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Chemical, Biological, Radiological, Nuclear and Explosive Issues CBRNE  for Veterinary Professionals Module 3 Colorado Vet...
CO VMRC Training Program <ul><li>Unit 1:  Overview of animal emergency management for veterinary professionals </li></ul><...
Learning objectives <ul><li>Define CBRNE and terrorism </li></ul><ul><li>Describe the potential impacts of CBRNE events on...
Objectives, continued <ul><li>Identify the basic physiology of explosive blast injuries </li></ul><ul><li>List the four le...
CBRNE <ul><li>C hemical </li></ul><ul><li>B iological </li></ul><ul><li>R adiological </li></ul><ul><li>N uclear </li></ul...
Terrorism <ul><li>The unlawful use of force or violence committed by a group or individual against persons or property to ...
Terrorism: animal impacts <ul><li>Secondary animal/ag impacts in general attack </li></ul><ul><li>Primary attack on livest...
Chemical threats <ul><li>Military chemical weapons </li></ul><ul><ul><li>Nerve agents </li></ul></ul><ul><ul><ul><li>Tabun...
Tokyo subway attack, 1995 <ul><li>Sarin (nerve agent) </li></ul><ul><li>AUM Shinrikyo group </li></ul>Shoko Asahara <ul><l...
Treatment of OP Poisoning <ul><li>Antidotes </li></ul><ul><ul><li>Atropine </li></ul></ul><ul><ul><li>2-PAM Cl </li></ul><...
Canine nerve agent antidotes <ul><li>Atropine: </li></ul><ul><ul><li>0.2 - 2 mg/kg IM.  </li></ul></ul><ul><ul><li>30 kg (...
Chemical agents: Agriculture <ul><li>Wisconsin 1996 </li></ul><ul><li>National By-Products, Inc. </li></ul><ul><li>Deliber...
Natural “CBRNE-like” event Wyoming/CO border, 2004 <ul><li>600 elk dead or dying with signs of paralysis </li></ul><ul><li...
Melamine ??? <ul><li>    </li></ul><ul><li>Wednesday, May 23, 2007  </li></ul><ul><li>On March 16, 2007, Menu Foods recall...
Should you enter a building with this on the door? 3 1 0
National Fire Protection Association   NFPA Hazardous Material Diamond
Material Safety Data Sheets <ul><li>MSDS forms contain the following: </li></ul>Section 16 - Other Information  Section 8 ...
Anhydrous Ammonia 3 1 0
Biological Agents
History of bio-warfare: examples <ul><li>Examples </li></ul><ul><ul><li>1346:  Caffa (Crimea) – human plague cadavers cata...
<ul><ul><li>WWI:  German use of glanders against 3500 horses in US bound for Europe </li></ul></ul><ul><ul><li>Afghanistan...
Bio-weapons programs <ul><li>United States:  Discontinued offensive program in 1969 </li></ul><ul><ul><li>1972:  US and 10...
Animal agricultural vulnerabilities <ul><li>Pre-production </li></ul><ul><ul><li>Water, medications </li></ul></ul><ul><ul...
Significant disease agents <ul><li>Foot and Mouth Disease </li></ul><ul><li>Bovine Spongiform Encephalopathy </li></ul><ul...
Foot and Mouth Disease <ul><li>Cloven-hoofed animals (ungulates) </li></ul><ul><ul><li>Cattle, sheep, pigs, goats, wildlif...
FMD outbreaks <ul><li>Great Britain, 2001 </li></ul><ul><ul><li>Over 3 million animals culled </li></ul></ul><ul><ul><li>O...
Bovine Spongiform Encephalopathy <ul><li>“ Mad Cow Disease” </li></ul><ul><li>Prion (protein) agent </li></ul><ul><li>Spre...
The Cow that stole Christmas <ul><li>Christmas Eve 2003 </li></ul><ul><li>1 positive cow in Washington State </li></ul><ul...
Classical Swine Fever  (Hog Cholera) <ul><li>Viral agent </li></ul><ul><li>Swine </li></ul><ul><li>Acute and chronic infec...
Rift Valley Fever <ul><li>Signs in animals:  </li></ul><ul><ul><li>Fever, diarrhea, jaundice, loss of appetite, nasal disc...
Burkholderia  <ul><li>Burkholderia mallei (Glanders) </li></ul><ul><ul><li>Horses, carnivores, people </li></ul></ul><ul><...
Avian Diseases <ul><li>Highly Pathogenic Avian Influenza </li></ul><ul><li>Exotic Newcastle Disease </li></ul>
=Extremely sick/dead birds
 
Exotic Newcastle Disease <ul><li>All birds </li></ul><ul><ul><li>Often sub-clinical in wild birds and psittacine birds (pa...
END Outbreak, U.S. 2002-2003 <ul><li>4 million poultry destroyed </li></ul><ul><li>Over $150 million in direct costs </li>...
 
Highly Pathogenic Avian Influenza <ul><li>Virus:  Influenza A </li></ul><ul><li>Severe in chickens and turkeys </li></ul><...
Potential of weaponized agents <ul><li>Increased virulence </li></ul><ul><li>Resistance to antimicrobials </li></ul><ul><l...
Weaponization <ul><li>Genetic selection </li></ul><ul><ul><li>Serial passage of microbial stains to select for desired cha...
Bio-toxins <ul><li>Non-living agents from a biological source: </li></ul><ul><ul><li>Clostridial toxins  </li></ul></ul><u...
Hoaxes & false alarms: <ul><li>Commodity markets are driven by investor  perceptions </li></ul><ul><li>Public  perception ...
Kansas FMD scare:  3-12-02 <ul><li>Holton Livestock Market </li></ul><ul><li>Veterinarian reported lesions  potentially  c...
Radiological threats <ul><li>Radiological dispersion device </li></ul><ul><ul><li>“Dirty bomb” </li></ul></ul><ul><li>Inte...
Radiological agents
Nuclear threats <ul><li>Military attacks </li></ul><ul><li>Terrorist/criminal attacks </li></ul><ul><li>Impacts </li></ul>...
Radiological/Nuclear Animal/Ag impacts <ul><li>Direct casualties </li></ul><ul><li>Companion animals </li></ul><ul><ul><li...
Radiation Protection Principles <ul><li>Time </li></ul><ul><li>Distance </li></ul><ul><li>Shielding </li></ul><ul><li>Quan...
Explosive attacks <ul><li>Examples </li></ul><ul><ul><li>Oklahoma City </li></ul></ul><ul><ul><li>NY, DC, PA </li></ul></u...
Blast Physics and Physiology <ul><li>Blast Pressure Wave </li></ul><ul><li>  (Friedlander wave form) </li></ul><ul><ul><li...
Blast Physics and Physiology <ul><li>Associated PSI’s with injury </li></ul><ul><ul><li>2 – 5 - Tympanic membrane rupture....
Blast injuries <ul><li>Primary:  from blast wave injury to tissues </li></ul><ul><ul><li>Mainly affects organ systems with...
Principles of Veterinary Triage <ul><li>General medical triage nomenclature </li></ul><ul><ul><li>Green:  Minor (walking w...
Decontamination ??
Decontamination zones WIND HOT ZONE Incident WARM ZONE Evacuation and decontamination Cold Zone Safe area
Decontamination: Equipment and vehicles <ul><li>Two step process </li></ul><ul><ul><li>Cleaning </li></ul></ul><ul><ul><li...
Decontamination resources <ul><li>HAZMAT equipment </li></ul><ul><li>Fire-fighting equipment </li></ul><ul><li>Food/agricu...
Decontamination: People <ul><li>Portable decon showers/HAZMAT resources </li></ul><ul><li>Scale </li></ul><ul><ul><li>Limi...
Decontamination Premises <ul><li>Debris removal </li></ul><ul><ul><li>Manure, bedding, feed </li></ul></ul><ul><ul><li>Non...
 
Animal Decontamination <ul><li>Biological </li></ul><ul><li>Chemical </li></ul><ul><li>Radiological </li></ul><ul><li>Deco...
Animal Decontamination Considerations <ul><li>Animal issues </li></ul><ul><ul><li>Susceptible v. non-susceptible </li></ul...
Web resources: <ul><li>Environmental Protection Agency: </li></ul><ul><ul><li>http://www.epa.gov/epahome/laws.htm </li></u...
NIOSH Agricultural Centers National Institute for Occupational Safety and Health <ul><li>http://www.cdc.gov/niosh/agctrhom...
Personal Protective Equipment (PPE) <ul><li>Equipment and training mandated by OSHA and other agencies </li></ul><ul><li>F...
General OSHA requirements: <ul><li>Section 5(a)(1) of the OSH Act, often referred to as the General Duty Clause, requires ...
What is PPE? <ul><li>Personal Protective Equipment  PPE= Articles worn or equipment used in order to protect wearer from h...
Level A <ul><li>Highest level of respiratory, skin, eye, and mucous membrane protection  </li></ul><ul><li>Fully-encapsula...
Level B <ul><li>Highest level of respiratory protection </li></ul><ul><li>Lesser degree of skin and eye protection  </li><...
Level C <ul><li>Lesser level of respiratory, skin, eye, and mucous membrane protection </li></ul><ul><li>Full face-piece <...
Level D <ul><li>Ranges from a work uniform to basic biological barrier protections </li></ul><ul><li>Respiratory protectio...
When do veterinary professionals need PPE? <ul><li>Anytime they will be exposed to potentially harmful agents </li></ul><u...
Risk Assessment <ul><li>Determining what hazards exist that would necessitate PPE for veterinary personnel </li></ul><ul><...
Basic veterinary bio-protection Level C-/D+ <ul><li>Barrier apparel </li></ul><ul><ul><li>Tyvek, apron, etc. </li></ul></u...
Barriers
Gloves <ul><li>Barrier, chemical and mechanical protection consideration </li></ul><ul><li>Latex allergies common </li></u...
Goggles <ul><li>Non-vented (fogging) </li></ul><ul><li>Direct vented (limited disease agent protection) </li></ul><ul><li>...
Foot protection <ul><li>Considerations </li></ul><ul><ul><li>Water resistance </li></ul></ul><ul><ul><li>Mechanical durabi...
Head covers <ul><li>Options </li></ul><ul><ul><li>Hooded coveralls </li></ul></ul><ul><ul><li>Bouffant caps </li></ul></ul...
Surgical masks <ul><li>What does this provide? </li></ul><ul><li>Provide splash/barrier protection </li></ul><ul><li>Curre...
Respiratory PPE <ul><li>For N-95 masks and better: </li></ul><ul><ul><li>Each employee must complete OSHA standard medical...
Specific exposure reduction percentages <ul><li>N-95 filtering face piece  75% </li></ul><ul><li>N-100 filtering face piec...
Voluntary use of respirators <ul><li>When not required by OSHA </li></ul><ul><li>Employer or employee provided </li></ul><...
Fit testing:  N-95 Respirators <ul><li>Qualitative fit testing </li></ul><ul><ul><li>Separate test for each brand/size! </...
Challenges related to PPE <ul><li>Cost of PPE, med clearance and training </li></ul><ul><ul><li>Inventory of needed make/m...
General responder health  and safety rules of thumb…. <ul><li>If you don’t think you should….. </li></ul><ul><ul><li>DON’T...
 
Foreign Animal Disease  Response Flowchart 4-24 hrs 8-36 hrs 16-96 hrs Suspicious  case reported FADD Investigates Hold/qu...
Animal Disease Response Tasks <ul><li>Clinical diagnosis & laboratory confirmation </li></ul><ul><li>Quarantine </li></ul>...
Response Tasks (cont) <ul><li>Mortality Management </li></ul><ul><li>Decontamination & repopulation </li></ul><ul><li>Move...
Disease Eradication v. Agribusiness Continuity <ul><li>Need to win the war, not just the battle </li></ul><ul><li>Agribusi...
Mortality Management
Euthanasia methods <ul><li>Barbiturate injection </li></ul><ul><ul><li>Cost/ environmental hazard </li></ul></ul><ul><li>C...
Biomass Management Options <ul><li>Methods: </li></ul><ul><ul><li>Burial </li></ul></ul><ul><ul><li>Rendering </li></ul></...
Mortality Management Factors: Summary <ul><li>Disease type </li></ul><ul><li>Location </li></ul><ul><li>Numbers </li></ul>...
Mortality Management Resources <ul><li>http://fss.k-state.edu/research/books/carcassdisp.html </li></ul>
Additional training: <ul><li>Biological, Nuclear, Incendiary, Chemical and Explosive:  Colorado BNICE Center </li></ul><ul...
CSU Foreign Animal Disease Course <ul><li>Annual program for practitioners </li></ul><ul><ul><li>Supported by Colorado Dep...
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Chemical, Biological, Radiological, Nuclear And Explosive Issues

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  • Transcript of "Chemical, Biological, Radiological, Nuclear And Explosive Issues"

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