Oregon drill finds deadly germs may be put on hold
Findings could reveal similar gaps in other states
The standing gallows humor in health care epidemiology is that no really severe outbreak of anything begins until late Friday on a holiday weekend. But emergency planners in Oregon were not laughing after finding that too many local health departments — a key component in the state response system — were unavailable when contacted after hours about emergency transport of a possible pandemic flu isolate for testing at the state reference lab.
It only was a drill, of course, but it revealed a critical breakdown in the state system that could reflect similar problems in other states. Want to check? Consider this suggestion by Teresa McGivern, BS, biological response coordinator in the Oregon State Public Health Laboratory (OSPHL) in Portland:
"Our recommendation is a simple one for every infection control coordinator and [workers] in the lab and microbiology department: wait until after 5 someday and try to contact your county health department," she says. "See what you get. Call the state epi department, [too]. You can say, "This is just an exercise; I am just curious if we had a specimen right now that needed to go up to the state public health lab, could you put me in touch with somebody?' We did it as a drill. Everybody knew what was happening and it didn't work."
On the positive side, the drill led to the development of a new policy that has now been added to the emergency preparedness plan. "The plan can be used as a template for Oregon counties when urgent after-hours transport of specimens to the state public health lab is needed," McGivern says.
An after-action analysis by McGivern and colleagues found that "after multiple functional Oregon clinical lab exercises, the objective of physically transporting and tracking simulated specimens urgently during business hours was accomplished, but after-hours transport could not be met. Health department epidemiologists activate the OSPHL after hours and on weekends so that rapid testing on specimens of critical public health significance can be performed, but standardized health department plans for the urgent transport of specimens to the OSPHL were not available," according to a study presented recently in San Jose at the annual conference of the Association for Professionals in Infection Control and Epidemiology.1
Other challenges identified during the transport exercise were trying to cover all 97,000 square miles of Oregon without a statewide OSPHL courier service; dealing with 35 distinct local health jurisdictions; and finding that hospitals and clinical labs were reluctant to allow staff to initiate transport of specimens after hours due to cost and liability issues. Then there was the problem of reaching anyone after regular hours at the local health departments, though one at least had somebody answering the phones. Turns out it was a student offering to provide emergency mental health counseling, but she couldn't help on transport of threatening biological specimens.
"The hospital tried to explain what we were doing, [saying], 'This is a drill; we need to get a specimen [transported] for possible avian influenza confirmation,'" McGivern says. "The lab couldn't get through and I called and tried to explain what we were doing. I think she thought we were 'cuckoo.'"
- McGivern TE, Crandall T. Exercising the urgent transport of clinical laboratory biothreat and pandemic influenza specimens to the Oregon State Public Health Laboratory. Abstract 3-33. Presented at the Association for Professionals in Infection Control and Epidemiology. San Jose, CA; June 24-28, 2007.