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Chemical, Biological, Radiological, Nuclear And Explosive Issues

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    • 1. Chemical, Biological, Radiological, Nuclear and Explosive Issues CBRNE for Veterinary Professionals Module 3 Colorado Veterinary Medical Reserve Corps
    • 2. CO VMRC Training Program
      • Unit 1: Overview of animal emergency management for veterinary professionals
      • Unit 2: Biodefense and biological risk management
      • Unit 3: Overview of CBRNE Hazards for Veterinary Professionals
      • Unit 4: Personal preparedness and contingency planning
      Each module lasts approximately 90 minutes, with 15 minute breaks and 1 hour for lunch
    • 3. Learning objectives
      • Define CBRNE and terrorism
      • Describe the potential impacts of CBRNE events on animals/agriculture
      • Identify the classes of chemical hazards
      • Identify antidotes for nerve agents
      • Identify Biological hazards
      • Identify radiological and nuclear threats
      • List the classes of radioactive particles
      • List key challenges related to animals in radiological events
      • List basic animal decontamination needs and challenges
    • 4. Objectives, continued
      • Identify the basic physiology of explosive blast injuries
      • List the four levels of personal protective equipment
      • Briefly describe foreign animal disease threats
      • Identify the key operational branches in a FAD response
      • Describe the basic biosecurity concerns for FAD emergency responders
      • Describe how to don and doff basic biological PPE
      • List the core issues for use of respiratory PPE
    • 5. CBRNE
      • C hemical
      • B iological
      • R adiological
      • N uclear
      • E xplosive
    • 6. Terrorism
      • The unlawful use of force or violence committed by a group or individual against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.
      • --U.S. Department of Justice
    • 7. Terrorism: animal impacts
      • Secondary animal/ag impacts in general attack
      • Primary attack on livestock/animals
      • Attack on a specific company or industry
        • Domestic terrorism
      • Targeting animal or human food supply in a covert attack
        • Public health threats
        • Public confidence in food supply
        • Economic impacts
        • Illustrated in general by recent pet food contamination incident
    • 8. Chemical threats
      • Military chemical weapons
        • Nerve agents
          • Tabun, Sarin, VX,
        • Vesicant or blistering agents
          • Mustard gas, Lewisite
        • Blood agents (cyanide compounds)
      • Industrial/other chemicals
        • Chlorine, phosgene, ammonia, cyanide, nitric acid
        • Pesticides
      • Misc.
        • Methamphetamine byproducts, mace, tear gas
      1 2 4
    • 9. Tokyo subway attack, 1995
      • Sarin (nerve agent)
      • AUM Shinrikyo group
      Shoko Asahara
      • 12 deaths
      • 990 treated
      • 9000 panic
    • 10. Treatment of OP Poisoning
      • Antidotes
        • Atropine
        • 2-PAM Cl
        • Diazepam
    • 11. Canine nerve agent antidotes
      • Atropine:
        • 0.2 - 2 mg/kg IM.
        • 30 kg (66#) canine, IM = 6 to 60 mg
        • Mark I injector contains only 2 mg!
      • 2-PAM Chloride:
        • 10 - 20 mg/kg IM
        • 30 kg canine = 300 to 600 mg.
        • The Mark I injector contains 600 mg (The LD50 for dogs is 190 mg/kg, so the injector dose should be relatively safe for dogs over 10kg)
      • Diazepam:
        • 0.2 - 2 mg/kg IV for seizure control, used to effect.
        • The CANA injector contains only 2 mg for IM use
        • IM diazepam in dogs unpredictably absorbed
    • 12. Chemical agents: Agriculture
      • Wisconsin 1996
      • National By-Products, Inc.
      • Deliberate contamination of product with chlordane (insecticide)
      • Perpetrator was a business rival
    • 13. Natural “CBRNE-like” event Wyoming/CO border, 2004
      • 600 elk dead or dying with signs of paralysis
      • No other species
      • Eventual ID as:
        • Xanthoparmelia chlorochroa
        • Lichen intoxication
      Walter Cook, Merl Raisbeck, Todd Cornish, Elizabeth Williams, Benge Brown, Greg Hiatt, and Terry Kreeger (in press):  Paresis and death in elk ( Cervus elaphus ) due to lichen intoxication in Wyoming.  Journal of Wildlife Diseases
    • 14. Melamine ???
      • Wednesday, May 23, 2007
      • On March 16, 2007, Menu Foods recalled more than 60 million cans and pouches of pet food that it are marketed under a variety of brand names.
      • The company acted after receiving reports from owners that their pets had become ill.
      New York Times
    • 15. Should you enter a building with this on the door? 3 1 0
    • 16. National Fire Protection Association NFPA Hazardous Material Diamond
    • 17. Material Safety Data Sheets
      • MSDS forms contain the following:
      Section 16 - Other Information Section 8 - Exposure Controls & Personal Protection Section 15 - Regulatory Information Section 7 - Handling and Storage Section 14 - MSDS Transport Information Section 6 - Accidental Release Measures Section 13 - Disposal Considerations Section 5 - Fire Fighting Measures Section 12 - Ecological Information Section 4 - First Aid Measures Section 11 - Toxicological Information Section 3 - Hazards Identification Including Emergency Overview Section 10 - Stability & Reactivity Data Section 2 - Composition/Information on Ingredients Section 9 - Physical & Chemical Properties Section 1 - Product and Company Identification
    • 18. Anhydrous Ammonia 3 1 0
    • 19. Biological Agents
    • 20. History of bio-warfare: examples
      • Examples
        • 1346: Caffa (Crimea) – human plague cadavers catapulted into castle under siege
        • Infected defenders fled, helped to trigger Black Death 1763: Fort Pitt, Pennsylvania, smallpox infected blankets given to Delaware Indians
        • WWII: Japanese test anthrax, typhoid, cholera and plague as weapons in China
        • US (2001): Use of anthrax spores through the mail
    • 21.
        • WWI: German use of glanders against 3500 horses in US bound for Europe
        • Afghanistan (1980s): Soviet Union suspected of using glanders against Mujaheddin horses
      Livestock Disease Agents as Bioweapons
    • 22. Bio-weapons programs
      • United States: Discontinued offensive program in 1969
        • 1972: US and 100+ nations sign treaty banning biological weapons
      • Former Soviet Union
        • Massive program
      • Iraq (?)
      • Al Qaeda in Afghanistan
        • 200+ documents found in caves related to bioterrorism
      Pandora (Dante Gabriel Rossetti, 1869)
    • 23. Animal agricultural vulnerabilities
      • Pre-production
        • Water, medications
        • Feed, fertilizers
      • Production
        • Farms & ranches
        • Concentrated operations
      • Exhibits
      • Transportation and markets
      • Processing
    • 24. Significant disease agents
      • Foot and Mouth Disease
      • Bovine Spongiform Encephalopathy
      • Classical Swine Fever
      • Rift Valley Fever
      • Burkholderia (Glanders, melioidosis)
      • Highly Pathogenic Avian Influenza
      • Exotic Newcastle Disease
    • 25. Foot and Mouth Disease
      • Cloven-hoofed animals (ungulates)
        • Cattle, sheep, pigs, goats, wildlife
      • Virus: One of the most contagious diseases known
        • Incubation 4-5 days
        • Fever, vesicles (blisters)
        • Mouth, nose, teats, feet
    • 26. FMD outbreaks
      • Great Britain, 2001
        • Over 3 million animals culled
        • Over 8000 infected premises
        • Cost over $5 billion US + tourism impacts
      • Uruguay, 2000
        • 6900 animals culled
        • 24 million doses of vaccine used
        • Costs of $247 million US
      • Taiwan, 1997
        • $1.4 billion US, entire swine industry
    • 27. Bovine Spongiform Encephalopathy
      • “ Mad Cow Disease”
      • Prion (protein) agent
      • Spread by cattle feeds with bovine proteins added
      • Prevention by feed bans
      • Over 150 human cases
        • Mostly UK and European nations
    • 28. The Cow that stole Christmas
      • Christmas Eve 2003
      • 1 positive cow in Washington State
        • Canadian origin
        • Older than feed ban
        • No human exposure
      • Over 3 Billion in trade impacts
      • Additional cases found
    • 29. Classical Swine Fever (Hog Cholera)
      • Viral agent
      • Swine
      • Acute and chronic infections
      • Acute:
        • Fever, loss of appetite
        • Erythema of skin
        • Staggering, weakness, death
      • Great Britain: 2000
        • 16 infected premises
    • 30. Rift Valley Fever
      • Signs in animals:
        • Fever, diarrhea, jaundice, loss of appetite, nasal discharge, death
      • Highly infectious for people
        • Varies from mild signs to hemorrhagic fever, meningioencephalitis, ocular disease, jaundice, and death.
      • Viral agent, direct and vector spread
      • Sheep, goats, cattle, buffalo, rodents, and many other species
    • 31. Burkholderia
      • Burkholderia mallei (Glanders)
        • Horses, carnivores, people
      • Burkholderia pseudomallei (Melioidosis) (Whitmore’s disease)
        • Cattle, sheep, goats, people
      • Respiratory and abscessation disease
    • 32. Avian Diseases
      • Highly Pathogenic Avian Influenza
      • Exotic Newcastle Disease
    • 33. =Extremely sick/dead birds
    • 34.  
    • 35. Exotic Newcastle Disease
      • All birds
        • Often sub-clinical in wild birds and psittacine birds (parrots, etc.)
      • Domestic poultry very susceptible
      • Hemorrhagic GI lesions
      • Neurological and respiratory signs
      •  mortality and sudden death
    • 36. END Outbreak, U.S. 2002-2003
      • 4 million poultry destroyed
      • Over $150 million in direct costs
      • 15,000 response personnel
        • Up to 2500 at one time
      • Smuggled parrots?
        •  fighting fowl
        •  backyard poultry
        •  commercial
      • Biosecurity standards correlated to infection rates
    • 37.  
    • 38. Highly Pathogenic Avian Influenza
      • Virus: Influenza A
      • Severe in chickens and turkeys
      • Less severe in ducks/wild birds
      • Depression,  appetite,  thirst
      • Diarrhea, respiratory disease, death
      • Some strains are zoonotic
    • 39. Potential of weaponized agents
      • Increased virulence
      • Resistance to antimicrobials
      • Environmental durability
      • Increase host range
        • People
        • Animals
      • “ Known” disease behavior may not apply!
    • 40. Weaponization
      • Genetic selection
        • Serial passage of microbial stains to select for desired characteristics
      • Genetic engineering
        • Mixing pathogen genes
        • Adding resistance factors
        • Potentially VERY DANGEROUS
          • Opening Pandora’s Box
    • 41. Bio-toxins
      • Non-living agents from a biological source:
        • Clostridial toxins
          • Botulinum neurotoxin
          • Perfringens epsilon toxin
        • Staphyloccocal enterotoxins
        • Mycotoxins
          • Aflatoxins, T-2 toxin
        • Shigatoxin (E. coli)
        • Others (Ricin)
      • Use more like a chemical attack
    • 42. Hoaxes & false alarms:
      • Commodity markets are driven by investor perceptions
      • Public perception drives consumer markets
      • Impacts of credible threats and false alarms may be initially similar to actual events
      • “ Proving the negative” may be a tremendous challenge
    • 43. Kansas FMD scare: 3-12-02
      • Holton Livestock Market
      • Veterinarian reported lesions potentially consistent with FMD
        • Precautionary action
        • Not highly suspect
      • Rumor of 9 infected cows spread quickly (hours)
      • Estimated market impact of 50 million dollars
    • 44. Radiological threats
      • Radiological dispersion device
        • “Dirty bomb”
      • Intentional radiological contamination of people, animals, food, water or the environment
      • Accidental contamination
      Alexander Litvinenko
    • 45. Radiological agents
    • 46. Nuclear threats
      • Military attacks
      • Terrorist/criminal attacks
      • Impacts
        • Mass casualties
        • Catastrophic infrastructure damage
        • Incident of national significance
    • 47. Radiological/Nuclear Animal/Ag impacts
      • Direct casualties
      • Companion animals
        • Evacuation
        • Decontamination
        • Sheltering
        • Search & Rescue
      • Livestock
        • Decon vs euthanasia and disposal
        • Food safety issues
      • Resource prioritization!
    • 48. Radiation Protection Principles
      • Time
      • Distance
      • Shielding
      • Quantity
      • Route
        • External vs internal
    • 49. Explosive attacks
      • Examples
        • Oklahoma City
        • NY, DC, PA
          • 9-11-01
      • Primary
        • Targeting persons at the site
      • Secondary device
        • Targeting responders
      Alfred P. Murrah Building, Oklahoma City, 1995
    • 50. Blast Physics and Physiology
      • Blast Pressure Wave
      • (Friedlander wave form)
        • Detonation.
        • Blast Overpressure (BOP).
        • Exponential decay.
        • Positive Pressure Phase.
        • Negative Pressure Phase.
    • 51. Blast Physics and Physiology
      • Associated PSI’s with injury
        • 2 – 5 - Tympanic membrane rupture.
        • 15 - Lung damage threshold.
        • 30 - 40 - Lethality threshold.
      • Blast Winds
        • Generated by the rapidly expanding gases displacing air.
        • Maximum speeds < 1500 mph.
    • 52. Blast injuries
      • Primary: from blast wave injury to tissues
        • Mainly affects organ systems with a high air to fluid ratio (auditory, pulmonary and GI.)
      • Secondary injuries: from bomb fragments or flying debris
      • Tertiary: victim propelled into stationary objects
      • Other: Burns, smoke, radiation
    • 53. Principles of Veterinary Triage
      • General medical triage nomenclature
        • Green: Minor (walking wounded)
        • Yellow: Delayed treatment OK
        • Red: Needs immediate care
        • Black: Dead/going to die
      • Veterinary professionals would triage for animals and potentially could triage people in catastrophic situations.
    • 54. Decontamination ??
    • 55. Decontamination zones WIND HOT ZONE Incident WARM ZONE Evacuation and decontamination Cold Zone Safe area
    • 56. Decontamination: Equipment and vehicles
      • Two step process
        • Cleaning
        • Application of suitable disinfectant or neutralizing agent as needed
      • Considerations:
        • Location
        • Equipment
        • Corrosion
        • Environmental concerns (runoff)
        • Temperature/humidity
    • 57. Decontamination resources
      • HAZMAT equipment
      • Fire-fighting equipment
      • Food/agricultural operation decontamination equipment
      • Personal protective equipment
      • Trained responders
      • Disinfectant sources:
        • Manufactures
        • Distributors
    • 58. Decontamination: People
      • Portable decon showers/HAZMAT resources
      • Scale
        • Limited
        • Major
        • Catastrophic
    • 59. Decontamination Premises
      • Debris removal
        • Manure, bedding, feed
        • Non-cleanable materials
        • Junk
      • Cleaning
      • Disinfection
      • Environmental testing
    • 60.  
    • 61. Animal Decontamination
      • Biological
      • Chemical
      • Radiological
      • Decontamination vs. euthanasia
    • 62. Animal Decontamination Considerations
      • Animal issues
        • Susceptible v. non-susceptible
        • Food animals v. companion animals
        • Restraint, sedation
      • Human issues
        • Human-animal bond
        • Cultural/language challenges
      • Resource availability!
      • Environmental/regulatory issues
      Euthanasia may be a reasonable decision in some cases
    • 63. Web resources:
      • Environmental Protection Agency:
        • http://www.epa.gov/epahome/laws.htm
      • Occupational Safety and Health Administration
        • http://www.osha.gov/
      • National Institute for Occupational Safety and Health
        • http://www.cdc.gov/niosh/homepage.html
    • 64. NIOSH Agricultural Centers National Institute for Occupational Safety and Health
      • http://www.cdc.gov/niosh/agctrhom.html
    • 65. Personal Protective Equipment (PPE)
      • Equipment and training mandated by OSHA and other agencies
      • For all personnel who have a recognized risk of exposure to hazardous materials
    • 66. General OSHA requirements:
      • Section 5(a)(1) of the OSH Act, often referred to as the General Duty Clause, requires employers to &quot;furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees&quot; .  Section 5(a)(2) requires employers to &quot;comply with occupational safety and health standards promulgated under this Act&quot;.
    • 67. What is PPE?
      • Personal Protective Equipment PPE= Articles worn or equipment used in order to protect wearer from harmful contaminants in environment
      • Provides a shield between you and agent
      • Must prevent/reduce exposure to airborne or surface agents
      • 4 Levels A>B>C>D
    • 68. Level A
      • Highest level of respiratory, skin, eye, and mucous membrane protection
      • Fully-encapsulated, vapor-tight, chemical-resistant suit
      • Chemical-resistant boots
      • Chemical-resistant inner/outer gloves
      • Coveralls, hard hat
      • Self-contained breathing apparatus (SCBA).
      3 1 0
    • 69. Level B
      • Highest level of respiratory protection
      • Lesser degree of skin and eye protection
      • disposable chemical-resistant coveralls or fully- encapsulated, non-vapor-tight suit and SCBA
    • 70. Level C
      • Lesser level of respiratory, skin, eye, and mucous membrane protection
      • Full face-piece
      • Powered, air-purifying, respirator (PAPR) or passive filter respirator
      • Chemical resistant
      • clothing
    • 71. Level D
      • Ranges from a work uniform to basic biological barrier protections
      • Respiratory protection:
        • None
        • “ Dust mask”
      • No vapor protection
      • Simple barrier skin protection
    • 72. When do veterinary professionals need PPE?
      • Anytime they will be exposed to potentially harmful agents
        • Biological
        • Chemical
        • Radiological
        • Mechanical
        • Noise
      http://www.osha.gov/SLTC/hazardcommunications/index.html
    • 73. Risk Assessment
      • Determining what hazards exist that would necessitate PPE for veterinary personnel
        • Mechanical
          • Animal handling
        • Noise
          • Kennels, swine
        • Chemical
          • Disinfectants, chemotherapy drugs
          • OSHA “Right to Know” requirements
        • Biological
        • Radiological
    • 74. Basic veterinary bio-protection Level C-/D+
      • Barrier apparel
        • Tyvek, apron, etc.
      • Footwear
      • Gloves
      • Head gear
      • Goggles
      • N-95 or better respirator when needed
    • 75. Barriers
    • 76. Gloves
      • Barrier, chemical and mechanical protection consideration
      • Latex allergies common
      • Challenges related to duct tape and disposable gloves!
      • Work gloves added for mechanical protection
      Latex Nitrile Vinyl
    • 77. Goggles
      • Non-vented (fogging)
      • Direct vented (limited disease agent protection)
      • Indirect vented (best for zoonotic risk)
      • May interfere with respirator fit!
    • 78. Foot protection
      • Considerations
        • Water resistance
        • Mechanical durability
        • Traction
        • Cleanable vs. disposable
      • Disposable shoe/boot covers
        • Not durable, may be very slick
        • May need to double
    • 79. Head covers
      • Options
        • Hooded coveralls
        • Bouffant caps
        • Hard hats
        • Other
      • Cold weather may necessitate combining with stocking cap underneath
    • 80. Surgical masks
      • What does this provide?
      • Provide splash/barrier protection
      • Currently not OSHA approved for respiratory protection (although may provide limited protection)
    • 81. Respiratory PPE
      • For N-95 masks and better:
        • Each employee must complete OSHA standard medical questionnaire (information confidentiality must be protected per HIPPA)
        • Questionnaires must be reviewed by a physician
        • Some may be required to have a physical
        • Must be trained and fit tested
        • Repeat every two years
      The OSHA Respiratory Protection Standard available at www.osha.gov 29 CFR 1910.134
    • 82. Specific exposure reduction percentages
      • N-95 filtering face piece 75%
      • N-100 filtering face piece 90%
      • Half face APR 90%
      • Full face APR 50 98%
      • Loose fitting hooded PAPR 96%
      • Full face PAPR (tight) 98%
      • SCBA 99+%
      • Note: APR = Air Purifying Respirator
    • 83. Voluntary use of respirators
      • When not required by OSHA
      • Employer or employee provided
      • Not required:
        • Fit testing
        • Medical clearance
    • 84. Fit testing: N-95 Respirators
      • Qualitative fit testing
        • Separate test for each brand/size!
      • Procedure
        • Hoods
        • Detect taste of nebulized solutions
        • 15-60 min per person
      • Repeat annually
      • Quantitative testing now available for filter masks
    • 85. Challenges related to PPE
      • Cost of PPE, med clearance and training
        • Inventory of needed make/model/size
      • Heat/humidity/medical risks
        • Limits for time in PPE based on temp, humidity, person’s physical limits
      • Restricted dexterity
        • 30% decrease in productivity
      • Enforcement of policies
      • Public perceptions/fears
    • 86. General responder health and safety rules of thumb….
      • If you don’t think you should…..
        • DON’T
      • If asked to do something that….
        • You are not qualified for
        • You think is dangerous
        • DON’T
      • Find appropriate personnel/equip
      • Seek appropriate supervision
      • Report to safety officer if unresolved
    • 87.  
    • 88. Foreign Animal Disease Response Flowchart 4-24 hrs 8-36 hrs 16-96 hrs Suspicious case reported FADD Investigates Hold/quarantine (as needed) Sample for FADDL (regional & national) If positive DX: Plan Activation
    • 89. Animal Disease Response Tasks
      • Clinical diagnosis & laboratory confirmation
      • Quarantine
      • Surveillance
        • Healthy, sick, & dead animals
      • Epidemiology
        • Animal ID systems
        • Tracing 
      • Appraisal/indemnity
    • 90. Response Tasks (cont)
      • Mortality Management
      • Decontamination & repopulation
      • Movement permits & compliance agreements
        • animals, products, waste
      • Biosecurity & producer education
      • Mental health considerations
      • Public outreach
      • Recovery
    • 91. Disease Eradication v. Agribusiness Continuity
      • Need to win the war, not just the battle
      • Agribusiness continuity:
        • Removal of infected animals/product
        • Mitigate impacts on economy
        • Preserve uninfected herds when possible
        • Allow untainted products to reach markets
        • Protect related sectors as possible
      • Effective/accurate public messaging
      • Return to disease free status
    • 92. Mortality Management
    • 93. Euthanasia methods
      • Barbiturate injection
        • Cost/ environmental hazard
      • Carbon dioxide
        • Poultry – Soluble Foam
      • Captive bolt/firearms
        • Cost effective
        • Mass euthanasia of livestock
      • Others
        • Per AVMA guidelines
        • Foam “depopulation”
    • 94. Biomass Management Options
      • Methods:
        • Burial
        • Rendering
        • Incineration
        • Composting
        • Alkali digestion
        • Anaerobic digestion and bio-fuels conversion
        • Other
    • 95. Mortality Management Factors: Summary
      • Disease type
      • Location
      • Numbers
      • Accessibility
      • Environmental regulations
      • Equipment availability
      • Manpower & time.
      • Soil types
      • Expense
      • Waterways
      • Water table
      • Permits
      • Capacity
      • Transportation
      • Biosecurity
      • Fuel
      • Public Health
      • Esthetics
    • 96. Mortality Management Resources
      • http://fss.k-state.edu/research/books/carcassdisp.html
    • 97. Additional training:
      • Biological, Nuclear, Incendiary, Chemical and Explosive: Colorado BNICE Center
        • Clinical care course
        • Field awareness and operations courses
        • www.bnice.org
      • AGERT
        • Agricultural Emergency Response Training: Noble Training Center, Anniston, AL
        • Arranged through Colorado Division of Emergency Management
    • 98. CSU Foreign Animal Disease Course
      • Annual program for practitioners
        • Supported by Colorado Department of Agriculture/USDA
        • 1 week course to provide increased skills related to the diagnosis and eradication of foreign animal diseases
    • 99. Questions?