> BIOLOGICAL THREAT INTERROGATORIES
>
> 1\. Occurrences that create suspicion of a BT event (illness or
> suspicious substance)
>
> This issue is designed to define either illnesses or suspicious
> substances or threats that would call into question the possibility of
> a BT event.

2\. First contact for suspect BT event

> This gives specific direction to any VA employee who suspects a BT
> event. This is divided into sections for whether it is a threat or
> substance vs. a suspect illness that may be related to a biologic
> threat agent.

3\. Chain of command -- within the facility

> This is divided into three sections with regard to chain of command.
> This should include the issue of who in the chain of command at the
> facility can activate the disaster plan. The response is divided into
> administrative hours, non-administrative hours, and who is in control
> at the scene of the event.

4\. Chain of command -- outside

> This deals with the chain of command for assuring interaction with
> those with a "need to know" outside the VA facility. This would
> include the Network Director, the FBI, or the 911 call. Specifically,
> this is designed to indicate how this chain of command will work and
> whom should be the person calling those outside the VA.

5\. Decontamination

> This again is divided into administrative hours and non-administrative
> hours since decontamination efforts need to be met 24 hours per day, 7
> days per week.

6\. Ventilation

> This deals with the need to change airflow within the hospital,
> particularly to shut down air systems in parts of the facility. Again,
> this is divided into administrative hours and non-administrative
> hours.

7\. Outpatient/Emergency Department Procedures

> This section is designed to answer the questions about decontamination
> as well as infection control practices to be followed. This can be an
> individual facility infection control plan or the use of those
> developed by others, such as the Walter Reed Army Medical Center. It
> should be noted that the easier the procedure is to follow, the better
> (since this may occur during non-administrative hours).

8\. Inpatient Infection Control

> This topic is generally part of the infection control manual, but
> should be specific for BT agents.

9\. Care of patients with suspect or proven BT agents

> This section defines what procedures should be followed if a patient
> is suspected to have an illness related to a BT agent. This could
> include data from the Morbidity and Mortality Weekly Report (MMWR),
> the VA Central Office pocket card that provides certain information,
> and the need for immediate involvement of the Infectious Diseases
> Section (where available).

10\. Prophylaxis decision making for persons arriving for care at the
facility

> This section outlines procedures for those who will intake patients 24
> hours per day, 7 days per week, and procedures to be followed for
> prophylaxis for potential exposure to BT agents.

11\. Veterans vs. non-veterans who arrive and who need prophylaxis or
care

> This section clearly defines the decision concerning the provision of
> humanitarian care for non-veterans and defines the system for assuring
> data entry into VistA for any person seen.

12\. Maintenance of operation during BT-related crisis.

> This needs a local policy to cover antibiotics and issues such as
> nutrition for employees, etc. This will require knowledge of the local
> setting and will likely be a continuous process.

13\. Antibiotic distribution

> This deals with the mechanism for any needed distribution of
> antibiotics during the first 12 to 24 hours after a suspect BT event
> and before the scene is managed by outside agencies.

14\. Decontamination stockpiles

> This defines how much of each component of a decontamination system is
> needed at the individual medical center level. In general, this would
> be included in the facility's decontamination policy/procedures.

15\. Lab specimen issues

> This is perhaps the most complex component of the interrogatories.
> This has been divided into five sections to deal with separate
> relationships between the laboratory and others. The divisions include
> the ordering physician, direct patient care needs, epidemiologic needs
> such as nasal swabs, cultures of the environment or suspect powders,
> and any guidance for these areas. Again, this will be based on
> individual facility preferences and the structure and infrastructure
> of the laboratory. Issues such as specimen movement between facilities
> or through outside agencies would also need to be considered here.

16\. Morgue and post-mortem processes

> Before a BT event occurs, precautions and issues regarding disposition
> of remains should be defined. Even though much of this may be managed
> through community health services, it should be defined.

17\. Suspect letters and packages

> This refers to a clear understanding by each employee of what should
> be done with a suspect letter or package.

18\. and 19. The press, families, and crowd control

All of these should already be clearly addressed in a facility disaster
plan.

20\. Alignment with current facility and community disaster plans

> This element is key to ensure that the facility disaster plan is in
> alignment with the BT agent plan. In addition, all of these plans must
> be in alignment and interlock with the community plans for each of
> these events.

21\. Quarantine

> The legal, ethical, and procedural issues regarding quarantine for
> such diseases as smallpox should at least begin to be addressed. This
> will likely be a continuous process since it is not at all clear that
> anyone in the country has comprehensively addressed this issue.

22\. The need for local training

> A specific plan for training should be developed. At the least,
> everyone needs to know the responses to the issues and concerns noted
> in these interrogatories, particularly for VA employees who do not
> deal with these issues on a day-to-day basis.

23\. Evacuation plan and possible hospital closure

> In the event of contamination of a VA facility, some plans need to be
> defined (before such an occurrence) for maintenance of operations.
> This may include shifting patients to Community Based Outpatient
> Clinics (CBOCs) or to other VA facilities. This would include both
> inpatients and outpatients and any emergency department needs that are
> anticipated. While this scenario may be somewhat unlikely, the
> potential adverse effects of such an eventuality may be lessened
> through early planning and agreements, written or otherwise, with
> other facilities.