Transcript The National Advisory Committee on Children and Terrorism and Current U.S. Changes in How Preparedness is Evaluated Peter D.

The National Advisory Committee
on Children and Terrorism and
Current U.S. Changes in How
Preparedness is Evaluated
Peter D. Rumm, MD, MPH, FACPM
Director, Center for Public Health
Readiness and Communication
Drexel School of Public Health
[email protected]
or 215-762-1652
Most Famous Anthrax Disaster:
Sverdlovsk
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In late April of 1979, an outbreak of pulmonary
anthrax occurred in Sverdlovsk (now
Yekaterinburg) in the former Soviet Union.
While, originally, the outbreak was described
as being due to ingestion of infected meat, it
was later discovered that the cause was from
an accidental release of anthrax in aerosol
form from the Soviet Military Compound 19, a
huge Soviet bioweapons facility.
Residents living downwind from this compound
developed high fever and difficulty breathing,
and a large number died. The final death toll
was estimated at the time to be between 200
and 1,000.
Cutaneous Anthrax (day 5)
www.dermatologyabout.com
Anthrax Inhalation Cases (10) and their
Timeline
CDC, EID Vol 7 No 6 Nov-Dec 2001
The “Challenge of Bioterrorism”
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Biological weapons are a formidable
challenge. The use of a bioagent as a
weapon is a multidimensional
problem because of the diversity of
bioagents, the large number of
vulnerable targets, and the varied
routes of dissemination.
Terrorists using biological warfare
can decimate a large population,
inflict enormous psychological and
economic hardship, and incite
political unrest by merely attacking
small populations in multiple sites
over a long period of time.
US Postal Cases
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In October 2001, anthrax spores were
sent through the U.S. mail and caused
18 confirmed cases of anthrax (11
inhalation, 7 cutaneous). Five
individuals with inhalation anthrax died;
none of the cutaneous cases was fatal.
One of the cutaneous cases was a child
that did well.
We learned a lot about the potential
vulnerability of children, the aged and
other populations.
Soviet Union and Russia
Although the former Soviet
Union was a signatory to the
Biological Weapons
Convention, their
development of biological
weapons only intensified
after the accord and
continued with full steam
into the 1990s.
Overlooked Populations
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Many groups of people are
frequently overlooked in
response plans, including those
regarding mental health, and the
needs of children, elderly,
disabled, and ethnic minority
groups that are vulnerable to
backlash or hate crimes.
Some Resources
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American Academy of Pediatrics
Children, Terrorism and Disasters:
Disaster Preparedness to Meet
Children’s Needs
Columbia University Mailman School
of Public Health
The National Center for Disaster
Preparedness, Program for Pediatric
Preparedness
American Red Cross
Children and Disasters
Other Populations
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Disabled: American Red Cross
Special Needs & Concerns: Disaster
Preparedness for People with Disabilities
Hate crimes: Council on American-Islamic
Relations
Muslim Community Safety Kit
Seniors: International Longevity Center
Emergency Preparedness for Older People
Mental Health: American Psychological
Association
Briefing Sheet: The Psychological Impact
of Terrorism on Vulnerable Populations
Children may be most vulnerable
population, at home or in schools
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A survey by the National Safety
Resource Officers in Schools in 2003
stated that 68% of schools
unprepared for a disaster or act of
terrorism.
Children have special vulnerabilities
both physiologically and mentally.
According to the WHO in 2002 most
casualties of both man made and
natural disasters were children.
Purpose of the NACCT
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Created by joint legislation introduced
first by Senator Hillary Clinton in
2001.
The objective of the National Advisory
Committee on Children and Terrorism
(NACCT) as specified in the legislation
was to assess and provide
recommendations for Health and
Human Services Secretary Tommy
Thompson
Public Health Security and
Bioterrorism Preparedness and
Response Act of 2002
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Established a National Advisory
Committee on Children and Bioterrorism;
assured that our national system of
responding and countering bioterrorism.
Provided training to health professionals
on the special needs of children;
Promoted 211 hotlines and other
communications systems.
Background Information
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There are more than 70 million
children under the age of 18 in the
United States today, and more than
22 million are ages five and younger.
In the event of a terrorist attack,
these children would be among the
most vulnerable populations in our
society
As recently as 1997, data collected by
FEMA showed that no state disaster
plans had pediatric components.
Reports Consensus
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Children are not simply small adults.
Children breathe faster and have
faster heart rates than adults, making
them more vulnerable to aerosolized
biological and chemical agents.
Children metabolize drugs differently,
requiring different dosages of drugs
and different antidotes to many
agents, as well as specially sized
equipment to administer many
treatments.
Classic Presentation of a Severe
Case about 1 Week, 10 Days
Committee Consensus
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Ill and injured children react
differently than adults to stress, and
their psychological vulnerabilities in
the aftermath of disasters and
emergencies are still only imperfectly
understood.
On every level, physical, medical,
psychological, emotional and social,
children have unique needs and
vulnerabilities that must be taken into
account.
Focus Areas
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Primary Care Pediatricians, Office-Based
Practice & Urgent Care Centers
Community Involvement
Children’s School and Childcare
Research and Data
Training
Mental Health Response Phase
Children with Special Health Care Needs
Mental Health Recovery and Mitigation
Phase
Hospital Preparedness
Public Health Departments
Pre-Hospital and Critical Care
Methods
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Each of 12 members began
working with 3-4 CDC staff and
consultants wrote a 30-50 page
draft report on their focus area
that they led. This involved a
massive literature review and
seeking out expert opinions.
Four meetings were held in two
places (DC, Atlanta)
Methods Continued
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Over a 3-4 month time we each spent
hours working with the CDC and HHS
senior staff and other staff to
compose report.
Report is available on line at
www.bt.cdc.gov and a supplement
has also been published at:
J Sch Health. 2004 Feb;74(2):3951.Schools and terrorism. A supplement to the
report of the National Advisory Committee on
Children and Terrorism.
Key Recommendation
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1.3 Conduct a national survey of
Federal, state and local
terrorism and disaster plans
that includes a specific
assessment of preparedness
and training for the medical and
psychological effects of
terrorism on children.
Key Recommendation of This Committee
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1.2 Assure that the unique
physical and mental health
needs of children are
recognized and resources
provided for in all DHHS
terrorism preparedness and
response funding initiatives,
strategic plans and priority
setting activities.
History of Bioterrorism = Not New!
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Before the era of modern microbiology
brought the prospect of germ warfare to
the world of the 21st century, ancient
armies used filth, cadavers, animal
carcasses and contagion as weapons
against each other.
They knew that fear of infectious
diseases could rapidly demoralize and
dismantle enemy forces.
During the North American colonization,
British forces purposely spread
smallpox among the native Indian
population by sending smallpox-infested
blankets as "gifts"; to Indian tribes who
resisted British authority.
Key Recommendation
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1.6 Expand the State Children's
Health Insurance Program
(SCHIP) to provide financial
mechanisms for States to
support post-disaster physical
and mental healthcare to all
children.
Key Recommendation – focus on
mental health and resiliency
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3.1 Conduct research relating to
identifying patterns of child
trauma, resilience, coping and
recovery in the aftermath of
disasters and terrorism.
This research should include
studying the topic of resiliency.
Key Recommendations on Risk
Communication and “Translational
Research”
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9.1-3 Implement risk communication
strategies to positively affect the nation as
a whole during times of elevated threat
levels and actual terrorist events, in light
of the special effects these threats and
events have on children.
Develop clear, concise and situationspecific guidance for parents, caregivers
and teachers concerning helping children
to cope with terrorism and disasters, and
ensure that consistent information is
disseminated by all DHHS agencies.
Public Health Ramps Up for Terrorism
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The CDC over the last four years has spent
approximately 1.2 billion per year on terrorism
preparedness.
They use about 150 million per year internally to
improve internal terrorism preparedness and the
syndrome biosurveillance initiative.
The rest of the money is distributed primarily to
state agencies and US territories through annual
appropriations (some goes directly to large cities)
The U.S. DHHS has also spent billions on hospital
and medical training primarily through the Human
Resources Services Administration.
www.cdc.gov/fmo.fmofybudget.htm
Future etc?
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Former members of the NACCT
believe that funding for children
and special populations is
increasing for this usage but is
not enough per recent
conference calls.
Will the Committee be
reinstated?
Red Cross and Special
Populations
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During emergencies and disasters, it
is especially important to provide
assistance to those people with
special needs. These include the
elderly and disabled and people with
limited English proficiency (LEP).
The Red Cross has developed
materials to assist these individuals.
http://www.redcross.org/services/
disaster/beprepared/disability.html
FEMA (Federal Emergency
Management Agency)
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Promotes self-help networks = are
arrangements of people who agree to
assist an individual with a disability in
an emergency. Discuss with the
relative, friend or co-worker who has
a disability what assistance he or she
may need.
(http://www.fema.gov/rrr/assistf.shtm)
A Renowned Local Effort
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One of the best is in the San Francisco
area that was spurred by the
earthquake during the 1997 baseball
World Series.
PrepareNow.org “provides the tools,
expertise and access to resources to
assist anyone engaged in disaster
planning for individuals with special
needs.
http://www.preparenow.org/purpose.html
Past Measures to
Gauge Preparedness
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Centered around U.S CHC and HRSA
guidance that dealt with focus areas.
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Centered on Capacity – several
instruments done on volunteer basis
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National BTAIP by ASTHO revealed a
nation better but still under—
prepared in workforce, information
systems and surveillance.
Billions for What?
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Sidell and Cohen others blast wasted
spending since 9’11” and anthrax attacks.
Rumm and others challenge that spending
has at least improved our public health
system and especially our laboratories.
Trust for America Report continues to
blast some state efforts and calls for
common metrics.
Gursky calls for a Force Protection
Agency.
Gaskin and Rumm Study
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Over 50 assessments, few on children
and special needs.
Continuing lack in some sectors in
training, communications,
surveillance systems and most
importantly in workforce.
Has been substantial improvement in
laboratory capacity and some
improvement in hospital surge
capacity.
Today Movement toward Metrics – away
from capacity toward capability!
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CPHRC leadership on the Lehigh
Valley Study and the Federal Regional
Preparedness Metrics.
Commonality of metrics coming under
the leadership of the U.S. DHS
Disaster Response Plan and Target
Capabilities.
CDC and other Capability studies
including those by RAND – is this a
good thing?