paul moyer, ms ct response coordinator minnesota department of health public health laboratory...
TRANSCRIPT
Paul Moyer, MS
CT Response Coordinator
Minnesota Department of Health
Public Health Laboratory Division
A Tiered Approach to All-Hazards Laboratory Testing of Unknown
Environmental Samples
2
Introduction
Why Is Unknown Sample Testing Important?– “Credible” Threats Exist– Surveillance
Why Is Testing at PHL Important?– Public Health Events– LRN Laboratories
3
Objectives
Describe a process for applying standardized procedures to non-standard events
Illustrate the significance of notification and threat assessment pieces (“Focus Areas” working together)
Discuss the advantages of a Bio/Chem/Rad tiered step analysis
4
Background
Anthrax 2001– Specific Protocol– Letters
Evolution to “All-Hazards” Approach– Specific Guidelines– Letters– Leaking Packages– Tainted Food/Water
5
Background
What the MDH plan “IS”– A Starting Point – Guidance– SOPs, Checklists, & Forms– Safety First
What the MDH plan “IS NOT”– A “Rote” Protocol – Thinking IS Required– A Lab Only Effort – Partners Crucial– Rigid
6
Safety
Lab Safety Officer – IHBSL 3 FacilityLimited QuantitiesBuddy + 1 SystemPPE
7
Safety
Chemical Splash Resistant Coveralls with
Hood and Boots
Chemical Resistant Sleeves
Full Face APR: Dual Particualte/Organic Vapor Cartridges
Outer Gloves:Nitrile
Inner Gloves: Nitrile or Chemical Laminate
8
What does “Tiered” Mean
Expandable SystemBegins with Field Information/“Tests”Minimum Testing – Tier 1 Can Include:
– Scenario/Submitter Directed Testing– Tier 2 Testing– Minimum Plus Testing
9
Resource Management
Anthrax Only Testing – “Too Cold?”
All-Agent Testing – “Too Hot?”
Tiered Testing – “Just Right”?
10
Plan Strategy
SOPs vs. SOGs
“Menu” of Tests/Procedures
Judgment – “What makes sense”
Here’s the “Road Map”
No
No
Referenced SOP
Decision
Data / Information
Additional Resource
Process SOP
Yes
Yes
Yes
OpenSample
SOP
Receive Sample /
Over-packSOP
Notification
SOP(Phase I)
Minimum Testing + Additional Biological
Staff Resource Call-Down
Final ReportSOP
Process SOP Sections- Communications- QA / QC- Documentation- Safety - Analysis
Rad Check
Positive?
Rad Check
Positive?
Results & Observation
s
Tier 2Testing?
Radiological ScreenSOP
Alert RadiationResponse
Team
GC/MS, ICP/MS,
OtherCT Analytical
SOPS
LRNBT Analytical
SOPS
BT / CT Personnel
AcceptSample?
DocumentSample
Rejection
No
Yes
ResultsNotificatio
nSOP
(Phase II)
Prioritize Tier 1
Testing
Information
Results & Observation
s
Minimum Testing &
ProcessingSetup
No
Document
Minimum Testing + Additional Chemical
Minimum Testing + Additional Toxin
Minimum Testing+ Viral
Minimum Testing
Or
Or
Or
Or
Document
Document
12
Plan Strategy
BT, CT & REP* TeamsOn-Call Pairs (BT, CT-Rad)Cross - Trained on:
– Threat Assessment– Sample Receiving – Chain-of-Custody– Sample Opening – Processing– Communications
*Radiological Emergency Program
13
Screening: Chemical vs. Biological
Serial Analysis:– Rule Out Chemical Agents
• What about the Bio-Hazard?
– Rule Out Biological Agents• What about the Chemical Hazard?
Parallel Analysis:– BT and CT-Rad Working Together– Broader Perspective / Depth of Knowledge– Use the Threat Assessment/Field Information
14
Testing: Is It Hazardous? (…and If Not, What Is It?)
ID and ConfirmRule Out Hazardous:
– Radioactivity– Chemicals– Biological Agents
What’s Left? Back to the “Map”
No
No
Referenced SOP
Decision
Data / Information
Additional Resource
Process SOP
Yes
Yes
Yes
OpenSample
SOP
Receive Sample /
Over-packSOP
Notification
SOP(Phase I)
Minimum Testing + Additional Biological
Staff Resource Call-Down
Final ReportSOP
Process SOP Sections- Communications- QA / QC- Documentation- Safety - Analysis
Rad Check
Positive?
Rad Check
Positive?
Results & Observation
s
Tier 2Testing?
Radiological ScreenSOP
Alert RadiationResponse
Team
GC/MS, ICP/MS,
OtherCT Analytical
SOPS
LRNBT Analytical
SOPS
BT / CT Personnel
AcceptSample?
DocumentSample
Rejection
No
Yes
ResultsNotificatio
nSOP
(Phase II)
Prioritize Tier 1
Testing
Information
Results & Observation
s
Minimum Testing &
ProcessingSetup
No
Document
Minimum Testing + Additional Chemical
Minimum Testing + Additional Toxin
Minimum Testing+ Viral
Minimum Testing
Or
Or
Or
Or
Document
Document
16
Key Pieces
NotificationThreat/Hazard AssessmentAction Plan – Scenario SpecificMinimum Testing – Tier 1
– Radiological– Chemical– Biological
Advanced/LRN Testing – Tier 2
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Notification
Incoming Request for Lab Analysis Internal Notification(s)
– Hazard Assessment• Response Coordinators (Focus Areas C & D)• Unit Leaders
– Management FYI• Director• Section Managers
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Notification
External Notification(s)– Hazard Assessment
• MDH Epidemiology (Focus Area B)• MDH Environmental Health Rep (Focus Area A)• FBI WMD Coordinator• CST
– Management FYI• MDH Health Protection Division Directors (All Focus
Areas)
Decision to Accept/Reject Sample
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Threat/Hazard Assessment
Credible Threat?
Excessive Hazard?– Fatalities– Explosives
Suitable Request?– Public Health Threat?– Forensics?
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Event Action Plan – Scenario Specific
Decisions By:– One Person– On-Call Pair– Group
Decide To:– Test or Not Test– Test At What Level – “Order Off the Menu”– Assign Duties and Responsibilities
21
Minimum Testing – Tier 1
Radiological Screen
Chemical Characterization
Biological Testing
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Minimum Testing – Tier 1
Radiological Screen– Inner Package / Sample– Geiger-Muller Counter (CPM)
• Alpha• Beta• Gamma
Over-pack Previously Screened at Loading Dock
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Minimum Testing – Tier 1
Chemical Characterization– Papers: pH, M8, Oxidizer– Solubility: Water, Methylene Chloride– FTIR: HazmatID– Head Space Vial Aliquot (GC/MS)
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Minimum Testing – Tier 1
Biological Testing– Slides: Wet Mount, Gram Stain– RT-PCR– TRF– Cultures: BAP, Chocolate, Thio Broth
25
Advanced/LRN Testing – Tier 2
Chemical– GC/MS – SVOC– ICP/MS – Metals – General/Bench Chemistry – Inorganic
Biological– LRN Level B/C Agent Specific Protocols
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References
Guidance on Initial Responses to a Suspicious Letter / Container With a Potential Biological Threat, FBI – DHS – HHS/CDC, 2004
Assessment of Methods for Handling Mixed-Threat Environmental Samples, NCEH – Battelle, 2004
Assessment of Protocols Involving Unknown Samples, NCEH – Battelle, 2004
Proposed Draft DHS Screening Protocol, 2005 (to augment/standardize existing assessments and field screening techniques)
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Contact Information
Paul Moyer, MS Chemical Terrorism Response Coordinator
612-676-5245
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Questions
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