The National Framework and Consequence Management Guidance Following a Biological Attack

Abstract

Consequence management following a release of aerosolized Bacillus anthracis spores requires a high level of technical understanding and direction. National policies and regulations address the topics of preparedness goals and organizational structure, but they do not tell responders how to perform remediation. Essential considerations include determining what must be cleaned, evaluating health risks, ascertaining the priority of cleanup, and selecting appropriate decontamination technologies to meet consensus and risk-derived clearance goals. This article highlights key features of a national-level framework that has been developed to guide a risk-based decision process and inform technical personnel of the best practices to follow during each activity leading to the restoration of functions at affected facilities or areas. The framework and associated guidance follows the scheme of 6 phases for response and recovery arrived at through interagency consensus and approval. Each phase is elaborated in a series of detailed decision flowcharts identifying key questions that must be addressed and answered from the time that first indications of a credible biological attack are received to final reoccupancy of affected areas and a return to normal daily functions.

Predicting Response to Reassurances and Uncertainties in Bioterrorism Communications for Urban Populations in New York and California

“…[38][39][40] As a significant act unfolds, some ongoing uncertainties would have been predicted; others will become apparent only as the event develops. [6][7][8][9]58,59,70,87 Distrust of government actions and decisions will be high in some communities, moderate in others, 11,17,23,28,75 and preexisting social and environmental vulnerabilities to extreme events will contribute to an unequal potential for loss. 6,50,89 During this dynamic phase, skilled communications about decontamination strategies, protection of public health, cleanup, restoration, and reoccupancy will be essential to support efforts to protect public health and maintain/restore public confidence within a context of disturbing events.…”

“…7,9,11,17,22 Effective risk and uncertainty communications during decontamination and recovery phases of a biological attack will play a crucial role in the mitigation of damage and timely recovery. [69][70][71][72] This study explored several challenges for the risk/crisis communication process during consequence management in 2 urban populations especially vulnerable to loss in the event of an extreme act of biological terrorism. Results from this preliminary research suggest possible explanations for why particular uncertainty communications and messages of reassurance from leaders might be effective for some individuals and not others, and how communication strategies might address these challenges.…”

Accountability between Experts and the Public in Times of Risk

“…Despite this high profile case, bioterrorism is still regarded as a new and exotic type of disaster by the general public, which remains unfamiliar with the details of the 2001‐2002 contamination and cleanup. Unfamiliar threats can be particularly frightening, and particularly when they involve uncertainty about detection and whether the perpetrator of an intentional release might strike again (Reynolds and Seeger : 44‐45; Raber, Hibbard, and Greenwalt : 271). While individuals may not worry about toxic chemicals that they encounter on a daily basis, the fear of unusual occurrences may cause them distress even if the risk levels are comparable (Rogers et al : 281).…”

“…Because the fear of potential contamination, even if unfounded, can remain well beyond the potential for exposure, confidence‐building in exposed areas is likely to be a protracted process. It should ideally include ‘a broad stakeholder group representing civic, community, and business interests’ to develop ‘mechanisms such as economic incentives to… stimulate re‐occupancy’ (Raber, Hibbard, and Greenwalt : 271, 275, 278‐279).…”

Implications Drawn from a Military Bioterror Exercise in Israel

“…These implications obligate government organizations, military forces, medical personnel, and public health officials to prepare and practice a coordinated plan of response. [2][3][4][5][6] Orange Flame is a capability-building project, led by the Ministry of Health and the Home Front Command, which is subordinate to the Israel Defense Forces (IDF). The Orange Flame project is designed to prepare civilian, military, medical, and nonmedical organizations to appropriately respond in a case of an unusual biological event.…”