ZEBRA PACKET 2010 Biological, Chemical and Radiological Terrorism Information for Clinicians County of San Diego Public Health Services Emergency Medical Services COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY PUBLIC HEALTH SERVICES EMERGENCY MEDICAL SERVICES BIOLOGICAL, CHEMICAL & RADIOLOGICAL TERRORISM INFORMATION FOR CLINICIANS ZEBRA PACKET September 2010 This document is funded by a Federal Centers for Disease Control and Prevention (CDC) grant for the Cities Readiness Initiative Program. The grant funding was awarded to the County of San Diego by the State of California. COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY PUBLIC HEALTH SERVICES EMERGENCY MEDICAL SERVICES ZEBRA PACKET Adapted by the County of San Diego Division of Emergency Medical Services from the Santa Clara County Public Health Department of the same title. ACKNOWLEDGMENTS County of Los Angeles Public Health, Emergency Medical Services Agency County of San Diego Epidemiology & Immunization Services Branch County of San Diego Department of Environmental Health County of San Diego Office of Emergency Services County of San Diego Operational Area Metropolitan Medical Strike Team County of San Diego Public Health Laboratory San Diego County Medical Society UCSD Medical Center Additional Acknowledgement: Catherine L. Blaser, R.N., EMS Summer/Fall 2010 Intern, Project Research COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY PUBLIC HEALTH SERVICES EMERGENCY MEDICAL SERVICES Table of Contents Introduction Acknowledgements Table of Contents Reporting Disease Reporting Confidential Morbidity Report Detecting Bioterrorism: The Clinicians Role Reporting Suspected Bioterrorism Related Illness Health Alert Network and Volunteer Medical Professionals California Health Alert Network (CAHAN) California Disaster Healthcare Volunteers (DHV) Biological Agents Ten Critical Steps for Handling Possible Bioterrorism Events Isolation Guidelines Bioterrorism Overview Category A Anthrax Anthrax Bioterrorism: Lessons Learned and Future Directions Smallpox Evaluating Patients for Smallpox Worksheet Diagnosis and Management of Smallpox Plague Botulism Tularemia Viral Hemorrhagic Fever Chemical Agents Overview Article Chemical Terrorism Information and Treatment Guidelines for Hospitals and Clinicians Biotoxins Vesicant Agents Blood Agents Pulmonary Agents September 2010 Incapacitating Agents Nerve Agents Riot Control Agents Nuclear/Radiological Emergencies Overview Article Nuclear/Radiological Terrorism Information and Treatment Guidelines for Hospitals and Clinicians Radiation Information Patient KI Pre-screening Questionnaire Mass Casualty Events Explosions and Blast Injuries Blast Injury Essential Facts Lung Injury Crush Injuries Abdominal Injury Extremity Injury Eye Injury Thermal Injury Mental Health Issues References September 2010 County of San Diego, Office of Public Health Physicians and health care providers must report the following conditions. Suspected, lab-confirmed, and/or clinical diagnoses are reportable within specified time intervals. Reporting enables appropriate public health interventions. PHONE PHONE 619-515-6620 619-515-6620 or after 5:00 P.M. FAX 619-515-6644 858-565-5255 IMMEDIATELY: ONE WORKING DAY: Anthrax Amebiasis Psittacosis Botulism Anisakiasis Poliomyelitis Brucellosis* Babesiosis Q Fever Cholera Campylobacteriosis Relapsing Fever Dengue Colorado Tick Fever RMSF Diphtheria Cryptosporidiosis Salmonellosis E-coli O157 Infection Encephalitis (infectious) Shigellosis Hantavirus infections Ehrlichiosis Streptococcal Infections Hemolytic Uremic Syndrome Haemophilus influenzae (invasive) Food Handlers and Measles Hepatitis A Dairy workers only Meningococcal Infections Listeriosis Syphilis Plague (any form) Lymphocytic choriomeningitis Swimmer’s itch Rabies (any form) Malaria Trichinosis Seafood poisoning Meningitis Typhoid Domoic Acid Neonatal conjunctivitis Typus Fever Ciguatera Pertussis Tuberculosis Scrombroid Any food-or-water-borne illness Vibrio infections Paralytic shellfish Yersiniosis Tularemia* Viral Hemorrhagic Fevers Yellow Fever Outbreaks of any disease Outbreak of Neonatal diarrhea Unusual disease occurrence PHONE, FAX, OR MAIL WITHIN ONE WEEK: AIDS Hepatitis, other viral PID Aspergillosis Invasive Group A Streptococcus Reye’s syndrome Chancroid Kawasaki’s syndrome Rheumatic fever, acute Chlamydial infections Legionellosis Rubella Coccidioidomycosis Leprosy Rubella syndrome, congenital Cysticercosis Leptospirosis Tetanus Echinococcosis Lyme Disease Toxic shock syndrome Giardiasis MRSA Toxoplasmosis Gonococcal infections Mumps VRE Hepatitis B,C, D NGU Monday - Friday 8 AM to 5 PM, call County of San Diego, Office of Public Health TEL (619) 515-6620 FAX (619)515-6644 1700 Pacific Highway, Room 107, San Diego, CA 92101 *Not reportable immediately in current regulations, however, because Brucellosis and Tularemia may be used as possible bioterrorism agents, immediate reporting is requested if these conditions are suspected. State of California—Health and Human Services Agency California Department of Public Health CONFIDENTIAL MORBIDITY REPORT NOTE: For STD, Hepatitis, or TB, complete appropriate section below. Special reporting requirements and reportable diseases on back. DISEASE BEING REPORTED: ___________________________________________________________________________________ Patient’s Last Name Social Security Number Ethnicity (✓ one) – – ❒ Hispanic/Latino ❒ Non-Hispanic/Non-Latino Birth Date First Name/Middle Name (or initial) Month Day Year Age Race (✓ one) ❒ African-American/Black ❒ Asian/Pacific Islander (✓ one): Address: Number, Street Apt./Unit Number ❒ Asian-Indian ❒ Japanese ❒ Cambodian ❒ Korean City/Town State ZIP Code ❒ Chinese ❒ Laotian ❒ Filipino ❒ Samoan ❒ ❒ Estimated Delivery Date Guamanian Vietnamese Area Code Home Telephone Gender Pregnant? Month Day Year ❒ Hawaiian – – M F Y N Unk ❒ Other:________________________ ❒ Area Code Work Telephone Patient’s Occupation/Setting Native American/Alaskan Native ❒ Food service ❒ Day care ❒ Correctional facility ❒ White: __________________________ – – ❒ Health care ❒ School ❒ Other _________________________ ❒ Other: __________________________ DATE OF ONSET Reporting Health Care Provider REPORT TO Month Day Year Reporting Health Care Facility DATE DIAGNOSED Address Month Day Year City State ZIP Code DATE OF DEATH Telephone Number Fax Month Day Year ( ) ( ) Submitted by Date Submitted (Month/Day/Year) (Obtain additional forms from your local health department.) SEXUALLY TRANSMITTED DISEASES (STD) VIRAL HEPATITIS Not Syphilis Syphilis Test Results Pos Neg Pend Done ❒ ❒ Primary (lesion present) ❒ Late latent > 1 year ❒ RPR Titer:__________ Hep A anti-HAV IgM ❒ ❒ ❒ ❒ ❒ Secondary ❒ Late (tertiary) ❒ VDRL Titer:__________ ❒ Hep B HBsAg ❒ ❒ ❒ ❒ ❒ Early latent < 1 year ❒ Congenital ❒ FTA/MHA: ❒ Pos ❒ Neg ❒ Acute anti-HBc ❒ ❒ ❒ ❒ ❒ Latent (unknown duration) ❒ CSF-VDRL: ❒ Pos ❒ Neg ❒ Chronic anti-HBc IgM ❒ ❒ ❒ ❒ ❒ Neurosyphilis ❒ Other:_________________ anti-HBs ❒ ❒ ❒ ❒ Gonorrhea Chlamydia ❒ ❒ Hep C anti-HCV ❒ ❒ ❒ ❒ ❒ PID (Unknown Etiology) Urethral/Cervical ❒ Urethral/Cervical ❒ ❒ Acute PCR-HCV ❒ ❒ ❒ ❒ ❒ ❒ Chancroid PID PID ❒ ❒ Chronic ❒ ❒ Non-Gonococcal Urethritis Other: ____________________ Other: _____________ ❒ Hep D (Delta) anti-Delta ❒ ❒ ❒ ❒ STD TREATMENT INFORMATION ❒ Untreated ❒ Other: ______________ ❒ ❒ ❒ ❒ ❒ ❒ Treated (Drugs, Dosage, Route): Date Treatment Initiated Will treat Suspected Exposure Type ❒ ____________________________ Month Day Year Unable to contact patient ❒ Blood ❒ Other needle ❒ Sexual ❒ Household ❒ Refused treatment transfusion exposure contact contact ____________________________ ❒ Referred to: _________________ ❒ Child care ❒ Other: ________________________________ TUBERCULOSIS (TB) TB TREATMENT INFORMATION Status Mantoux TB Skin Test Bacteriology ❒ Current Treatment ❒ Active Disease Month Day Year Month Day Year ❒ INH ❒ RIF ❒ PZA ❒ Confirmed ❒ EMB ❒ Other: ____________ ❒ Suspected Date Performed Date Specimen Collected Month Day Year ❒ Infected, No Disease ❒ Pending Date Treatment ❒ Convertor Results:______________ mm ❒ Not Done Source _______________________________________ Initiated ❒ Reactor Smear: ❒ Pos ❒ Neg ❒ Pending ❒ Not done Chest X-Ray Month Day Year Culture: ❒ Pos ❒ Neg ❒ Pending ❒ Not done ❒ Untreated Site(s) ❒ Will treat BCG Vaccine Given? Yes No ❒ Pulmonary Date Performed ❒ Unable to contact patient If yes, at what age/year? ___________________ ❒ Extra-Pulmonary ❒ Normal ❒ Pending ❒ Not done ❒ Refused treatment ❒ Both ❒ Cavitary ❒ Abnormal/Noncavitary Other test(s) ___________________________________ ❒ Referred to: _____________________ REMARKS PM 110 12/08/2009 (EPI 03/05/2010) State of California - Health and Human Sevices Agency Department of Public Health Title 17, California Code of Regulations (CCR) §2500, §2593, §2641.5-2643.20, and §2800-2812 Reportable Diseases and Conditions* § 2500. REPORTING TO THE LOCAL HEALTH AUTHORITY. ● § 2500(b) It shall be the duty of every health care provider, knowing of or in attendance on a case or suspected case of any of the diseases or condition listed below, to report to the local health officer for the juridiction where the patient resides. Where no health care provider is in attendance, any individual having knowledge of a person who is suspected to be suffering from one of the diseases or conditions listed below may make such a report to the local health officer for the jurisdiction where the patient resides. ● § 2500(c) The administrator of each health facility, clinic, or other setting