Developing a Consensus Framework and Risk Profile for Agents of Opportunity in Academic Medical Centers: Implications for Public Health Preparedness

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>Agents of opportunity (AO) in academic medical centers (AMC) are defined as unregulated or lightly regulated substances used for medical research or patient care that can be used as “dual purpose” substances by terrorists to inflict damage upon populations. Most of these agents are used routinely throughout AMC either during research or for general clinical practice. To date, the lack of careful regulations for AOs creates uncertain security conditions and increased malicious potential. Using a consensus-based approach, we collected information and opinions from staff working in an AMC and 4 AMC-affiliated hospitals concerning identification of AO, AO attributes, and AMC risk and preparedness, focusing on AO security and dissemination mechanisms and likely hospital response. The goal was to develop a risk profile and framework for AO in the institution. Agents of opportunity in 4 classes were identified and an AO profile was developed, comprising 16 attributes denoting information critical to preparedness for AO misuse. Agents of opportunity found in AMC present a unique and vital gap in public health preparedness. Findings of this project may provide a foundation for a discussion and consensus efforts to determine a nationally accepted risk profile framework for AO. This foundation may further lead to the implementation of appropriate regulatory policies to improve public health preparedness. Agents of opportunity modeling of dissemination properties should be developed to better predict AO risk.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2010;4:318-325)</jats:p>

Accidental organophosphate insecticide intoxication in children: a reminder

“…Tachycardia, however, is not a contraindication to atropine administration [12]. The pupillary response (resolution of miosis) is not considered an end point of atropine therapy, as miosis may persist for weeks after significant exposure [11]. In our cases, the miosis was resolved within 12 and 24 h in the girl and boy, respectively.…”

“…Frequent atropine doses or continuous titrated infusions are used to achieve drying of secretions and the resolution of bradycardia [11,12]. Tachycardia, however, is not a contraindication to atropine administration [12].…”

“…A different dose of pralidoxime or a continuous infusion is used in severe poisoning up to the resolution of the symptoms or restoration of normal plasma PCE levels [13]. …”

Biowarfare and Bioterrorism

“…To provide the best possible overall perspective on the epidemiology of bioterrorism agents, Table 4 offers a comprehensive overview of past use of bioweapons as compiled from several sources. 1,4,6,7,13,19,22,24,[35][36][37] In addition to the general risks discussed in the introduction, academic health centers potentially play a unique role in the epidemiology of bioterrorism. Any public area where mass gatherings occur or any infrastructure critical for the smooth functioning of society are potential targets for bioterrorism attacks.…”

Applying the Haddon Matrix to Hospital Earthquake Preparedness and Response

“…28 The World Health Organization, as a component of its Framework for Action 2005-2015, sought to enhance resilience to disasters for hospitals and health facilities as part of its multi-agency Safe Hospitals Initiative. 29 Despite these wide-ranging applications, the Haddon matrix has rarely been used to examine vulnerable infrastructure, 30,31 including hospitals. 22 This gap is critical given the large global burden of earthquake-associated morbidity, mortality, and displacement 32 and adverse impact on critical infrastructure such as hospitals.…”