Lab Matters Winter 2019 | Page 16

FROM THE BENCH Ricin Exercise a Win-Win in Arizona By Susan Runcorn, MS, chemical threat coordinator, Chemical Emergency Response Program, Bureau of State Laboratory Services, Arizona Department of Health Services Every year Arizona infectious disease epidemiologists put together an exercise for the state’s public health community. Typically, the exercise involves identification and response to a viral or bacterial outbreak but in July of 2018, the Arizona Chemical Emergency Response (CT) section was invited to participate in development and facilitation of the exercise involving contamination of food with ricin. Ricin is a toxin found naturally in castor beans. When processed, it can harm people if released into water, air or food. At monthly meetings, the Arizona CT section collaborated with other members of the planning team to develop a realistic scenario that would meet benchmarks for a Homeland Security Exercise and Evaluation Program (HSEEP) exercise. The scenario centered on an intentional ricin poisoning of parmesan cheese by a couple of disgruntled former employees at a distribution plant. The scenario began with students getting sick at school, which led exercise participants to believe the poisoning was from food at a school club party. Eventually it ended at a food court in an Arizona expo center. The Arizona CT section provided guidance to the planning team to ensure the accuracy of the scenario. It shared recommended timelines, relevant partners and specimen type, and explained that in an actual event initial analysis of clinical specimens would occur at the US Centers for Disease Control and Prevention (CDC) with shipment facilitated by the CT section. If a surge of specimens was expected, the Laboratory Response Network for Chemical Threats (LRN-C) would activate all capable Level 1 and 2 labs across the country. The CT section also detailed its sample submission procedures, how long testing would take, and matrix and shipping requirements. The exercise brought together a diverse group of 175 participants who were divided into 10 groups. Each group included a representative from first responders (either law enforcement or local fire department), county epidemiology, environmental health, infection prevention, preparedness and public health nursing plus a health officer. Groups were all assigned a facilitator and an evaluator. A CT section representative was one of the facilitators. During breaks, all 175 participants met to discuss key questions and determine lessons learned. For example, though many jurisdictions had good processes in place for shipping of specimens from patients potentially exposed to bioterrorism agents, some were not prepared for this type of response. The exercise briefback allowed participants to discuss different approaches to address this gap and to share what they had learned in their groups. In addition, the briefback gave facilitators a chance to see where they might be able to improve. Overall, the exercise went well. Participants successfully navigated a novel (for Arizona) chemical exposure event. They quickly identified that the patients had been exposed to a toxin based on the symptomology and were eager to learn about proper response and recovery from such an exposure. At the end of the exercise, a panel of representatives from Poison Control, the FBI and Arizona’s CT program answered questions about the exercise and chemical exposures in general. The introductory group session during the 2018 Arizona Infectious Disease Exercise As a result of the exercise, the Arizona CT section has built new relationships with state epidemiologists, county public health partners and poison control. As a result of the exercise, the Arizona CT section has built new relationships with state epidemiologists, county public health partners and poison control. Local health workers are thinking about how to respond to a toxin or chemical exposure as well as a viral or bacterial outbreak. Moreover, local hospital staff are familiar with procedures for CT specimen collection, packaging and shipment, and with the capabilities and roles of the Arizona state laboratory and the CDC. Many thanks to Rebecca Kruc, a CDC Field Preparedness Assignee, for including the Arizona CT section in this exercise and for spending so many hours in writing and editing. Joli Weiss and her team of epidemiologists also worked hard to put the exercise and conference together. Another thank you to the CDC for providing support and guidance to the LRN-C. n Ricin is a toxin found naturally in castor beans. 14 LAB MATTERS Winter 2019 PublicHealthLabs @APHL