Imagine that over a 24-hour period 17 patients report to the Emergency Department of a small hospital in a rural community. Clinically, the patients present with fever, malaise, flushing, conjunctivitis, myalgia, abdominal pain, nausea, diarrhea, and a petechial rash. One of the patients is coughing up blood (hemoptysis) and another has seizures in the Emergency Department and falls into a coma.
An infectious diseases specialist is called in to determine the cause of this outbreak. The specialist collects blood and urine from most of the patients and orders a battery of tests. Samples are sent on
to the hospital laboratory for routine blood and urine tests. A subset of the patient samples is forwarded to a commercial laboratory where more elaborate testing is available. Based on initial findings from the hospital laboratory, the specialist comes up with a differential diagnosis of viral hemorrhagic fever, bacterial sepsis, Rocky Mountain spotted fever or other rickettsial disease, leptospirosis, borreliosis, dengue hemorrhagic fever, septicemic plague, or hemorrhagic smallpox.
The specialist begins to piece together information gathered from the patients and family members. There appears to be one common event shared by all the case patients: All attended a major sporting event, a championship college football game that occurred nearly two weeks previously. The physician has a reasonable suspicion that the cases are all related to an intentional act or at least to some bizarre coincidence.
At this point, isolates from case patients would be forwarded to a regional laboratory in the state’s capital city for further testing. If the isolate is found to test positive for one of the CDC bioterrorism agents (Category A, B, or C), an isolate would be sent to the national laboratory in Atlanta for definitive testing.
The state Bureau of Investigation, the Federal Bureau of Investigation, and a local joint terrorism task force would send agents to the community to work with epidemiologists to determine the source of the outbreak. The FBI’s Hazardous Materials Response Unit, along with the state’s Army National Guard’s WMD civil support team might be requested to respond to collect and process evidence within the community. The evidence that these teams collect would be delivered to the laboratory via local, state, or federal law enforcement. Environmental and clinical samples would be gathered from numerous sites. The field collection effort would be enormous and likely to include thousands of samples.
Discuss the implications for local emergency managers and response organizations from the jurisdictions that will be included in the response and investigation.
Where does the National Incident Management System, Incident Command System, unified command, and the National Response Framework come into play here?
What agency will be in charge of the response? What agency will be in charge of the investigation? Consider something like this occurring in your town.
