This Is a Test: Georgia Practices for Bioterrorist Threats

It is November 2015, and Georgia’s emergency personnel are preparing to respond to an outbreak of plague.

Don’t worry, it’s not the real plague. This is only a test. No one is actually sick or in any danger. But what if it were real?

Armed with the knowledge that practice makes perfect, the Georgia Department of Public Health is conducting a statewide exercise to test its systems and practice responding to a large-scale public health emergency. In this case, the state is simulating a bioterrorist attack involving an intentional release of the communicable Category A biological agent Yersinia pestis, commonly known as plague. It is a giant effort involving the entire state: all 18 regional emergency operations centers are activating, and they are working closely with CDC.

It’s all pretend, but for those participating, the exercise is very real. There are real phone calls and real trucks and drivers delivering real pallets of materials with real bottles (of pretend medicine). Each pallet and bottle has a real lot number for tracking. Real people – volunteers – will test their ability to dispense medicine quickly in every corner of the state. It’s a critical part of being ready to save lives in case of a bioterrorist attack.

Making the call

The exercise begins with a phone call from the Georgia Department of Public Health to the watch desk located inside CDC’s Emergency Operations Center. In an actual event, this would be the first step to set plans in motion.

“When the state makes that first call to request assistance from the Strategic National Stockpile, they need to be able to tell us who, what, when, where, and how many,” explains Pete Alvarez, an emergency management specialist in CDC’s Strategic National Stockpile who helps states coordinate exercises like this one. “The most vital piece of information we need in the beginning is how many people are potentially affected.”

This exercise uses an imaginary, but realistic, scenario: plague has been released by a person, or group of people, dressed as a gardener spraying “pesticide” at several large outdoor events across the state. The aerosolized plague has been detected and now presents a danger to everyone in the community.

The initial phone call reporting the incident to CDC sets off a cascade of activity. The watch desk officer takes note of the relevant information, particularly the large number of patients said to be presenting with symptoms. Immediately, the officer reaches out to CDC’s experts – both subject matter experts in plague and those who manage CDC’s stockpile, the nation’s largest supply of life-saving medicines and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.

Within 30 to 45 minutes, everyone, including CDC leadership, is on the line to discuss the specific health threat, consider the number of people affected, and make the best possible decisions to control the disease right away.

Getting things moving

Plague has a 2-day incubation period, and people who are exposed must receive antibiotic prophylaxis right away. Therefore, once plague is suspected or identified, state and local responders have to act fast. Due to the magnitude of this incident, authorities agree mass amounts of antibiotics from CDC’s stockpile need to be delivered to the affected area as quickly as possible.

Logistics experts with CDC’s stockpile quickly coordinate with commercial transportation partners who will provide trucks to deliver the medicines and relay anticipated delivery timelines to the state.

Meanwhile, a flurry of preparation takes place. While the trucks are on the way, the team in CDC’s stockpile warehouse pulls the requested products and prepares them for pick up. Georgia officials are getting ready to receive and stage the coming shipments. Emergency responders take their stations. Public health officials begins setting up “PODs” – points of dispensing – in public areas and at places of business. This is where people will come to get the medicine. Volunteers, both from the Medical Reserve Corps and the community, line up to act as “patients.”

Testing the system

Many of the PODs are set up in large parking lots, at malls, and other places in the community. Some are set up as drive-thrus. People in cars can bring a pre-filled “head of household” form to the line and pick up antibiotics for their whole family. Cars pull up to three stations, one at a time. First is reception, where volunteers hand in their forms. Next is triage, where they answer questions about their health and the health of others who will be taking the antibiotics (a separate line handles those with health concerns, like those who are pregnant or have allergies). Next, they receive a supply of medication to take home.

At least 50 volunteers move through each POD to test how quickly and efficiently the system works. Every person and every bottle of medicine at every station across the state is tracked carefully and logged. The state and regional emergency operations centers stay nimble and ready to add resources or shift focus at a moment’s notice.

While the exercise is taking place, emergency planners insert what are called “injects” into the process. An “inject” is a surprise issue that comes up during the exercise, and it is meant to simulate the kinds of unexpected twists that can happen during a real response. For instance, a team in the field might send a message back to the state emergency operations center that they have not received the right amounts of each antibiotic or that a patient has presented with an allergic reaction to the medicine. Each “inject” tests how a different part of the system will react when things do not go as planned. In an emergency, you have to be ready for anything.

Help from all corners

To make this exercise as real as possible, Georgia invites other partners to join in the activities. They reach out to all the states in FEMA region 4 to figure out how neighboring states can help each other if an emergency like this actually happens.

They conduct a communication drill with ham radio operators in Tennessee, Alabama, Mississippi, and Florida. Ham operators are especially prepared to step in if regular communication channels are compromised, providing a critical lifeline in emergencies.

“We also practiced air transport with the National Guard,” said Charlisa Bell, planning and exercise manager at the Georgia Department of Public Health. “We put the request in through our state operations center. They brought in a Black Hawk, loaded it, and delivered medication to one of our remote districts.”

Lessons learned

In the end, the drill goes off without a hitch. But it teaches a few good lessons along the way, helping the state firm up its plans for staffing, volunteer training, and building security.

“The exercise was well planned and coordinated,” said Alvarez. “The state wanted to know its gaps – public health planners were not afraid of finding out what they needed to improve. They did really well.”

Collaborative exercises like the one in this story are a critical part of keeping our nation’s health secure. The Public Health Emergency Preparedness (PHEP) cooperative agreement provides funding guidance to Georgia and other state and local health departments to help them develop and test response plans so that, when a real event occurs, the state is better prepared to protect its citizens.