bibliography, and draft recommended models for stakeholder review and refinement. Guidelines and models focus on planning with applications to an operational setting, instead of operational guidelines that would be developed after a site specific concept-of-operations plan. Guidelines and models are meant to synthesize best demonstrated practices and offer practical solutions to overcome currently identified gaps and shortfalls. The targeted end user is a health-care emergency planner, in either a pre-hospital or facility-based setting.