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Biopreparedness in Nebraska

The terrorist attacks on September 11, 2001, and the anthrax attacks that followed, forever changed the biopreparedness landscape in the United States. The federal government poured funding into the states to improve health care infrastructures in the event of future disasters.

Faculty and staff at UNMC and Nebraska Medicine took this opportunity to develop cutting-edge research, educational resources, and health care practices. Much of this work was spurred by a team under the guidance of UNMC epidemiologist Philip Smith, MD. He foresaw the needs of Nebraska, the United States, and the world that has put UNMC and Nebraska Medicine at the forefront of biopreparedness.


Philip Smith

Philip W. Smith, MD

c. 2016

Dr. Smith is known as the “father of biopreparedness” having led the development of the

Nebraska Biocontainment Unit and the Center for Biosecurity, Biopreparedness and Emerging Infectious Diseases.

Press Conference with recovered Ebola patient, Rick Sacra, MD

Donated by Angela Hewlett, MD, medical director of the Nebraska Biocontainment Unit, from the McGoogan Health Sciences Library Special Collections and Archives

Nebraska Biocontainment Unit

Commissioned in 2005 by the U.S. Centers for Disease Control (CDC), the Nebraska Biocontainment Unit (NBU) is a collaborative project involving UNMC, Nebraska Medicine, and the Nebraska Department of Health and Human Services. It provides the first line of treatment for people affected by bioterrorism or highly hazardous communicable diseases. The NBU is one of only a few biocontainment units in the United States and is the largest, with up to a 10-bed capacity, depending upon the specific infection.

The unit is equipped to safely care for anyone exposed to a highly contagious and dangerous disease. Early isolation of an infected patient is essential–buying time for public health officials and providing the chance to either stop an outbreak or help to contain one. The unit’s location, on the same campus as Nebraska’s Bio-Safety Level 3 Laboratory, allows for timely diagnosis and immediate treatment of patients.

NBU personnel consist of a staff of select physicians, registered nurses, respiratory therapists, and patient care technicians specially trained in high level isolation and biopreparedness. Most work full-time in other areas of Nebraska Medicine but remain on-call to report promptly when the unit is activated.


Tour the NBU


NBU Ribbon Cutting, March 2005

Courtesy of the Nebraska Biocontainment Unit

After years of hard work and vision, the third and largest biocontainment unit in the United States opened at Nebraska Medicine in 2005. In attendance for the ribbon cutting of the Nebraska Biocontainment Unit (NBU) were Nebraska Medicine CEO Glenn Fosdick, director of the CDC Julie Gerberding, MD, Nebraska Governor Dave Heineman, and UNMC Chancellor Harold Maurer, MD.

NBU Training in Progress Sign

Courtesy of the Nebraska Biocontainment Unit

Given the location of the NBU near other clinical units, the team displays this sign during training, drills, and exercises to let colleagues know that it is not an activation response.

Training occurs randomly at varying hours of the day to ensure the unit members are always ready.

Philip W. Smith, MD, Founding Medical Director of the NBU


Philip Smith: That is the $24,000 question. Why Nebraska? Because it doesn't seem logical, but then when you think about it, it made sense, because—first of all we thought of it, and other people—nobody else really came up with the idea at that point. Things changed after Ebola, I can tell you, but Nebraska's in the center of the US. There were only two other biocontainment units, one in Atlanta, Emory University, and one at USAMRIID. And they were both two-bed units and they were both on the East Coast. We had a number of other things going for us as well. We had the fact that we had both civilian and military airports with dual access to the civilian and to the military casualties that might lead us to activate our units. And Dr. Hinrichs had built a BSL-3 laboratory that was very good and safe and capable of dealing with pathogens like this. So for all those reasons, it just fell into place. And it happened to be it had to be in Nebraska[.]

Shelly Schwedhelm, MSN, RN, Associate Director, Emergency Management and Clinical Operations, Global Center for Health Security


Shelly Schwedhelm: It was an old bone marrow transplant unit that had been sort of set aside—a pediatric bone marrow transplant unit. And it had its own air-handling, so that was really a feature that made a lot of sense financially, so we were able to really operationalize it with limited capital and had some support to do that from the state of Nebraska, from those bioterrorism dollars. And then we literally functioned it for 10 years on a shoestring. We had some money from our state health department through hospital preparedness funds that was given to us, I think it was $20,000. [Laughs] And we exercised with our team every three months and most every exercise included personal protective equipment training. We did an exercise like twice a year and then I had a small part of an FTE that was supported to help write protocols, procedures, and the nurse you're going to interview is Kate Boulter, who sort of led on that and just kind of kept things moving for all that time. But we really, we didn't keep supplies on the shelf, we created just in time inventories. So if we literally needed to be activated, we could quickly, you know, within four to eight hours, be good to go.

Steven Hinrichs, MD, Former Director, Nebraska Public Health Laboratory


Steven Hinrichs: Well, actually, we had a lab in the unit in the beginning, but they actually needed that space and the actual number of tests that the laboratory in the unit could perform was so minimal it wasn’t worth keeping up anymore. And another interesting thing happened—so the doctors who we originally had interviewed, Dr. Smith—and said what test do you need us to provide. And it was very similar, they were very simple, CBC, smear analysis, that’s all we’re going to ask you to provide when we take care of a patient in the unit. As soon as Ebola actually happened, the doctors said, “If we’re coming into the unit risking our lives, we want as many tests as if this patient was in the ICU of the hospital and don’t tell us you’re only going to give us these five tests. We want every test available.” So now the whole clinical laboratory became involved and we had to develop a method and a process for bringing potentially contaminated samples into the laboratory and running them on automated instruments in the laboratory environment which was not BL3 and how to develop a containment policy and infection control policy, all those sorts of the things was a very significant challenge.



TSQC Trainings, c. 2020

Courtesy of the UNMC Department of Strategic Communications

Due to the COVID-19 pandemic, UNMC residents received training in conducting their everyday duties while wearing Personal Protective Equipment (PPE). 

National Training, Simulation and Quarantine Center

The result of a nearly $20 million grant from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR), the National Training, Simulation, and Quarantine Center (TSQC) encompasses an entire floor of the new $119 million Dr. Edwin G. & Dorothy Balbach Davis Global Center on UNMC’s Omaha campus.
The state-of-the-art facility includes the 20-bed National Quarantine Unit, the nation's only federal quarantine unit, and a six-bed simulated biocontainment unit for advanced experiential training, the National Biocontainment Training Center. This high-fidelity simulation center includes a mock lab and autoclave. Within the Davis Global Center building, TSQC is in close proximity with several high-tech advanced interprofessional simulation and learning environments.



The NPHL during Covid-19, June 2020

Courtesy of the UNMC Department of Strategic Communications 

Nebraska Governor Pete Ricketts toured NPHL facilities with UNMC Chancellor Jeffrey P. Gold, MD, and NPHL Director Peter Iwen, MS, PhD, to view the lab’s COVID-19 testing process. 

Nebraska Public Health Laboratory

The Nebraska Public Health Laboratory (NPHL) was established in 1997 by the state legislature and governor as a partnership between UNMC, Nebraska Medicine, and the Nebraska Department of Health and Human Services (NE-DHHS). The original focus of testing was to provide support for state-sponsored prevention programs for the detection of sexually transmitted diseases, enteric diseases such as salmonellosis, and respiratory diseases such as influenza. In 1999, testing at the NPHL was expanded through grant funding from the Centers for Disease Control and Prevention (CDC) to include testing for bio-threat agents in environmental samples and the detection of chemical agents in human specimens. This unique arrangement between UNMC and NE-DHHS has resulted in saving millions of tax dollars and has leveraged expertise of existing UNMC personnel and state-of-the-art equipment for the benefit of all Nebraskans.

Management and operation of the laboratory is overseen by individuals within the UNMC Department of Pathology and Microbiology, including Peter Iwen, PhD, director; Tony Sambol, MA, assistant director; and Emily McCutchen, manager. The NPHL has an extensive outreach and education program throughout the entire state and helps facilitate the transportation of specimens to the NPHL.




Clinical Research Unit Ribbon Cutting, February 2021

Courtesy of the UNMC Department of Strategic Communications 

The center’s new Clinical Research Unit gave UNMC and Nebraska Medicine the infrastructure to serve as a host site for a national clinical trial investigating COVID-19 vaccines for adults. 

Global Center for Health Security

The Global Center for Health Security was established in 2017 to oversee all biopreparedness efforts at UNMC and Nebraska Medicine. The center focuses on clinical care and operations, driving innovations in research and development, and training and education.

As UNMC and Nebraska Medicine’s umbrella entity for biopreparedness, the Center manages several of the entities previously identified. These include:

  • The Nebraska Biocontainment Unit 

  • The National Training, Simulation, and Quarantine Center 

  • The National Quarantine Unit 

  • The National Biocontainment Training Center 

  • The National Emerging Special Pathogen Training and Education Center 




NETEC Changes Name, 2020

Courtesy of the UNMC Department of Strategic Communications

NETEC became the National Emerging Special Pathogens Training and Education Center to reflect the broader nature of the organization’s work outside of Ebola.

National Special Pathogen System (NSPS), c. 2021

Courtesy of the UNMC Department of Strategic Communications 

NETEC created the NSPS to provide a coordinated and standardized health care network to care for patients infected by a special pathogen in the United States. 

The National Emerging Special Pathogen Training and Education Center

In 2015, UNMC/Nebraska Medicine teamed up with Emory University in Atlanta and Bellevue Hospital Center in New York City to establish and co-lead the National Ebola Training and Education Center, now known as the National Emerging Special Pathogen Training and Education Center (NETEC). Together, these institutions were awarded a $12 million grant by the U.S. Department of Health and Human Services (HHS) for the project. They also partner with the Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) to support the training of health care providers and facilities on strategies to manage Ebola and other emerging infectious diseases.


Since 2015, NETEC has created an online platform that provides webinars, videos, workshops, readiness consultations, and an online training repository. The website also includes a regional resource map that provides information for treatment centers, contact details, and resources for various regions in the U.S. NETEC is part of the National Special Pathogen System, which received $100 million from HHS in April 2020 to aid health care systems in preparing for the surge of COVID-19 patients.



Center for Preparedness Education Logo, c. 2006

Courtesy of the Center for Preparedness Education 

PrepEd operates out of the College of Public Health’s Center for Biosecurity, Biopreparedness, and Emerging Infectious Diseases (CBBEID). 

Center for Preparedness Education

The Center for Preparedness Education (PrepEd) was established at UNMC in 2002 as a joint endeavor with Creighton University School of Medicine and The Nebraska Department of Health and Human Services. The center provides training opportunities and resources for public health professionals across Nebraska and aids with disaster planning and disaster preparedness exercises. They also provide resources in the form of a free-standing library devoted exclusively to preparedness-related topics, award-winning training videos, and a website containing additional resource materials.

UNMC College of Public Health Timeline


Keith Hansen, MBA, Co-Director, Center for Preparedness Education


Keith Hansen: The Center for Preparedness Education is the group that was started shortly after September 11th when the bioterrorism funds came out. Early on, that organization was responsible for training and education in Nebraska for public health, for healthcare, but it was primarily around bioterrorism. We did a lot with these seven agents—anthrax, smallpox, tularemia—the seven category A agents. A lot of education on that. Early on, we were fairly focused on the bio part of it. Since then, we've become more focused on the preparedness part of it. Doesn't matter if it's a tornado or hurricane or whatever it is, a lot of those principles apply. If you have to evacuate a hospital for a fire or a shooter, doesn't matter. It's the same evacuation, right? You still have to move patients, so we broadened our definition quite a bit, but our job is to work with planning and training and exercising healthcare and public health in Nebraska.

Darby Kurtz: So with the Center for Preparedness Education, are you often coordinating with Nebraska Health and Human Services?

KH: Absolutely. That's where a significant part of our funding comes from. So for example, we're work—I'm currently working on an exercise with them that we will do with Nebraska Health and Human Services and Nebraska public health departments and what we call organizations that represent access and functional needs populations here in the state. We work quite closely with them, because it's their job to identify what the priorities are for the state and that's our job to help execute that.

Ali Khan, MD, Dean, College of Public Health


Ali Khan: So this growing prominence has reinforced the role of the College of Public Health in emergency preparedness. We have additional faculty members who work on health security issues, all of them affiliated obviously with the Global Center since the Global Center is a function of all of us coming together. We've increased the number of our domestic activities. We've increased the number of our international activities. We've added in additional academic programs. Our responsibility is all the academic programs around preparedness, so we've always had a Masters of Science in Emergency Preparedness. We've added, then, an MPH in Emergency Preparedness. Now we have a DRPH, Doctorate in Public Health and Emergency Preparedness, so we've slowly, you know, increased all the programs that are available to individuals who would like to get more academic training in emergency preparedness and response.



UNMC 'HEROES' Resumes Statewide Training

Courtesy of Stephen Smith, Instructional Technologist, UNMC College of Nursing

The HEROES program resumed full in-person training across the state in 2021 after a year of virtual and small focused programs in emergency preparedness. New trainings include donning and doffing protocols and collection of lab specimens for testing COVID-19.

The Healthcare and Emergency Responder Organization Education Through Simulation Program

Created out of a University of Nebraska Programs of Excellence Grant in 2005, the Healthcare and Emergency Responder Organization Education through Simulation (HEROES) program focuses on providing in-person, statewide instruction and training in a wide variety of preparedness subjects. Led by the UNMC College of Nursing, the program collaborates with the College of Medicine, College of Allied Health Professions, and the Center for Preparedness Education to offer an interdisciplinary approach to biological, chemical, radiological, and natural disaster emergencies. Resources are focused on developing hands-on emergency preparedness trainings across the state as well as training materials that are accessible online.

Among their online resources, HEROES has created informative programming related to the various aspects of caring for Ebola patients. They have also continued to be an active resource for healthcare professionals during the COVID-19 pandemic in relation to PPE usage and infection control. Learn more about HEROES and their educational programs by visiting their website.

Elizabeth Beam, PhD, RN, Assistant Director of Research, Nebraska Biocontainment Unit


Elizabeth Beam: [T]he thing that we tried to do, one of the media projects we took on pretty early was not only this donning and doffing and respirators in general, which we kind of had that one in the bag, but we worked on one for the extended use and reuse, because reuse was something that really nobody had anything on, and that was one of our fastest growing videos once it came out. Initially, we kind of tried to do everything and we realized that was like a 30 minute video and nobody watches a 30 minute video. So we focused on that reuse piece, because extended use is pretty much just wear it longer. But if you're going to reuse something, you really have to think about the dance of taking it off gently and putting it somewhere where it can kind of desiccate and dry. And so, helping people understand that was important. And so, we kind of filtered it down to just that part. But all of that, you know, were the things that we could do to help people. And, you know, I had people reach out who had been our long term—long time HEROES, groupies, if you will, who said, “My gosh, thank you. Like, we used your video to make sure everybody was educated on how to wear their respirator” and so on and so forth. And so, I think that's the weird thing about being HEROES is you don't know exactly every story, but like you hear later, whether it was COVID or whether it was Ebola. Like I remember, you know, like I said, I was breastfeeding and other things during that time, but a lot of the groups that went down to like Texas after the Thomas Duncan case to help with education down there that like, “HEROES is amazing. [Laughter] Like, we found so much stuff on there, it was great.” It was just like, it was kind of cool to hear at least secondhand from people that people were finding our content and were really grateful for, not because it was exactly what they were going to do, but at least it was an example and then they could tweak. I remember we went to Denver Health for one of the site visits for NETEC and they were so—they were like, “We get it, we get it. So we’re going to do this part and then we're going to walk a little bit further into the decon shower and take this part off and that part off based on kind of what you did. But our situation is a little different.” Like that's exactly what the education’s designed to do.



Federal and Global Partners

Over the years, UNMC and Nebraska Medicine have had the opportunity to partner with several national and international institutions for the global betterment of biopreparedness efforts. View the oral histories below to learn more about our various partners.

Sharon Medcalf, PhD, Director, Emergency Preparedness Professional Academic Programs


Sharon Medcalf: [C]redit to Dr. Khan and his connections with the WHO—and this is a small division of the WHO called GOARN, G-O-A-R-N, Global Outbreak Response and Alert Network. So, this group's been around since 2000 and he was involved with them when he was at CDC before he came here. So as that group grew—and the premise behind GOARN is that they have partners across the globe, and I think they're up to about 200 or 250 partners. A partner is an organization or an institution. So we, as UNMC, are one of 250 partners in this global outbreak network. And then what happens is when there is an outbreak around the globe, regardless of how large the outbreak is, they put out a call to all these partners to say we need people with epidemiology experience, infection prevention, and they'll list it and they'll give the criteria. And then what we try to do is find people who can fit the bill and propose that they deploy. As an institution and as a partner with GOARN, we have committed to allowing deployees the time and the resources to do that deployment. WHO pays for the deployment, but we give them the time off. So, our dean has gone multiple times. We've had a couple of faculty in the college that have gone on deployments, but as this partnership has grown and as GOARN has grown—they formed in about 2016 or ‘17, a training subcommittee. What they did is they recruited people from the partner institutions who had expertise in training and workforce development, so we became—we got involved with that in 2017. And the first meeting was in London, and they've moved the meetings around, because again, these are partners around the globe, so they try to move these meetings around the globe so that no one person is traveling literally around the world to get to a meeting. So, they've been in London. They've been in Geneva. We had one in Vancouver. There's one coming up in August in Singapore, and what this group is doing—and we're part of this group—is building the training for all these people that deploy to these outbreaks around the globe. And so, what we feel like we're bringing to the table, we as in UNMC, is that vision for using state of the art simulation.


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Kenneth Bayles, PhD, Vice Chancellor of Research, UNMC


Kenneth Bayles: [W]e have unique access to the biomedical portfolio of the DoD, unique access in the country compared to all other institutions, we had this special access. So then the question is how do you take advantage of that? How do you leverage that access? We have a seat at the table with this major department that's a big funding agency. So you got to figure out how to take advantage of that. And we're just kind of like building this plane as it's flying. And we made mistakes along the way, but then we eventually figured out that if we have a funding vehicle that makes it easy for the federal government to send us money, then we better be thinking about things that they want to buy, right? So that's when I started thinking about core capabilities that they might be interested in, and that's where I came up with the idea of the Nebraska Drug Discovery and Development Pipeline. I would go to different DoD labs and pitch this idea, “Come to us. I know you're interested in making different drugs that—” in, you know, in those days I was thinking about—as a microbiologist, I'm thinking about antibiotics and I was pitching this, “use this core capability to make antibiotics that would kill anthrax or that would kill tularemia bacteria or, you know, some of these biological weapons of mass destruction.” That was my pitch. They liked the concept, but there was a group within the DoD that had no interest in antibiotics. They were interested in countermeasures to radiation exposure. And so, they said, “Hey, we can use this core capability, but we want you to help us make radiation counter measures, radiation drugs.” And so, that's what we're doing now. We're making anti-radiation drugs for the federal government.


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Jennifer Larsen, MD, Louise and Morton Degen Professor in the Division of Diabetes, Endocrinology and Metabolism


Jennifer Larsen: The National Strategic Research Institute was an opportunity that came about early on as I was becoming the vice chancellor of research and, you know, it was kind of a foreign concept from my standpoint. It’s a university-affiliated research center. It's a designation by the Department of Defense saying that you can have sole source contracting for research kind of jobs that are relevant to your areas of competency, which are combating weapons of mass destruction. Now, as a clinician, it's like, “Are we doing that [laughs] here on our campus?” But I think I came to realize that the Department of Defense, you know, you have to think in Department of Defense terms, but we absolutely were and are doing research that combats weapons of mass destruction. If nothing else, keep in mind—first of all this was a University of Nebraska initiative, so obviously UNL had a role to play, UNO, UNK. But if you think about if you have a weapon of mass destruction, it doesn't just destroy things, it impacts people. And there has to be healthcare at the moment, in a remote site, in a plane—in a ship, in a remote field, and remote medicine is a lot about what we are trying to do here at University of Nebraska Medical Center. Nebraska is a rural state, so we already were doing a lot of telemedicine or other strategies to be able to provide remote care. And so that dovetailed very, very well.


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