For at least one household, their aggressive dog is what stood between them and the life-saving medication after a simulated anthrax attack on the Minneapolis St.-Paul area.

On May 5-6, the Minnesota Department of Health (MDH) in conjunction with the Department of Health and Human Services (HSS) and the United States Postal Service (USPS) ran the first full-scale test of a bioresponse plan that would rely on postal workers todeliver the first dose of antibiotics after a large-scale biological attack. Of 33,000 addresses, workers were unable to deliver to around 1,600 households, according to an after-action summary released by MDH on Tuesday.

The simulation,Operation Medicine Delivery, began Friday, May 4 after the first “evidence” of a likely terrorist attack involving a biological agent was discovered. The agent was “laboratory-confirmed” as anthrax and the amount of anthrax released was assumed to be sufficient to expose the entire population of the Minneapolis-St. Paul Metropolitan area.

Forty teams made up of one postal worker and one law enforcement escort mobilized and delivered simulated medications to more than 32,998 households in the Minneapolis-St. Paul (MSP) area in less than 12 hours. Untreated inhalation anthrax has a 90 percent mortality rate, but deaths from anthrax can be drastically reduced if antibiotics are started within 48 hours (the mortality rate drops to 75 percent if treated).

In the past, Jude Plessas, countermeasures distribution and delivery manager at the USPS saidthe postal service was ideal for this type of operation because of its capability to reach all addresses. But during Operation Medicine Delivery, some homes were missed, according to initial field reports.

A public summary of the final report confirmed that 1,674 homes were missed for reasons including a dangerous dog and mail slots too small to deliver medication through. MDH officials were not immediately available to provide more detail on the circumstances. For one neighborhood, high water from heavy rains left it inaccessible by vehicles, according to initial field reports. 

“If this was a real emergency we would message those folks and tell them they shouldgo to a medical distribution center[later] instead,” said USPS spokesman Pete Nowacki after the exercise.

Communication with the public prior to the exercise, command operations, law enforcement participation, and response to “real world incidents,” like flat tires and traffic congestion were noted as the operation’s major strengths. However, the report said more clarity was needed regarding who has authority to reallocate teams after a delivery and what terminology would be used to indicate route completion.

USPS and public health officials are pleased with the initial results. “We think that this exercise really established that the postal option is a viable way to get medicine to the public quickly in an emergency," said MDH spokesman Buddy Ferguson during an interview in May.

The report released on Tuesday echoes his sentiment and Operation Medicine Delivery will be used to establish baseline metrics for the National Postal Model.

“The lessons learned during the planning process and identified throughout exercise play will help inform other jurisdictions that are beginning to incorporate the Postal Plan model into their mass prophylaxis plans,” the report says.

The non-public after-action report is still in draft form and "won’t be completed for a while," an MDH official said. Click below to read the 8-page summary released by MDH.OMD - Public Summary.pdf

photo bydoophallus/flickr