Embed Size (px)
DESCRIPTION
Public Health Preparedness: Roles and Contributions of a Not-for-Profit Research Institute during a Tumultuous Period Scott F. Wetterhall, MD, MPH Senior Program Director Health Security and Systems Research. RTI International is a trade name of Research Triangle Institute. - PowerPoint PPT Presentation
Citation preview
RTI International is a trade name of Research Triangle Institute
Public Health Preparedness: Roles and Contributions of a Not-for-Profit
Research Institute during a Tumultuous Period
Scott F. Wetterhall, MD, MPHSenior Program Director
Health Security and Systems Research
Health Security and Systems Research: Current Portfolio
Research on case definitions for BioSense program
Evaluation of BioSense Program
Community assessment of non-pharmaceutical interventions to prevent influenza
Training needs assessment of federal partners who may support quarantine efforts
Health Security and Systems Research: Current Portfolio (cont.)
Evaluation of the Medical Reserve Corps
Rapid response team for public health research on disasters
Focus of today’s talk:
Patient Tracking & Locating Model
Cyanide K/A/P among EMS providers
Poll Question
In disaster response, patient tracking and locating systems are:
A. Very important
B. Important
C. Moderately important
D. Not at all important
Activation of NDMS after Hurricane Katrina, September 2005
Role for Patient Tracking and Locating System
Identify persons in need
Locating missing persons
Allocating medical resources
Conducting public health interventions
Managing emergency shelters
Evacuating patients
Background on PTLocator
Agency for Healthcare Research and Quality (AHRQ) provides support
Conceived in 12/2004
Work began 08/2005
Review of extant products EMSystem
Ratheon
Dept. of Defense projects
Schematic of PTLocator
Current Version of PTL
Assumptions
Focus on identification of patient and location
Broad definition of patient/victim
System can serve at “national level” while also providing working model for “local” jurisdictions
Capabilities
Fully functional prototype accessible through Web
Manual Data Interface
Home Page of PTLocator
Screenshot of Data Entry Screen
Issues Facing Use of PTLocator
Data exchange across systems using XML—need for standards
Deployment during emergencies
Duplicate entries
HIPPA
Other privacy protections, esp. with public searches
AHRQ Companion Projects
Patient Tracking and & Locating Model
HAvBED hospital bed tracking system
Facility evacuation tool for estimating time and resources needed to evacuate a hospital
Cyanide Knowledge, Attitudes, andPractices among EMS providers
Poll Question
What is the highest risk of cyanide poisoning?
A. Fire
B. Industrial release
C. Release in transport
D. Terrorism
Multiple, heterogeneous sources of human exposure
Fire smoke
Intentional poisoning: terrorism, genocide, murder, suicide
Industrial release
Occupational injuries
Transportation mishaps
Ingestion of cyanogenic foods, drugs
Mass casualties likely in either unintentional or intentional poisonings
Effective remediation possible through adequate preparedness, including ability to provide empiric prehospital treatment rapidly
Cyanide Poisoning as a Public Health Issue
Cyanide Poisoning: Remediable Public Health Threat
Unlike toxicity associated with many other poisons,
cyanide poisoning can be effectively treated
Requires antidote and supportive care
Requires prompt intervention (within minutes to
hours) because of rapid progression of poisoning
Study Objectives
To assess cyanide awareness, preparedness, and practices of emergency medical service (EMS) providers in the U.S.
To assess cyanide antidote stocking practices among EMS providers in the U.S.
Methods
Design: Cross-sectional survey Questionnaire administered via the Internet, mail, or telephone
Sample: Target population: all advanced life support (ALS) emergency
providers working with fire departments in the U.S. Sample frame: 22,524 fire departments identified through US Fire
Administration’s National Fire Department Census Sample of 1,033 fire departments randomly selected from
sampling frame 832 ALS providers surveyed 507 evaluable surveys completed
Perceived Sources of Greatest Risk of Cyanide Exposure
Source of Greatest Risk
Percent respondents
Northeast
(n=91)
Midwest
(n=154)
South
(n=183)
West
(n=79)
Fire 40 42 43 37
Industrial Release 15 13 13 8
Release in Transport 39 40 42 48
Terrorism 6 5 3 7
Fire Smoke Viewed as Source
82 82 82 8286
35 3431
4035
20
40
60
80
100
Sample(n=507)
Northeast(n=91)
Midwest(n=154)
South(n=183)
West(n=79)
% R
esp
on
den
ts
Potential Source of Cyanide Exposure
Cyanide Exposure from Fire Smoke Is Likely or Very Likely in Their Service Area
Percent who view fire smoke as potential or likely source of cyanide exposure
Industrial Release Viewed as Source
Sample(n=507)
Northeast(n=91)
Midwest(n=154)
South(n=183)
West(n=79)
59
73
58 57
47
15 159
23
6
20
40
60
80
100
% R
esp
on
den
ts
Potential Source of Cyanide Exposure
Cyanide Exposure from Industrial Release Is Likely or Very Likely in Their Service Area
Percent who view industrial release as potential or likely source of cyanide exposure
Transport Viewed as Source
Sample(n=507)
Northeast(n=91)
Midwest(n=154)
South(n=183)
West(n=79)
% R
esp
on
den
ts
75 77
70
7874
27 26 27
34
1220
40
60
80
100
Potential Source of Cyanide Exposure
Cyanide Exposure from Transport Is Likely or Very Likely in Their Service Area
Responses did not differ as a function of estimated actual risk.
Percent who view transport as potential or likely source of cyanide exposure
Antidote Reported as Standard Treatment
14 13 11
24
15 13 15
7
20
40
60
80
100
% R
esp
on
den
ts When Cyanide Poisoning Is SuspectedWhen Cyanide Poisoning Is Confirmed
Northeast(n=91)
Midwest(n=154)
South(n=183)
West(n=79)
Percent reporting standard treatment for cyanide poisoning is antidote
Criteria for Estimating Likelihood of Cyanide Exposure
Fire-smoke injury rates per 100,000
No. CERCLIS (Superfund) sites
No. Au, Ag, Cu mines
No. EPA Toxic Release Inventory (TRI) facility counts (for select CN chemicals)
Max. amt. TRI select CN chemicals, in lbs.
Creation of Community Exposure Likelihood Variable
Strata Definition of Srata Percent Fire Departments in Final Frame
High Any CRITERIA = 3 49
Medium 2 or more CRITERIA = 2 28
Low All others 23
Estimated Cyanide Risk, United States,2005, by County
Estimated Cyanide Risk, United States,2005, by County
Cyanide Interest Level
Low Medium High
Cyanide Antidote Stocked
21
2823
1820
40
60
80
100
% R
esp
on
den
ts
Sample (n=507)
High-Risk Area
(n=111)
Medium-Risk Area
(n=147)
Low-Risk Area
(n=249)
2823
1820
40
60
80
100
% R
esp
on
den
ts
Sample (n=507)
High-Risk Area
(n=111)
Medium-Risk Area
(n=147)
Low-Risk Area
(n=249)
Percent reporting a cyanide antidote stocked on standard ALS vehicle
Importance of Stocking Antidote
1720
40
60
80
100%
Res
po
nd
ents
Sample (n=507)
High-Risk Area
(n=111)
Medium-Risk Area
(n=147)
Low-Risk Area
(n=249)
29
14 1420
40
60
80
100%
Res
po
nd
ents
Sample (n=507)
High-Risk Area
(n=111)
Medium-Risk Area
(n=147)
Low-Risk Area
(n=249)
Percent reporting cyanide antidote is very important, compared with other equipment carried on ambulances
Cyanide Antidote Kits Available
25.7
32.7
9.6
31.9
5
10
15
20
25
30
35
Mea
n N
um
ber
Ava
ilab
le
Sample (n=507)
High-Risk Area
(n=111)
Medium-Risk Area
(n=147)
Low-Risk Area
(n=249)
Mean number of cyanide antidote kits for prehospital use per 100,000 persons
Cyanide Study Conclusions
Fewer than half of EMS providers recognize fire smoke as the most likely source of CN exposure.
Only 15 percent report that an antidote is the standard treatment when cyanide poisoning is suspected.
Only 21 percent of ALS vehicles have cyanide antidote kits stocked.
There are only 25 antidote kits available per 100,000 persons, an inadequate number for a mass casualty event.
Closing Remarks
Working in public health preparedness at a not-for-profit institute:
Competitive, fast-paced environment
Mixture of investigator-initiated and contract work
Client satisfaction is high priority
Diverse activities—from software development to program evaluation to policy analysis
Multiple opportunities to make a difference
And finally…
Relationships Are Still the Key Ingredient for Success
