Application of Technology to Transportation Operations in Biohazard Situations
Figure 1: NIMS and NRP Framework
If an incident occurs, the National Incident Management System (NIMS), which provides standardized processes and procedures for incident management. NIMS aligns command, control, organizational structure, terminology, communication protocols, resources and resource-typing for synchronization of response efforts at all echelons of government., local, state, and federal resources, and the National Response Plan interact to respond to an incident. Local state, and federal agencies provide support or response. The Department of Homeland Security (DHS) integrates and applies federal resources both pre-incident and post-incident. If the incident is of national significance, the National Response Plan (NRP) is activated to integrate federal resources into the response.
Figure 2: Mass Prophylaxis Plan for Distribution of Resources in the SNS
The Strategic National Stockpile (SNS) mass prophylaxis plan for distribution details the following:
who should be involved in response (population, public health, emergency management, health care professionals, law enforcement, community relations, health care system, media, and liaison (interagency/interregional));
what is needed to deliver and manage prophylaxis to the site (supplies and stockpiles, staff, protocols, floor/flow plan, support services, and transportation);
where is the location and size of the incident, security, access, storage, support services, and communications for the response;
when local triggers and regional and federal response are activated; and
how to plan, manage and command the incident, and inform the public.
Figure 3: Modular Emergency Medical System
The flow chart starts with identification of a patient, either at home or by a private medical doctor. The patient may be referred to the Neighborhood Emergency Help Center (NEHC) for treatment and triage, registration, and medication. If the doctor or the NEHC diagnoses the patient as requiring acute care, the patient is sent to the Acute Care Center (ACC) at an area hospital. The NEHC manages patient information, transportation, and logistics. The ACC manages the medical command centers, acute treatment and triage, relocation for casualties and their “worried well,” and also fatalities. Community outreach, such as door-to-door searches, citizen mobilization, and fire or law enforcement, communicate and coordinate with the NEHC.
Figure 4: Types of Biological Agents
This illustration lists examples of the three types of biological agents: bacteria, viruses, and toxins. Bacteria types shown are anthrax, Q-fever, tularemia, psittacosis, glanders, RMSF, melioidosis, brucellosis, and plague. Virus types shown are dengue fever, equine encephalitis, Hantaan, Congo-Crimean HF, chikungunya, variola, Ebola, and smallpox. Toxins listed are botulinum, SEB, perfringens, ricin, saxitoxin, tetrodotoxin, and mycotoxins.
Figure 7: Public Health Response to Biohazard Events
This flow chart shows how public health response moves from continuous medical surveillance to active investigation to emergency response once an unusual event occurs. If continuous medical surveillance indicates that an unusual event has occurred, then active investigation begins. Active investigation includes medical surveillance, medical diagnosis, epidemiological investigation and criminal investigation. Once these results are available, the key decisions are to: decide that a major health event is occurring; decide on potential cause and population at risk; decide on medical prophylaxis and treatment measures; and decide on appropriate activation of modular emergency medical system and other response functions. See page 21 for description of these tasks.If emergency response is activated, then emergency management operations begin. These tasks are: mass prophylaxis; fatality management; residual hazard assessment and mitigation; logistics and resource support; continuity of infrastructure: control the affected area and population through physical control and emergency public information; family support services; and care of casualties.
Flow Chart
Unless otherwise stated, all steps represent formal actions or communications.
The local health department (LDH) recognizes the need for SNS.
Informal communications when the LDH requests technical assistance
or additional supplies from the state department of public health (SDPH)
and the CDC. The SDPH develops recommended medical prophylaxis and
treatment measures and informally provides them to the LDH, and formally
to those who sign for and break apart the SNS Push Package when it
it received. Upon receiving the informal request, the CDC confers with
local and state health agencies and the U.S. departments of Health
and Human Services (U.S. HHS), Homeland Security (DHS), the Federal
Bureau of Investigation (FBI), and the Federal Emergency Management
Agency (FEMA). Once supplies are received, the LHD subdivides shipments
for delivery to distribution points and monitors shipments, which informally
completes response to the request.
The local emergency operations center (EOC) initiates SNS request.
In response, the state EOC initiates a formal request for the SNS through
Governor’s designee upon recommendation of the secretary of SDPH.
This formal request is supplied to the SDPH, the CDC, and the state
emergency management agency (EMA). Also in response to the EOC’s
SNS request, the state EMA activates local resources SNS through medical,
pharmaceutical, and law enforcement notification.
Upon receiving the formal request, the CDC confers with local and state
health agencies and the U.S. departments of Health and Human Services
(U.S. HHS), Homeland Security (DHS), the Federal Bureau of Investigation
(FBI), and the Federal Emergency Management Agency (FEMA). The CDC
orders deployment of the SNS.
The reception and distribution operations center is established once
the CDC deploys the SNS and the state EMA activates both state resources
and local resources.
The SNS Technical Assistance Response Unit TARU) arrives on site.
The SNS Push Package arrives on site. The SDPH signs for the Push Package,
and, using recommended medial prophylaxis and treatment measures, oversees
breaking the Push Package into requested lots. The lots are shipped
to the requesting local health departments, which sign for them. The
local health department subdivides the shipment for distribution points
and monitors shipments. Distribution points are first responders, hospital
supply departments, and mass post-exposure prophylaxis (PEP) sites.
Each of these distribution points signs for the shipments, distributes
materiel from the shipment, and accepts returned materiel.
Distribution points return materiel to the local health department,
which returns it to the SDPH.