Emergency Response to Terrorism: Operations

A Safe Response for Public Safety Personnel

The International Association of Fire Fighters

General PresidentHarold A. Schaitberger

General Secretary-Treasurer Vincent J. Bollon

UNIT 5: Biological Agents

Introduction

• Group ActivityBIOLOGICAL AGENTS

Objectives

• By the end of this unit, you will:

• Recognize the threat characteristics of biological agents

• Determine possible types of harm posed to First Responders at biological WMD incidents

• Describe the use of First Responder PPE and its limitations at biological WMD incidents

• Identify First Responder protective actions at incidents involving biological hazards

Background

• May seem unlikely

• Availability greater• 20+ Countries with Active CW Programs• 12+ Countries with Active BW Programs• 30+ Countries with Nuclear Capabilities

• At home - FBI• 37 cases - 1996• 74 cases - 1997• 181 cases - 1998• 2001 + - ???

The Worst Source of Contagion

…Your Fingers

Did you know that 80 % of all infectious illnesses, from the common cold, to flesh eating bacteria, to lethal viruses (i.e. EBOLA), are transmitted by touch?

The Secret Life of Germs

Grand Central Station Hidden Camera

• 60% of people observed did not wash their hands after using the restroom

• 90% of those who did wash their hands did not wash them effectively

• Tested random headsets and found: • E Coli; Fecal germ

• Tested a bar glass at an exclusive hotel and found: • Group D Strep; Fecal germ

• Tested public telephone on Madison Avenue and found:– Hemolytic Strep A; Flesh eating bacteria

New York Observer Swipe Study

Bathroom

• Potential Sources• Toothbrush• Soap Bars• Hand Towels

Flushing a toilet spreads contamination……

everywhere in YOUR bathroom

Stomach Viruses

• 80% of all are foodborne

• Found often on cruise ships

• Doctors call them stomach viruses• ie; E Coli, Shigella Coli

• Transmitted via Fecal-Oral route

What’s In a Sneeze?

• Aerosolized dispersion

• Particles may travel up to 20’

• Coughs can also spread bacteria

Identify Responder Issues SM 5-5

• Determine the following:

• Team 1: Threat Characteristics

• Team 2: Types of Harm

• Team 3: PPE Considerations

• Team 4: First Responder Protective Actions

Team 1

• Threat Characteristics

• Exposure/Contamination

• Secondary devices

• Other hazardous materials

Team 2

• Types of Harm

• Illness

• Death

Team 3

• Personal Protective Equipment

• Self Contained Breathing Apparatus (SCBA)

• Body Substance Isolation (BSI)

Team 4

• First Responder Protective Actions

• Establish Command

• Isolate/Assess

• Prepare for Decon

Biological

WMD

Pathogen Toxin (poison)

Biological

WMD

Pathogen

Bacteria or Viruses

Living organisms

Can be contagious

Symptoms are often delayed

Examples

Bacillus anthracis

Ebola virus

Hepatitis B

HIV

Biological

WMD

Toxin (poison)

Non-living

Not contagious

Symptoms may develop in minutes to hours

ExamplesBotulinumRicinSEB (staphylococcal enterotoxon B)

Biological

Toxin (poison)

Non-living

Not contagious

Symptoms may develop in minutes to hours

Examples

Botulinum

Ricin

SEB (staphylococcal-enterotoxon B)

Pathogen

Bacteria or Viruses

Living organisms

Can be contagious

Symptoms are often delayed

Examples

Bacillus anthracis

Ebola virus

Hepatitis B

HIV

Threat Characteristics

• Pathogens

• Are living organisms

• Multiply once released into the environment or host (carriers)

• Symptoms are often delayed from days to weeks

• Bloodborne and airborne

Threat Characteristics

• Toxins

• Are not living organisms

• Do not multiply once released into the environment or host

• Not transmitted by carriers

• Symptoms may happen within minutes to hours

Threat Characteristics

Pathogens(bacteria, viruses)

examples: Bacillus anthracis bacteria (Anthrax)*, Ebola virus, Hepatitis B virus, HIV, Mycobacterium tuberculosis

Toxins

examples: Botulinum, Ricin (derived from castor beans), Saxitoxin, SEB (Staphylococcal Enterotoxin B

Living organisms; can multiply after dispersion

Non-living; cannot multiply after dispersion

Can be contagious; can cause epidemics/mass casualties

Not contagious; do not cause epidemics

Symptoms often delayed several days to weeks

Symptoms may develop within minutes to hours

Workbook Task SM 5-7

List three ways First Responders can contract diseases in the course of their work.

• Inhalation of pathogens spread through coughs or sneezes of sick patients

• Ingestion of pathogens spread through food and water

• Injection/needle sticks with infected blood/body fluids

Threat Characteristics

• Dissemination• Needs to contact as many as possible

• Aerosols most effective

• Others?

Dissemination

• Unusually high number of sick patients• Numerous patients with similar symptoms• Unusual number of patients within the same neighborhood/s• First Responders may have asked and discovered that patients recently ate at the same restaurants

Discussion - Recognizing a Problem

In the 1980s, members of a cult in Oregon contaminated several salad bars with salmonella bacteria in an effort to affect the outcome of a local election. As a result, 751 people became ill; 45 were hospitalized.

What is the Threat? SM 5-7

Bloodborne/Body FluidBloodborne/Body FluidAirborneAirborne

Not usually transmittedBloodborne/AirborneAirborneNot usually transmittedAirborne

Threat CharacteristicsKey Point

• Importance of BSI

• Use Protective Clothing

• Use Respiratory Protection

Types of Harm SM 5-15

• Fill in the blanks

on page 5-15

Naturally Occurring Diseases

Body System/s

Affected

Initial Signs and Symptoms

AIDS Immune

Hepatitis B, C

Lack of appetite, mild abdominal pain, nausea and vomiting, jaundice; many patients experience no symptoms

Influenza Respiratory

Tuberculosis Most patients show no signs or symptoms

WMD-Related Diseases

Body System/s

Affected

Initial Signs and Symptoms

Anthrax Initial symptoms include fever, malaise, mild cough, chest pain

Hemorrhagic fevers Blood, Liver, Kidneys

Pneumonic plague Respiratory

Ricin Weakness, fever, cough, pulmonary edema, pulmonary distress

Smallpox

Early symptoms resemble the flu, then small blisters develop on the face, hands, and forearms and, eventually, the trunk

Symptoms are often delayed for years; eventually may be noticed as skin lesions and respiratory infections occur

Liver

Fever, headache, body aches, cough, malaise

Systemic, beginning with respiratory

Respiratory

Initial symptoms resemble the flu—sudden onset of fever, headache, malaise

Early symptoms resemble the flu

Respiratory

Systemic, beginning with skin

Page 5-15

PPE

• Review Routes of Entry• Absorption• Inhalation• Injection• Ingestion

• Types of PPE• Fire• EMS

PPE

• How to enhance PPE Effectiveness

• Open building windows• Open ambulance windows• Increase air flow in the area of the patient• Put a mask on the patient• Avoid blood and body fluids• Limit crew exposure

• Review Workbook Activity – SM 5-19

PPE

• First Responder Protective Actions

• Establish Command• Isolate hazard/assess situation• Evaluate rescue• Decon• Call for technical assistance

• Does the ERG help?

25 meters (75 feet) in all directions

ERG 2004 ERG 2004

First Responder ActionsQuestion to Consider SM 5-21

• How do you protect yourself if encountering a patient who has been exposed to a biological release?

• Wear appropriate PPE (SCBA, barrier materials)

• Utilize Back-up team

• Victims must be viable

• Victims can be quickly removed

Decontamination

• Removing contaminated clothing may remove up to 80% of contamination

• Use of hypochlorite is controversial

• Use on equipment

• Technical Assistance

Team Activity: Identify Responder Issues SM 5-25

• Determine the following:

• Team 1: Threat Characteristics

• Team 2: Types of Harm

• Team 3: PPE Considerations

• Team 4: First Responder Protective Actions

Team Activity SM 5-25Your department has been called to assist law enforcement personnel at a self-storage facility. They have gathered information that leads them to believe that evidence, including biological materials, may be stored inside the self-storage unit.

Three days following your response to this situation, your department conducts a post-incident analysis. The stored product was tested and has been identified as Ricin.

Team 1

• Threat Characteristics

• Exposure/Contamination

• Secondary devices

• Other hazardous materials

Team 2

• Types of Harm

• Illness

• Death

Team 3

Personal Protective Equipment

• Self Contained Breathing Apparatus (SCBA)

• Body Substance Isolation (BSI)

Team 4

• First Responder Protective Actions

• Establish Command

• Isolate/Assess

• Prepare for Decontamination

Case Study

• Answers are basically the same

• Good, basic protective actions --- used all the time --- protect against hoaxes and real incidents