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Physician-scientists in the Department of Public Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have created the first nationwide planning guide for community-based response to bioterrorism and other infectious disease outbreaks since the 2001 anthrax attacks. The document and accompanying computer planning model will help communities ensure that all Americans have needed drugs and vaccines in the event of a natural epidemic or bioterrorist attack.

The effort, funded by the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ), is written to explain the formation of community-wide mass prophylaxis plans to a wide range of audiences, including public health and emergency management planners, community organizations, and the media.

"States and localities are charged with the enormous task of readying medicines needed in an emergency," says Department of Health and Human Services Secretary Tommy G. Thompson. "This guide goes a long way toward helping them put the necessary resources into place and to meeting the Federal government's call for readiness."

"We wanted this planning guide to be both a practical roadmap and a 'tool kit' for everyone implementing these important steps," says Dr. Nathaniel Hupert, the guide's lead author, assistant professor of public health and medicine at Weill Cornell Medical College, and assistant attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

The new guide complements the Strategic National Stockpile guidebook prepared by the Centers for Disease Control and Prevention (CDC), which includes a chapter on dispensing medications and vaccines.

The new guide:

• provides a framework for understanding the components of epidemic outbreak response (surveillance, stockpiling, distribution, dispensing, and follow-up care), and the planning and conduct of dispensing operations, using specially designated dispensing clinics;
• applies these concepts to develop model pill-dispensing and vaccination clinics run on the Bioterrorism and Epidemic Outbreak Model (BERM), a computer staffing model also developed by Dr. Hupert and his colleagues at NewYork-Presbyterian/Weill Cornell that can be customized to meet local community needs, and is available for download as an MS Excel spreadsheet at http://archive.ahrq.gov/research/biomodel.htm; and
• discusses implementation of a command-and-control framework for dispensing clinics, based on the CDC's National Incident Management System.

Entitled "Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness," the guide can be found at http://archive.ahrq.gov/research/cbmprophyl/cbmpro.htm. Printed copies are available by contacting AHRQ's Publications Clearinghouse at 1-800-358-9295, or by sending an e-mail to [email protected].

NewYork-Presbyterian/Weill Cornell's Public Health Contribution

Since 2000 (well before the September 11 attacks), NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Department of Public Health has pioneered approaches to bioterrorism preparedness — including the development of computer models for determining optimal antibiotic and vaccine dispensing; research on hospital capacity to treat mass casualties for a bioterrorist event; and extensive educational activities for medical students, residents, and practicing physicians. With more than one million dollars in Federal research funding for these efforts, faculty from Weill Cornell have been working with the Agency for Healthcare Research and Quality (AHRQ) and Centers for Disease Control and Prevention (CDC) of the Department of Health and Human Services to research solutions for and educate emergency management and public health officers around the country about the design and operation of antibiotic and vaccine prophylaxis centers.

In related work, Dr. Hupert and NewYork-Presbyterian/Weill Cornell's Department of Public Health published the first evidence-based outpatient triage protocol for inhalational anthrax by identifying key symptoms that distinguish inhaled anthrax from the flu and other common respiratory conditions. These findings are being used to develop effective response strategies that preserve vital hospital surge capacity in the event of future bioterrorist attacks.