Introduction: CBRN for Public Health

1. Introduction: CBRN for Public Health Bonnie Henry, MD, MPH, FRCPC Public health CBRN course

2. Course Faculty www.CEEP.ca • Dr Daniel Kollek • Dr Dan Cass • Dr Brian Schwartz • Dr Doug Sider • Dr Chris Mackie • Dr Bonnie Henry

3. Course Objectives (1) • To understand the potential for a CBRN incident and how to assess local risk • Describe the role of the health system, and public health, in preparedness, mitigation, response to and recovery from a CBRN incident

4. Course Objectives (2) • To understand the roles of other organizations including police, fire and emergency medical services and emergency management in a CBRN incident • To understand the Incident Management System and define and use a Public Health IMS model

5. Overview of Course Day 1 • Precourse review • Roles of Public Health • CBRN introduction • Review of provincial initiatives • Disaster concepts • Hazard Identification and Risk Analysis exercise • Incident Management System

6. Overview of Course: Day 2 • Focus on biological incidents and public health • Personal Protective Equipment • Mass vaccination/prophylaxis clinics • Psychosocial support • Rapid community needs assessment • Crises communication

7. Public Health Roles • Early Detection • Mass Patient Care • Mass Immunization/Prophylaxis • Epidemiologic investigation • Communication • Command and Control

8. Public Health Roles (2) • Mass Fatality Management • Evacuations/sheltering (humans and animals) • Environmental Surety • Community Recovery (rapid health risk assessment, mental health etc)

9. Precourse Review 1. Forms of anthrax include all of the following except: • Neurological • Cutaneous • Gastrointestinal • Pulmonary Answer: a 2. Appropriate Personal Protective Equipment to be worn while handling specimens suspicious for anthrax include: • Surgical mask, Tyvek suit and goggles • N95 mask, face shield, gloves, hat and boots • Powered air purifying respirator, gown, gloves • Surgical mask, eye protection, gloves, gown if necessary Answer: d

10. Precourse Review 3. Botulism is caused by: • A neurotoxin produced by a spore that is ingested • Septicemia caused by a gram negative bacillus • A coronavirus • Handling livestock Answer: a 4. Symptoms of botulinum poisoning include all of the following except: • Visual disturbance • Difficulty swallowing • Paralysis on one side of the body • Generalized weakness (hypotonia) in an infant Answer: c

11. Precourse Review 5. Which of the following statements is incorrect regarding Plague? • Caused by a gram negative bacillus • May cause fatal pulmonary infection • Incision and drainage of buboes is the key to appropriate treatment • May be passed from person to person via large droplets Answer: c 6. Appropriate management of pneumonic plague includes all of the following except: • Droplet precautions until patient has completed 72 hours of antimicrobial therapy • Doxycycline 100 mg. twice daily for post-exposure prophylaxis following confirmed or suspected bioterrorism exposure • Post exposure vaccination • sputum or tracheal aspirates for Gram’s, Wayson’s, and fluorescent antibody staining Answer: c

12. Precourse Review 7. An identified case of smallpox: • Should be treated aggressively with antibiotics • Is a public health emergency • Should be assumed to be due to a failure of precautions at a BSL 4 laboratory • Should be managed using droplet and contact precautions Answer: b 8. Post exposure to someone with smallpox, public health may require quarantine of contacts for what time period? • 7-19 days after last exposure • 1-21 days after last exposure • 1-17 days after last exposure • Quarantine is not necessary after exposure to smallpox Answer: a

13. Precourse Review 9. Nerve Agents: • Are more toxic in liquid form than in gaseous when released • Stimulate acetylcholinesterase • Result in tachycardia and large pupils • Are lethal due to bronchorrhea and copious secretions Answer: d 10. Cyanide: • Is almost impossible to obtain • Works by inhibiting cellular aerobic respiration • Is classified as a blister agent • Produces tearing and salivation Answer: b

14. Precourse Review 11. Treatment for cyanide poisoning: • Must be started within 2 hours of the exposure • Is often extremely effective • Has significant potential toxicity due to methemoglobinemia • Includes decontamination with copious washing and dilution Answer: c 12. Which of the following is not a radiological/nuclear hazard? • Alpha particle • Beta particle • Gamma ray • Delta ray Answer: d

15. Precourse Review 13. When treating victims exposed to radiation, one must: • Wear full protective equipment, including a level C air purifying respirator • Stabilize and treat injuries first and foremost (wearing level D protection), as contamination of the health care worker is unlikely • Decontaminate first; if the patient succumbs from their injuries they likely would have died from radiation sickness • Not treat the patient until a formal dose assessment is performed Answer: b 14. With respect to Acute Radiation Sickness, which one of the following is true? • If, in the first 6 hours after a suspected exposure, there are no symptoms of exposure serious ARS is unlikely • Distance, time and administration of potassium iodide are the 3 most important factors in determining the level of illness • The absorbed dose is measured in Curies • The most serious manifestation is bone marrow stimulation Answer: a

16. Precourse Review 15. Potassium Iodide should not be used: • In pregnant women • In children or infants • In persons situated more than 20 kilometres from an incident • In a nuclear event involving I131 Answer: c 16. What is the most effective way of protecting the public after a critical event? • Assessment at hospital emergency departments • Shelter in place and evacuation when necessary • Mass administration of chelating agents • Distribution of N95 respirators Answer: b

17. Questions?