Environmental Health Training in
Emergency Response
Special Health Concerns
CDR William Greim, MS, MPH, REHS/RS
CDC, Atlanta, GA
Richard Wellinghurst, RS.
Louisville Metro Health Department, Retired
Special Health Concerns
Biological
Chemical
Radiological
Intentional
Terrorism
Non-intentional
Accidents
Natural events
OBJECTIVES
• Discuss three areas of special health
concerns from an environmental health
perspective.
• Describe critical information needed to
respond to these events.
• Discuss health and safety issues for
responders.
Terrorism and Public Health Response
• The techniques and strategies used today in
public health emergency planning for the
most part transcend terrorism and can be
used in any public health emergency.
• Some differences can include:
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Lead Agency
Size and Scope of Response
Risk Communication Messages
Evidence Issues
Public Health Issues After a Disaster
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Assessment of Health and Medical Care Delivery
Rapid Assessment of Community Health/Medical Needs
Delivery of Health and Medical Care
Pharmaceutical Supply
Potable Water, Safe Food, and Sanitation and Hygiene
Injury and illness Surveillance
Vector Control
Solid Waste
Hazardous Materials
Registry
Mental Health
Sheltering and Housing
Mass Congregation
Handling of the Deceased (humans and animals)
Staffing
Rumor Control
Public Service Announcements/Media
Environmental Health Roles
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Planning and exercising
Health Educator
Risk communicator
Detection and monitoring
Regulatory enforcement
Health Assessment
Exposure studies
Terrorism Attack and Environmental
Delivery
Agents

Biological

Chemical

Radiological
Environmental
Delivery
System
Targets

Public

Environment

Agriculture
Air - Food -Water
Threats to Food Security
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Food distribution chain
Employees
Physical security
Raw materials
Food processing plants
Packaging
Imported foods
Issues for Food Safety and Bioterrorism
• Exposure to foods is universal
• Complex nature of the food supply
– Foods are often widely distributed
– Open food market system means many potential critical
control points
– Many persons/organizations involved from farm to table
• Lab methods are directed at the usual suspects
• “Agroterrorism” direct attack on plants and animals
Addressing Foodborne Bioterrorism
• Strengthening the food safety infrastructure
– Adequate staffing, training, facilities, laboratories,
communication
• Developing an effective LRN for food
– Methods for select agents
– Functional integration of public health, agriculture, and
regulatory labs that deal with clinical and food
specimens
• Exercising the partnerships between public health and food
safety with every foodborne outbreak
• Expecting the unexpected
Threats to Drinking Water
• Biological agents
• Chemical agents -industrial, natural toxins
– Direct injection
– Secondary contamination
• Radiological agents
• Damage, destruction of
physical infrastructure
• Disruption to computer
systems
Threats to the Air \ Environment
BioWatch
• Environmental monitoring
• Collaboration with Homeland
Security, EPA and cities/states
• LRN expedited assay
development, reagent production
for high throughput real-time PCR
testing
• 19 LRN/BioWatch facilities
support air sampling in 30 US
cities
An example of a BioWatch
Monitor
Public Health Response
Public Health System
Environmental Health
Laboratory
Epidemiology
Laboratory Response Network
2005
The LRN and its partners
will develop and
maintain an integrated
national and international
network of laboratories that
can respond quickly to acts
of biological or chemical
terrorism and other public
health emergencies.
Classification of
Bioterrorism Laboratories
Level D Lab
BSL-4
D - High level characterization (seek evidence of
molecular chimeras) and secure banking of isolates
Safety & proficiency to probe for universe of
bio- and chemical agents in non-clinical specimen
Level C Lab
BSL-3
Level B Lab
Work at BSL-3 with BT agents
Level-A Labs - Assess Risks
for Aerosols and Use Biosafety Cabinet
C - Safety and proficiency sufficient
to probe, type, perform toxigenicity testing
B - Safety and proficiency adequate
to confirm & characterize susceptibility
A - Adequate safety to rule-out
and forward organisms
Bioterrorism: Priority Agents
 Most likely used
 Easily disseminated
or transmitted
 High mortality and
morbidity
 Special public health
preparedness
 Panic and social
disruption
Category A Agents:






Anthrax
Botulism
Plague
Smallpox
Tularemia
Viral Hemorrhagic
Fevers
Category B Agents
• Brucellosis
• Epsilon toxin of
Clostridium
perfringens
• Food safety threats
• Glanders
• Meliodosis
• Psittacosis
• Q fever
• Ricin toxin
• Staphylococcal
enterotoxin B
• Typhus fever
• Viral encephalitis
• Water safety threats
Category B Agents
• Moderately easy to disseminate
• Moderate morbidity rates and low mortality
rates
• Require specific enhancements of
diagnostic capacity and disease
surveillance
Category C Agents
• Emerging infectious
diseases such as Nipah
virus and hantavirus
• Could be engineered for
mass dissemination in the
future because:
• Availability
• Ease of production and
dissemination
• Potential for high
morbidity and mortality
rates and major health
impact
Incubation Period
• Toxin weapons: minutes to hours to days
• Viral and bacterial weapons: days to
weeks
• Fungal weapons: weeks to months
• Some other bio-agents: up to several
years
Survivability of organisms
• Anthrax: days and weeks in the air and years (on
surfaces)
• Brucellosis: up to 2 days in the air
• Coccidioidomycosis: days and weeks in the air
• Ebola: 30 min (liquid) in the air and up to several hours
(dry)
• Glanders: several hours in the air
• Marburg: 30 min (liquid) in the air and up to several
hours (dry)
• Plague: 1 to 2 hours in the air
• Smallpox: up to 24 hours in the air
• Tularemia: several hours to one day in the air
• Q fever: up to several days in the air
• H5N1 avian: room temperature 1-7 days
No.
Affected
Infectious Disease Outbreak
Exposure
Symptoms
Seek Care
Time (days)
Chemical Exposure
No. Affected
Exposure
Acute symptoms
Chronic symptoms
Time (in minutes or hours)
Time (in years)
Specificity and Response
Pre-diagnostic………Diagnostic..…...…Laboratory
Public Health Information
Anthrax
 Gram positive spore forming
bacterium
 Bacillus anthracis Spores highly
stable Viable in soil for decades
 Viable/infectious in aerosol form
Zoonotic disease of herbivores
Epidemiology of Transmission
Cutaneous anthrax
Oropharyngeal and
gastrointestinal anthrax
Pulmonary/mediastinal
anthrax
Direct contact and fly bites
Ingestion
Inhalation
Infected herbivores and
soil are reservoir
Infection Control Anthrax
• No person-to-person transmission
• Use standard precautions
• Avoid direct contact with wound or wound
drainage
– Hand hygiene should be performed after any
contact with wound or wound drainage
– Gloves should be worn when contact with
wound or wound drainage is necessary
Smallpox Introduction
 Smallpox is caused by
Variola virus in the genus
Orthopoxvirus
 Last naturally-acquired case
on Earth in 1977
 Smallpox was declared
eradicated in 1980
Epidemiology of Transmission
Humans are the
Smallpox Virus
only natural reservoir
Transmission via
contact or aerosol
• Up to 30% mortality in unvaccinated persons
• Any case of smallpox would probably mean
an intentional release
Infection Control Smallpox
• Isolate patients - contact and airborne
precautions
• For single or few cases use hospital
with isolation rooms (negative
pressure preferred)
• If large outbreak, may need facility
designated only for smallpox cases
• Notify Public Health immediately
Plague Introduction
Severe bacterial disease of humans and
animals produced by the gram negative
nonsporulating bacillus Yersinia pestis
• Bite of a rodent flea, or by handling
an infected animal
• Millions of people died when human
dwellings were inhabited by fleainfested rats
• Modern antibiotics are effective, but
without prompt treatment the disease
can likely cause illness or death
Types of Plague
• Four types of plague
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Bubonic plague
Pneumonic plague
Septicemic plague
Oropharyngeal plague
“Safety Pin” Y. Pestis in
blood
Epidemiology of Natural Transmission
A
B
Yersinia pestis
Primary
bubonic plague
A
D
D
Secondary
plague
cases
Flea vector such as
Xenopsylla cheopis
B
C
Primary
septicemic plague
Primary
pneumonic plague
C
Enzootic and epizootic
animal reservoirs
Routes of Plague Transmission
A = Bite of Flea
B = Contact with animal or carcass
C = Inhalation of respiratory droplets
D = Contact with sputum or fluid
Infection Control Plague
Botulism: Overview
Description of Spores
Spores can be found in
• Soil (commonly)
• Marine and Lake sediments
• Intestinal tracts of animals including
fish
Can withstand extreme conditions
• Resistant to UV light, irradiation
• Survive boiling for up to 4 hours
• Survive food processing procedures
• Resistant to desiccation
Readily killed by chlorine
Epidemiology of Natural Transmission
Toxin production in foods
prepared or stored at
ambient temperature
Colonization and
toxin production in
an open wound
Botulism:
Acute, symmetric,
descending flaccid
paralysis with bulbar
palsies
C. botulinum
in the soil,
flora and fauna
Intestinal colonization and
toxin production in susceptible
infants and adults
Infection Control Botulism
• Rapid treatment of patients
• Identify and eliminate source of outbreak
• Determine if accidental or deliberate release vs.
endemic disease
• Consider bioterrorism if:
• Large number of cases
• Unusual toxin type
• Multiple outbreaks with no common source
Tularemia Introduction
• Gram negative coccobacillius,
Francisella tularensis
• Identified in 1911 in Tulare County,
California
• Also known as Rabbit fever or Deer-fly
fever
Tularemia Introduction
• Organism persists in
environment
• Infections acquired by:
• Bites
• Handling infected materials
• Ingestion of food, water, or
soil
• Inhalation of infectious
aerosols
• Laboratory exposures
Tularemia as a Biological Weapon
• Highly Infectious when
aerosolized
• Respiratory infectious
dose between 10 and 50
organisms
• Possible to produce vaccineresistant and antibioticresistant strains
• Easily killed by heat and
disinfectants
Epidemiology of Natural Transmission
A
A
Ulceroglandular
B
Vector ticks, biting flies,
mosquitoes
Francisella
tularensis
B
Glandular
Enzootic and epizootic
animal reservoirs
Rabbits, muskrats, voles, etc.
D
Oropharyngeal
C
Oculoglandular
C
Pulmonary
Routes of Tularemia Transmission
A = Bite of infected arthropod
B = Contact with infected animals,
tissues or fluids
C = Exposure to infectious aerosols
D = Ingestion of infectious materials
Viral Hemorrhagic Fevers
• Crimean-Congo hemorrhagic fever
(CCHF)
• Ebola hemorrhagic fever
• Hantavirus Pulmonary Syndrome
• Hemorrhagic fever with renal syndrome
(HFRS)
• Lassa Fever
• Marburg hemorrhagic fever
VHFs
• A severe multi-system syndrome in which the
overall vascular system is damaged, and the
body's ability to regulate itself is impaired.
• Zoonotic, rodents and arthropods are the main
reservoirs and vectors for viruses causing
VHFs.
• With few exceptions, there is no cure, vaccine,
or established drug treatment for VHFs.
• Some HTH transmission-Ebola, Marburg,
Lassa
Prevention
• Avoiding contact with host species
• Preventing further transmission from person to
person
• Controlling rodent populations, safe cleanup of
rodent nests and droppings.
• Arthropod vectors prevention efforts
• Avoiding close physical contact with infected
people and their body fluids
• Infection control techniques include isolating
infected individuals and wearing protective
clothing.
Lassa Fever virus inactivated by:
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•
•
•
o
heating to 56 C
pH<5.5 or >8.5
UV/gamma irradiation
Detergents, 1:100 bleach solution to
disinfect surfaces, medical equipment,
patient bedding, reusable protective
clothing
Emerging Diseases
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Pandemic Influenza
SARS
West Nile Virus
Monkeypox
Chagas Disease
Antibiotic/Antimicrobial Resistance e.g.,
MRSA, tuberculosis, malaria, head lice,
typhoid fever
Pandemic Influenza
Avian Influenza A Viruses
Infect respiratory and gastrointestinal tracts of birds
• Natural reservoir is wild waterfowl - usually infections
do not cause disease (wild ducks and geese)
• Genetic re re-assortment occurs
Viruses are present in respiratory secretions, excreted
in feces
• Can survive at low temperatures and low humidity for
days to weeks
• Can survive in water
• Disinfection of the environment is needed
Transmission
• Highly contagious
• Primarily person-to-person
• – Respiratory droplets: coughing and
sneezing
• – Direct and indirect contact
• – Airborne transmission occurs very rarely,
if ever
• Incubation period: 1-4 days
• Subclinical infection can occur
Factors in Infectious Disease Emergence
• Ecological Changes
• Human Demographics and Behavior
• International Travel and Commerce
• Technology and Industry
• Microbial Adaptation and Change
• Breakdown in Public Health Infrastructure
• Human Susceptibility to Infection
• Economic Development and Land Use
• Climate and Weather
• War and Famine
• Lack of Political Will
• Poverty and Social Inequality
• Intent to Harm
Preparedness for Bioterrorism Event
• Trained and staffed public health workforce
• Surveillance and epidemiology capability
• Laboratory expertise, capacity, and coordination
• Communication and information networks
• Therapeutic and preventative capability
• Partnerships, partnerships, partnerships
1
The Threat Spectrum
And Historical Precedents
1
1
10,000,000
Possible Casualties
Pathogens
Nuclear
Weapon
Spanish Flu
Toxic
Industrial
Chemicals
1
1,000,000
Hiroshima
1
100,000
Chemical
Weapons
0
10,000
Conventional
High Explosives
Bhopal
Radioisotopes
Halabja
poison gas
attack
0
1,000
Tokyo
Subway
0
100
World Trade
Center
Dalles,
Oregon
Chernobyl
Oklahoma
City
Biotoxins
0
10
0
Bulgarian
Assignation
Low
1
High
2
Likelihood
3
4 of Occurrence*
5
6
7
8
* Per FBI Briefing, October 2, 2000
Environmental Health Effects
TOXICITY
• The relative ability of a substance to cause adverse
effects in living organisms,
• “The Dose is the Poison”,
ROUTES OF EXPOSURE
• Inhalation
• Ingestion
• Dermal
– Absorption
– contact
– Injection
Environmental Health Effects
• Exposure
vs.
• Contamination
Types of “Chemical Agents”
• Nerve Agents
– Sarin (GB), tabun (GA), Soman (GD), VX
• Blood Agents,
– Cyanides, a common chemical
• Blister agents or visicant
– Sulfur mustard ( H, HD, and HT) Lewisite (L),
• Pulmonary agents
– Phosgene (CG), chlorine
http://www.bt.cdc.gov/agent/agentlistchem-category.asp
Health Concerns of
“Nerve Agents”
• ROUTES OF EXPOSURE
– Liquid on skin
• Very small drop: twitching at site
• Small drop: nausea, vomiting, diarrhea
• Drop: Loss on consciousness, convulsions, respiratory arrest,
flaccid paralysis
– Vapor in air
• Small: pupils, red conjunctiva, dim vision, nausea/vomiting, runny
nose, salivation, shortness of breath
• Large: Respiratory and cardiac arrest
• TOXICITY
– IDLH
GB (Sarin) = 0.03ppm (0.2mg/m3)
GD (Soman) = 0.008ppm (0.07mg/m3)
VX
= 0.002ppm
(0.02mg/m3)
Health Concerns of
“Blister Agents”
• ROUTES OF EXPOSURE
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–
–
–
–
Damage to eyes, skin, airways
Irritating, painful contact
Tissue damage
Lewisite effects appear within minutes
Sulfur mustard effects appear from 2-24 hours after
exposure.
• TOXICITY
– Symptoms do not improve with time and fresh air
– IDLH
• Mustard (HD) = 0.7mg/m3
• Lewisite (L) = 0.003mg/m3
Health Concerns of Pulmonary
(Choking/Blood) Agents
• ROUTES OF EXPOSURE
– Irritation of eyes, nose and airways
– Inhalation primary hazard
• TOXICITY
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–
–
–
Shortness of breath
Cough / asphyxiation
Effects begin up to 24 hours after exposure,
IDLH
Chlorine
Cyanide (AC)
Phosgene
= 10 ppm (30mg/m3)
= 50 ppm (60mg/m3)
= 2 ppm (10mg/m3)
Radiation,
Potential hazards
• Major radiation sources and releases,
• Health concerns of radiation exposure,
Potential “Rad” Incidents
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•
Radiological
– Laboratory
– Medical
– Transportation
– Space
– “Dirty” bomb / device
Nuclear
– Power Plant
– Reactors
– Weapons
Nuclear Power Plants
Potential incidents,
Possible Targets:
There are 103 operating
nuclear power reactors at 65
sites across the United
States, using nuclear energy
to generate electricity.
•Plant Security
•Waste Generation and
Disposal
Nuclear Pharmaceuticals
• Nuclear Pharmacies
located in many
communities,
• Provide radioactive
pharmaceuticals to
hospitals and clinics,
• Results in radioactive waste
in hospitals
Radiographic device
• May be present
for a long period
of time before
discovery
• Could cause
health concerns
for many people
• Will cause
widespread
public concern
Improvised Nuclear Device (IND)
• Incorporates nuclear materials
designed to produce a nuclear
explosion.
• Could consist of diverted
nuclear weapon components, a
modified nuclear weapon, or
indigenous-designed device.
Faulty Improvised Nuclear Bomb design
from an Al Qaeda report
A Radiological Dispersion Device, RDD)
• Any weapon that is designed
to spread radioactive material
with the intent to kill, and
cause disruption by
psychologically and financially
impacting
Time
fuse
Radioactive
material
Detonator
Conventional
explosive
(e.g. fertilizer,
semtex)
Radiation Exposure
Health Effects
Exposure
With Medical Symptoms
Care
100-200 R
≤ 5% will
become ill
200-300 R
600
15-30 %
may Die
50 %
may Die
Radiation,
Annual Dose
Between 320 – 360 mr/yr
May Nausea Vomit
within 4 hours
Nausea Vomit Quickly
30-50 % die no
medical
95-100 % die with no
medical
Dose Limits for
Emergency Workers
•
•
Rem
5
–
•
10
•
25
–
>600
>90 %
May Die
All die in 2 weeks or
sooner with no
medical
•
>25
–
•
Condition
General monitoring
(no life safety involved)
Protection of a large
population
Life saving
(once in a lifetime)
Life saving
(authorization required)
Source: U.S. EPA 400 1994
Toxic Industrial Chemicals
(TICs)
• TICs are chemicals that are manufactured,
stored, transported, and used throughout
the world.
– Routes of Exposure – ALL
– Toxicity
• Can be chemical hazards (e.g., carcinogens,
reproductive hazards, corrosives, or agents that
affect the lungs or blood) or
• physical hazards (e.g., flammable, combustible,
explosive, or reactive).
Chemical Hazard Classes
FY 2000 Most Common Chemicals involved
in Causing Deaths, Injuries, or Evacuations
Chemical Name
Chemical Name
Chemical Name
Chemical Name
Ammonia
Freon
Heptanoic Acid
Perchloroethylene
Chlorine
Sulfur Dioxide
Hydrazine
Sodium Hypochlorite
Hydrogen Chloride
Hydrofluoric Acid
Hydrogen Cyanide
Asbestos
Sulfuric Acid
Carbon Monoxide
Malathion
Ethylene Glycol
Mercury
Formaldehyde
Methacrylic Acid
Ethylene Oxide
Sodium Hydroxide
Hydrogen Sulfide
Methanol
PCBs
Phosphoric Acid
Mercaptans
Phenol
Propylene Glycol
Acetone
Benzene
Thioglycol
Bromine
Butadiene
Chromic Acid
Sodium
Ethanol
Radioactive Materials
Oxides of Nitrogen
Based on reports to ATSDR from the National Response Center. No rank order intended
What are the potential
“TIC” Threats?
• Use as a WMD / Weapon
• Accidental release (Haz Mat)
– Total for 2006 = 36,855 (NRC)
• Environmental contaminant during and
following natural disaster (i.e. Katrina)
Chemicals in Transport
• Roads
• Rails
• Water
Graniteville, SC. (Jan. 2005)
Chlorine gas
•9 fatalities
•554 treated at hospitals
•75 admitted
•5,400 evacuated
•$6.9 million property damage
Incendiaries \ Explosives
Principles of
Radiation & Chemical Safety
• Selection and use of
proper PPE
• Use available
shielding
– Sheltering,
• Use nearby buildings
and structures
• Even a vehicle offers
some shielding
Potential Public Health Issues Following
a Major WMD \ Haz Mat Event
• Emergency Support Function #8 includes:
–
–
–
–
–
–
–
–
–
–
Assessment of Health and Medical needs,
Medical Care, Equipment and Supplies
Victim evaluation
Food and Drug safety
Worker (Responder) Health / Safety
Radiological, Chemical and Biological Hazards
Public Health Information
Potable Water / Wastewater & Solid Waste management
Health Surveillance
Victim Identification and Mortuary Services
EH Issues at
“Special Concerns” Response
•
Health and Safety information regarding:
Airborne contaminants (may be intentional)
Chemicals
Radiological
Biological
Worker Safety
Contaminated waters
Food and Water Safety
Waste Management
•
EH Issues at
“Special Concerns” Response
• Environmental assessment activities
• Monitoring, Sampling and Inspection
plan, development and approval
• Site Safety and Re-entry sampling
• Food / Water safety inspections
• Epidemiology activities
– Data collection and management
– Mapping and Long-term trend analysis
• Community Education, Public Health
Information
What do the Responders and
Public Need to Know “ASAP”?
• What is the agent,
• What are its hazards,
• How to protect themselves
– Stay upwind of vapors, (Sheltering and or
Evacuations,)
– Stay out of liquids and dust (what to be on the lookout
for),
• What to do if they are exposed,
• Who to contact for more information.
Initial Response Activities
• Initiate Contamination Control
Immediately
– Restrict access to contamination,
– Assure Decontamination activities
conducted
• Responders
• victims
Contamination Control and
Decontamination
• Advise responders and victims on initial
decontamination
• External contamination can be reduced
80-90% by removal of outer clothing
• Washing the contaminated area with soap
and water very effective
• Ensure all contaminated tools, clothing,
equipment & other material that can’t be
decontaminated are bagged, tagged &
stored for later disposition
• Be prepared to refer questions on the
contamination & control of exposed
individuals to the “experts”,
Examples of
Local Environmental Health
Response
•Emergency Response activities & decision making,
–Hazard identification and environmental monitoring,
–Inform responders and public about protective actions
needed,
–Assist implementation of evacuation or Shelter in Place
instructions
–Assure regulatory compliance,
•Assist with distribution of prophylaxis,
Remember –
Front Line Response
Begins at the Local Level
What do EH Practitioners
bring to a response that is unique?
• Possess a Broad Science Base
• Understand Environmental Systems
• Working Field Familiarity
• Operational Surveys of Environmental
Systems
• Recognize Problems and Vulnerabilities
• Influence the Operation of the System
Public Health Issues Following a
Major WMD \ Haz Mat Event
Initial Response
(Early Phase: 1-7 Days)
• Sheltering,
• Medical Care, including prophylaxes,
• Monitoring and Decontamination of Responders and
Victims,
• Environmental Contamination, monitoring and
control,
• Handling & disposition of potentially-contaminated
remains,
• Hazardous and solid (liquid) waste management,
• Infrastructure disruption
– power outages, communication systems, water
supply, waste water, food safety, others,
Public Health Issues Following a Major
WMD \ Haz Mat Event
Intermediate Phase: Weeks to Months
Recovery Phase: Months to Years
– Relocation of populations
– Agricultural products, as crops and in transit
– Contaminated air plume and later resuspension of
debris
– remediation of land, waters and property
– Health surveillance of exposed populations
– Response planning
– Mitigation of Hazards
Resources available
(free from CDC)
HSDB
Other Information Resources
World Wide Web
Partner Agencies
• 911
• County Emergency
Management
• Law Enforcement
• Fire \ EMS
• Hazmat
• Local Health
Department
• Local Hospitals
• Other 1st Responders
• Regional WMD\Haz
Mat Teams,
• State EOC \ Warning
Point
• Federal Bureau of
Investigation
State & Regional Response
Resources
• Air National Guard, Weapons of Mass
Destruction Civil Support Teams (WMDCST),
• State Department of Health
– Radiation Safety
• Environmental Protection, ERT
• State Emergency Management
– EMAC, the Emergency Management
Assistance Compact,
CDC Emergency Assistance 24 \ 7
Emergency Operation Center #770-488-7100
•
•
•
Technological Disasters:
- Radiation
- Hazardous chemicals
- Oil
- Biologics
Natural Disasters:
- Hurricanes
- Severe weather
- Earthquakes
- Volcanic eruptions
- Floods
- Extreme heat/cold
Terrorism:
- Biologic
- Radiological
- Chemical
CDC
Emergency Assistance
• CDC Teams
– Identify agent rapidly
– Determine exposure
distribution
– Evaluate long-term health
implications
– Identify worried well
• National Center for
Environmental Health
Laboratory Response
Team
– Support collection of
clinical samples
– 15 min response, 1 hr
arrival at CDC
– Shipping/tracking
information
– Work w/ Rapid Response
lab on analysis
Federal Notification,
Response and Coordination
• National Response Center (800-424-8802)
– FBI, Federal Lead Agency if Terrorism / WMD
incident
• Resources include HMRT etc.
– EPA is Federal Lead Agency for Environmental
Recovery Phase
• On Scene Coordinator
• Remediation funds available via OSC
Remember
All disasters are local and require
“local coordination”
Strong federal
“leadership” will be
evident.
Special Concerns - Exercise
•
There has been a response, in your community, to a
large family planning clinic where a package has
puffed out a cloud of unknown powder. Contained in
the package is a letter indicating that the clinic staff will
now die for their sins. A few of the clinic staff are
beginning to complain of respiratory distress etc.
1. Based on your training and experience, what roles
could\should you play, (e.g., 1st responder,
environmental assessment, EOC liaison, etc?)
2. Assuming that role, what would be your next steps?
3. In that role, what information do you need?
4. Who would you be working with?
5. Where in the ICS would you likely be working?