A decision framework for coordinating bioterrorism planning: Lessons from the BioNet program

Dawn K. Manley, PhD, Dena M. Bravata, MD, MS

Abstract


Background: Effective disaster preparedness requires coordination across multiple organizations. This article describes a detailed framework developed through the BioNet program to facilitate coordination of bioterrorism preparedness planning among military and civilian decision makers.
Methods: The authors and colleagues conducted a series of semistructured interviews with civilian and military decision makers from public health, emergency management, hazardous material response, law enforcement, and military health in the San Diego area. Decision makers used a software tool that simulated a hypothetical anthrax attack, which allowed them to assess the effects of a variety of response actions (eg, issuing warnings to the public, establishing prophylaxis distribution centers) on performance metrics. From these interviews, the authors characterized the information sources, technologies, plans, and communication channels that would be used for bioterrorism planning and responses. The authors used influence diagram notation to describe the key bioterrorism response decisions, the probabilistic factors affecting these decisions, and the response outcomes.
Results: The authors present an overview of the response framework and provide a detailed assessment of two key phases of the decision-making process: (1) pre-event planning and investment and (2) incident characterization and initial responsive measures. The framework enables planners to articulate current conditions; identify gaps in existing policies, technologies, information resources, and relationships with other response organizations; and explore the implications of potential system enhancements.
Conclusions: Use of this framework could help decision makers execute a locally coordinated response by identifying the critical cues of a potential bioterrorism event, the information needed to make effective response decisions, and the potential effects of various decision alternatives.


Keywords


bioterrorism, decision making, organization and administration, regional health planning

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References


Hurricane Katrina: Providing oversight of the nation’s preparedness, response, and recovery activities, US General Accounting Office. GAO Publication GAO-05-1053T, September 28, 2005.

Russell C: BioNet program manager, Defense Threat Reduction Agency ed., 2006.

Nease RF Jr, Owens DK: Use of influence diagrams to structure medical decisions. Med Decis Making. 1997; 17(3): 263-275.

Owens DK, Shachter RD, Nease RF Jr: Representation and analysis of medical decision problems with influence diagrams. Med Decis Making. 1997; 17(3): 241-262.

Howard R, Matheson J: Influence diagrams. In: Howard R, Matheson J (eds.): The Principles and Applications of Decision Analysis. Palo Alto, CA: Strategic Decisions Group, 2004: 719-762.

Owen D: The use of influence diagrams in structuring complex decision problems. In: Howard R, Matheson J (eds.): The Principles and Applications of Decision Analysis. Palo Alto, CA: Strategic Decisions Group, 2004: 763-771.

Shea D, Lister S: The BioWatch Program: Detection of Bioterrorism. Congressional Research Service. November 19, 2003.

Bravata DM, McDonald KM, Szeto H, et al.: A conceptual framework for evaluating information technologies and decision support systems for bioterrorism preparedness and response. Med Decis Making. 2004; 24(2): 192-206.

Fowler RA, Sanders GD, Bravata DM, et al.: Cost-effectiveness of defending against bioterrorism: A comparison of vaccination and antibiotic prophylaxis against anthrax. Ann Intern Med. 2005; 142(8): 601-610.

Bravata DM, Zaric GS, Holty JE, et al.: Reducing mortality from anthrax bioterrorism: Strategies for stockpiling and dispensing medical and pharmaceutical supplies. Biosecur Bioterror. 2006; 4(3): 244-262.

Cannon CE, Pavlin JA, Vaeth MF, et al.: Department of Defense West Nile virus surveillance. Ann N Y Acad Sci. 2001; 951: 340-342.

Kortepeter MG, Pavlin JA, Gaydos JC, et al.: Surveillance at US military installations for bioterrorist and emerging infectious disease threats. Mil Med. 2000; 165(8): ii-iii.

Lewis MD, Pavlin JA, Mansfield JL, et al.: Disease outbreak detection system using syndromic data in the greater Washington DC area. Am J Prev Med. 2002; 23(3): 180-186.

Pavlin JA, Mostashari F, Kortepeter MG, et al.: Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: Results of an interagency workshop on health indicator surveillance. Am J Public Health. 2003; 93(8): 1230-1235.

Heatherley SS: The laboratory response network for bioterrorism. Clin Lab Sci. 2002; 15(3): 177-179.

Vanner CL, Combs WS Jr, Bertrand T, et al.: Identifying bacterial agents of bioterrorism: The pivotal role of the laboratory response network .2. Med Health R I. 2001; 84(5): 178-180.




DOI: http://dx.doi.org/10.5055/ajdm.2009.0007

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