WMD and All Hazards Response

1
WMD and All Hazards Response
Jack Pittman Director, Public Health
Preparedness Leon CHD and NFRDSTF Heather
Lake Preparedness Coordinator Division of
Environmental Health
2
WMD and All Hazards Response

• Training Objectives
• Be aware of the effects of weapons of mass
  destruction (WMD) and other hazardous releases
• Understand types of expected WMD casualties
• Understand impact of a HAZMAT or WMD event on
  public health and the environment
• Understand principles of agent identification
  using the Emergency Response Guide
• Understand levels of personal protection
• Recognize requirements for evacuation, shelter
  in place, decontamination, isolation, or
  quarantine

3
WMD and All Hazards Response
Weapons of Mass Destruction BNICE Biological,
Nuclear, Incendiary, Chemical, Explosive
CBRNE Chemical, Biological, Radiological,
Nuclear, Explosive
4
WMD and All Hazards Response

• Explosive and Incendiary Threats
• Favorite Terrorist weapon
• Mass casualty trauma
• - Crushing
• - Fragmentation
• - Burns
• Relatively cheap
• High visibility
• High terror

5
WMD and All Hazards Response
Chemical Threats Industrial chemicals
Chemical warfare agents
6
WMD and All Hazards Response
Chemical Threats Industrial chemicals
FBI Most Likely chemical terrorism event -- A
Deliberate Industrial Chemical Release -- Rail --
Road -- Fixed Facility -- Pipeline
7
WMD and All Hazards Response
Chemical Threats Accidental industrial chemical
releases Rail
According to the Federal Railroad Administration,
there were 14,264 rail accidents in 2002 -- 59 in
Florida. 704 involved cars carrying HAZMAT in
the US with 13 HAZMAT accidents in Florida. In
1978, an Atlanta St Andrews Bay Railway train
derailed near Youngstown, Florida.  Chlorine gas,
released from a derailed car, killed 8 persons
and injured 138 downwind of the accident site.  
8
WMD and All Hazards Response
Chemical Threats Accidental industrial chemical
releases
Fixed Facility In 1984, a release of methyl
isocyanate in Bhopal, India killed 3,800 persons
40 suffered permanent total disability and
2,680, who lived as far as 25 miles downwind,
were partially disabled. Pipeline In May 2003,
gt 50 tons of anhydrous ammonia escaped after
someone tapped into a pipeline in Brandon, FL.
The leak sent noxious fumes into a subdivision,
shutting down two schools.
9
WMD and All Hazards Response
Chemical Threats Response
Except for the criminal investigation, a
deliberate release of an industrial chemical
would be handled as a HAZMAT event in the same
way as an accidental release.  Depending on the
characteristics of the chemical, met conditions,
etc., the event may require rapid evacuations and
decontamination. First responders should be aware
that terrorists may plant secondary explosives or
booby traps around the scene of a chemical
release incident.
10
WMD and All Hazards Response
Chemical Threats Response
Recognition Isolation Protection Notification
11
WMD and All Hazards Response
Chemical Threats Response
The US Department of Transportation (DOT) is
responsible for coordinating the national safety
program for transport of hazardous materials and
for accident response.      DOT publishes the
Emergency Response Guidebook (ERG) that provides
info on identification of hazards, public safety,
emergency response, and initial isolation and
protective actions for over 3000 industrial
chemicals.  
Recognition
12
WMD and All Hazards Response
Chemical Threats Response

• Recognition Clue 1 Occupancy and Location
• Fixed facilities -- specific occupancy or general
  area (e.g., an industrial park)
• Hazardous materials transportation modes
• Rail, air, marine, highway and pipeline
• Drug lab considerations

13
WMD and All Hazards Response
Chemical Threats Response

• Recognition Clue 2 Container Shape and Size
• Classifications
• Fixed, portable, or in transport
• Pressure
• Non-pressurized, low or high pressure
• Vapor Pressure and Storage
• The higher the pressure, the greater the
  potential for catastrophic failure
• See ERG pages 18-19

14
WMD and All Hazards Response
Chemical Threats Response

• Recognition Clue 3 Placards and Labels
• Placards have limitations
• Not always required
• The 1000 pound rule
• Nine Hazard Classes subdivided into divisions.
  ERG Page 13
• Placards and labels used for transport are based
  on DOT Hazard Class. ERG Pages 16-17

15
WMD and All Hazards Response
Chemical Threats Response
Recognition Clue 4 Shipping Papers (ERG inside
cover)
16
WMD and All Hazards Response
Chemical Threats Response
Recognition Clue 4 Facility Documents

• Material Safety Data Sheets (MSDS)
• Required by the Federal Hazard Communication
  Standard and Florida Right-to-Know Law
• Provide general information ingredients,
  physical and chemical characteristics, fire and
  explosion hazards, reactivity data, health
  hazards and toxicology, precautions for safe
  handling, first aid, control and clean up
  measures, transportation data, disposal data, and
  label data.
• Emergency Response Plans (ERP)
• Emergency Action Plans (EAP)

17
WMD and All Hazards Response
Chemical Threats Response

• Recognition Clue 5 Markings and Colors
• Container colors are not standardized
• National Fire Protection Association 704 Diamond
• Military markings

18
WMD and All Hazards Response
NFPA 704 Diamond
19
WMD and All Hazards Response
Chemical Threats Response
Recognition Clue 6 Human Senses
SMELL SIGHT SOUND TOUCH TASTE
20
WMD and All Hazards Response
Chemical Threats Response
Recognition Isolation Protection Notification
21
WMD and All Hazards Response

• Chemical Threats Response
• Isolation
• Contain the immediate hazard
• Explosion
• Fire
• Contamination
• See ERG Yellow, Blue, and Green Sections

22
WMD and All Hazards Response
Chemical Threats Response This is a Test Match
the chemical with its ID number? 3065 2015 1005
What are Hazards associated with each?
23
WMD and All Hazards Response
Chemical Threats Response
Recognition Isolation Protection Notification
24
WMD and All Hazards Response

• Chemical Threats Response
• Protection
• Self
• Personal Protective Equipment (PPE) -- OSHA
  29CFR.1910.120
• Others
• Downwind Hazard -- ERG Green Pages
• Evacuate
• Shelter-in-place
• Decontamination

25
WMD and All Hazards Response

• Chemical Threats Response
• Protection Self
• Portals of Entry
• Respiratory System
• Eyes
• Skin
• Ingestion System

26
WMD and All Hazards Response
Chemical Threats Response Protection Personal
Protective Equipment Level A Best Respiratory and
skin protection.
Positive pressure SCBA, fully encapsulated
chemical protective suit. For unknown skin
absorptive material and high splash hazards.
27
WMD and All Hazards Response
Chemical Threats Response Protection Personal
Protective Equipment Level B High level
respiratory protection but less for skin
protection.
Positive pressure SCBA, hooded chemical resistive
clothing. For areas less than 19.5 Oxygen,
unidentified gas and vapor and low skin hazard.
28
WMD and All Hazards Response
Chemical Threats Response Protection Personal
Protective Equipment Level C Modest skin
protection.
Full or half hooded APR, hooded chemical
resistive clothing. For no skin hazards, no
unknowns, and sufficient oxygen.
29
WMD and All Hazards Response
Chemical Threats Response Protection Personal
Protective Equipment Level D No respiratory or
skin protection needed. Ordinary work
uniform. May include coveralls, reinforced-toe
boots, and safety helmet.
30
WMD and All Hazards Response

• Infectious Disease
• Personal Protective Equipment
• Airborne precautions
• Particles lt 5 µM
• Remain suspended in air, can be dispersed by air
  currents
• Recommendation Fitted respirators meeting NIOSH
  N95 or better

31
WMD and All Hazards Response

• Chemical Threats Response
• Protection
• Self
• Personal Protective Equipment (PPE)
• Others
• Downwind Hazard ERG Green Pages
• Evacuate
• Shelter-in-place
• Decontamination

32
WMD and All Hazards Response
Chemical Threats Response Protection
Others Downwind Hazard ERG Green Pages Met
Conditions Lapse Cool/Warm Inversion Warm/Coo
l Neutral Cool/Cool
33
WMD and All Hazards Response
Chemical Threats Response Protection This is a
Test What is the DWHD for Methyliodide 1005 Chlor
ine Compare small/large/day/night
34
WMD and All Hazards Response
Chemical Threats Response Decontamination The Hot
Zone, also called the Exclusion Zone, fully
encloses the Incident site -- the immediate scene
of the terrorist event.   The hot zone will
extend downwind depending on the level of vapor
hazard.  All personnel must be in PPE.
35
WMD and All Hazards Response
Chemical Threats Response Decontamination The
Warm Zone, also called the Contamination
Reduction Zone, is located upwind and preferably
up gradient from the Hot Zone.  Rescue, decon,
and medical personnel are located here and all
must be in PPE.  A triage point is located near
the Hot Zone exit control point for rapid
assessment and further disposition of
contaminated casualties.
36
WMD and All Hazards Response
Chemical Threats Response Decontamination The
Cold Zone, also known as the Support Zone, is
located upwind and up gradient from the Warm
Zone.  All persons working in the Cold Zone
should have respirators available in the event of
a wind shift that would put them at risk for
downwind vapor inhalation.  A second triage
point and a medical aid station may be set up
here to further evaluate casualties for on-site
treatment or immediate evacuation to a fully
capable medical facility.  
37
WMD and All Hazards Response
Contagious Disease Isolation Rooms

• Patients housed in rooms under negative pressure
• At least 6 to12 air changes/hour
• Air not re-circulated to other rooms

38
WMD and All Hazards Response
Chemical Threats Response
Recognition Isolation Protection Notification
39
WMD and All Hazards Response

• Chemical Threats Response
• Notification (Also See ERG page 384)
• Who ya gonna call?
• All major chemical releases must be reported to
  the State Warning Point 800-320-0519.  Suspected
  chemical terrorism events, must also be reported
  to the FBI.
• The National Response Center maintains a
  one-stop point of contact site and hotline number
  800-424-8802 for reporting oil and chemical
  spills -- to include chemical or biological
  terrorism releases. 
• CHEMTREC established by the chemical industry as
  a public service hotline [phone] for fire
  fighters, law enforcement and other emergency
  responders to obtain information about emergency
  incidents involving toxic chemicals and hazardous
  materials.

40
WMD and All Hazards Response
Chemical Threats Commercial and industrial
chemicals
Chemical warfare agents
41
WMD and All Hazards Response
Chemical Threats Chemical Warfare Agents

• Classifications
• Choking/Asphyxiation
• Phosgene
• Blister/Vesicants
• Mustards, Lewisite, Phosgene oxime
• Blood/Cytochrome oxidase inhibitors
• Hydrogen Cyanide, Cyanogen chloride
• Nerve/acetylcholine esterace inhibitors
• Sarin, Soman, Tabun, VX

42
WMD and All Hazards Response
Chemical Threats Chemical Warfare Agents
Sarin (2810) Military Designation  GB Physical
State  Liquid at 25o C/77o F  Odor/color 
None/colorless liquid Symptoms Onset  Seconds to
minutes.  If lethal dose is absorbed, symptoms
can progress to death in 15 minutes. Vapor
Toxicities in mg-min/m3   LCt50  100    ICt50 
75  Skin Absorption    LD50  1700 mg  Eye
Injury  (Miosis)  in mg-min/m3 MCt50   3
43
WMD and All Hazards Response
Chemical Threats Chemical Warfare Agents
VX (2810) Military Designation  VX Physical
State  Liquid at 25o C/77o F  Odor/color 
none/colorless to amber liquid Symptoms Onset 
Seconds to minutes.  If lethal dose is absorbed,
symptoms can progress to death in 15 minutes or
less.  Vapor Toxicities in mg-min/m3  LCt50 
50    ICt50  35 Skin Absorption Toxicities   Skin
LD50   10 mg Eye Injury  (Miosis)  MCt50in
mg-min/m3   lt 1
44
WMD and All Hazards Response
Chemical Threats Chemical Warfare Agents
Sarin (2810) Medical Management.   Depending on
the dissemination method and the dose received,
casualties may require decon, administering of
antidotes, ventilation, and supportive
care.   There are three therapeutic drugs used to
treat nerve agent exposure atropine, pralidoxime
chloride (2-PAMCl), and anti-convulsive drugs
such as diazepam.  In cases of severe nerve
agent exposure, ventilation has been required for
up to three hours.   Long term supportive care
will be required for those with prolonged central
nervous system effects.
45
WMD and All Hazards Response
Chemical Threats Chemical Warfare Agents
Sarin Protection  Because nerve agents can cause
casualties from exposure to both vapors and
liquid contact, full respiratory and
non-permeable outer garment protection is
required (Level A Level B).  Decontamination  
Nerve agents hydrolyze under conditions of high
pH.  Hot soapy water solutions can be effective
in removing agent from skin, but complete
hydrolysis occurs over time and run-off from
decon waters may still contain sufficient agent
to cause casualties among unprotected people. 
Skin decontamination is not needed for those who
have only been exposed to vapor only however,
clothing should be removed because it may outgas
trapped vapor.  
46
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack
After numerous failed attempts to
disseminate anthrax spores and botulinum toxin,
in and around Tokyo, on March 20, 1995, members
of the Aum Shinrikyo cult, led by Shoko Asahara
succeeded in releasing sarin in 5 trains running
on three major subway lines converging in
downtown Tokyo.   More than 5,500 people were
affected.  There were 641 casualties resulting
from sarin inhalation that required medical
treatment and 12 deaths. 
47
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack
48
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack The Tokyo Fire Department
transported 688 victims to area hospitals. The
remainder of the victims were transported by
police vehicle, taxicabs, or self-evacuated to
hospitals on their own.  The nearest medical
facility in central Tokyo was St. Lukes
International Hospital which treated 641
casualties on the morning of the attack with 349
follow-up cases seen during the next week.  
49
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack The first EMS request was
made at 809 a.m. Tokyo Fire Department sent 340
units and a total of 1,364 personnel to 16
stations.
There was no attempt to establish
decontamination.  About 10 of the responding
personnel (a total of 135) were among the injured
after direct or indirect sarin exposure.
50
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack There were 5 patients in
critical condition.  3 arrived with
cardiopulmonary arrest 2 were unconscious went
into respiratory arrest soon after arrival. 
Three were successfully resuscitated.  One
patient did not respond to cardiopulmonary
resuscitation and died.  A second patient was
resuscitated but died on day 28 after the attack
due to irreversible brain damage.   The other 10
deaths occurred at the attack scene.   Those who
died included two station employees who had tried
to remove the bags of sarin.
51
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack 106 casualties (43 men and 63
women, including 4 who were pregnant) were
triaged into the moderate severity category and
hospitalized for overnight observation. Many
complained of headache dyspnea, nausea,
vomiting, muscle weakness, coughing, agitation,
and fasciculation.  Hospitalized patients were
treated initially with 2 mg of intravenous
atropine sulfate and 2 g of pralidoxime chloride
after the agent was confirmed as sarin. 
Intravenous diazepam was administered for
fasciculation.  The remaining 531 casualties had
mainly with eye problems (miosis).  They were
treated with intravenous atropine sulfate,
observed for six hours and released if no other
symptoms developed.  
52
WMD and All Hazards Response
Chemical Threats Case Study

• Tokyo Subway Attack
• One month after the attack, St. Luke's mailed
  questionnaires to 610 of those they treated.   Of
  those responding nearly 60 reported post
  traumatic stress disorders.   Many sought the
  services of psychiatrists to relieve their
  psychological symptoms.
• 32 of the victims harbored phobias related to
  using the subway. 
• 29 reported insomnia.
• 16 still had flashbacks of scenes they witnessed
  on the day of the attack.
• 16 reported depression.
• 10 reported vivid nightmares.

53
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack Lessons Learned 1. Attack
Effectiveness.  Although the sarin was not pure
or concentrated and the dissemination method was
crude, it created a mass casualty event. 2.
Initially, there was no control possible at the
scene.  Many of those affected self-evacuated to
area hospitals.  Some with mild symptoms chose
not to seek medical attention.   3. Although
Tokyo-area hospitals had emergency and disaster
plans because of the high incidents of
earthquakes, they were unprepared for a mass
casualty incident where all victims were exposed
to the same toxic substance.  
54
WMD and All Hazards Response
Chemical Threats Case Study
Tokyo Subway Attack Lessons Learned 4. There
was no attempt by on scene responders to alert
the hospital or communicate investigation
results. 5. There was no attempt to decontaminate
victims either at the scene or at the hospital. 
Although the major threat from sarin is vapor
inhalation, some of the victims apparently
contacted the liquid sarin or had pockets of
vapor trapped in their outer clothing.  Over 10
of first responders and 20 of the St. Luke's
staff who treated victims developed nerve agent
symptoms that included miosis, ocular pain,
headache, sore throat, dyspnea, nausea,
dizziness, and nose pain.  5. Mass psychogenic
illness and post traumatic stress are factors
that must be considered in the treatment of
weapons of mass destruction attacks in addition
to the treatment of physical symptoms. 
55
WMD and All Hazards Response
Chemical Threats
Questions? Issues? Discussion?
56
Bioterror Threat
Jack Pittman Director, Public Health
Preparedness Leon CHD and NFRDSTF Heather
Lake Division of Environmental Health
57
Bioterror Threat

• Why Bioterror is an attractive option?
• Spectrum of effects
• Dial an outcome mild to lethal
• Contagion vs. contamination
• Covert Ops
• Extremely high terror and psychological
  consequences

58
Bioterror Threat
Emerging Diseases

• Is mother nature the ultimate bioterrorist?
• HIV/AIDS
• WNV
• EEE
• SARS
• Monkeypox
• Malaria
• Antibiotic resistance
• Pandemic Flu
• Unknown unknowns

59
Bioterror Threat
Bioterror Defense

• Education and training
• Intelligence
• Surveillance
• Vaccination
• Isolation and quarantine
• Stockpile
• Responsive logistics
• Research

60
Bioterror Threat
Questions? Issues? Discussion?