In 2001, the Centers for Disease Control and Prevention (CDC) conducted an investigation and response to the release of Bacillus anthracis (the causative agent of anthrax) in the U.S. postal system. Approximately 1,700 CDC staff members worked on more than 20 teams at CDC headquarters in Atlanta, Ga., and in the field during this investigation and response. Federal, state, and local agencies collaborated with CDC to mitigate the public-health impact of the intentional anthrax release. Although most of the CDC staff members involved had never worked on a bioterrorism response before, their basic skill sets (e.g., epidemiology, laboratory, environmental microbiology, and public information) were needed to meet the potentially massive threat. After the event, CDC officials learned that many staff members had spent valuable time searching for documents, including patient management guidelines, lab protocols, clinical and immunization protocols, and on-call rosters.
The speed with which CDC responded to the 2001 threat would be equally essential to the success of an investigation of any infectious-disease outbreak. The CDC participants recognized the need for a comprehensive information system that would be a one-stop database for both headquarters and field personnel. The new system also would provide important information for staff members working on large-scale events outside of their own areas of expertise.
The system used in 2001 and since is called the All Threats Agent Content System (ATACS) – a name selected because it not only provides information on infectious-disease threats but also can be expanded to include information on non-infectious agents – e.g., chemicals as well as radiation and nuclear materials – that could, if released, have profound public-health consequences.
When Time Is of the Essence
Because ATACS was intended primarily for use by experienced public-health professionals with a limited amount of time available to search for information, the system needed to be: (a) quick; (b) intuitive; (c) secure; and (d) searchable. The design of the system was based on an organizational model created during the 2001 anthrax event. CDC staff started by creating a columnar matrix to represent pathogens of interest (e.g., plague, smallpox, tularemia, botulism, anthrax, and viral hemorrhagic fever), crossed by rows representing several categories of critical components. Content information appears when the user navigates to the intersection of any agent and any critical component.
The critical-component categories listed are: emergency-response plans; media/communications outlets; quarantine information; environmental microbiology information; patient-management guidelines; investigational/research informational materials; epidemiology/surveillance information; professional information; a list of vaccines and pharmaceuticals; food information; the names of public-health partners; water information; infection-control information; public information guidelines; and both zoonotics and laboratory information.
In addition to the pathogen-specific information, the CDC staff included cross-cutting content across the pathogens. This section contains critical components common across all pathogens and procedures that do not require frequent updates, specifically including the following: clearance procedures; communications/media instructions; deployment protocols; information-technology (IT) guidelines; other preparedness/response plans; lists of public-health partners; quarantine regulations; select agent lists; shipping regulations; strategic national stockpile locations; and lists of subject-matter experts/points of contact.
One ancillary benefit provided by use of the ATACS system is its ability to assess (not measure) various levels of preparedness. For example, each matrix box includes certain definitive content. Empty matrix boxes clearly imply, therefore, a knowledge gap for that particular component. In turn, the information gaps not only prompt adjustments to the CDC’s strategic-research agenda but also provide a method to facilitate improvements in the overall level of agency preparedness.
ATACS-like systems can easily be adapted by other organizations whose staff perform duties similar, but not identical, to their normal responsibilities during significant events. Moreover, ATACS need not be limited to terrorism or bioterrorism events; CDC recently enhanced ATACS to include pandemic-influenza information that would be helpful in preparing for an influenza pandemic. This enhancement will allow hundreds of CDC staff personnel to work more effectively in the future on a pandemic-flu response, even if influenza is not necessarily in their own areas of expertise.
Joe Posid, the principal author of this article, is an emergency response coordinator, who since 2001 has worked in CDC's Coordinating Center for Infectious Diseases and the center's Coordinating Office for Terrorism, Preparedness, and Emergency Response. Also contributing significantly to the preparation of the article were: Julie T. Guarnizo, a Northrop Grumman contractor with CDC's Division of Bioterrorism Preparedness and Response; Molly Kellum, a CDC laboratorian and program/policy liaison who has worked in several CDC divisions dealing with infectious diseases and environmental emergencies; and Cathy Stout, a former public-health advisor and recent CDC retiree who worked for six years on the development and implementation of the ATACS system.