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Public health officials, Sandia test Labs-designed antiterrorism planning tool

Public health officials, Sandia test Labs-designed antiterrorism planning tool

Two dozen officials from Alameda County and environs teamed up with Sandia recently to practice responding to a mock anthrax attack using a response and planning tool designed by Sandia.

Participants in the exercise included the Alameda County Public Health Department (ACPHD), Contra Costa Health Services, the City of Berkeley Public Health Department, Highland Hospital, Kaiser Oakland Hospital, California Department of Health Services (DHS), Alameda County Office of Emergency Services, and the Federal Bureau of Investigation.

"The scenario, while vast in scale, was quite realistic," says Tony Iton, M.D., who participated in the exercise that evaluated the county’s new 300-page bioterrorism plan. Dr. Iton is the Alameda County Health Officer at ACPHD. "The exercise re-emphasized that the core components of bioterrorism response are surveillance, disease control, communication, and coordination," he says. "The Sandia folks have developed an excellent tool to help local public health agencies test drive their response plans."

Iton was also pleased to work with such a large collection of bioterrorism experts. "The benefits of the planning process are in establishing relationships and understanding what our various roles are," he says.

It was far more helpful than handing out business cards to collaborative agencies, agrees Jim Morrissey, the disaster coordinator with the Emergency Medical Services division of ACPHD. "It was much better to actually meet the related disaster staff in-person and to work with them side-by-side to provide a more efficient, interagency effort with the hopes of then having this become standard in the real events," he says. "I feel this was a tremendous opportunity to not only test out the Sandia system with them, but also to try our combined skills and expertise in a particular type of simulated event."

In a disaster situation, ACPHD coordinates the county-wide medical response, shifting around county staff and resources to stabilize the situation. Sandia and ACPHD got together to test ACPHD’s readiness to respond to a bioterrorism attack after ACPHD learned about Sandia’s decision-analysis computer program.

For this six-hour drill, participants gathered in Sandia’s Visualization Design Center, where information was displayed and updated via maps, charts, and text on three large screens lining the walls. Representatives from Sandia’s Weapons of Mass Destruction-Decision Analysis Center (WMD-DAC) described an increasingly severe, simulated scenario involving a release of a few ounces of highly infectious, weapon-grade anthrax at the Berkeley Marina.

Participants were asked to imagine that it was January, the weather was cloudy, the country had recently gone from "code orange" to "code red," and there appeared to be a spike in the number of respiratory illnesses in Alameda County. As they made decisions, the outcome of the simulation changed to reflect their choices.

"This is the first exercise I’ve been in that actually feels like the real thing to me because we were forced to make some decisions," says Dr. Poki Namkung, the Public Health Officer for the City of Berkeley.

Divided into groups of four to six people, participants had about ten minutes to decide how to respond to the change in alert status and discuss it in their groups. Decisions included asking hospitals to be on the alert for unusual symptoms and reschedule elective surgeries, increasing security in Alameda County, and getting an inventory of prophylactic drugs.

Then participants were told the situation had worsened. The "spike" turned into 35 cases of suspected inhalation anthrax. The groups stepped up their response: treating the affected individuals with antibiotics, investigating the cases, conducting press briefings, and communicating with the Centers for Disease Control and Prevention (CDC) and state DHS.

During the next 24 hours modeled in the scenario — requiring just a few minutes of computer simulation time — the situation got even worse. The 35 cases were confirmed as anthrax, and 613 more "suspect" cases were reported. In talking again, the groups decided to close all schools in Alameda County and set up clinics to administer prophylactic drugs, while holding more press briefings and issuing news advisories.

By the 11th day of the simulated attack, roughly half of the population exposed to the anthrax had died — but those deaths would be reduced significantly if there had been earlier detection and antibiotic distribution, the public health experts concluded.

"It was an excellent opportunity to come together and to participate in an experience like this that we hope will not be real, but may be one day," says Linda Frank of the Alameda County Communicable Disease Department.

ACPHD was not the only group to benefit from the experience. "I feel like we definitely learned a lot," says Advanced Technologies Dept. 8101 Manager Howard Hirano, who arranged the visit. "And that’s the point of WMD-DAC — to provide a learning tool for decision-makers who are tasked with protecting us and responding to potentially catastrophic events."

Initially conceived in early 2001, the WMD-DAC bioterrorism simulation engages the perspectives of many decision-makers as they seek to deal with a complex event that unfolds over days, often having to make decisions along the way with incomplete information. Sandia researchers began with the premise that it was only a matter of time until the US suffered a terrorist attack, and it would be wise to prepare for one.

There are several ongoing enhancements to the models. Epidemiological work by Los Alamos National Laboratory and analysis for atmospheric releases created by scientists at Lawrence Livermore National Laboratory are being incorporated. A nuclear terror scenario has also been developed. Another feature in the works will allow health officials to track the spread of diseases, such as smallpox, that spread person-to-person. Recent news coverage of the rapid worldwide spread of SARS underscores the importance of this capability.

In addition to the Bay Area models — including Alameda/Contra Costa County as well as San Francisco — another model involving a simulated bioterrorism attack on the 1.9 million residents of New Mexico has been completed. The CDC in Atlanta has also requested a presentation on the model this summer.