# Presentation: 397176

## Bioterrorism Workbook and Decision Support: The Pittsburgh Matrix

**Michael Allswede, D.O.**
- Section Chief
- Special Emergency Medical Response
- University of Pittsburgh Medical Center Health System

## Pittsburgh Matrix 

- Provide a decision support tool for hospitals and hospital systems preparing for or responding to bioterrorism events
- Provide a method of determining value for bioterrorism capability
- Guide funding for hospital capability development

## Pittsburgh Matrix: Stratification of Tasks

|  | High Priority | Moderate | Low Priority |
| --- | --- | --- | --- |
| Immediate | Anthrax Protocols | Education Programs | Command Center Development |
| Short Term | Lab capacity
Quarantine Protocols | Special Lab Capability | New Research |
| Long Term | Improve Mass Decon  | Standardization of Training | Medical School Curriculum |

## The Pittsburgh Matrix:Medical Decision-Making

- Allswede, MP, Watson SJ., *AHRQ Partnership for Quality, 2002*

## Pathogen Rating

- Communicability/Quarantine Needs
- 0: Non-communicable/No Quarantine  	Example: Bot Toxin
- 1: Blood and Body Fluid/Universal Precautions	Example: HIV Virus
- 2: Close Contact/Universal Precautions	Example: Ebola Virus
_***3: Airborne/HEPA Filtration***__***	***__***	***__***Example: Variola Virus***_
- Effectiveness of Medical Treatment
- 0: Comfort Measures Only Needed	Example: Salmonella
- 1: Highly Effective-Survival Probable	Example: Skin Anthrax
- 2: Improved Survival-Survival Improved	Example: Yersinia Pestis
_***3. Ineffective-Survival Not Improved***__***	***__***Example: Variola Virus***_
- Availability of Medical Treatment
- 0: Non-Pharmaceutical Treatment 		Example: Clear Liquid Diet
- 1: Multiple Available Pharmaceuticals	Example: Ames Strains
- 2: Insufficient Local Supply Pharmaceutical 	Example: Bot Antitoxin
_***3: Obscure or Experimental Pharmaceuticals***__***	***__***Example: Variola Vaccine***_

- Allswede, MP, Watson SJ., *AHRQ Partnership for Quality, 2002*

## Effects of Preparedness 

- Allswede, MP, Watson SJ., *AHRQ Partnership for Quality, 2002*

- Better Technology

- System Preparedness

## Anthrax Aerosol 

- Allswede, MP, Watson SJ., *AHRQ Partnership for Quality, 2002*

- Note:
- Numbers represent pathogen scores
- (Percentages) represent estimated mortality rates

- Allswede, MP, Watson SJ., *AHRQ Partnership for Quality, 2002*

## Variola 

- Allswede, MP, Watson SJ., *AHRQ Partnership for Quality, 2002*

- Note:
- Numbers represent pathogen scores
- (Percentages) represent estimated mortality rates

## Decision Support Tool 

- Each Medical Asset can determine capacity levels based on daily census, surge disaster planning, and community outreach
- Timeline will be evident so a given box can be accessed
- Each box has Key Decisions and Key Resources enumerated in a logical response hierarchy

## Resource Valuation

- Key Resources (capabilities) within each matrix box are accounted using UPMC Health System data
- Survivorship estimates yield value in dollars/lives saved for each matrix Key Resource

## Pittsburgh Matrix: Work to do

- Complete methodological workbook for other medical facilities to follow
- Estimation of probability of a given attack occurrence
- EX: World events change the threshold and likelihood of each given attack
- Estimation of detection capability of a given attack
- EX: Syndromic detection is better for larger scale events

## For More Information

- AHRQ-sponsored Workbook for Regional Bioterrorism Preparedness
- A collaborative effort between Research Triangle Institute,
- UPMC Health Systems, and Intermountain Health Care
- Available:  September 30, 2003
- Contact:  Lucy Savitz at savitz@rti.org