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BioTerrorism Response Disaster Plan

PURPOSE:  
To provide plans for Sandhills Regional Medical Centerís response to a bioterrorism attack.

POLICY: 
Sandhills Regional Medical Center will respond to a bioterrorism attack in an efficient and effective manner that will utilize resources, personnel, and space.  This plan will be implemented in conjunction with the Emergency Management Plan in a manner that will reduce the risk of exposure to others. 

PROCEDURE:
Recommendations for Any Suspected Bioterrorism Event

A. Potential Agents
There are four diseases with recognized bioterrorism potential (anthrax, botulism, plague and smallpox). The CDC does not prioritize these agents in any order of importance or likelihood of use.

B. Detection of Outbreaks Caused by Agents of Bioterrorism
Bioterrorism may occur as covert events, in which persons are unknowingly exposed and an outbreak is suspected only upon the recognition of unusual disease clusters or symptoms.  Prompt identification of symptoms related to exposure of Bioterrorist agents is key to recognizing the need for containment and isolation.
Features that should alert healthcare providers to the possibility of an outbreak include:

A rapidly increasing disease incidence (e.g., within hours or days) in a normally healthy population.
An epidemic curve that rises and falls during a short period of time.
Unusual increases in the number of people seeking care, especially with fever, respiratory or gastrointestinal complaints.
An endemic disease rapidly emerging at an uncharacteristic time or in an unusual pattern.
Lower attack rates among people who had been indoors, especially in areas with filtered air or closed ventilation system, compared to people who had been outdoors.
Clusters of patients arriving from a single locale.
Large numbers of rapidly fatal cases.
Any patient presenting with a disease that is relatively uncommon and has bioterrorism potential (e.g., pulmonary anthrax, tularemia or plague).

C. Infection Control Practices for Patient Management
1. Standard Precautions is utilized for all patients to reduce the transmission of recognized and unknown sources of infection.

2. For certain diseases or syndromes, additional precautions may be needed to reduce the likelihood of transmission.  These may include Contact, Droplet or Airborne Precautions.  (Refer to Infection Control Manual for specific information regarding these precautions.)

3. Patient placement: In small-scale events, routine facility patient placement and infection control practices should be followed.  However, in the event of large numbers of patients, it will be necessary to apply alternatives.  It may be necessary to isolate the Emergency Dept.  The Emergency Dept physician, Infection Control, Administration and local Health Dept will make this recommendation.

4. Patient transport: The transport and movement of patients with suspected bioterrorism-related infections should be limited to movement that is essential to provide patient care, thus reducing the opportunities for transmission of microorganisms within the healthcare facility.

5. Cleaning, disinfection and sterilization of equipment and environment will be done according to routine hospital policy.

6. Discharge management: It is expected that patients will not be discharged until they are deemed noninfectious.  

7. Post-mortem care: Pathology and the laboratory should be informed of a potentially infectious outbreak prior to submitting any specimens for examination or disposal.  Local Health Department personnel will advise on the handling of bodies.
 
D. Reporting Requirements and Contact Information
If a bioterrorism event is suspected, local emergency response systems should be activated.  Notification should immediately include local infection control personnel and the hospital administration.  Then prompt notification of the local health department and local law enforcement.
Internal Contacts:

Infection Control: 205-8123 or beeper 417-0875

Administration:  205-8106 or check the Administration On-call List

External Contacts:

Local Health Dept: 997-8300.   After hours call 911 for On-call person

Richmond County Emergency Management: 911

Local Law Enforcement Agency: Hamlet Police - 582-2551

Richmond County Sheriff - 997-8283

E. Post Exposure Management
1. Decontamination of Patients and Environment-refer to Emergency Management Plan.

2. Prophylaxis and post-exposure immunization
Recommendations for prophylaxis are subject to change.  Up-to-date recommendations will be obtained in conjunction with the local and state health departments and CDC.  

3. Triage and management of large scale exposures/suspected exposures
If Bioterrorism-agent or other infectious process is suspected, a CODE YELLOW should be announced.  This will help reduce the number of staff coming into the ED area. Triage of patients will be done by the ED nursing staff in a manner that will reduce the risk of exposure to the staff and others.  This may require directing all patients to enter the ED through the Ambulance entrance.
Further management of the situation will be coordinated with the appropriate local agency based on the County Terrorism Response Plan.

4. Psychological aspects of bioterrorism
Following a bioterrorism-related event, fear and panic can be expected from both patients and healthcare providers.  Psychological responses following a bioterrorism-event may include horror, anger, panic, unrealistic concerns about infection, fear of contagion, paranoia, social isolation or demoralization. Management of the psychological aspects will be coordinated with the appropriate local agency based on the County Terrorism Response Plan.

F. Laboratory Support and Confirmation 
1. Obtaining diagnostic samples should be performed in accordance with Standard Precautions.  Other precautions will be used as indicated.

2. Transport requirements
Specimen packaging and transport must be coordinated with local and state health departments.  A chain of custody document should accompany the specimen from the moment of collection.

G. Patient, Visitor and Public Information
1. Marketing Director: will be primary liaison between the Incident Command Center and the media (television, radio, the press, etc)

2. During bioterrorism-related outbreaks, visitors may be strictly limited.  Administration in cooperation with Infection Control and the local and state health departments will make this decision.