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Cover of Regionalization of Bioterrorism Preparedness and Response

Regionalization of Bioterrorism Preparedness and Response

Evidence Reports/Technology Assessments, No. 96

, MD, MS, Project Director, , MM, Stanford-UCSF EPC Associate Director, and , MD, MS, Principal Investigator and EPC Director. Investigators: , BA, , PhD, , PhD, , MD, , MD, MPH, MBA, and , MPH.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 04-E016-2ISBN-10: 1-58763-150-4

Structured Abstract


No single community can prepare fully, nor respond completely, to a large-scale bioterrorism event. Regionalization of some aspects of preparedness planning for bioterrorism may facilitate a timely and effective response.


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.

Data Sources:

We searched the medical, emergency management, and supply chain management literatures and government documents. For each literature, we searched databases (e.g., MEDLINE®), Web sites, prominent journals, and bibliographies of retrieved articles.

Study Selection:

We sought articles describing the key tasks during responses to bioterrorism or bioterrorism-related events, the resources required for these responses, and existing regional systems for delivery of these resources. We included articles describing regionalized responses to the 2001 anthrax attack, naturally occurring outbreaks, and disasters; we also included articles describing regionalized systems for trauma care, bioterrorism surveillance, and the bioterrorism response supply chain.

Data Extraction:

From articles meeting the inclusion criteria, we extracted information about the type of regionalized response system described in the article, whether it had been evaluated, and any evaluative results reported.

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.


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.


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.


Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract Number 290-02-0017. Prepared by: Stanford-UCSF Evidence-based Practice Center.

Suggested citation:

Bravata DM, McDonald KM, Owens DK, Wilhelm ER, Brandeau ML, Zaric GS, Holty JEC, Liu H, Sundaram V. Regionalization of Bioterrorism Preparedness and Response. Evidence Report/Technology Assessment No. 96. (Prepared by Stanford-University of California San Francisco Evidence-based Practice Center under Contract No. 290-02-0017.) AHRQ Publication No. 04-E016-2. Rockville, MD: Agency for Healthcare Research and Quality. April 2004.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.


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Bookshelf ID: NBK37270


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