Emergency
Response to Chemical / Biological Terrorist Incidents
"If
I have indeed acquired these weapons, then I thank
God for enabling me to do so. And if I seek to acquire
these weapons, I am carrying out a duty. It would
be a sin for Muslims not to try to possess the weapons
that would prevent the infidels from inflicting
harm on Muslims."
- Osame Bin Laden, terrorist suspected of bombing
the World Trade Center, the Pentagon and embassies
in Africa
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Jerusalem-----October
2001.......The unthinkable became reality on September 11,
2001.
An accident waiting to happen.
I remember back in 1986, as I was working in my offices in
New York's World Trade Center - "what an easy target
- a landmark of the greatest proportions representing the
United States had no security!"
Then a few years later, Islamic terrorists attempted to take
down the Twin Towers with car bombs - an attempt that ended
in smoke and failure. But an incident which served as a "red
flag", as a warning to every intelligence and law enforcement
organization worldwide of tragic events to become us. A warning
which was ignored - met by arrogance, ignorance and isolationism.
Yes - the World Trade Center previous to the attack had security
- people checking to see that you were not carrying a gun,
a bomb and even providing photo ID's to all visitors. I know.
I was there with my children two weeks before the World Trade
Center vanished. But even this security was greatly flawed
as I passed through metal detectors at the Center with my
Palm Pilot and other carry-ons which were detected by equipment
but ignored by security staff!
Following
the devastating terror attacks on the World Trade Center three
weeks ago, I toured "ground zero" in Manhattan,
and I again saw something that startled me - a complete absence
of biochemical equipment on the soldiers, firefighters and
police on the scene. Perhaps equipment was there - but if
it was - it was not within timely reach of the rescuers. What
if Anthrax or Sarin were brought aboard one of those passenger
jets which hit the Trade Center?
Do not panic, nor get anxious. That would be the successful
effect of terrorism! The United States government has contingency
plans for such an attack. But what you should do is ask your
local fire, police and civil defense authorities exactly what
kind of protection do you and your family have!
In Israel we are prepared. Every family has a biochemical
warfare kit. We were ready during the Gulf War, carrying our
Bio-Chem kits with us everywhere we went. The unthinkable
happened on September 11th - it can and will most likely happen
again.
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.
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/injured
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
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
Biologic
Terrorism - Responding to the Threat, by Philip K. Russell,
Johns Hopkins University
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.
And perhaps
the United States has started this process with President
Bush recently creating a new office - The Director for Homeland
Security. But the ultimate responsibility for one's safety
is purely with yourself. The citizen. As a citizen living
in a democratic nation, it is your responsibility to make
sure that the representatives that you have elected are protecting
you and your family. See to it that they are.
On a positive
note, your lives will have changed after September 11th, you
will lose some privacy, but you will have gained greater personal
security. It's a tragedy that 7,000 people had to lose their
lives so that democratic nations today would be better prepared
for a terrorist threat. Don't blame your elected officials
for not getting the job done earlier - look at yourself and
those around you.
Do not be sheep. Do not believe blindly that your local and
or federal government knows all!
Respect - but question. Be aware - be active - take notice
and have your local media take notice of any accident waiting
to happen.
That is the beauty of democracy - being an active participant
in your country's growth, strength and success.
The
ISRAEL NEWS AGENCY,
the sponsor of this page, wants you to talk about your
experience if you were in New York City on September 11th.
We were there - we know how it was and is. We know that it
is still going on - the shock, the trauma, the loss, the depression
and grief. Below we have provided an excellent discussion
group for survivors - SurvivorCheckin.com - just click on
the logo below.
If you don't feel like discussing your experience in this
format - we strongly suggest that you discuss your experiences
with professional counselors - talking about it, helps
to heal.
Turn off the TV and radio, kick aside the newspapers - get
out - take a walk, exercise, see some friends for coffee or
wine. It will pass and we shall cherish the good memories
of these days - people helping, volunteering, the meaning
of family and friends. The sun will continue to rise and the
warm colors of life seen in a baby's smile or an elderly couple
walking hand in hand will fill the void...............
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