Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-19T02:05:50.920Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  08 April 2013

Abstract

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.

(Disaster Med Public Health Preparedness. 2010;4:318-325)

Type
Concepts in Disaster Medicine
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Sternberg, E, Lee, GC.Meeting the challenge of facility protection for homeland security. J Homeland Secur Emerg Manag. 2006;3:1.Google Scholar
2.Chipley, M, Kaminskas, M, Lyon, W, Beshlin, D, Hester, M.Reference manual to mitigate potential terrorist attacks against buildings. http://www.fema.gov/plan/prevent/rms/rmsp426. Published December 2003. Accessed March 28, 2010.Google Scholar
3.American College of Medical Toxicology. Chemical agents of opportunity for terrorism: the medical and psychological consequences of TICs (toxic industrial chemicals) and TIMs (toxic industrial materials). http://www.acmt.net/_Library/docs/AgentsOfOpportunityDescription.doc. Accessed March 28, 2010.Google Scholar
4.Török, TJ, Tauxe, RV, Wise, RP, et alA large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. JAMA. 1997;278 (5):389395.Google Scholar
5.Kolavic, SA, Kimura, A, Simons, SL, Slutsker, L, Barth, S, Haley, CE.An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. JAMA. 1997;278 (5):396398.Google Scholar
6.Muller, RA.The dirty bomb distraction. http://muller.lbl.gov/TRessays/29-Dirty_Bombs.htm. Published June 23, 2004. Accessed October 3, 2010.Google Scholar
7.Wax, PM, Becker, CE, Curry, SC.Unexpected “gas” casualties in Moscow: a medical toxicology perspective. Ann Emerg Med. 2003;41 (5):700705.Google Scholar
8.Department of Homeland Security. Information bulletin: false hospital inspections. http://www.nefafoundation.org/miscellaneous/FeaturedDocs/DHS_FalseHospitalInspections.pdf. Published April 25, 2005.Accessed March 28, 2010.Google Scholar
9.Rotz, LD, Khan, AS, Lillibridge, SR, Ostroff, SM, Hughes, JM.Public health assessment of potential biological terrorism agents. Emerg Infect Dis. 2002;8 (2):225230.Google Scholar
10.Centers for Disease Control and Prevention. National select agent registry. 7 CFR Part 331, 9 CFR Part 121, and 42 CFR Part 73. http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html. Accessed March 28, 2010.Google Scholar
11.Drug Enforcement Administration. Controlled Substances Act. Title 21: Food and Drugs; Chapter 13: Drug Abuse Prevention and Control. http://www.justice.gov/dea/pubs/csa.html. Accessed March 28, 2010.Google Scholar
12.Nuclear Regulatory Commission. Radionuclides of Concern. http://www.nrc.gov/reading-rm/doc-collections/enforcement/security/2005/ml053130250.pdf. Accessed March 28, 2010.Google Scholar
13.Black, S, Hultquist, MLHealth care facility hazards. In: Sullivan JB, Krieger GR, eds. Clinical Environmental Health and Toxic Exposures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:600-614.Google Scholar
14.Sullivan, JB, Micale, LMMedical waste and blood-borne pathogen exposures. In: Sullivan JB, Krieger GR, eds. Clinical Environmental Health and Toxic Exposures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:623-630.Google Scholar
15.Wax, PM.Antiseptics, disinfectants, and sterilants.In: Flomenbaum N, Goldfrank LR, Hoffman RS, eds, et al. Goldfrank's Toxicologic Emergencies. 8th ed. New York: McGraw-Hill; 2006:1384-1397.Google Scholar
16.Burgess, JL.Hospital evacuations due to hazardous materials incidents. Am J Emerg Med. 1999;17 (1):5052.Google Scholar
17.Centers for Disease Control (CDC). Listeriosis outbreak associated with Mexican-style cheese--California. MMWR Morb Mortal Wkly Rep. 1985;34 (24):357359.Google Scholar
18.National Infrastructure Protection Plan. Partnering to Enhance Protection and Resiliency. Washington, DC: Department of Homeland Security; 2009.Google Scholar
19.Hauschild, VD, Bratt, GM.Prioritizing industrial chemical hazards. J Toxicol Environ Health A. 2005;68 (11-12):857876.Google Scholar
20.Dun, S, Wood, J, Martin, B.Decontamination, cleanup, and associated issues for sites contaminated with chemical, biological, or radiological materials. EPA/600/R-05/083. http://www.epa.gov/NHSRC/pubs/600r05083.pdf. Published October 2005. Accessed March 28, 2010.Google Scholar
21.Department of Homeland Security. Appendix to chemical facility anti-terrorism standards. www.dhs.gov/xlibrary/assets/chemsec_appendixafinalrule.pdf. Published 2007. Accessed March 28, 2010.Google Scholar
22.Department of Defense. Minimum antiterrorism standards for buildings. UFC 4-010-01. www.wbdg.org/ccb/DOD/UFC/ufc_4_010_01.pdf. October 8, 2003. Accessed March 28, 2010.Google Scholar
23.Barnett, DJ, Balicer, RD, Blodgett, D, Fews, AL, Parker, CL, Links, JM.The application of the Haddon matrix to public health readiness and response planning. Environ Health Perspect. 2005;113 (5):561566.Google Scholar
24.Riley, RL, Mills, E.Aerial disseminability of pulmonary tuberculosis. Am J Hyg. 1959;70:185196.Google Scholar
25.Butler, AS, Panzer, AM, Goldfrank, LR.Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington, DC: Institute of Medicine; 2003.Google Scholar
26.Environmental Protection Agency. Whitman details ongoing agency efforts to monitor disaster sites, contribute to cleanup efforts. http://yosemite.epa.gov/opa/admpress.nsf/bf92f4e7d755207d8525701c005e38d7/75aef680e69adf6585256acc007c2fc8!OpenDocument. Published September 18, 2001. Accessed March 28, 2010.Google Scholar
27.Varney, S, Hirshon, JM, Dischinger, P, Mackenzie, C.Extending injury prevention methodology to chemical terrorism preparedness: the Haddon Matrix and sarin. Am J Disaster Med. 2006;1 (1):1827.Google Scholar
28.Arnold, JL.The 2005 London bombings and the Haddon matrix. Prehosp Disaster Med. 2005;20 (5):278281.CrossRefGoogle ScholarPubMed
29.Graham, ME, Tunik, M, Farmer, BM, et alAgent of opportunity task mitigation: people, engineering and security efficacy. Disaster Med Public Health Prep. 2010;4:291299.Google Scholar