First Aid Test 1
Identify the three main goals in foodborne outbreaks the investigations and what should be done first
"1. Quickly detect outbreaks 2. Gather the evidence 3. Communicate to consumers and retailers about the source of the outbreak"
-How often a pandemic strain of influenza occurs
A pandemic strain of influenza occurs about every 50-70 years.
-about CBRNE events and which category has the greatest threat to national security.
Acts of terrorism utilizing CBRNE agents are increasingly concerning, largely due to ongoing action on the part of terrorist states and organizations to inflict fear and chaos among the American public. Among the CBRNE events, the threats that pose the greatest risk to national security are the Category A biological agents. These agents are easily acquired, and while they pose danger to those handling them, when actors are successful in altering the genetic characteristics of these organism for the purpose of weaponization, their presence is relatively undetectable until the effects begin to be manifested. It is the responsibility of public health officials and other responders not only to know and understand the consequences of all CBRNE threats, but also to develop plans and processes for protecting the public from these threats.
The average death rate from influenza in the USA and the percentage of deaths that occur in people over 65.
Annually, the average death rate from influenza in the U.S. is 36,000 deaths per year with more than 90% of these deaths occurring in persons over the age of 65
the minimum amount of time local jurisdictions must ensure they can appropriately respond and sustain themselves.
As previously stated, all events are inherently local and local jurisdictions must ensure they have the capability to properly respond to emergency events, and sustain themselves for minimally 72 hours. This is not to say that assistance will not be available prior to 72 hours; however, this is the generally accepted timeframe for self-sustainment.
the nerve agent that was released in Tokyo in 1995 as part of a terrorist attack.
Aum Shinrikyo's intentional release of SARIN in the Tokyo subway on March 20, 1995, is the most compelling example of a terrorist attack using a nerve agent. Aum Shinrikyo, which means "Supreme Truth," had about 40,000 members at this time, and it is known that Japanese authorities were planning a raid on the headquarters in light of other suspicious activities.Members of this group placed five wrapped packages in the stations of three subway lines and punctured them with umbrella tips, allowing the liquid to seep out.18 Twelve people died, and thousands were injured.
about the use of generators during power outages and the hazards it present
Because power outages lead to an increased use of generators, these events often cause a spike in carbon monoxide exposures. One study found that the most common cause of disaster-related carbon monoxide poisoning was generator use, which was attributed to 54% of nonfatal cases and 83% of fatal cases
the role of Biological agents and how they came about
Biological agents are viruses, bacteria, or other germs that have been weaponized for intentional use against humans, plants, or animals.7 The intentional release of biological agents is intended to cause injury, illness, or death within populations for the sole purpose of inciting fear and chaos. Biological agents are spread through the air, food, or water and can be transmitted to humans via inhalation or ingestion into the body, or through the skin.22 These agents are inexpensive to obtain, some occur naturally in the environment, and they are relatively easy to weaponize and disseminate.
what chemical agent was first used in battle.
Choking agents were the first chemical weapons used in battle. As chlorine and phosgene settle in low areas, these gases were effective in the trenches of World War I; a large majority of the deaths were caused by phosgene.Between 1915 and 1918, first the Germans, then the British, and finally, the United States used chlorine and phosgene.The "successful" use of these agents resulted in the development of expanded chemical weapons programs.
Four categories identified as chemical agents that affect the skin, eyes, lungs, and digestive tract.
Four of these categories stand out as the most threatening because of their use in warfare or terrorist attacks: blister, blood, choking or lung, and nerve agents.
The dilemmas that practitioners can or should expect disasters and public health emergencies.
These dilemmas can relate to prioritization of patient treatment, rationing of supplies, risks to the lives of first responders, evacuation decisions, and how to handle uncooperative members of the public.
what a gradual natural disaster is.
Those with more gradual onset include droughts, famine, desertification, and deforestation.1 As depicted in TABLE 4-1, natural disasters can have significant environmental impacts. These environmental effects can cause a number of public health challenges during mitigation.
The factors that do and do not affect the emergence or re-emergence of infectious disease
We know that social, political, behavioral, and environmental factors shape the emergence and reemergence of infectious diseases -
-what constitutes as a natural disasters
While natural disasters can be predicted, planning for their full impact can be somewhat elusive. Natural disasters are unpreventable, often unpredictable incidents whose onset can be acute or gradual. Also, natural disasters cannot be confined to a geographical area, so planning for response to these types of disasters can be significant, especially in areas that are prone to frequent occurrence of these disasters. Maintaining knowledge of natural threats and their impacts can help communities plan mitigation/prevention, response, and recovery efforts.
Identify who is the leading organization in a power outage, hazardous material spill, or train derailment.
While public health would not be the lead agency in a power outage, hazardous materials spill, or train derailment, it is the lead agency during a foodborne outbreak. -Public health would also be responsible for bringing nontraditional responders into the response effort during any of these emergencies.
health security?
a state in which the nation and its people are prepared for, protected from and resilient in the face of health threats or incidents with potentially negative health consequences.
The goals of epidemiology and surveillance are to
identify the source or cause of disease, determine if additional risks of infection still exist, disseminate information about the source of the infection, provide treatment recommendations to minimize morbidity and mortality, and monitor cases to ensure the treatment modalities are being effective against the infection.
The six recommendations include the development of CSC protocols that encompass the following:
-A strong ethical grounding, ensuring fairness, transparency, consistency, proportionality, and accountability -Community and provider engagement, education, and communication -The necessary legal assurances that CSC can be ethically implemented without legal repercussion -Clear indicators, triggers for declaring crisis operations, and lines of responsibility -Evidence-based clinical processes and operations
The critical functions of an Epidemiologist during an outbreak
-Conducting epidemiological investigations -Determining risk of exposure for various populations -Identifying populations in need of prophylaxis -Providing recommendations to the healthcare community and public -Determining criteria to be used for identification of cases and controls -Monitoring morbidity and mortality associated with the emergency
the five fundamental principles of the NRF to allow it to maintain its priorities
1.Engaged partnership: All levels of government and the whole community must develop shared response goals and align capabilities to ensure no one entity is overwhelmed in times of crisis. 2.Tiered response: Incidents must be managed at the lowest possible jurisdictional level (local) and supported by additional capabilities when needed. 3.Scalable, flexible, adaptable operational capabilities: As incidents change in size, scope, and complexity, the response must adapt to meet these changing requirements. 4. Unity in response through unified command: Respect the chain of command of participating organizations and ensure seamless coordination across jurisdictions in support of common objectives. 5.Readiness to act: Ensure the best response possible that is grounded in a clear understanding of potential risks and decisive actions.
Blister Agents
Blister agents, or vesicants, affect the skin, eyes, lungs, and digestive track. The most well-known blister agents are lewisite and mustard gas, both of which cause pain, swelling, and tearing of the eyes, sneezing and runny nose, cough and shortness of breath, diarrhea and vomiting, and redness and blistering of the skin.
he name of the hurricane in 1972 helped underscore the inadequacy of the federal government's response to major disasters.
Federal Emergency Management Agency (FEMA) Hurricane Agnes
concpets around the law and its expression of public health policy
Law is something of a rudder for American social life and an important one at that. It establishes frameworks, creates formal relationships, and articulates guidelines. It prescribes and proscribes. Law is perhaps the clearest and most obvious expression of public policy. -Public health law as a whole and emergency preparedness law in particular focus on protecting the health and safety of the population. Law of this sort is so important as to constitute a major part of the public health infrastructure.1 Statutes, regulations, and judicial decisions are crucial in emergency preparedness. These statutes, regulations, and judicial decisions related to emergency preparedness can be found at the local, state, and federal levels. The laws vary from jurisdiction to jurisdiction, and the relationships among the laws at these levels of government have evolved over time for a variety of reasons.1(pp166-167) As a result, there are many laws in each of the states that address public health matters and emergency preparedness specifically.
what empowers local and state governments as defined in state constitutions to protect the public's health and safety.
Local and state governments are empowered through the police powers as defined in state constitutions to protect the public's health and safety. Isolating and quarantining those with communicable diseases in specified circumstances is one way to safeguard the public's health and safety. State statutes specify a list of diseases that must be reported to state health departments and to the Centers for Disease Control and Prevention (CDC), which maintains a national surveillance system of notifiable diseases.
Identify who has the authority to issue quarantine and isolation orders.
Local jurisdictions, states, and the federal government have the authority to issue quarantine and isolation orders to protect the health and safety of residents. These orders restrict the movement of people who have been exposed to a communicable disease (quarantine) or who have symptoms and are presumed to have the communicable disease (isolation). At the local and state levels, this authority is codified in state statutes. At the federal level, this authority is codified in Sections 311, 361, and 362 of the Public Health Service Act. Federal regulations address interstate and foreign quarantine.
Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988
The next significant legislation related to disaster declarations was the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (PL 100-707) that amended the 1974 Disaster Relief Act. This act, now the current source of regulations for disaster declarations, requires that a governor indicate through a formal request that the state is responding to the disaster and that the state lacks sufficient resources for its response.10 The president may issue two types of declarations: "Emergency" or "Major Disaster." These declarations are defined in
the purpose of the first national disaster declaration that occurred in 1803
Tracing the history of disaster declarations in the United States takes us back to 1803. Katz9(p48) cites the Congressional Act of 1803 as the first national disaster declaration. This act, the Federal Domestic Disaster Aid Bill, provided relief for merchants in Portsmouth, New Hampshire, following a major fire by suspending the collection of bonds owed to the U.S. government. The approach for the next century or so was similar, that is, individual declarations approved by Congress for federal assistance after specific disasters. By the 1930s, both the Reconstruction Finance Corporation and the Bureau of Public Roads, among other federal agencies, also supported relief for specific disasters.
Small mutations in the viral structure are called
antigenic drifts
Identify the deadliest type of influenza
antigenic shift-Pandemic strains usually affect a high percentage of the population because most people do not have protection from the new or "novel" strain, and no vaccine is available. As a result, pandemic strains tend to have higher disease attack rates and higher death rates than seasonal or normal influenza. -By far, the worst and most deadly of these three pandemics was the Spanish flu, which occurred in 1918-1919. Characterized by widespread illness and death, the 1918 pandemic caused 20 million deaths worldwide, and more than 650,000 in the United States.7 To date, the 1918 Spanish flu remains on record as the deadliest strain of influenza to ever occur in the United States and the world
What Epidemiology studies and its definition
defined as the study of diseases and injuries in human populations, disease patterns, and the frequency of occurrence. It is the scientific method of problem solving used by epidemiologists, lab scientists, statisticians, and physicians to understand the origins and causes of disease in a community. Epidemiology is considered to be the basic science of public health
which entity developed The early iterations of the preparedness competencies
developed by staff at the Columbia University School of Nursing, Center for Health Policy. The Pandemic and All-Hazards Preparedness Act called for a comprehensive, competency-based training program that is responsive to the needs of state, local, and tribal public health organizations and emphasizes public health security capabilities.
Surveillance is the
hallmark of public health response, and inadequate surveillance and response capability in one area of the world can endanger national populations and the public health security of the entire world.4 During emergencies, public health officials need to ensure the availability of epidemiology and disease surveillance tools and systems, including the capability to identify disease incidence, disease prevalence, and severity of illness. Epidemiology and surveillance staff need to have the capacity to quickly process, analyze, and interpret data. Data are integral to decision-making during an emergency. Data may come from a variety of sources including syndromic surveillance mechanisms, such as community medical providers, hospital emergency departments and healthcare systems, sentinel surveillance systems, and other data reporting systems.
role of public health in CBRNE events.
he role of public health in CBRNE events involves surveillance, planning, partnership, and carefully coordinated response operations. While the public health role in any CBRNE event is significant, public health practitioners must partner with a range of governmental, community, and private entities, all of whom will be needed to ensure a comprehensive and coordinated response to these complex threats.
Sentinel surveillance
is an active form of surveillance and involves the collection of data from a carefully selected sampling of reporting sites. Selected healthcare providers agree to report cases of specific illnesses to a central health department on a regular basis. Sites must be willing to serve as sentinels; be located near or in a relatively large population; have the staff and expertise to diagnose, treat, and report cases of the disease they are monitoring; and have a high-quality diagnostics laboratory. Data collected at sentinel sites can be used by epidemiologists and public health departments to identify trends and outbreaks in a more cost-effective way than traditional Types of Surveillance.
what plants naturally produce cyanide
lima beans, almonds, apricots, peaches
-the four functional sections along with the incident commander that are part of the traditional ICS structure
planning, logistics, operations, and finance/administration
Support Annexes describe the essential supporting
processes and considerations that are most common to the majority of incidents.
Zoonotic surveillance
systems collect data on animals infected with diseases that can be transmitted to humans. One such example is ArboNET.
The CHEMPACK program
was established in 2003 to provide the forward placement of critical nerve agent medicines around the country. According to the CDC, the CHEMPACK program resources can reach about 90% of the U.S. population within 1 hour, or nearly everyone in the country within a few minutes to less than 2 hours of recognition of the need for these medicines.19 One thousand three hundred and forty (1340) locations around the country monitor and maintain 1960 containers with medicines and supplies.Most of the locations, or cache sites, are hospitals and fire stations, and first responders work with local and state public health partners in coordinating planning as well as training and exercises. While CDC administers the CHEMPACK program, local and state health departments manage the local/state planning process and coordinate program oversight and implementation. TABLE 3-1 summarizes the responsibilities of CDC and the states or localities.
Identify the ethical consideration in decision making and what why types of decisions may erode the trust that public health individuals are trying to build with the general public.
-The response offers the best care possible given the resources on hand -Decisions are fair and transparent -Policies and protocols within and across states are consistent -Citizens and stakeholders are included and heard
about the risk of post-flooding such as mold and its devastating effects and how common it is
-Water pipes and sewage systems can quickly become overwhelmed during flood events, leading to contamination of drinking systems and the "toxic soup" of flood water, sewage, gasoline, and chemicals through which we often see survivors wade in news footage. -When the flood waters recede, communities and individuals will find themselves in a race against mold. Mold is common in post-flood locations and can pose a serious threat to the public's health. Experts generally recommend that anything touched by flood water be removed and replaced, including drywall and carpeting. Because this is such a costly and time-consuming effort, those in lower socioeconomic communities may not be able to afford to remove mold and rebuild homes and places of business, leading to a secondary and slow-moving public health disaster that unfolds over years.
understand the three core functions of public health
1.Assessment deals with the collection and analysis of health status information for communities. 2.Policy development deals with the development of policies and the determination of appropriate interventions to address the problems in health. 3.assurance deals with the responsibility of public health to implement strategies and interventions to promote health.
how many components are part of and make up the emergency preparedness cycle
1.plan 2.organiza/equip 3.train 4.exercise 5.evaluate/improve
why the pandemic and All-Hazards Preparedness Act of 2006 was enacted, the role of Pandemic Flu and how it influenced what states have to do
1.the Pandemic and All-Hazards Preparedness Act of 2006 (Public Law No. 109-417; 120 STAT. 2832) addressed organizational issues as well as security infrastructure, surge capacity, and medical countermeasures.10 This Act established that, "The Secretary of Health and Human Services shall lead all Federal public health and medical response to public health emergencies and incidents covered by the National Response Plan developed pursuant to section 502(6) of the Homeland Security Act of 2002, or any successor plan. 2.The Act required states to prepare pandemic flu plans and provided grants to states for enhancing their "public health situational awareness systems for public health emergencies,"19 as well as for workforce and health professional volunteers training. Finally, the Act also authorized creation in DHHS of the Biomedical Advanced Research and Development Authority (BARDA; PL 109-417) to promote the development of vaccines and drugs through collaboration among a range of government, private, and academic institutions. This step was consistent with the government's goal of implementing a national security plan that addressed the issue with a variety of action
identify why Vulnerable populations may be considered vulnerable and what are the contributing factors
Above all in preparedness planning, it is incumbent on public health practitioners to ensure that vulnerable populations are treated fairly and ethically. These populations may be considered vulnerable because of their age, underlying health conditions, socioeconomic status, disability, or even limited English proficiency, and any CSC plan must address these populations specifically.
the average rate of earthquakes between 1973 and 2008
According to the U.S. Geological Survey (USGS), "between the years 1973 and 2008, there was an average of 21 earthquakes of magnitude 3 and larger in the central and eastern United States,"3 but this rate has ballooned to more than 600 earthquakes of magnitude 3 or larger in 2014 and over 1000 in 2015 alone.
the most common type of disaster that occurs around the world
All around the world, flooding is the most common type of disaster, and in the United States, flash floods are the leading cause of weather-related deaths. Climate change and more frequently alternating ocean oscillations mean that hurricanes of Category 3 or greater now hit the continental United States approximately every 18 months, often bringing devastating floods.2
about the 1988 Robert T. Stafford Act and what and whom it covers.
An amendment to the 1988 Robert T. Stafford Act (see discussion of the Stafford Act later in this chapter), the Pets Evacuation and Transportation Standards Act of 2006 (PETS; Public Law No. 109-308) focused on people with pets and service animals through planning, funds, and delivery of services. The Act authorized the FEMA director to establish standards for preparedness planning at the local and state levels for people with pets and service animals. The director could designate funds for emergency shelters for approved animal preparedness projects. Finally, the Act also "authorizes . . . provision of rescue, care, shelter and essential needs to individuals with household pets and service animals and to such pets and animals -An amendment to Title IV of the Robert T. Stafford Act (see discussion of the Stafford Act later in this chapter), the Sandy Recovery Improvement Act of 2013 was intended to simplify disaster assistance administered by FEMA. To enhance flexibility and speed up the recovery process, eligibility criteria for individual assistance were clarified; childcare expenses were deemed allowable along with funeral, medical, and dental costs; debris removal was to be based on a cost-share program with the federal government, with incentives for local and tribal governments with specific contractors in place before the declaration of a major disaster; and FEMA could lease multifamily housing to speed up the resettlement process.23 In addition, tribal leaders of federally recognized nations would be able to request an emergency or major disaster declaration directly from the president, without going through the governor of the state. FEMA accepted comments on a draft Tribal Declaration Pilot Guidance through August 2014.24
how many categories Bioterrorism agents are divided into and which category causes the most significant concern
Category A-Category A agents cause the greatest amount of concern. These agents pose the highest risk to the public's health and are considered to be the highest threats. Category A agents primarily occur in nature but can be weaponized and delivered relatively easily for malicious intent. The major concern with Category A agents includes the fact that they: ---Can be easily transmitted via person-to-person contact ----Can cause high rates of illness and death (public health concern) ----Can cause a large degree of public panic and chaos Require specific preparedness actions22 Category A agents are those that have the best potential to cause the greatest amount of morbidity and mortality. These agents are also fairly stable in the environment and thus can be readily spread nondescriptly to cause disease or other harm. Additionally, great harm can be caused to large numbers of people utilizing small amounts of these disease agents. TABLE 3-2 depicts the Category A agents. Category B-Category B agents are the second highest category of biological agents (TABLE 3-3). Category B agents are of less concern than Category A agents. Characteristics of Category B agents include the following: ----They are moderately easy to spread. ---They result in moderate illness rates and low death rates. ---They require specific enhancements of CDC's laboratory capacity and enhanced disease monitoring. Category C-The third category of biological agents is the Category C agents. These third-priority agents consist of viruses and organisms that are emerging diseases that could be engineered for malicious purposes. Category C agents: Are easily available Are easily produced and spread Have a high potential for morbidity and mortality ----Category C agents include: Nipah virus Hantaviruses Tickborne hemorrhagic fever viruses Tickborne encephalitis viruses Yellow fever Multidrug-resistant tuberculosis
Choking Agents
Choking agents affect the nose, throat, and lungs through damage to the respiratory system. Examples of choking or lung agents include ammonia, chlorine, and phosgene. Chlorine has a yellow-green color and strong odor of bleach, while phosgene ranges from colorless to pale yellow with a strong odor in high amounts.11 Among the symptoms caused by these gases are watery eyes and blurred vision, difficulty breathing, nausea and vomiting, and fluid in the lungs.
The National Health Security Strategy (NHSS) was released in
December 2009 and focused on a "whole community" approach to preparedness and response to emergency events. The goals of the strategy include protecting the public's health during an emergency and guiding the nation's efforts to minimize the risks associated with a wide range of potential large-scale incidents that put the health and well-being of the nation's people at risk.
identify the Potential health impacts of natural disasters and what it does and doe not include.
Displacement of people Sanitation in crowded living conditions Water supply contamination Damage to healthcare infrastructure Mental health impacts Nutrition and food availability Communicable disease Availability of medications to treat chronic illnesses Exposure (to extreme heat or cold) Power outages Damage to public infrastructure such as transportation systems and roadways Vulnerable populations who may be trapped
How International Travel has played a role and contributed to potential pandemics worldwide
Global interconnectedness, aided by the ease of international travel, has heightened the concern of potential pandemics and their impact. This interconnectedness has also made the United States more susceptible to the introduction of exotic, uncommon infectious diseases that the U.S. public health and healthcare system have not had to confront previously. The emergence of previously unseen, and sometime highly pathogenic, infectious diseases creates a specific challenge in that hospitals, healthcare systems, and public health systems may not have the resources and treatment interventions necessary to readily mitigate the newly emerging threat.
Identify the more common hosts for the flu
High-risk individuals include those who are over the age of 65 or under the age of 2, as well as those with chronic illnesses. Persons with HIV, lymphomas, and other immune-compromising conditions are also at increased risk.
How many pandemic influenzas occurred in the 20th century.
In the 20th century, three influenza pandemics occurred around the world. -hong kong flu -asian flu -spanish flu
Know the impact of pandemic influenza and its capability to reduce the overall effect on the healthcare infrastructure and the workforce
Pandemic influenza is extremely disruptive to societies, their functioning, and the economy. Typically, in pandemic situations, we see large rates of worker absenteeism and lost productivity due to the inability to obtain or transport supplies and raw materials. We also see disruptions in utilities and critical infrastructure, as the ability to access fuel and basic utilities, telecommunications, and information technology systems is uncertain. The availability of public safety personnel and public services as well as food and medical suppliers is affected. Pandemics also bring increased demands on the healthcare infrastructure and the workforce. From an economic perspective, reduced tourism, travel, entertaining, and the hospitality industries can be negatively affected, due to low rates of occupancy and tourism. Because pandemic effects are widespread, there is no help available from other areas, as they are also affected. This is why pandemic influenza planning and preparedness is so critical for emergency planner
What is public health emergency preparedness?
Public health emergency preparedness is the ability to prevent, prepare for, protect against, respond to, and recover from health emergencies. Public health emergencies are emergencies whose "scale, timing, or unpredictability threaten to overwhelm routine capabilities" to provide health care.3(pS9) These emergencies are characterized by their high severity, inability to be managed with routine resources, and tendency to cause increased illness, injury, or death. Public health emergencies span a broad range of emergency and disaster situations, including natural hazards, acts of terrorism, and large-scale infectious disease outbreaks. We discuss the various types of emergency and disaster events more thoroughly in Chapters 4 and 5.
what a presidential disaster declaration means and what it may entail, such as states' rights.
Signed into law by President Harry Truman, the program required a presidential disaster declaration5(p8) and was intended only to "supplement the efforts and available resources of States and local governments."8 President Truman's 1953 Executive Order 10427 underscored that, "Federal disaster relief provided under this act shall be deemed to be supplementary to relief afforded by State, local, or private agencies and not in substitution therefore; Federal financial contributions for disaster relief shall be conditioned upon reasonable State and local expenditures for such relief; . States: a state is eligible for specific types of financial, technical, and logistics assistance in the specified local jurisdictions.27 Individuals may receive assistance directly, local jurisdictions dealing with a major disaster may request grants for hazard mitigation, and local jurisdictions and certain other organizations (e.g., the American Red Cross) may qualify for public assistance for help with removal of debris, repairs to infrastructure, and provision of emergency medical care, food, water, and housing
Identify the role and importance of the public health workforce in developing and maintaining the appropriate skills, knowledge, and competencies for responding to emergency events.
The Pandemic and All-Hazards Preparedness Act called for a comprehensive, competency-based training program that is responsive to the needs of state, local, and tribal public health organizations and emphasizes public health security capabilities. In response to the call for the development of a comprehensive competency framework for educational programs in public health emergency preparedness, the Association of Schools and Programs of Public Health developed the Master's Preparedness & Response Model.16 This model was designed for use by graduate level educational programs to ensure students obtain the necessary knowledge, skills and attitudes associated with public health emergency preparedness and response. Under this model, students should gain competency in roles and relationships, communication and information management, planning and improvement, assessment and incident management. The model's framework is based on a series of tenets that are all designed to build competency in future generations of the public health workforce with particular expertise in preparedness and response.
what attack in 2001, increased America's focus on biological threats as part of their public health preparedness programs that started back in the 1990s.
The World Trade Center attacks in New York City on September 11, 2001 (9/11), and the subsequent anthrax attacks on the United States in October 2001 changed this thinking. With these two events came the sharp realization that the United States could not properly respond to a large-scale bioterrorism attack on the country. This was due in large part to the severely depleted infrastructure of the U.S. public health system. As a result, Congress appropriated $1 billion to public health to build the public health infrastructure in a manner that would strengthen the country's ability to respond to a bioterrorism attack. FIGURES 1-1A and 1-1B illustrate funding levels since the beginning of the Public Health Emergency Preparedness (PHEP) Cooperative Agreement and the Hospital Preparedness Program Cooperative Agreement funding. Funding was allocated to 62 public health awardees, including the state health departments in all 50 states, 8 territories, and 4 directly funded cities. These directly funded cities—Chicago, New York City, Los Angeles County, and the District of Columbia—were considered to have the highest risk of a terrorist attack and thus the need to be funded separately from their states.
Define syndromic surveillance and Zoonotic surveillance
The data collected through surveillance may come from a variety of sources, including community medical providers, hospital emergency departments and healthcare systems (syndromic surveillance), sentinel surveillance systems, zoonotic surveillance, and other data reporting systems. Surveillance almost always involves cooperation among multiple entities, so the partnerships and necessary systems for reporting must be in place prior to an emergency to ensure seamless availability of information.
Be aware of how highly pathogenic and infectious diseases create for patients and healthcare workers.
The emergence of previously unseen, and sometime highly pathogenic, infectious diseases creates a specific challenge in that hospitals, healthcare systems, and public health systems may not have the resources and treatment interventions necessary to readily mitigate the newly emerging threat. As was seen during the Ebola outbreak in 2014, specialized equipment and training were needed not only to care for potentially affected patients but also to ensure the protection of healthcare workers responsible for providing patient care. Effective isolation, patient assessment, diagnosis, and treatment required designated treatment rooms and equipment, resulting in the removal of these resources from daily, routine use within facilities designated to care for potentially infected patients, or patients under investigation for Ebola infection. Newly emerging infectious diseases put the United States at risk of shortages in healthcare personnel and medical supplies needed for proper patient care. Traditional medical school curricula do not include courses or seminars that teach future physicians how to recognize the symptoms of and be able to diagnose exotic infectious diseases or illness resulting from other biological agents, which further burdens public health epidemiological and surveillance experts in tracking and identifying the definition of and source of infection. Thus, it is increasingly important for broad participation and collaboration among public health systems, healthcare systems, and other public safety partners to ensure timely and effective identification of disease agents and proper treatment and other response efforts.3
When the Public Health Security and Bioterrorism Preparedness and Response Act was enacted,
The first legislation for public health preparedness, the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (PL 107-188) is notable for the speed with which the U.S. House and U.S. Senate considered and passed the bill, and the House and Senate Conference Reports were agreed to within a day of each other.9(p68) There was an urgency for coordination among key federal agencies as well as an approach to planning across all levels of government.
-the chemical that was involved in the deadliest chemical accident on December 3, 1984, in Bhopal India.
The most deadly chemical accident worldwide involved the choking agent methyl isocyanate. On December 3, 1984, in Bhopal, India, a Union Carbide pesticide factory leaked about 40 tons of this chemical, killing between 3000 and 5000 immediately, injuring thousands, and affecting thousands more with various health effects in the 30-plus years since then.14 While Union Carbide paid a settlement of $470 million in 1989 to the Indian government, there has been only limited cleanup of the site of the abandoned plant, and there is no scientific evidence about the health effects of contaminated water in the area.15 Dow Chemical acquired Union Carbide in 2001, and responsibility for who should pay for the cleanup remains mired in the Indian courts. Meanwhile, local nongovernmental agencies provide resources to help families address very challenging situations.
Most common blood agent.
The most well-known blood agent is cyanide, of which there are four types. Hydrogen cyanide (HC) and cyanogen chloride are colorless gases, while sodium cyanide or potassium cyanide are crystals. Breathing cyanide, absorbing it through the skin, or eating foods with it causes dizziness, headache, nausea/vomiting, rapid breathing, rapid heart rate, and/or restlessness, as cells cannot use oxygen. In serious cases of exposure, loss of consciousness can occur. The heart and brain are most affected by cyanide since these organs depend on oxygen -Plants such as lima beans and almonds produce cyanide, and the pits of apricots and peaches can release chemicals that make cyanide. In industry, cyanide is used in the manufacturing of plastics, paper, and textiles and is found in cigarette smoke
Identify who has the responsibility for the first response to disasters.
While the response to disasters has always been driven at the local level, the federal government's role in the face of external events has become more centralized with respect to the articulation of a national preparedness goal and a national response plan for all phases of an emergency event.
The first individuals to be infected with Ebola through transmission in the United States
a Liberian man traveled to Texas without disclosing his contact with an infected patient in Liberia, he began exhibiting symptoms and was admitted to a Dallas hospital. Eventually, he became the first person in the United States to be diagnosed with Ebola and subsequently infected two nurses, who became the first cases of Ebola transmission in the United States
Define ArboNET and what it surveils
a passive national surveillance system managed by the Centers for Disease Control and Prevention (CDC) and state health departments. ArboNET collects data on veterinary disease cases, dead birds, mosquitos, sentinel animals, and presumptive viremic blood donors (PVDs).11 ArboNET is critical in the surveillance of diseases such as Zika virus, West Nile virus, Chikungunya fever, Dengue fever, Yellow fever, and Japanese encephalitis.
when flu viruses change significantly, an
antigenic shift occurs.
Public health laboratories are another critical component for identifying threats to the public's health. They are responsible for
assuring laboratory services in support of public health, including preparedness and response.12 During the conduct of epidemiological disease investigations, specimens are often collected for the purpose of laboratory testing. This aids in the identification process for determining the cause of an outbreak. For preparedness and response purposes, local and state public health laboratories must maintain the ability to "conduct rapid and conventional detection, characterization, confirmatory testing, data reporting, investigative support and laboratory networking to address actual or potential exposure to all hazards.
Along with epidemiology, surveillance is understood to
be the second scientific pillar of public health
Surveillance refers to the
collection, analysis, interpretation, and dissemination of data on disease occurrence. Surveillance can be passive, in which health systems are collecting and reporting data to a public health department, or active, in which epidemiologists are proactively seeking and gathering data for an investigation. Global disease threats require diligent surveillance activity to protect countries from large-scale emer
Nerve agents
effect the nervous system by overstimulating the production of the enzyme acetylcholine and thereby speeding up the respiratory system and muscle contractions. Examples of nerve agents are sarin, tabun, soman, and VX, all tasteless liquids that become vaporized through heating or evaporation. These chemical agents cause symptoms ranging from tearing eyes, runny nose, blurred vision, chest tightness, diarrhea, confusion, and slow or fast heart rate to convulsions, paralysis, and possibly death.16 Although nerve agents are classified as organophosphates, like the pesticides/herbicides parathion, malathion, and diazinon, they are highly toxic, man-made chemical warfare agents. Sarin, tabun, and soman were originally developed as pesticides by Germany in the 1930s and 1940s, while VX was developed by England in the 1950s.16, 17 There is evidence that nerve agents were used during the Iran-Iraq war in the 1980s, with the most documented instance thought to be the March 16, 1988, Iraqi attack on Halabja, a Kurdish city near the Iranian border.10, 17 In addition to mustard gas, Saddam Hussein's forces likely dropped sarin and tabun on the city.
who are considered vulnerable populations and what affects them
elderly, chronicly ill, and lower income communities -extreme temperature
ESF Annexes describe the
federal coordinating structures that group resources and capabilities into functional areas that are most frequently needed in a national response.
Identify the consequences and effects of delayed national recognition of pandemics.
illness and death of national populations including health workers, potential spread to other countries, and significant disruptions in travel and trade, thus adversely affecting the economic viability of countries.
Syndromic surveillance
is the use of data from healthcare providers, in real time, to investigate and analyze potential outbreaks. A passive form of surveillance, it was originally developed as a means to detect a large-scale release of a biological agent, but today the goals of syndromic surveillance extend far beyond preparing for a terrorist event.9 The overarching goal is to use real-time data to identify illness clusters before diagnoses are even confirmed or reported to public health agencies. This type of surveillance focuses on data about symptoms in the earliest stages of an illness. Syndronic surveillance may also collect surrogate data such as reported absences from school or work, veterinary data such as unexpected avian deaths, or even social media posts about illness.
the NHSS is designed to guide the nation's efforts to
minimize the risks associated with a wide range of potential large-scale incidents that put the health and well-being of the nation's people at risk. State and local emergency planners must be diligent in their efforts to effectively plan and prepare to protect the nation from pandemic influenza threats. As has been seen over the last century, pandemics take many years to occur, but they do occur. When that happens, most of the population will have little to no immunity against the pandemic strain. Thus, public health officials need to constantly plan for mitigation of
In 1999, the Laboratory Response Network (LRN) was formed. The LRN is a
national system of more than 150 sentinel laboratories that provide rapid detection of, and response to, threats related to chemical, biological, and radiological threats as well as natural disasters. Founded by the Association of Public Health Laboratories, CDC, and the Federal Bureau of Investigation to advance national readiness for bioterrorist threats. The LRN's members include local, state, and federal public health laboratories, food testing laboratories, veterinary diagnostic laboratories, and environmental testing laboratories The LRN establishes standard protocols to identify dangerous pathogens, provides guidelines for the safe handling of suspected threat agents, identifies threats using complex molecular identification, and provides expert advice. Since its inception, the LRN has responded to multiple threats, including avian influenza, the anthrax attacks of 2001, and SARS.
how Public Health differs from traditional medical care
public health in terms of its mission to "fulfill society's interest in assuring conditions in which people can be healthy," and the report further depicts public health's "aim to generate organized community effort to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health -public health employs policies and interventions to minimize disease and improve health outcomes for populations, as opposed to narrowly focusing on how to address the health of an individual. Public health is "measured in terms of improved health status, diseases prevented, scarce resources saved and improved quality of life.
the average impact (%) of influenza infection
the average impact of influenza is infection of about 5% to 20% of the population. Typically, over 200,000 people in the U.S. are hospitalized annually. In about half of these hospitalizations, those affected are persons over the age of 65. Annually, the average death rate from influenza in the U.S. is 36,000 deaths per year with more than 90% of these deaths occurring in persons over the age of 65.
In 2012, the Department of Homeland Security, under President Barack Obama, released the National Strategy for Biosurveillance. The directive called for
the creation of a networked system of federal, state, local, and tribal governments; private-sector businesses; nongovernmental organizations, and international partners that can cooperate to collect and report timely data on infectious, toxic, and metabolic threats to human and animal health. Including a number of guiding principles, the strategy defined an approach to the nation's biosurveillance efforts aimed at addressing both short-term and long-term information needs for decision makers at all levels of government. The Guiding Principles of the strategy included: ---"Leverage Existing Capabilities ----Embrace an All-of-Nation Approach [to biosurveillance] -----Add Value for All Participants -----Maintain a Global Health Perspective"16
Incident Annexes describe the
unique response aspects of incident categories.
Unintentional emergencies are,
unplanned accidents. They can include Power outages Hazardous materials spills Train derailments Foodborne outbreaks
what Public health is and is not responsible for as it pertains to threat mitigation
yes: -plan the effective strategies to minimize morbidity and mortality following an emergency or disaster. -responsible for participation in the hazard vulnerability assessment of the community or juristic -the identification of threats and hazards, public health officials should be evaluating the expected consequences of the hazard event, specifically looking to identify health and medical consequences that are likely to occurction -for identifying actions, strategies, systems, and resources that are necessary to minimize morbidity and mortality should the hazard or threat occur. Potential actions that public health officials might identify include the initiation of surveillance and epidemiological investigations to determine the source and spread of the disease or other hazard as well as the determination of potential treatment options, including laboratory testing, medical countermeasures, and the appropriateness of quarantine and isolation measures or other nonpharmaceutical interventions. Strategies to limit the spread of disease and illness frequently involve efforts to isolate the disease and implement targeted measures aimed at mitigating the threat. -Public health is also responsible for engagement and coordination with the healthcare system, namely, hospitals, community clinics, long-term care facilities, specialty providers, and other public health entities. Other healthcare system partners could include but are not limited to blood banks, dialysis centers, mental health providers, and home healthcare providers. Public health has a unique role in healthcare system coordination—that of coordinating collaboration among the multiple healthcare partners and ensuring that healthcare partners are equipped with supplies, equipment, and other resources that foster preparedness capability across the healthcare system In fact, public health is not responsible for all aspects of emergency response, but is, however, responsible for engaging the appropriate stakeholders and partners who hold specific expertise that will aid in the emergency response or those who may also play a role in the response effort. Engagement of community and social service partners who can lend expertise in planning for the needs of at-risk, access, and functional needs persons is critical. Faith-based organizations hold strong trust relationships with community members and have an in-depth knowledge of the needs of the community. Thus, they are uniquely positioned to provide support and assistance not only during the planning phase but also in response.
