WMD and All Hazards Response
Jack Pittman
Heather Lake
Ken Hendricks
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
WMD and All Hazards Response
Weapons of Mass Destruction:
BNICE
Biological, Nuclear, Incendiary, Chemical, Explosive
CBRNE
Chemical, Biological, Radiological, Nuclear, Explosive
WMD and All Hazards Response
Explosive and Incendiary Threats:
Favorite Terrorist weapon
• Mass casualty trauma:
- Crushing
- Fragmentation
- Burns
• Relatively cheap
• High visibility
• High terror
WMD and All Hazards Response
Chemical Threats:
Industrial chemicals
Chemical warfare
agents
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
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.
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, > 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.
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.
WMD and All Hazards Response
Chemical Threats:
Response
Recognition
Isolation
Protection
Notification
WMD and All Hazards Response
Chemical Threats Response
Recognition
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.
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
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
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
WMD and All Hazards Response
Chemical Threats Response
Recognition – Clue 4 Shipping Papers (ERG inside
cover)
MODE
CALLED
LOCATION
Rail
Waybill and
Cosist
With crew
Highway
Bill of Ladding
Driver / on seat
or door pocket
Air
Airbill
Pilot
Pipeline
Marker
At cross with
other mode of
transport
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)
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
WMD and All Hazards Response
NFPA 704 Diamond
WMD and All Hazards Response
Chemical Threats Response
Recognition – Clue 6 Human Senses
SMELL
SIGHT
SOUND
TOUCH
TASTE
WMD and All Hazards Response
Chemical Threats
Response
Recognition
Isolation
Protection
Notification
WMD and All Hazards Response
Chemical Threats Response
Isolation
Contain the immediate hazard
• Explosion
• Fire
• Contamination
See ERG Yellow, Blue, and Green Sections
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?
WMD and All Hazards Response
Chemical Threats
Response
Recognition
Isolation
Protection
Notification
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
WMD and All Hazards Response
Chemical Threats Response
Protection: Self
Portals of Entry
• Respiratory System
• Eyes
• Skin
• Ingestion System
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.
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.
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.
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.
WMD and All Hazards Response
Infectious Disease
Personal Protective Equipment
• Airborne precautions
– Particles < 5 μM
– Remain suspended in air, can be dispersed
by air currents
• Recommendation: Fitted respirators meeting
NIOSH N95 or better
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
WMD and All Hazards Response
Chemical Threats Response
Protection Others
Downwind Hazard ERG Green Pages
Met Conditions:
Lapse
Cool/Warm
Inversion
Warm/Cool
Neutral
Cool/Cool
WMD and All Hazards Response
Chemical Threats
Response
Protection
This is a Test
What is the
DWHD for:
Methyliodide
1005
Chlorine
Compare
small/large/day/
night
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.
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.
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.
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
WMD and All Hazards Response
Chemical Threats
Response
Recognition
Isolation
Protection
Notification
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 800-424-9300 for fire fighters, law
enforcement and other emergency responders to obtain
information about emergency incidents involving toxic
chemicals and hazardous materials.
WMD and All Hazards Response
Chemical Threats:
Commercial and
industrial
chemicals
Chemical warfare
agents
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
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
Skin Absorption LD50 1700 mg
Eye Injury (Miosis) in mg-min/m3 MCt50 3
ICt50 75
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 < 1
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 anticonvulsive 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.
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.
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.
WMD and All Hazards Response
Chemical Threats: Case Study
Tokyo Subway Attack
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.
Luke’s International Hospital which treated 641
casualties on the morning of the attack with 349 followup cases seen during the next week.
WMD and All Hazards Response
Chemical Threats: Case Study
Tokyo Subway Attack
The first EMS request was made at 8:09 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.
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.
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.
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.
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.
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.
WMD and All Hazards Response
Chemical Threats
Questions?
Issues?
Discussion?
Bioterror Threat
Jack Pittman
Director,
Public Health Preparedness
Leon CHD and NFRDSTF
Heather Lake
Division of Environmental Health
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
Bioterror Threat
Emerging Diseases
Is mother nature the ultimate bioterrorist?
•
HIV/AIDS
•
WNV
•
EEE
•
SARS
•
Monkeypox
•
Malaria
•
Antibiotic resistance
•
Pandemic Flu
•
Unknown unknowns
Bioterror Threat
Bioterror Defense
•
Education and training
•
Intelligence
•
Surveillance
•
Vaccination
•
Isolation and quarantine
•
Stockpile
•
Responsive logistics
•
Research
Bioterror Threat
Questions?
Issues?
Discussion?