Background Information
On Oct. 1, 2001, the University of Pittsburgh Medical Center (UPMC) formed the UPMC Bioterrorism Preparedness Group in order to strengthen its already existing ties with federal, state and local law enforcement and public health agencies. The mission of the group is to make sure the quality of patient care is not compromised in the event of a disaster; and to devise systems with the expertise of infectious disease and disaster specialists to ensure that life-saving antidotes and vaccines to bioterrorism agents can be accurately tested and implemented in a timely manner.
UPMC’s bioterrorism preparedness programs include the following:
UPMC MedCall Service – MedCall, which was developed by UPMC 14 years ago, is an extensive physician tracking system that includes immediate contact information on more than 14,000 UPMC physicians that is available 24 hours per day, seven days per week, and maintains more than 400 on-call schedules. The average volume of calls in one week is 4,000, with a corresponding outbound volume of 4,400 calls. After the Sept. 11 terrorist attacks, MedCall was modified to include a database of experts in bioterrorism, infectious disease and disaster medicine.
UPMC Safety Link – The UPMC Safety Link program is a series of educational sessions to help managers and staff better understand their roles in the event of a disaster or emergency. If a terrorist attack were to occur in our region, UPMC would be called upon to provide fast and effective medical services. The program is designed to include detailed information on how to respond to a specific disaster, whether natural or manmade. In the event of a disaster, each UPMC hospital would have a command center that would be activated with instructions on how to respond. To date, more than half of UPMC employees have received Safety Link training.
RaPiD-T WMD Response Training for Local and Regional EMS Services – RaPiD-T stands for Recognition, Personal Protection, Decontamination and Triage/Treatment, the steps a first responder must accomplish in order to minimize injury to him or herself and to maximize victim survival. Borne from both military and civilian disaster experiences, the RaPiD-T methodology is an attempt to systemize first response to a wide range of potential terrorist hazards. The heart of the RaPiD-T system is a symptom-based, diagnostic matrix intended to aid non-medical or non-specialists in the recognition of the potential agent. By observing common symptoms in exposed victims, the matrix will suggest a probable agent class and provide a color-code. The color-code then indicates the personal protection, decontamination and triage/treatment recommendations to guide the first responder in his or her actions. The RaPiD-T Program is customized for the equipment and disaster response plans of the service trained, giving the training immediate relevance.
Real-time Outbreak and Disease Surveillance System (RODS) – RODS is a computer-based surveillance, analysis and communication system that conducts ongoing real-time monitoring and analysis of data that is continually evaluated to detect various kinds of threats to the public health, whether naturally occurring outbreaks or potential bioterrorism attacks.
RODS monitors, among other things, emergency department and acute care visits. Seconds after a patient registers in a participating facility, complaining of cough or other symptoms, this fact is transmitted (without the patient’s name or identifying information) directly from the hospital computer system to the RODS system where it is combined with information from other visits in the region for analysis. Investigators then look for possible geographical or other relationships among these patients to achieve specificity in diagnosis for the group of patients with common symptoms.
The Pittsburgh Matrix – The Pittsburgh Matrix is an emergency response application that can be used by hospital and public health officials wishing to become more prepared in the event of a bioterrorism attack or infectious disease outbreak. The Pittsburgh Matrix can identify up to 20 different bioterrorism scenarios along with a timeline of detection to determine cost worth data. For example, the Pittsburgh Matrix would be able to determine, based on a particular scenario, whether or not a hospital should stockpile medications or invest in better bioterrorism detection technology systems.
As a public health and medical management tool, the pre-disease outbreak information can be used as a decision support tool to guide medical decision-making early in a large or small emergency, at the moment of detection. To plan for a specific risk, the Pittsburgh Matrix is intended to model the impact of a specific potential act of bioterrorism, assess a medical system's critical shortages for that risk, identify the costs associated with filling the critical gaps, and estimate the benefit in survivorship expected by the addition of that resource. The Pittsburgh Matrix project is based upon the work of the UPMC Bioterrorism Preparedness Group and the data and survivorship estimates are derived from analysis of the UPMC capabilities. The project was funded by the Agency for Healthcare Research and Quality and our research partner is the Research Triangle Institute.
UPMC Critical Incident Stress Management Team (CISM) – The UPMC Critical Incident Stress Management (CISM) team began operations in 1989 in response to an incident at the Three Rivers Regatta. Since then, the UPMC CISM team has assisted with other high profile disasters such as the 1994 USAir Flight 427 crash in Hopewell Township, Pa., the United Flight 93 crash site in Shanksville, Pa., on Sept. 11, and most recently the Quecreek Mine Rescue in Somerset, Pa., last year.
The team consists of emergency medicine personnel and mental health experts from Western Psychiatric Institute and Clinic and offers assistance through four phases of counseling. The first phase involves on-scene support. The second phase is demobilization for emergency responders, which entails providing them with day-to-day updates on their efforts at the scene. The defusing phase involves assessing the needs of those being relieved of their duties for possible referral to mental health or other services. The final phase is debriefing, where the CISM team meets with the group several weeks or even months after the disaster to see who may need to be referred for further counseling. It may be during this time that many relief workers experience the greatest stress.
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