RECOGNITION & PREPARATION OF A BIOINCIDENT & INITIAL MITIGATION
The concept of integrated, layered CBRN defense (Protect, Understand, Mitigate) can also be adapted to the preparation, recognition, and mitigation of a bioincident (Figure 5 and Figure 6). Note that the “red flags” contained in Figure 5 are combined from multiple sources.16,25,27 Some of the “red flags” suggest a deliberate source causing a bioincident, while others are less specific, indicating either a natural or deliberate source.
Once a potential bioincident is recognized, initial mitigation steps need to focus on surveillance and control measures, medical situational awareness, and obtaining the appropriate resources and assistance to mitigate the event (Figure 6). For a comprehensive review of bioreponsiveness, see the NATO Smart Defence Project 1.1045 Concept of Operations. 58,59 See Table 10 for a perspective on how different medical staff critical tasks could progress for any given bioincident from pre-event to recovery.
Rapid initiation of outbreak investigations and implementation of basic control measures are critical to reduce risk in a suspected bioincident. While outbreak investigations are primarily a Preventive Medicine (PVNTMED) function,12 all tactical care providers must understand the basics of how to recognize an outbreak, understand the steps of outbreak investigation (Table 11), be able to initiate basic control measures and report up the chain of Command (Table 12). Understanding these concepts will allow earlier investigation/notification of an outbreak and will be important in a PCC environment during LSCO in the event there is a delay in mobilizing PVNTMED support. Once the disease is recognized, appropriate prophylaxis, treatment, and other measures to decrease disease spread, such as isolation (if needed for a contagious illness) are instituted. An expanded table of outbreak investigation steps for PVNTMED staff is contained in Appendix F. Outbreak response plans should be predefined and exercised by Commands to ensure all elements understand their roles during an outbreak.