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Turner, Nunn, Health Experts Release Results of Georgia Exercises, Propose Actions to Improve Preparedness for Bioterrorism and Bird Flu

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Turner, Nunn, Health Experts Release Results of Georgia Exercises,
Propose Actions to Improve Preparedness for Bioterrorism and Bird Flu

The State of Georgia has conducted a series of emergency response exercises designed to test and improve the state’s readiness to respond to public health threats, including biological terrorism and avian flu, state, federal and private sector leaders announced today in Atlanta. At a special briefing to unveil the results, leading experts outlined what governments, businesses and individuals must do to defend against potential biological threats and described how Georgia’s exercises can be a model for strengthening biological preparedness in other states and nations.

The exercises were funded by the Nuclear Threat Initiative’s Global Health and Security Initiative and the Woodruff Foundation and were developed and coordinated by the RAND Corporation in cooperation with Georgia Department of Human Resources’ Division of Public Health and the Rollins School of Public Health at Emory University.

Overview of Exercises. A key feature of the assessment of Georgia's public health preparedness infrastructure came in the form of tabletop exercises, where participants were given disease scenarios–for example, the spread to Georgia of avian influenza–and forced not only to take action to contain the outbreak, but also to involve law enforcement partners because of the suspicion that this had been intentionally introduced.

RAND conducted six tabletop exercises at the local level and one at the statewide level in 2005. The local exercises involved two smallpox outbreak simulations; one avian influenza simulation; and three botulism outbreak simulations. All of these diseases tested the public health processes, but required slightly different responses, skills and capacities. The local districts were selected by Division of Public Health staff to represent the diversity of Georgia’s health districts in geography, population and variation in the perceived level of experience and preparedness.

The last of the six district-level exercises evolved into a statewide exercise, simulating a local health emergency widening into a state-level problem. This exercise involved a simulated outbreak of avian influenza and included representatives from both the public health and agricultural communities. All of the exercises were preceded by interviews with key informants to understand the progress they had made to date and the barriers and facilitators to improving preparedness.

“The multiple exercises proved invaluable is assessing the readiness of state emergency response plans generally and identifying specific challenges that might arise when responding to different types of emergencies,” said Dr. Stuart Brown, director of the Georgia Department of Human Resources Division of Public Health. “Putting a plan down on paper is really only the first step. Putting that plan through a test exercise really allows you to see what works well and what doesn’t.”

“We at NTI were very gratified to learn from Georgia public health officials that lessons learned from the exercises allowed Georgia emergency response officials to mount an effective and coordinated response to a real-life emergency – Hurricane Katrina – which occurred a month after the exercises were completed and brought tens of thousands of evacuees to the state in need of medical care and other services,” said former Senator Sam Nunn, Co-Chairman of the Nuclear Threat Initiative.

“Following Katrina, Georgia emergency response officials were able to identify specific areas where the RAND exercises helped the public health, emergency response and other government agencies respond more effectively to the influx of displaced persons,” said Dr. J. Patrick O'Neal, Medical Director for the Office of EMS/Trauma/Emergency Preparedness in the Georgia Division of Public Health. “Specifically, improvements were seen in the areas of communication, interoperability, the identification of priority groups, surge capacity, volunteer providers, and partnerships with community and private-sector groups.”

“It doesn’t matter whether a disease outbreak is naturally occurring or caused by terrorists – major health threats are also security threats, and they have been for as long as we’ve recorded our history,” said Senator Nunn. “This puts us in a race between cooperation and catastrophe. We must win that race through the kind of planning and cooperation among government leaders, health officials and the private sector to identify and quickly contain an epidemic that we’ve seen with these exercises here in Georgia. As these exercises demonstrate, the cooperation and planning that is essential must start locally and move quickly, in real time, to state, federal and international coordination and communication.”

“These exercises have provided recommendations that are not only being put into practice in Georgia, but also offer promise for improving health systems around the United States and the world,” said Ted Turner, Co-Chairman of the Nuclear Threat Initiative. “Getting ready to fight the next epidemic in Georgia is essential, but it’s not enough. If we can stimulate similar exercises by other governments around the world, they can learn what they need to know to fight disease in their own countries. Then we have a chance to stop a local outbreak before it becomes a global epidemic. If we work together, we have a chance to save millions of lives.”

Recommendations. Coming out of the exercises, RAND developed a set of recommendations aimed at filling gaps and strengthening the state’s preparedness. Among them:

  • Enhance and exercise communications plans, and improve interoperability of information sharing technology across response disciplines.
  • Assure appropriate surge capacity plans are in place.
  • Integrate outside partners into planning and response. This includes partners such as the business community, the Red Cross, volunteers, and state and local elected officials.
  • Improve workforce training at all levels.
  • Clarify who has responsibility for special needs populations.

“The ever-present threat of contamination and disease outbreaks illustrate that preparedness of our government health care and emergency response infrastructure should be of the highest priority,” said Dr. Nicole Lurie, Senior Natural Scientist and Paul O’Neill Alcoa Professor at the RAND Corporation. “The exercises and interviews in Georgia highlighted a number of strategies that, when implemented, will dramatically improve Georgia’s already impressive response capabilities.”

"The exercises established valuable lines of communication between the poultry industry and the public health community which have led to continued collaboration in planning efforts," said Mike Giles, vice president of the Georgia Poultry Federation. "They also highlighted the importance of providing accurate information to the public about the significant differences, in terms of risks to public health, between pandemic influenza and an occurrence of avian influenza among farm animals."

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