Coordinated response to reports of possible anthrax contamination, Idaho, 2001 - Bioterrorism-Related Anthrax

Emerging Infectious Diseases, Oct, 2002 by Leslie Tengelsen, Richard Hudson, Shana Barnes, Christine Hahn

In 2001, the intentional release of anthrax spores in the eastern United States increased concern about exposure to anthrax nationwide, and residents of Idaho sought assistance. Response from state and local agencies was required, increasing the strain on epidemiologists, laboratorians, and communications personnel. In late 2001, Idaho's public health communications system handled 133 calls about suspicious powders. For each call, a multiagency bridge call was established, and participants (public health officials, epidemiologists, police, Federal Bureau of Investigation personnel, hazardous materials officials, and others) determined which samples would be tested by the state public health laboratory. A triage system for calls helped relieve the burden on public safety and health systems.

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After the intentional spread of anthrax spores in 2001, states without anthrax cases were nonetheless affected by the outbreak. Idaho recorded a sharp rise in emergency calls, and the response requirements for traditional first responders, public health officials, laboratorians, and communications personnel increased. Before the outbreak, public health officials and first responders had little experience in jointly managing health-related issues. New response protocols and functional interagency relationships needed to be developed rapidly. Responders were faced with new scenarios and an increased call volume. In addition, safe handling protocols were needed for managing potential anthrax cases and handling clinical samples. The response and distribution of timely, accurate information between local, state, and federal public health partners, first responders, the health-care community, and the general public were crucial. Through this experience, procedures have been streamlined for a more effective response.

Notification and Initial Response to Possible Anthrax Exposures

Anecdotal information suggests that all states had to respond to public inquiries about powdery substances found in the mail or public areas. Despite being removed geographically from anthrax cases and contaminated sites, Idaho was no exception. The state uses a centralized State Emergency Medical Services Communications Center (StateComm), which receives emergency calls in areas that lack 911 services and provides the emergency communication system for and between all state agencies. This center was established in 1974 through a Robert Wood Johnson Foundation grant to enhance rural Emergency Management System communications services but has expanded over the last 10 years to include public health inquiries. StateComm, which is part of the Idaho Department of Health and Welfare, operates 22 remote mountaintop transmitter sites connected by microwave links to a central location. StateComm staff dispatch regional hazardous materials (hazmat) teams, page public health officials, and provide bridge call services; up to 48 ports are available for a single bridge call.

From August 1 to October 7, 2001, StateComm received 73 routine hazmat calls and no biohazard calls, which was a typical calling pattern for the hotline (Figure). However, from October 8 to December 31, 2001, StateComm received 53 routine hazmat calls and 133 biohazard calls; all biohazard calls were related to suspicious powders. Most of the biohazard calls were made by local law enforcement, who were on-scene incident commanders following state hazmat response protocols during powder investigations. StateComm staff then convened emergency bridge calls for each biohazard call and used state hazmat protocols to determine who should participate in the call. Public health, law enforcement (including Federal Bureau of Investigation [FBI]), hazmat, and other officials routinely participated in these calls and discussed how to respond to possible anthrax exposures. All powder-related incidents were treated as potential criminal acts, and all samples were maintained as evidence to ensure a standardized response. For each call, participants asked the incident commander if a written threat was present and who was the apparent target. If an envelope or package had a return address, the on-scene incident commander contacted the sender to verify that he or she sent the item and to identify its contents. The threat level was then assessed based on suspicious package guidelines (1) and other requirements listed previously.

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During the first days of calls, emergency bridge call participants agreed that no samples would be sent to the state public health laboratory for testing until approved by call participants. The state public health laboratory was notified when samples were routed to them. Persons who may have been exposed to anthrax were informed by the on-scene incident commander that results would be available within 48 h, that antibiotics were not recommended pending test results, and that they were free to consult with their medical provider. With this protocol, only 50 (37.6%) of the biohazard calls yielded items for testing by the state Bureau of Laboratories. All test results from the laboratory were reported directly to StateComm, which then notified the on-scene incident commander of the results.