Emergency Response to Chemical/Biological Terrorist Incidents

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, 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.

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)

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.

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

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.

Nuclear