Authors' objectives:

The purpose of this project was to first identify the key tasks of responders during a bioterrorism response and the resources required to perform them, and then to evaluate the evidence about the potential effectiveness of existing regional systems for the delivery of these resources and services for bioterrorism preparedness and response.

Authors' results and conclusions: Data Synthesis: We reviewed 9542 publications and more than 500 Web sites. Of these, 396 articles, 61 government reports, and 75 Web sites met our inclusion criteria. We found numerous existing regionalized systems for the delivery of goods and services relevant to bioterrorism preparedness and response; however, these systems are not well coordinated and few have been evaluated for their ability to facilitate a response to bioterrorism or a bioterrorism-relevant event. For example, we found that the regionally organized Laboratory Response Network provided laboratory surge capacity during the 2001 anthrax attack and that an international research network rapidly identified the pathogen during the SARS outbreak. In several instances, mutual aid agreements successfully facilitated the regional provision of emergency goods and services; and regionalization of trauma care has reduced costs and improved patient outcomes. How well these regional systems would perform during a large-scale bioterrorism event remains untested. Simulations: Because we found no evidence describing regionalization of bioterrorism surveillance, we developed a simulation model to evaluate the tradeoffs in sensitivity and specificity when analyzing surveillance data locally as opposed to regionally. We found that warning thresholds may need to be modified to prevent increases in false positives when pooling data. Because we found no evaluations of regionalized inventory management for resources for bioterrorism responses, we developed a simulation model to address the costs and benefits of differing strategies for pre-attack stockpiling and post-attack distribution of antibiotics. Preliminary results indicate that the number of deaths resulting from an anthrax-like attack is sensitive to the number of people seeking prophylactic antibiotics and to the time required for dispensing. Maintaining local inventories is only effective when the probability of bioterrorism is relatively high.

Authors' recommendations: Numerous regional systems exist for responding to bioterrorism; however, few have been evaluated. Efforts to coordinate them are ongoing and would likely benefit from evaluations of regionalized information management systems; of strategies to rapidly distribute and dispense pharmaceuticals and other response resources; and of plans to specify response roles, remuneration, and chain of command.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/bioregtp.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)