Monday, September 27, 2010

Public Health and Chemical Testing

The Centers for Disease Control (CDC) released a report last week that looks at preparedness for threats to public health from natural, accidental or intentional means. This report focuses on the CDC’s evaluation of laboratory support metrics and response performance measures for public health threats. The report (pg 6) lists four major categories of these threats
● Biological Threats
● Natural Disasters
● Chemical and Radiological Materials
● Explosions
While everyone has an interest in the effectiveness of public health services in each of these four areas, members of the chemical security community have a special interest in the third category (at least the chemical aspects of it) with a lesser specific interest in the fourth category.

Laboratory Metrics

The report identifies the key role that public health labs play in responding to public health threats. It states that (pg 21):

“Laboratories identify disease agents, toxins, and other health threats found in tissue, food, or other substances. Rapid detection and characterization of health threats is essential for implementing appropriate control measures.”
To support public health agencies the CDC manages “the Laboratory Response Network (LRN), a group of local, state, federal, and international laboratories with unique testing capabilities for confirming high priority biological and chemical agents” (pg 22). There are currently 54 LRN facilities, of which 47 are level 1 or 2 (actually capable of identifying some all or some of the biological and chemical agents identified by the CDC as being a potential threat to public health.

Those 47 labs “undergo proficiency testing to determine if they can use six core methods to rapidly detect and measure chemical agents that can cause severe health effects. These methods can help determine the scope of an incident, identify those requiring long-term treatment, assist with non-emergency medical guidance, and help law enforcement officials determine the origin of the agent.” (pg 23)

Wrong Chemical Targets

Now when people talk about ‘chemical agents’ they typically mean military grade chemical warfare agents. There is certainly some level of concern that terrorists will get their hands on military chemical munitions of some sort, or attempt to manufacture their own like we saw in Japan with the Sarin subway attacks. But this is a very low probability attack scenario; a high-consequence possibility, but a low probability event.

With low-probability yet high-consequence attacks like this it probably makes sense from a risk-management perspective to limit the equipping, training, and conducting performance evaluations on a limited number of laboratories. Unfortunately, what this report doesn’t address is who will be doing the testing on the high-probability potentially high-consequence chemical that would result from either a deliberate attack on or an accidental release from an industrial chemical facility.

Part of the reason for that issue not being addressed is the problem of the overwhelming complexity of the problem. If these LRN facilities were required to be able to effectively test for every dangerous industrial chemical that could be released in a deliberate release or a chemical accident they would not have time to complete the necessary proficiency training, much less the training require to conduct the tests.

Decentralized Testing Capability

Instead of expecting the testing methodology to be maintained at centralized testing labs, industrial chemical identification should be pushed down to the local level. Then, instead of being required to be able to test for all potential industrial chemicals, they would be able to concentrate on just those chemicals used in the local area. Each chemical facility that was required by law to maintain a chemical response plan, would be required as part of that plan to identify on site chemicals to local health agencies.

Actually there would be two categories of chemicals required to be reported. The most important would be chemicals with potential off-site chemical hazards. This would include chemicals stored on-site that were of large enough volume to have off-site consequences in the event of a worst-case release. It would also include smaller volume chemicals that were shipped to or from the facility that could be released in transit as the result of an accidental or deliberate release.

The second category would be chemicals used on site that, in the event of an on-site release could affect on-site workers or visitors. This would allow doctors to confirm the chemical contaminant affecting a particular patient when they were brought in for industrial accidents, for example.

These lists of chemicals would have benefit beyond just establishing the testing capability for these chemicals. The local health officials, armed with the list of potential local chemical injuries could ensure that treatment protocols for those chemicals were established (drawing on CDC assets to identify those protocols) and then ensuring that those protocols were distributed to local medical facilities, doctors and emergency medical responders. This would also allow for the identification of training, equipment and medical supply needs to be established for large scale chemical releases of either a deliberate or accidental origin.

Effective Chemical Public Health Preparedness

I am glad to see that the CDC is not trying to push testing requirements for low-probability chemical release testing down to the local level. Time and resources at the local level are extremely limited and need to be focused on those tasks that they will most likely be required to perform. Testing for and providing treatment for industrial chemical releases in their local communities is a much higher probability event. This is what local public health agencies and providers need to be focusing upon.

No comments:

/* Use this with templates/template-twocol.html */