DB for Public health in Disaster Management

DB for Public health in Disaster Management
Sample Answer for DB for Public health in Disaster Management Included After Question
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Summarize any one chapter of the handbook on epidemiological investigation and provide one example of a US or international public health emergency in which this science was used or likely used.
Joint Criminal and Epidemiological Investigations Handbook 2015 DOMESTIC EDITION TABLE OF CONTENTS INTRODUCTION SUMMARY Purpose………………………………………………………………………………………………………………………………………………………………………………………………………..6 The Biological Threat………………………………………………………………………………………………………………………………………………………………….9 Federal Bureau of Investigation (FBI)………………………………………………………………………………………………………………… 10 Centers for Disease Control and Prevention (CDC)…………………………………………………………………………. 14 Key Highlights of Introduction Section………………………………………………………………………………………………………….. 71 Key Highlights of Public Health Section………………………………………………………………………………………………………..72 Key Highlights of Law Enforcement Section…………………………………………………………………………………………… 74 Key Highlights of Joint Criminal and Epidemiological Investigations Model Section……………………………………………………………………………………………………………………………………… 76 PUBLIC HEALTH Epidemiological Investigation Goals………………………………………………………………………………………………………………….20 Epidemiological Investigative Methods………………………………………………………………………………………………………… 21 LAW ENFORCEMENT Criminal Investigation Goals…………………………………………………………………………………………………………………………………………38 Preventing Biological Attacks……………………………………………………………………………………………………………………………………..39 Criminal Investigative Methods………………………………………………………………………………………………………………………………..42 JOINT INVESTIGATIONS MODEL Introduction……………………………………………………………………………………………………………………………………………………………………………………….52 Benefits of the Joint Criminal-Epidmiological Investigations Model……………………….53 The Joint Criminal-Epidemiological Investigations Model: An Overview………….54 ●● Building Relationships……………………………………………………………………………………………………………………………………………. 55 ●● Information Sharing………………………………………………………………………………………………………………………………………………….. 55 ●● Joint Threat Assessment…………………………………………………………………………………………………………………………………….. 60 ●● Joint Investigations…………………………………………………………………………………………………………………………………………………….62 ●● Memorandum of Understanding/Joint Protocols…………………………………………………………….. 66 ●● Joint Training / Exercises……………………………………………………………………………………………………………………………………….. 67 2 APPENDICES Sample Joint Criminal-Epidemiological Investigations Material Appendix 1: Sample Procedure for a Joint Threat Assessment………………………………………. 81 Appendix 2: Sample Procedure for Joint Interviews……………………………………………………………………. 84 Appendix 3: Sample Joint Interview Questions…………………………………………………………………………………..92 Reference Material Appendix 4: List of Select Agents and Toxins (2014)……………………………………………………………………. 94 Appendix 5: Laboratory Response Network…………………………………………………………………………………………….97 Appendix 6: CSTE List of Nationally Notifiable Conditions (2013)…………………………….100 Appendix 7: HIPAA Privacy Rule & Permitted Disclosures………………………………………………….. 107 Appendix 8: Overview of the FBI’s WMD Coordinators………………………………………………………….. 111 Appendix 9: Bio-Related Laws to Prevent Bioterrorism…………………………………………………………..115 Appendix 10: Common Public Health and Law Enforcement Terminology…118 Joint Criminal and Epidemiological Investigations Handbook 3
A Sample Answer For the Assignment: DB for Public health in Disaster Management
Title:  DB for Public health in Disaster Management
INTRODUCTION INTRODUCTION Purpose This handbook was developed to facilitate the use of resources and maximize communication and interaction between law enforcement and public health. This combined effort can minimize potential barriers prior to and during the response to a biological threat. Specifically, this handbook aims to: ●● Provide an overview of both law enforcement and public health to enhance the appreciation and understanding of each discipline’s expertise ●● Discuss criminal and epidemiological investigational procedures and methodologies for a response to a biological threat ●● Identify challenges to sharing information and provide potential solutions that may be adapted to meet the needs of the various agencies and jurisdictions ●● Demonstrate effective law enforcement and public health collaboration Even with these common concerns, each discipline may be hesitant to share information because of actual or perceived limitations or barriers. Identifying and resolving these issues in advance of a biological threat will help facilitate more effective dialogue and information exchange, thereby increasing the likelihood of identifying an incident and protecting public health and safety in a more efficient manner. Simply put, working together helps both law enforcement and public health achieve their separate but often overlapping goals and ultimately allows for a more effective and efficient response to a biological threat. The 2015 edition of the Criminal and Epidemiological Investigation Handbook has been updated to reflect current Federal policies and includes modifications based upon experiences gained since the previous version was published. Law enforcement and public health are encouraged to read the entire handbook and not limit their review to just their respective sections. It is important to take the time to understand the different goals and needs of each other’s organization before a suspicious biological event occurs. Doing so, will enable law enforcement and public health personnel to more effectively respond in a coordinated manner during a biological threat. While both disciplines have varying objectives and protocols, both public health and law enforcement ultimately share three common concerns: 6 ●● Early identification of an outbreak ●● Determining whether the outbreak is intentional or naturally occurring ●● Protecting public health and public safety Joint Criminal and Epidemiological Investigations Handbook 7 INTRODUCTION The Biological Threat Key Highlights of Introduction Section ●● There has been a demonstrated interest and willingness by terrorist groups and individuals to acquire and employ biological agents at weapons against the American population. ●● The intentional release of a biological agent may initially be difficult to discern from a natural incident, which can result in separate law enforcement and public health investigations. ●● It is in public health and law enforcement’s best interest to work together when first investigating a suspicious biological outbreak, which includes fostering mutual awareness and establishing joint communication procedures. ●● By working together, public health and law enforcement can achieve their separate but often overlapping objectives of identifying the biological agent, preventing the spread of the disease, preventing public panic, and apprehending those responsible. There has been a demonstrated interest and willingness by terrorist groups and individuals to acquire and employ biological agents as weapons against the American population. Weapons of mass destruction (WMD) terrorism is an evolving threat to U.S. national security. In his 2010 testimony before the Senate and the House of Representatives, the Director of National Intelligence stated that terrorist groups have expressed an interest in obtaining WMD for use in future acts of terrorism. Indicators of this threat include the 2001 Amerithrax letters, the possession of WMD-related materials by Aafia Siddiqui in 2008, and multiple attempts by terrorists at home and abroad to use explosives improvised from basic chemical precursors. Over the past few years, there has been an increased interest in extracting ricin from castor beans, which are readily available to the public, to intentionally harm others. Ricin is one of the most discussed toxins online, which includes discussions of criminal plots. In 2011, federal authorities disrupted a plot by a militia group in Georgia to deploy 10 pounds of ricin against various federal employee and facility targets. Since 2013, there have been several incidents involving individuals creating ricin and utilizing the U.S. Postal System as a delivery system for ricin-laced letters. Most recently, the ‘Dark Web’ — the virtual black market for drugs, guns, explosives, and other illicit materials — has shown a growing number of sellers and buyers of biological material. The FBI has opened investigations on individuals who have attempted to sell or purchase illicit biological material, such as ricin and abrin, through the Internet. Concern that nefarious actors might use biological material as a weapon will likely remain a persistent threat for years to come, especially as scientific advancements in technical capability, knowledge, and accessibility continue to grow. Despite 8 Joint Criminal and Epidemiological Investigations Handbook 9 INTRODUCTION continued efforts in bioterrorism preparedness, the intentional use of biological agents as a weapon still poses challenges to both law enforcement and public health due to the unique circumstances of a biological incident. Since biological agents are often endemic or naturally occurring in the environment, an intentional release of a pathogen may be initially difficult to discern from a natural event, and efforts to respond to the attack and apprehend those responsible may be delayed. In the past, it was common for public health (which conducts epidemiological investigations to natural incidents) and law enforcement (which conducts criminal investigations to intentional incidents) to conduct independent investigations. Due to the challenges posed by a biological threat, an effective response calls for a high level of cooperation between both these two disciplines. The lack of mutual awareness and understanding, as well as the absence of established communication procedures, could limit the effectiveness of these disciplines’ separate, but often overlapping, investigations. During a suspicious biological incident, it is mutually beneficial for public health and law enforcement to work in partnership. By working together, public health and law enforcement can more effectively achieve their shared objectives of identifying the biological agent, preventing the spread of the disease, preventing public panic, and apprehending those responsible. Federal Bureau of Investigation (FBI) The FBI is an intelligence-driven and threat-focused national security organization with both intelligence and law enforcement responsibilities — the principal investigative arm of the U.S. Department of Justice and a full member of the U.S. Intelligence Community. The FBI is vested by law and Presidential directives as the primary agency of the U.S. Federal Government with the authority and responsibility to investigate threats to national security, including biological threats, within the United States and relating to U.S. citizens and 10 interests overseas. Activities of “threat to the national security” commonly involve violations (or potential violations) of federal criminal laws, such as Title 18, U.S. Code, Section 175 (biological weapons). Hence, investigations of such threats may exercise both of the FBI’s criminal investigation authority and of the FBI’s authority to investigate threats to the national security. Generally acting through the FBI, the Attorney General, in cooperation with other federal agencies engaged in activities to protect national security, coordinates the activities of other members of the law enforcement community to detect, prevent, preempt, and disrupt terrorist attacks against the United States. The FBI has multiple operational units to provide assistance in the event of a terrorist attack, including response teams trained to collect and handle hazardous materials and contaminated evidence. Along with the FBI Headquarters in Washington, D.C., there are numerous FBI field offices located in major cities throughout the United States. These field offices implement national level policy at the local level, where they are able to tailor their outreach to reflect the particular geographic threats and vulnerabilities unique to their specific jurisdiction. There is a common misconception that the FBI prosecutes cases; however, this is incorrect. The FBI gathers facts and evidence and then presents the results to the Department of Justice, which is responsible for deciding if an individual will be brought to trial and if so, conducts the prosecution of the case. Therefore, during a suspicious biological incident, the FBI would work closely with public health to investigate whether the outbreak is criminal in nature and if so, gather evidence to build a case for prosecution of those responsible. FBI WMD Coordinator The FBI is headquartered in Washington D.C. The offices and divisions at FBI Headquarters provide direction and support to 56 field offices in big cities, approximately 360 smaller offices known as resident agencies, several Joint Criminal and Epidemiological Investigations Handbook 11 INTRODUCTION specialized field installations, and more than 60 liaison offices in other countries known as legal attachés (Figure 1). These offices allow the FBI to interact with Figure 1. Map of FBI Field Offices and Resident Agencies local stakeholders and obtain unique geographic knowledge of their area of responsibility. Each field office has a designated Special Agent, called a WMD Coordinator, who serves as a WMD subject matter expert and point of contact for local and state emergency responders and public health. In the event of a bioterrorism event, the WMD Coordinator would act as a conduit for obtaining federal assistance (e.g., threat credibility evaluation and operational response) for local law enforcement. See Appendix 8 for additional information on WMD Coordinators. and knowledge of various federal, state, and local law enforcement agencies to maximize the United States’ collective ability to combat terrorism. Often memoranda of understanding (MOUs) are developed between participating law enforcement agencies to assist in determining in advance how law enforcement agencies can best prevent and respond to a terrorist event. The National Joint Terrorism Task Force is headquartered in Washington, D.C., and there are over one hundred area-specific Joint Terrorism Task Forces nationwide (many located at FBI field offices). FBI International Efforts The resources of the FBI are available to assist all law enforcement agencies throughout the world. FBI resources can be requested through the FBI Legal Attaché Office. The FBI has Legal Attaché personnel located in almost 70 countries throughout the world. The mission of these Legal Attaché offices is to foster strategic partnerships with foreign law enforcement, intelligence, and security services by sharing knowledge, experience, capabilities, and exploring joint operational opportunities. FBI Special Agents with specific expertise in WMD matters are located in Tbilisi, Georgia, and Singapore, Singapore. The FBI also coordinates extensively with INTERPOL and has a Special Agent with expertise in WMD stationed at the INTERPOL Headquarters in Lyon, France. FBI Legal Attaché contact information may be found at: http://www.fbi.gov/contact-us/legat Joint Terrorism Task Force In an effort to promote communication and collaboration across the various law enforcement entities, the United States implements a partnership called the Joint Terrorism Task Force. These task forces combine the resources 12 Joint Criminal and Epidemiological Investigations Handbook 13 INTRODUCTION Centers for Disease Control and Prevention (CDC) The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and a leader in promoting activities associated with the medical and public health response to a biological incident. As an entity of HHS, CDC plays a critical role in leading the nation’s public health efforts in strengthening capacity to detect and respond to a biological incident. To carry out these efforts, CDC conducts critical science and provides health information that protects the United States against For public health, health threats and responds when these arise. all response is CDC Global Health Efforts CDC’s global health programs, research, and training activities improve health and save lives around the world and protect Americans from diseases and other health threats that begin overseas. Collaborating with other federal agencies and with international partners CDC helps other countries build capacity to prevent, rapidly detect and effectively respond to emerging infectious diseases and biological threats, whether they occur naturally, are intentionally produced, or are the result of laboratory accidents. LOCAL! The response to a public health emergency, including an intentional release of a pathogen, is the responsibility of public health at the state and/or local level. Public health agencies at the state and local level will likely be the first agencies to recognize cases of illness associated with a biological threat. Upon recognition of an incident, public health will initiate an investigation and respond to determine the source and implement interventions to prevent additional illness. If the state and local public health agencies need additional resources then they will request federal assistance. Since a biological incident can occur in a variety of locations and populations, the FBI, CDC, and the Association of Public Health Laboratories (APHL) established the Laboratory Response Network (LRN). The mission of the LRN is to develop, maintain, and strengthen an integrated national and international network of laboratories that can respond quickly to needs for rapid testing, timely notification, and secure reporting of results that are associated with acts of biological terrorism or other high-consequence public health emergencies. All LRN member laboratories work under a single operational plan and adhere to strict policies of safety and security. 14 Joint Criminal and Epidemiological Investigations Handbook 15 PUBLIC HEALTH PUBLIC HEALTH Key Highlights of Public Health Section ●● The ultimate aim of an epidemiological investigation is to identify the source of the disease and implement efforts to control the outbreak and protect the public’s health. ●● An epidemiological investigation primarily involves the meticulous accumulation of information from patient interviews and surveys as well as data collected from surveillance systems. ●● 18 Goals of an epidemiological investigation include: »» Stopping the spread of disease (identify causative agent, determine source, mode of transmission and population at risk) »» Protecting the public’s health (surveillance, medical countermeasures, health education) »» Protecting public health and other response personnel (protective equipment and preventive vaccines/medications) ●● Important elements of an epidemiological investigation are: »» Detect unusual events »» Confirm diagnosis »» Identify and characterize additional cases »» Determine source of exposure »» Develop and implement interventions ●● Laboratory analysis of clinical specimens is used to assist the physician in making a definitive diagnosis. While most physicians will wait for definitive laboratory results to confirm a biological threat agent diagnosis, physicians are likely to begin treatment before laboratory test results are confirmed since early treatment of disease increases the probability the patient will recover from the illness. ●● A laboratory that tests for biological agents should meet applicable standards (e.g., quality control measures, biosafety, and biosecurity) and participate in relevant proficiency testing. Joint Criminal and Epidemiological Investigations Handbook 19 PUBLIC HEALTH Epidemiological Investigation Goals Epidemiology is the fundamental science of public health. It is used by According to the World epidemiologists to study diseases or Health Organization (WHO), events that impact human health in “Epidemiology is the study of the distribution and determinants of order to reduce disease or disability in health-related states or events a population. Whether it is in response (including disease), and the to a naturally occurring outbreak application of this study to the or a biological threat, public health control of diseases and other will conduct an epidemiological health problems.” investigation to gather information that will move investigators toward determining the source of the disease and the extent of the outbreak. When conducting an epidemiological investigation for a naturally occurring outbreak or biological threat, public health has the following basic goals: 20 ●● To stop the spread of disease: One of the most basic missions of public health is the prevention of illness in the population. While physicians focus on curing the sick and promoting health in the individual, public health strives for health promotion and disease prevention in the entire population. For the illness under investigation, epidemiologists use interviews, surveys and data analysis to identify the causative agent, mode of transmission, source of exposure, and population at risk to limit the spread of the outbreak. ●● To protect the public: Public health utilizes surveillance of health trends, medical information, and a variety of analytical tools to establish methods and implement interventions that protect the public from health threats. Vaccine campaigns, medical countermeasure distribution programs, disease surveillance, and health education all play a role in preventing and responding to serious health emergencies. ●● To protect public health and other response personnel: A major consideration during an investigation is the protection of responders. Since epidemiologists and other responders may come in contact with potentially infectious individuals, provision of proper protective equipment and preventive medications or vaccines for investigative personnel is essential. Epidemiological Investigative Methods Public health uses investigative techniques to identify the causative agent and determine the source and extent of disease outbreaks. An epidemiological investigation primarily involves the meticulous accumulation of information from patient interviews and surveys, as well as data collected from surveillance systems. Since interview or disease surveillance information may be relevant to a criminal investigation, law enforcement should become familiar with the elements of an epidemiological investigation. The following section provides a brief synopsis of the elements of an epidemiological investigation. Joint Criminal and Epidemiological Investigations Handbook 21 PUBLIC HEALTH In an epidemiological investigation, the nature of each outbreak and the availability of personnel and resources will determine the sequence and scope of the actions that will be performed during the investigation. Detect unusual events Develop and nd implement nt interventions ons Confirm diagnosis Epidemiological cal Investigationn Determine ne source of exposure re Identify additional cases Characterize additional cases Figure 2. Elements of an epidemiological investigation. Detect Unusual Events The first indication of an unusual event is often an unexpected increase in the number of people with similar symptoms, referred to as cases. This increase in cases is detected either by monitoring surveillance systems or receiving notifiable disease reports from healthcare providers. If an unexpected increase occurs, public health will begin to collect additional patient information, as well as further characterize the illness to determine the nature of the incident. 22 Based on the information collected, the incident may be classified as an infectious disease outbreak and public health would begin an epidemiological investigation to determine the extent and source of the outbreak. An outbreak is defined as an occurrence of cases associated with a specific place or group of people over a given period of time. For example, public health may determine that 15 cases of E. coli O157:H7 infection were due to victims having recently consumed unpasteurized apple cider from a local orchard in the last month. Since all of the cases have an association with the orchard over a similar period, public health may consider this an outbreak. For rare or uncommon diseases in the United States (e.g., botulism, SARS), public health may determine that a single case of the disease constitutes an outbreak since cases are not normally observed in their jurisdiction. Case Reporting All states and territories possess laws that require reporting of specific infectious diseases by healthcare providers. It is mandatory that reportable disease cases be reported to state and territorial jurisdictions when identified by a health provider, hospital, or laboratory. Each state has its own laws and regulations defining what diseases are reportable and the list varies among states and over time. In addition, notifiable disease cases are voluntarily reported to CDC by state and territorial jurisdictions (without direct personal identifiers) for nationwide aggregation and monitoring of disease data. The Council of State and Territorial Epidemiologists (CSTE) maintains a list of diseases that are reportable to the CDC (Appendix 6). States use the CSTE list of notifiable conditions to create their own reporting laws and may choose to add other diseases. For additional information on reporting requirements for a jurisdiction, contact the city, county or state health department. Joint Criminal and Epidemiological Investigations Handbook 23 PUBLIC HEALTH While disease case reporting is standard practice for identifying unusual events, it is a time and resource intensive process that can be adversely impacted by delays in symptom onset, clinical diagnosis, laboratory testing and results reporting. Depending on the illness, it may be days or weeks before public health is notified by a healthcare provider or laboratory of a case report. (See Figure 3) Lab Result Available Exposure 0–7 Courtesy of New Mexico Department of Health 1–3 Specimen Received at Public Health Laboratory 1–3 1–5 Symptom Onset Sample Collected Report Received Figure 3. A depiction of the typical reporting time from initial exposure to receipt by public health. Typically, a person is exposed to a pathogen and may experience symptoms within a few days. After a patient is seen by a physician, specimens are collected and sent to a clinical laboratory for initial diagnostic testing, results are provided within a few days. If specimens are positive for a reportable disease, public health is notified of the case and specimens may be sent to a public health laboratory for additional testing. 24 Frequent and timely disease reports are critical for detecting outbreaks; identifying populations or geographic areas at high risk; developing, implementing, and evaluating prevention strategies; and improving public health policies. Surveillance Systems Public health surveillance is defined as the ongoing collection, analysis, and interpretation of health data for use in the planning, implementation, and evaluation of public health practices. Generally, public health tends to rely on passive methods of disease detection. This may include receiving case reports from physicians, laboratories, or other individuals or institutions as mandated by law. However, in the event of an outbreak or other event of public health concern, more active surveillance techniques may be used, in which public health will regularly contact reporting sources to obtain information. Any surveillance system must include the capacity for collecting and analyzing data, as well as the means to disseminate the data to individuals or groups involved in disease prevention and control activities. Ideally, a surveillance system will detect the occurrence of disease within a sufficient time frame that allows public health to initiate an investigation and implement timely prevention and control programs, thereby limiting any impact on the public. For example, early detection of a contagious disease (e.g., influenza, measles, and smallpox) allows for implementation of a vaccination program that would greatly reduce the spread of disease and the number of people affected. For incidents involving biological threats, public health will want to decrease the length of time between exposure and traditional disease reporting. To assist with this process, some cities and states may utilize a syndromic surveillance system to track pre-clinical healthcare indicators. Syndromic surveillance is a Joint Criminal and Epidemiological Investigations Handbook 25 PUBLIC HEALTH system that relies on existing health data to identify clusters of disease, prior to clinical diagnosis or laboratory testing, or to look for disease symptoms that indicate patients are being misdiagnosed. The advantage of syndromic surveillance is that it may provide initial indication of an outbreak; track the size, spread, and tempo of an outbreak; monitor disease trends; or provide evidence that an outbreak has not occurred.2,3 Some healthcare indicators found in syndromic surveillance systems include: ●● Number of upper respiratory disease cases seen in emergency departments ●● Number of ambulance runs within an allotted period of time ●● Number of antibiotics or over-the-counter drugs sold at pharmacies It should be noted that syndromic surveillance is not guaranteed to detect the occurrence of an outbreak and does not replace other surveillance methods or direct case reporting to public health. However, it is a useful tool that enhances collaboration among public health, healthcare providers, information system professionals, academic investigators, and industry.3 Since many biological threat agents cause illness with symptoms similar to common ailments, supporters of syndromic surveillance believe that monitoring and analyzing healthcare indicator data will allow for