| Identify agents | IDENTIFY nuclear, biological or chemical agents from signs and clinical history, autopsy and other evidence. |
| Generate bioterrorism response plan | GENERATE a public health bioterrorism (BT) response plan for epidemiology and surveillance (OR Environmental Health OR Public Health Laboratory OR Medical Examiner’s Office OR Public Health Information Office) that is integrated with the emergency response plan for the agency by applying the following competencies: |
| Establish communications roles | ESTABLISH emergency communications roles and responsibilities for bioterrorism response. |
| Maintain resource directory | MAINTAIN a directory of materials and resources on bioterrorism. |
| Prepare for crime scenes | PREPARE public health personnel responding to a bioterrorism event regarding procedures of crime scene preservation, proper handling, transportation and storage of criminal evidence. |
| Ensure laboratory capacity | ENSURE Level A laboratories can conduct "rule-out" testing, specimen packaging and handling, and referral of suspected biological threat agents to a higher level laboratory and that Level B and Level C laboratories have the capacity and proficiency to identify and confirm biological threat agents and can refer specimens to higher level laboratories for further characterization. |
| Ensure lab bioterrorism plans | ENSURE that laboratories within the jurisdiction or agency have bioterrorism response plans. |
| Identify Level A labs | IDENTIFY Level A laboratories serving the jurisdiction or agency. |
| Maintain info on B and C labs | MAINTAIN contact and location information for Level B/C laboratories in the bioterrorism lab response network serving the agency or jurisdiction. |
| Establish written lab policies | ESTABLISH written policies and procedures for rapid (lab) identification and electronic reporting of results. |
| Define lab communication plans | DEFINE laboratory communications plans and protocols for disseminating information to emergency response partners during a public health emergency. |
| Establish LRN protocols | ESTABLISH written Laboratory Response Network (LRN) approved protocols. |
| Maintain agent protocols | MAINTAIN agent identification protocols to be used in the laboratory. |
| Maintain lab training | MAINTAIN ongoing training to ensure specimen security, including transportation of specimens, limiting access to reference cultures, isolates, etc. |
| Delineate environmental protocols | DELINEATE protocols for patient decontamination, and environmental remediation, including populations with special needs. |
| Develop risk assessment protocols | DEVELOP protocols for risk assessment of potential biological, chemical or radiological hazards in the community to determine roles and responsibilities of those involved in public health bioterrorism response. |
| Establish SNS protocols | ESTABLISH protocols for handling and distribution of the Strategic National Stockpile |
| Establish lab system | ENSURE a system is established and functioning that provides rapid rule-out testing, referral, identification, confirmation, and characterization of biological threat agents to include rapid reporting of results during a bioterrorism event. |
| Design enhanced surveillance protocols | DESIGN bioterrorism specific protocols for enhanced surveillance, including activating additional personnel (e.g., infection control practitioners, public health nurses, epidemiologists, and data entry clerks from other institutions, jurisdictions and/or agencies). |
| Generate risk assessment plans | GENERATE plans to conduct risk assessments in public health emergencies. |
| Establish surge capacity protocols | ESTABLISH protocols to address public health surge capacity, including the use of volunteers. |
| Evaluate drills | EVALAUTE every emergency response drill to identify needed internal/external improvements. |
| Integrate response plans | INTEGRATE the agency's bioterrorism response plan into the Incident Command or Unified Command System used by other responders (Fire, Police, Etc.) in the jurisdiction. |
| Determine roles through risk assessments | USE risk assessment of potential biologic, chemical or radiological hazards in the community to determine roles and responsibilities of those involved in public health bioterrorism response. |
| Define further investigation needs | DEFINE algorithms that trigger further epidemiological investigation. |
| Manage psychological impact | RECOGNIZE and TREAT the psychological impact of bioterrorism event on victims and health care professionals. |
| Ensure psychological support | ENSURE ongoing support for the psychological impact of a Weapons of Mass Destruction (WMD) event on the families of victims. |
| Handle human remains | HANDLE human remains appropriately, addressing safety, psycho-social, and forensic needs. |
| Address training gaps | ENSURE that knowledge/skill gaps identified through emergency response evaluation are filled. |
| Evaluate event response | EVALUATE every emergency response to identify needed internal/external improvements. |
| Apply recovery measures | APPLY appropriate science-based public health measures to ensure continued population protection appropriate to the biological threat involved, including follow up of those exposed, vaccinated, or quarantined. |