Developmental Milestones/Developments to Date:
Current Assessment/State of the Field:
Benjamin, Georges C. “Chemical and Biological Terrorism: Planning for the Worst” Physician Executive Volume 26 Issue 1. 80. January/February 2000.
- Chemical or biological terrorism is the use of pathogenic microbes or toxins derived from plants, animals, microbes, or chemical agents to achieve terror.” – page 80
- ”Chemical and biological weapons, like nuclear weapons, are categorized as weapons of mass destruction (WMD) because of the high number of potential victims that can result from their use.” – page 80 *
- ”While any chemical can be weaponized, the chemical agents traditionally of concern fall into four categories: nerve agents like sarin, which create an anticholinergic-like syndrome; vesicants like mustard gas, that cause a blistering or burn-like syndrome; cyanide, which interrupts aerobic metabolism; and riot control agents such as mace, which generally cause incapacitation.” – page 80
- ”Biological agents act like chemical agents but have a slower onset of action. Agents of concern include Ricin.” – page 81
- ”The ideal bioweapon is hard to detect from the usual microbial flora, has person-to-person spread, and is easy to aerosolize. There are two groups of organisms of public health concern: those that cause a high morbidity or a high mortality.” – page 81
- ”Examples of high morbidity organisms include salmonella, cholera, or E. coli. The number of highly toxic organisms is fortunately quite low and includes anthrax, smallpox, and the viruses that cause hemorrhagic fevers, plague, brucellosis, and tularemia.” – page 81
- “Clues that biological terrorist events have occurred include an unexplained increase in respiratory cases or deaths, or dead and dying animals. Epidemiological clues include diseases with the wrong mode of transmission, which occur in an inappropriate geographic distribution or infect a new or novel population.” – page 81
- “Components of a biological/chemical terrorism disaster plan: plan how to identify the threat; develop an effective public health disease surveillance system; link the public health system and the traditional medical care delivery system; develop command and control systems; determine hospital bed availability; define disease containment, isolation, and quarantine procedures; plan how to obtain extra life support equipment such as respirators; plan how to train clinical staff to identify high-risk unusual diseases; ensure non-clinical staff are trained on the management of suspicious packages and mail; identify experts; plan simple handling and transport; plan how to communicate high risk information; manage medical examiner cases; and maintain a crime scene.” – page 81
- ”Effective disease control strategies such as case finding, decontamination, prophylaxis and vaccination, and quarantine must be defined.” – page 82
Chemical, WMD, Bioterrorism, Public Health, Military, Sarin, Japan, Ricin, E. coli, Cholera, Salmonella, Anthrax, Smallpox, Hemorrhagic fever, Plague, Brucellosis, Tularemia, Prophylaxis, Vaccination, Quarantine
Vergano, Dan, “Bioterrorism defense under fire Doctors say military plans are wrong approach”. USA TODAY. June 21, 2000.
- “At a recent briefing sponsored by the American Medical Association, infectious-disease specialists argued that military planners have botched the nation’s bioterrorism defenses and ignored the doctors who would form the leading lines of defense against terrorists wielding diseases to kill.”
- “”It’s not the military who will respond to a biological event, but biologists,” says AMA briefing speaker Michael Osterholm of the Minneapolis-based Infection Control Advisory Network, an infectious-disease consulting firm. A former state health official, he warns “it’s just a matter of time” before a bioterrorist attack occurs. He estimates an anthrax attack could cause 3 million deaths.”
- “Osterholm criticizes the federal government’s allocation of funds as already too military-oriented, with about $ 121 million sent to the Centers for Disease Control and Prevention to combat bioterrorism, out of about $ 10 billion in the 1999 federal counterterrorism budget”
- “Biological weapons pose a unique public threat. Unlike explosives or gunfire, microbes overwhelm people slowly, spreading through the populace with symptoms that can mimic more benign maladies, like the flu.”
- “Lab analysis, vaccines and drugs, “disease detectives,” and quarantine are all tools that can be directed toward a biological disaster by the CDC director without the involvement of any other federal agency, Lillibridge says. ‘We anticipate the rest of the government catching up with us.’”
- “Instead of funding military bioterrorism response teams, he says, the government should bulk up disease surveillance efforts staffed by physicians”
- “Most bioterrorism planning revolves around worst-case scenarios,” says terrorism expert Bruce Hoffman, who heads the Washington, D.C., office of RAND, a military and public policy think tank. Terrorists desire terror, he suggests, a goal achieved far more easily and cheaply with a gun or a bomb than with microbes.”
Higham, Steve, “Chernobyl Challenge”. International Construction. August 2001.
- “Within six months, Russian and Ukrainian teams had contained the damaged reactor under a makeshift ‘tomb’. This helped plug to plug immediate radioactive leakage, but will not outlive the danger posed by its contents.”
- “Parts of Chernobyl’s interior have not been seen since the day of the accident—even by remote-controlled cameras. In experimental explorations, robots carrying such cameras had their electronic components destroyed instantly by the high levels of ambient radiation.”
Editors, “Terrorism. Iodine pills, just in case.” Harvard Medical School. July 2002.
- “People are also buying potassium iodide (KI) pills, which help protect the thyroid gland from radiation.”
- “Health officials worry that people who take the potassium iodide will think they’re safe and ignore evacuation orders”
- “If a nuclear catastrophe were to occur, the threshold for taking the pills would be lower for children and pregnant women than for other adults.”
- “Potassium iodide pills flood the thyroid with the stable version, lowering the uptake of the radioactive atoms, which are subsequently excreted in urine.”
- “One Web site, www.nukepills.com, sells 130-mg pills in packets of 14 for $9.95, but adds a hefty $6.95 shipping charge.”
Mattews, Gene, “Legal Preparedness for Bioterrorism” EBSCO Publishing, 2002.
- “In fact, many emergency health laws consist of one sentence stating that the health officer in an emergency may take whatever actions he/she deems necessary” (Pg. 1)
- “The Draft Model State Emergency Health Powers Act, which was fashioned out of existing state laws, was designed to assist states in reviewing their emergency public health powers. The draft covers reporting of diseases cases, quarantine, vaccination, protection of civil liberties, property issues, infectious waste disposal, control of healthcare supplies, access to medical records and effective coordination with other state, local, and federal agencies.” (Pg. 1-2)
- “It is important to know the legal ground rules in advance of an emergency. It will be necessary to brief the public, in multiple languages, on the nature of the disease and how to respond.” (Pg. 4)
- “In an emergency, public health officials will be called upon to deal with a variety of hoaxes and people who are concerned but not sick.” (Pg. 4)
- “The smallpox vaccine is currently classified as an Investigational New Drug, a classification that raises research implications because each state maintains a separate Institutional Review Board overseeing research protocols.” (Pg. 4)
- “Thoughtful decisions will need to be made about closing schools, advising the public to remain at home, and delivering necessary services.” (Pg. 5)
Mitka, Mike, “SARS thrusts quarantine into the limelight,” JAMA, oct 1, 2003, vol. 290, no. 13. history of quarantine, civil rights.
Gerberding, Julie L., “SARS: How effective is the state and local response?“, Hearing before the Permanent Subcommittee on Investigations, May 2003, pgs 10-12.
- “As of May 2003 globally there was 7,700 cases of SARS and 643 deaths.
- “The epidemic in the United States was controlled by methods of isolation and quarantine.”
- “Furthermore active monitoring done by health officials on people exposed to SARS have been occurring in hospitals or at their homes.”
- “Communication has been critical at the local and state levels”
- “We have learned from SARS that the United States can respond quickly to define the virus, develop tests, and sequence it.”
- “The question is are we quick enough to contain it if we end up having a highly infectious person who sets off a cascade of transmission.”
- “Containment of SARS has been successful even in developing countries.”
- “The perceived weakest link is that SARS could spread so entire public health system needs to be strengthened.”
Day, T., “Predicting Quarantine Failure Rates,” Emerging Infectious Diseases 3, 2004:487-88.
Bevelacqua, Armando, “THE NEW HAZ-MAT QUESTION: WHAT ARE YOUR BIOLOGICAL CAPABILITIES?“. Pen Well Publishing Co. November 2004.
- “In some cases, fire response personnel used levels of protection specifically designed for chemical entry (level B and level A encapsulation), multiple alarms to handle one ounce of powder assumed to have hazardous qualities, and countless .support resources, in some places, powder found outside donut shops and funnel cake stands bad tire response personnel dressed in level A just for a cleanup.” (Pg. 1)
- “We must have protocols in place—actions that are followed and performed in conjunction with the public health service. A biological event is a public health response, and a health representative must be involved with the education, training, and tactical response so the system can act as one.” (Pg. 1)
- “A relationship must be established with the local Federal Bureau of Investigation’s weapons of mass destruction (WMD) coordinator to obtain guidance and collaboration in support of procedure and documentation” (Pg. 2)
- “The key issue to consider is if the environment has been identified strictly as a chemical or a potential biological. The fundamental answer comes from the air-monitoring/ detection systems within the response agency” (Pg. 3)
- “Joint Hazard Assessment Teams” (JHAT). JHAT teams are comprised of two haz-mat with a law enforcement representative [additional strike teams have developed into three-person teams comprised of a haz-mat person, an Explosive Ordinance Disposal (EOD). and a law enforcement crime scene officer or intelligence unit representative]” (Pg. 3)
Editors, “PATIENT DECONTAMINATION RECOMMENDATIONS FOR HOSPITALS” EMSA. July 2005.
- “In the case of a medical radiation emergency, response and recovery radiation exposure limits should be established to preserve lifesaving capabilities while taking into consideration risk to staff and facility operation.” (Pg. 13)
- “After removal of contaminated clothing, patients should be instructed (or assisted if necessary) to immediately shower with soap and water. Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided” (Pg. 17)
- “Patient clothing should be handled only by personnel wearing appropriate personal protective equipment, and placed in an impervious bag to prevent further environmental contamination.” (Pg. 17)
- “Gloves should be worn when contact with blood or body fluids is anticipated. Gloves should be removed immediately, without touching non-contaminated surfaces, as soon as the patient care task is complete.” (Pg. 17- 18)
- “Facial protection should be worn when performing patient care tasks likely to generate splashing or spraying of blood and body fluids onto the mucous membranes of the face.” (Pg. 18)
- “Disposable fluid-repelling gowns should be worn to protect skin and clothing” (Pg. 18)
- “Hospitals should plan for decontamination operations that will not exceed their capacity, but should also develop a contingency plan for mass decontamination when patient numbers do exceed their capacity.” (Pg 19)
- “Ensure large quantities of water are available for decontamination in order to dilute the agent as much as possible. Direct excess waste water to the sanitary sewer and immediately notify the POTW and/or MS4.” (PG. 21)
Snyder, Michael and Sobieski, Thomas, “Decontamination Operations in a Mass Casualty Scenario” Joint Force Quarterly. 2008.
- “principles of decontamination that also apply to a nuclear detonation scenario: expect a 5:1 ratio of unaffected to affected casualties, decontaminate as soon as possible, disrobing is decontamination: top to bottom, more is better, water flushing generally is the best mass decontamination method, after known exposure to a liquid agent, first responders must self-decontaminate as soon as possible to avoid serious effects” (Pg. 2)
- “DSCA environment require special considerations by military CBRN planners in the following areas: determining who needs to be decontaminated, multisite operations, integration of decontamination operations with other plans, disposition of runoff, disposition of personal effects, accountability, crowd control.” (Pg. 3)
- “It is reasonable to assume that not everyone within the evacuation zone would be contaminated. Identifying those who are “clean” would greatly reduce the resources needed and expended” (Pg. 3)
- “To respond to the magnitude of need, several mass decontamination sites probably would be established around the plume perimeter.” (Pg. 4)
- “Successful decontamination operations include planning initial medical triage and follow-on medical care, as well as providing subsequent transport, clothing, food, and shelter to all those who process through prescreening.” (Pg. 4)
- “Keeping large groups orderly is essential for effective mass decontamination operations. Local law enforcement would vector victims to the various mass decontamination sites established upwind of the blast and outside the projected plume path.” (Pg. 4)