title: A decision framework for coordinating bioterrorism planning: lessons from the BioNet program.
abstract: BACKGROUND
  Effective disaster preparedness requires coordination across multiple organizations. This article describes a detailed framework developed through the BioNet program to facilitate coordination of bioterrorism preparedness planning among military and civilian decision makers.
  
  
  METHODS
  The authors and colleagues conducted a series of semistructured interviews with civilian and military decision makers from public health, emergency management, hazardous material response, law enforcement, and military health in the San Diego area. Decision makers used a software tool that simulated a hypothetical anthrax attack, which allowed them to assess the effects of a variety of response actions (eg, issuing warnings to the public, establishing prophylaxis distribution centers) on performance metrics. From these interviews, the authors characterized the information sources, technologies, plans, and communication channels that would be used for bioterrorism planning and responses. The authors used influence diagram notation to describe the key bioterrorism response decisions, the probabilistic factors affecting these decisions, and the response outcomes.
  
  
  RESULTS
  The authors present an overview of the response framework and provide a detailed assessment of two key phases of the decision-making process: (1) pre-event planning and investment and (2) incident characterization and initial responsive measures. The framework enables planners to articulate current conditions; identify gaps in existing policies, technologies, information resources, and relationships with other response organizations; and explore the implications of potential system enhancements.
  
  
  CONCLUSIONS
  Use of this framework could help decision makers execute a locally coordinated response by identifying the critical cues of a potential bioterrorism event, the information needed to make effective response decisions, and the potential effects of various decision alternatives.
authors.affiliation: Sandia National Laboratories, Livermore, California, USA.
authors.forename: Dawn K
authors.initials: DK
authors.lastname: Manley
authors.forename: Dena M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D023482:Bioterrorism; D003661:Decision Support Techniques; D004189:Disaster Planning / Q000458:organization & administration*; D006801:Humans