(ERRI "Lessons on Line" - #1-97, For the authorized use of
Fire/Police/EMS/Military personnel)
(Contact ERRI for more information on additional upcoming modules)
Emergency Response to Chemical/Biological
Terrorist Incidents
By: Clark L. Staten, Executive Director
Emergency Response & Research Institute
08/07/97
In March of 1996, Fire Chief Lamont Ewell, who was then the president of
the International Association of Fire Chiefs (IAFC), told the U.S. Senate Permanent
Subcommittee on Investigations that it would be the responsibility of local firefighting,
police and emergency medical units to cope with a terrorist attack that used nuclear,
chemical or biological weapons. He also made the startling announcement that
Fire/Police/EMS services, collectively, were not prepared for the challenge 1.
Ewell affirmed something that the Emergency Response and Research Institute (ERRI) in
Chicago has been saying for a number of years 2. The chief told
the packed Senate hearing room, "It will be local fire and emergency service
organizations...who will have to pick up the pieces. Of the overall government efforts to
prevent and respond to terrorist incidents, these local fire, law enforcement and
emergency medical services agencies are the least prepared to respond to a chemical or
biological terrorist incident." International emergency analysts say that the same
thing can be said for emergency service agencies all over the world.
Is a terrorist chemical and/or biological attack inevitable? A report released on the same
day by the U.S. Senate Subcommittee says that it is. The report said, "It is not a
matter of IF, but rather WHEN such an event will occur. Many of the terrorist groups of
today appear more and more likely to utilize weapons of mass destruction."
First/Primary Concern; Scene Safety and Security
When dealing with any potential terrorist attack, past experience has taught that the
first necessary task is to secure the area and ascertain the nature and severity of the
threat. Particularly in the past few years, several instances have been reported when a
secondary device has been targeted at emergency responders 3, or armed
secondary assault has been perpetrated by offenders, in an attempt to harm or kill
rescuers and disrupt emergency operations.
In most cases, both a primary and secondary secured perimeter must be established. A
thorough search of these perimeters must be a priority at the onset of the incident. In
the event of a biological or chemical release, a large downwind area may also need to be
rapidly secured and evacuated in order to minimize civilian casualties.
Priority Problem; Identification
The second most pressing problem involving Weapons of Mass Destruction (WMD), and a
terrorist release of a chemical or biological agent, is that of identification. As is the
case in most common industrial hazardous-materials accidents, the first priority in the
management of the incident involves ascertaining the identity and physical properties of
the substance that has been released. It is only after the product identity can be
ascertained that an effective outer perimeter can be established, neutralizations plans
formulated, decontamination procedures entertained, emergency medical treatment plans
made, and environmental preservation precautions taken.
Of most serious consideration by emergency planners is the fact that most civilian
emergency service agencies, including specialized hazardous materials teams, currently do
not possess the effective testing equipment to help identify sophisticated chemical or
biological warfare agents that might be used in a potential terrorist attack. While they
may be able to quantify those agents that have civilian counter-parts, for instance -
organophosphate pesticides - there are any number of others, for which they have no
testing reagents or detection meters. It is suggested that federal funding be made
available for the purchase of the necessary detection and monitoring equipment that
emergency agencies will need to manage this burgeoning threat.
Click here to see -- Case Study; Sarin
Poisoning of Subway Passengers in Tokyo, Japan, March 20, 1995
EMERGENCY SERVICE DUTIES TO BE PERFORMED AT A
CHEMICAL/BIOLOGICAL WEAPONS RELEASE:
The primary functions that must be performed at any toxic release remain fairly
consistent. The top twenty actions that must be taken will generally involve:
1. Incident "Size-up" and assessment
2. Scene Control/establishment of perimeter(s)
3. Product Identification/information gathering
4. Pre-entry examination and determination/donning of appropriate protective clothing
& equipment
5. Establishment of a decontamination area
6. Entry planning/preparation of equipment
7. Entry into a contaminated area and rescue of victims (as needed)
8. Containment of spill/release
9. Neutralization of spill/release
10. Decontamination of victims/patients/rescuers
11. Triage of ill/injuried
12. BLS Care
13. Hospital/expert consultation
14. ALS care/specific antidotes
15. Transport of patients to appropriate hospital
16. Post-Entry evaluation examination of rescuers/equipment
17. Complete stabilization of the release/collection of evidence
18. Delegation of final clean up to responsible party
19. Recordkeeping/after-action reporting
20. Complete analysis of actions/recommendations to action plan
(Author's Note: Several of these actions will be occurring simultaneously. They are listed
in an approximate order of occurrence for the purposes of planning and coordination of
activities.)
TOXICOLOGY UNDERSTANDING
In order to effectively perform their duties at a chemical/biological release,
EMS/medical/management personnel must understand some basic toxicology principals. They
include (but are not limited too):
A. Acute and Delayed toxicity
B. Routes of Exposure
1. Inhalation**
2. Absorption
3. Ingestion
4. Through open wound/Injection
C. Local and systemic effects of exposure
D. Dose Response as it relates to risk assessment
E. Synergistic effects of combined substances
F. Assessment and use of toxicology information services/treatment modalities
G. Relationship of proper decontamination to higher mortality and morbidity
H. Alteration of triage principals as they relate to toxically exposed patients.
I. Levels of personal protective clothing and equipment needed
(** Most likely route of introduction of chemical/biological warfare agents and with
the greatest and most rapid effect)
Chemical Agent Terrorism by Frederick
R. Sidell, M.D.
FREE access to the National
Institute of Health's MEDLINE.
Preplanning and Multi-Agency Response
Another major consideration is the need for an effective pre-planning process. Although
the site of an unexpected/intentional toxic release can't be anticipated or identified,
the personnel and equipment that would be needed to respond to it can be. Response
mechanisms and interagency agreements, that may need to be implemented, must be up to date
and workable. Jurisdictional issues should be resolved before even the first two agencies
arrive on the scene of this kind of incident. It is mandatory that these plans be made and
exercised prior to the onset of any emergency; this is particularly true when an incident
of the magnitude of a terrorist chemical/biological attack is involved.
Logically, as in any crisis, the local Police, Fire departments, and EMS agencies will be
immediately responsible for an operation involving a chemical/biological release and mass
casualties. But, depending on the circumstances of the incident, it may also be necessary
to rapidly involve other state and federal agencies. The pre-plan and dispatch protocols
should include the ability to contact the nearest field office of the Federal Bureau of
Investigation (the federally designated lead agency in a confirmed domestic terrorist
event), the Secret Service, the Department of Alcohol, Tobacco, and Firearms, state
disaster agencies, military units and specialized medical personnel/units. Local agencies,
depending on their location, however, should be aware of the possibility that the
assistance of some federal agencies may not be forthcoming for as long as 24 hours, and
that they should plan to manage any incident until the arrival of outside agencies.
It would appear that any number of types of incidents would mandate a response of any
number of federal agencies (i.e., terrorism, an attack on dignitaries, foreign embassies,
airports, military installations, and government buildings) and consideration must be
given to the fact that federal law enforcement agencies will assume jurisdiction and the
leadership role. Conversely, law enforcement personnel, who may have assumed command of an
incident involving a chemical/biological attack, must be cognizant of the fact that if any
possible perpetrators have fled and the scene is secure, and there are still victims or a
gas plume present, that a majority of the remainder of the operation will functionally and
legally be the responsibility of Fire/EMS command personnel and subsequently responding
federal or military personnel. Obviously, excellent interagency cooperation and
communication is a necessity in consequence management of chem/bio attacks.
Consequence
Management: Domestic Response to Weapons of Mass Destruction, By CAPT. CHRIS SEIPLE, USMC
Terrorists,
WMD, and the US Army Reserve, By Col. CHARLES L. MERCIER, JR., USAR
Intelligence and Information Sharing
One of the present problems concerning the response to chemical/biological agents is the
fact that very little information sharing is taking place between differing agencies,
except on an informal or individual basis. Secondarily, there is no national
"clearing house" or database of exercises that have been conducted,
"lessons learned," outcomes of actual incidents, or model programs to emulate in
planning efforts. It is highly recommended that a national central repository be
designated and funding provided for its operation. In the absence of such a designated
center, the Emergency Response & Research Institute has been acting as an informal
(and self-funded) "go-between" and has been attempting for the past two years to
gather, analyze, disseminate and/or redistribute pertinent information and analysis
regarding Chemical/Biological-related issues.
More importantly, there is little sharing of intelligence information between local,
state, and federal agencies in regard to threats of chemical or biological attacks, real
or imagined. Rumors, misinformation, innuendo, and "just plain mistakes" abound.
Often overlooked intelligence-gathering resources are available and unused within the
civilian response community. Far greater strides should be made in regard to developing
viable channels of communications that would transfer applicable information to and from
"the street."
Psychogenic Component
Emergency planners should be aware that the release of any CW/BW agent is likely to induce
a psychological reaction on the part of a largely unprotected civilian population, and
that problems with crowd control, rioting, and other opportunistic crime could be
anticipated. The primary counter to these effects must involve an effective
"psy-ops" operation to include extensive participation by public
information/affairs officers and the media. Extensive attempts must be made to prevent a
"panic reaction" among those that might potentially be exposed to a warfare
agent. It is anticipated that early interventions/statements by technical experts and
political leaders can help to defuse public feelings of confusion and fear...and lead
citizens to appropriate behaviors.
Chemical Weapons (CW)
A United Nations report from 1969 defines chemical warfare agents as "..chemical
substances, whether gaseous, liquid or solid, which might be employed because of their
direct toxic effects on man, animals and plants...". The Chemical Weapons Convention
defines chemical weapons as including not only toxic chemicals but also ammunition and
equipment for their dispersal. Toxic chemicals are stated to be "... any chemical
which, through its chemical effect on living processes, may cause death, temporary loss of
performance, or permanent injury to people and animals".
A 1996 threat assessment by ERRI analysts would suggest that the possibility of a chemical
attack would appear far more likely than either the use of nuclear or biological
materials, largely due to the easy availability of many of the necessary precursor
substances needed to construct chemical weapons. Additionally, the rudimentary technical
knowledge needed to build a working chemical device is taught in every college level
chemistry course in the world.
Further, in any number of parts of the United States, an innovative terrorist would not
even have to build a complicated chemical release device. He/she could simply wait for
favorable weather conditions and then sabotage or bomb an already existing chemical plant
and allow the resulting toxic cloud to drift into a populated area. The end result could
be just as dangerous as having placed a smaller chemical device in a more confined space.
Certainly, such an incident could be expected to cause the maximum amount of fear,
trepidation, and potential panic among the civilian population...and thus achieve a major
terrorist objective.
Also likely is the possibility of a chemical release into a transportation system
(particularly underground), sports stadium, office building, public building, or any other
confined space that contains a large number of people. These settings provide the
terrorist with a tempting target that is sure to draw mass media exposure and provoke
wide-spread fear. It should be noted that even though such places frequently have
(private) security forces, that most would still be considered "soft-targets" by
sophisticated terrorists and almost struck at will. Education and training of these
private security personnel is also a necessary adjunct to an integrated approach to
combating chemical/biological terrorism.
Some typical examples of chemical warfare agents might include:
A. Sarin
B. Tabun
C. VX
D. Soman
E. Cyanide
F Mustard/Blistering agents
Click here for further technical
dicussion of chemical warfare agents
Decontamination of Chemical Agents
After identification of a toxic substance has been accomplished, technical information
about it's physical properties must be obtained. In the case of chemical warfare agents,
it is recommended that one ascertain whether or not it is a persistent or non-persistent
agent. In the case of some non-persistent agents, it is designed to dissipate or degrade
fairly readily after it comes in contact with wind, water, sunshine, and other natural
elements. Often non-persistent agents can be cleaned from people and equipment with soap
and water. The U.S. military has specific decontamination solutions for use in the
"de-con" of various types of chemical agents.
When faced with a more persistent agent, however, the decontamination procedure is likely
to be more difficult as these chemicals often have an "oily base" and are
designed to remain in place and deny access to enemy troops in the area where they are
used. Decontamination may require the use of alcohol, acetone, or other solvent.
In either case, the need for rapid and thorough decontamination is mandatory. It is
strongly recommended that no contaminated person or vehicle be allowed to leave the scene
of a chemical release...to do so will only increase the size of the disaster and may lead
to additional injuries or deaths.
Biological Weapons (BW)
Toxins, i.e., poisons produced by living organisms and their synthetic equivalents, are
classed as chemical warfare agents if they are used for military purposes. However, they
have a special position since they are covered by the Biological and Toxin Weapons
Convention of 1972. This convention bans the development, production and stockpiling of
such substances not required for peaceful purposes.
Although biological warfare, sometimes called germ warfare, has never been officially
employed on the modern battlefield, the increased amount of research and testing of
disease-producing viruses and bacteria for military purposes has caused worldwide alarm.
As a result, the Biological Weapons Convention signed by the United States, the United
Kingdom, the Soviet Union, and 67 other nations in 1972 prohibited the development,
production, and stockpiling of bacteriologic agents and toxins.
The threat of the intentional use or even accidental release of a airborne
"class-4" biological weapon (BW) is, in some ways, far more frightening to
analysts and researchers than that of a chemical release, for which there may be known
specific antidotes and counter-measures. In the case, for instance, of a mutated or
genetically engineered strain of Ebola or some hemorrhagic fever, there may be no known
effective treatment. By genetically combining one of the particularly virulent bio-agents,
for instance, with a rapidly and easily spread common virus like the flu, the terrorist
may be able to cause an heretofore unknown airborne spread of a deadly bio-toxin.
Infectious disease scientists point out that a spread of deadly pathogens could take place
without any immediate recognition on the part of the emergency or medical community, until
after the incubation period is over and hundreds or even thousands of people had been
infected. To further complicate matters, a biological release could involve a slowly
developing, and hard to recognize cluster of extremely ill patients, who are highly
contagious, and are found at a wide-spread number of locations.
During the first few vital hours of potential recognition of such a situation, analysts
suggest that many emergency agencies would be suffering from an "information
vacuum." With few exceptions, they would not have immediate access to the needed
medicines or supplies, nor contact with the necessary experts to successfully resolve the
situation. It is also probable that they also would not have the appropriate protective
clothing, equipment, nor isolation procedures to protect the rescuers and the public.
The expert help that local agencies would need must come from the Center For Disease
Control (CDC) in Atlanta, the U.S Army Medical Research Institute for Infectious Diseases
(USAMRIID) at Ft. Derrick, Maryland, or a new specially trained team of U.S. Marines
called the Chemical/Biological Incident Response Force (CBIRF). Unfortunately, it might be
several hours before these highly trained specialists could arrive on the scene of the
incident. In the mean time, local fire, EMS, police agencies, and hospital personnel will
be responsible for the management of the emergency.
It should be noted that infectious disease specialists from a larger area hospital or
university medical center may be of great assistance in the early hours of a suspected
biological release or the recognition of an emerging epidemic. They should be consulted if
they are available and willing to offer advice and/or consultation.
An examination of current preparedness levels of emergency service agencies, to deal with
a potentially deadly release of a biological agent, in the United States, might be pause
for concern. Former Georgia Senator Sam Nunn said, in March of 1996, that the United
States has a "remarkable lack of domestic preparedness" to deal with such
situations.
Some typical examples of biological warfare agents might include:
A. Anthrax
B. Staphylococcal Enterotoxin B (SEB)
C. Bubonic/Pnuemonic Plague
D. Cholera
E. Other bio-engineered agents
Click here for further technical
discussion of biological toxins
Biologic Terrorism -
Responding to the Threat, by Philip K. Russell, Johns Hopkins University
Click here
to see a 12/15/97 Dept. of Defense announcement on innoculations of American troops for
Anthrax
Decontamination of Biological Agents
Unlike the complexity of ascertaining the varied physical properties of chemical warfare
agents and deciding on appropriate counter-agents for neutralization and decontamination,
in the case of most biological agents a diluted solution of common household bleach
(sodium hypochorite) may often be effective in decontaminating procedures involving people
and equipment. Other antispetics and disinfectants, as appropriate for the individual
bio-toxin, can also be used.
With rare exception, when faced with suspected virulent bio-agents, full strength sodium
hypochorite may be dumped into/onto the general area of the released agent and may assist
in preventing a further spread of the contaminant. Although not all types of bio-agents
will be immediately killed by the emergency application of bleach, it is thought in many
circles that such an action might be helpful in preventing further infections.
Conclusions:
All of these facts and opinions point out the need for immediate funding of new and
different kind training and equipment for local Police/Fire/EMS personnel. They are the
front-line of defense if the unthinkable happens...and some fanatic were to attack our
country with these weapons of mass destruction(WMD). Bottom-line...we need to develop and
deploy a totally integrated response against terrorists and terrorism...this must include
all State, Federal, and local emergency agencies, the military, and the medical research
community... if we, collectively, are to be truly prepared for the threat of a chemical or
biological attack.
Additional ENN/ERRI articles that
may be of interest:
Click here to take a quiz on the above "lesson-on-line"
01/02/2000 - Sorry, due
to a lack of internal funding for this project, we can no longer grade your quiz
and return completion certificates. Correct answers to the quiz will be
provided at the bottom of the quiz page, so that you may self-correct your quiz.
A special thanks and congratulations goes out to the more than 50,000 people who
completed this lesson-on-line and submitted their results. [Note: This
project NEVER had
any public funding]
Selected references:
Suggested books/articles
Emergency Response Guidebook, U.S. Dept. of Transportation
Emergency Care For Hazardous Materials Exposure, Bronstein & Currance, C.V. Mosby Co.
Hazardous Materials Injuries, Stutz, et al, Bradford Communications Corp.
NIOSH/OSHA Pocket Guide to Chemical Hazards, U.S. Dept. of H.H.S., National Institute of
Occupational Safety & Health
Fire Protection Guide to Hazardous Materials, National Fire Protection Assn.
Toxicologic Emergencies, Rumack, et al, Robert J. Brady Co.
First Aid Manual for Chemical Accidents, Lefevre, et al, Dowden, Hitchinson, and Ross,
Inc.
TREATMENT OF CHEMICAL AGENT
CASUALTIES AND CONVENTIONAL MILITARY CHEMICAL INJURIES; ARMY FM 8-285, NAVY NAVMED P-5041,
AFJMAN 44-149, MARINE CORPS FMFM 11-11 -- [Entire Field Manual On-Line]
MEDICAL MANAGEMENT OF
CHEMICAL CASUALTIES HANDBOOK, 2nd Edition, Sept. 1995; by UNITED STATES ARMY MEDICAL
RESEARCH INSTITUTE OF CHEMICAL DEFENSE
The Specter of Biological Weapons;
Scientific American Article
Computer Software:
TOMES Plus CD-ROM Database-Haz/Mat-Medical Information System, Micromedex Inc.
Chemtox Database Software System, Resource Consultants, Inc.
"CHRIS" System, U.S. Coast Guard
Emergency Response Guide Software, Labelmaster, Inc.
CAMEO Incident Planning & Command, US EPA, US NOA, National Safety Council
"On-Line" Computer Services
Agency for Toxic Substances and Disease Registry
National Institute of Health - "Med-Line"
"Hazard-Line"
"Tox-line"
Compuserve Information Services
(C) Emergency Response & Research Institute and the author, 1997. All rights
reserved.
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