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Bioterrorism Preparedness, Regionalization

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Full Title: Regionalization of Bioterrorism Preparedness and Response

April 2004

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Structured Abstract

Objectives: To identify the key tasks of responders during a bioterrorism event and the resources required to perform them and to evaluate evidence of the potential effectiveness of existing regional systems for delivering bioterrorism preparedness and response resources and services.

Data Sources: The researchers examined the medical, emergency management, and supply chain management literatures and government documents through searches of databases (e.g., MEDLINE®), Web sites, prominent journals, and bibliographies of retrieved articles.

Review Methods: Articles were considered if they described the key tasks during responses to bioterrorism or bioterrorism-related events, the resources required for these responses, and existing regional systems for delivery of these resources. Included were articles describing regionalized responses to the 2001 anthrax attack, naturally occurring outbreaks, and disasters; also included were articles describing regionalized systems for trauma care, bioterrorism surveillance, and the bioterrorism response supply chain.

Results: The numerous existing regionalized systems for the delivery of goods and services are relevant to bioterrorism preparedness and response, but are not well coordinated. Few have been evaluated for their ability to facilitate a response to bioterrorism or a bioterrorism-relevant event. The regionally organized Laboratory Response Network provided laboratory surge capacity during the 2001 anthrax attack and an international research network rapidly identified the pathogen during the SARS outbreak. In several instances, mutual aid agreements successfully facilitated the regional provision of emergency goods and service; regionalization of trauma care has reduced costs and improved patient outcomes. How well these regional systems would perform during a large-scale bioterrorism event remains untested.

Because no evidence was found that described regionalization of bioterrorism surveillance, the researchers developed a simulation model to evaluate the tradeoffs in sensitivity and specificity when analyzing surveillance data locally as opposed to regionally. The simulation suggests that warning thresholds may need to be modified to prevent increases in false positives when pooling data. Similarly, a simulation model was developed to address the costs and benefits of differing strategies for pre-attack stockpiling and post-attack distribution of antibiotics. Preliminary results indicate that the number of deaths resulting from an anthrax-like attack is sensitive to the number of people seeking prophylactic antibiotics and to the dispensing time. Maintaining local inventories is only effective when the probability of bioterrorism is relatively high.

Conclusions: Efforts to coordinate the numerous regional systems for responding to bioterrorism are ongoing and would likely benefit from evaluations of regionalized information management systems, of strategies to rapidly distribute and dispense pharmaceuticals and other response resources, and of plans to specify response roles, remuneration, and chain of command.

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Regionalization of Bioterrorism Preparedness and Response

Evidence-based Practice Center: University of California, San Francisco (UCSF)-Stanford
Topic Nominator: Agency for Healthcare Research and Quality (AHRQ) and the Health Resources and Services Administration (HRSA)

Current as of April 2004


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