Chemical response plan good

WMD and All Hazards Response
Jack Pittman
Director, Public
Health
Preparedness
Leon CHD and
NFRDSTF
Heather Lake
Preparedness
Coordinator
Division of
Environmental
Health

Training Objectives:
• Be aware of the effects of weapons of mass
destruction (WMD) and other hazardous releases
• Understand types of expected WMD casualties
• Understand impact of a HAZMAT or WMD event
on public health and the environment
• Understand principles of agent identification using
the Emergency Response Guide
• Understand levels of personal protection
• Recognize requirements for evacuation, shelter in
place, decontamination, isolation, or quarantine

Weapons of Mass Destruction:
BNICE
Biological, Nuclear, Incendiary, Chemical,
Explosive
CBRNE
Chemical, Biological, Radiological, Nuclear,
Explosive

Explosive and Incendiary Threats:
Favorite Terrorist weapon
• Mass casualty trauma:
- Crushing
- Fragmentation
- Burns
• Relatively cheap
• High visibility
• High terror

Chemical Threats:
Industrial chemicals
Chemical warfare
agents

Chemical Threats:
Industrial chemicals
FBI: Most Likely chemical terrorism event -- A
Deliberate Industrial Chemical Release
-- Rail
-- Road
-- Fixed Facility
-- Pipeline

Chemical Threats:
Accidental industrial chemical releases
Rail:
According to the Federal Railroad Administration,
there were 14,264 rail accidents in 2002 -- 59 in
Florida. 704 involved cars carrying HAZMAT in
the US with 13 HAZMAT accidents in Florida.
In 1978, an Atlanta & St Andrews Bay Railway train
derailed near Youngstown, Florida. Chlorine
gas, released from a derailed car, killed 8
persons and injured 138 downwind of the
accident site.

Chemical Threats:
Accidental industrial chemical releases
Fixed Facility:
In 1984, a release of methyl isocyanate in Bhopal,
India killed 3,800 persons; 40 suffered
permanent total disability; and 2,680, who lived
as far as 25 miles downwind, were partially
disabled.
Pipeline:
In May 2003, > 50 tons of anhydrous ammonia
escaped after someone tapped into a pipeline in
Brandon, FL. The leak sent noxious fumes into a
subdivision, shutting down two schools.

Chemical Threats:
Response
Except for the criminal investigation, a deliberate
release of an industrial chemical would be
handled as a HAZMAT event in the same way as
an accidental release.
Depending on the characteristics of the chemical,
met conditions, etc., the event may require rapid
evacuations and decontamination.
First responders should be aware that terrorists may
plant secondary explosives or booby traps
around the scene of a chemical release incident.

Chemical Threats:
Response Recognition
Isolation
Protection
Notification

Chemical Threats Response
Recognition The US Department of
Transportation (DOT) is responsible
for coordinating the national safety
program for transport of hazardous
materials and for accident response.
DOT publishes the Emergency
Response Guidebook (ERG) that
provides info on identification of
hazards, public safety, emergency
response, and initial isolation and
protective actions for over 3000
industrial chemicals.

Recognition – Clue 1 Occupancy and Location
• Fixed facilities -- specific occupancy or general
area (e.g., an industrial park)
• Hazardous materials transportation modes
– Rail, air, marine, highway and pipeline
• Drug lab considerations

Recognition – Clue 2 Container Shape and Size
• Classifications
Fixed, portable, or in transport
• Pressure
– Non-pressurized, low or high pressure
• Vapor Pressure and Storage
– The higher the pressure, the greater the potential for
catastrophic failure
• See ERG pages 18-19

Recognition – Clue 3 Placards and Labels
• Placards have limitations
– Not always required
– The 1000 pound rule
• Nine Hazard Classes subdivided into divisions.
ERG Page 13
• Placards and labels used for transport are
based on DOT Hazard Class. ERG Pages 16-17

Recognition – Clue 4 Shipping Papers (ERG inside
cover)
MODE CALLED LOCATION
Rail Waybill and
Cosist
With crew
Highway Bill of Ladding Driver / on seat
or door pocket
Air Airbill Pilot
Pipeline Marker At cross with
other mode of
transport

Recognition – Clue 4 Facility Documents
Material Safety Data Sheets (MSDS)
• Required by the Federal Hazard Communication
Standard and Florida Right-to-Know Law
• Provide: general information ingredients,
physical and chemical characteristics, fire and
explosion hazards, reactivity data, health
hazards and toxicology, precautions for safe
handling, first aid, control and clean up
measures, transportation data, disposal data,
and label data.
Emergency Response Plans (ERP)
Emergency Action Plans (EAP)

Recognition – Clue 5 Markings and Colors
• Container colors are not standardized
• National Fire Protection Association 704 Diamond
• Military markings

NFPA 704 Diamond

Recognition – Clue 6 Human Senses
SMELL
SIGHT
SOUND
TOUCH
TASTE

Chemical Threats
Response
Recognition
Isolation
Protection
Notification

Isolation
Contain the immediate hazard
• Explosion
• Fire
• Contamination
See ERG Yellow, Blue, and Green Sections

This is a Test
Match the chemical with its ID number?
3065
2015
1005
What are Hazards associated with each?

Protection
Self
Personal Protective Equipment (PPE) --
OSHA 29CFR.1910.120
Others
Downwind Hazard -- ERG Green Pages
• Evacuate
• Shelter-in-place
• Decontamination

Protection: Self
Portals of Entry
• Respiratory System
• Eyes
• Skin
• Ingestion System

Chemical Threats
Response
Protection: Personal
Protective Equipment
Level A
Best Respiratory and
skin protection.
Positive pressure SCBA, fully encapsulated
chemical protective suit.
For unknown skin absorptive material and high
splash hazards.

Chemical Threats
Response
Level B
High level respiratory
protection but less for skin
protection.
Positive pressure SCBA, hooded chemical
resistive clothing.
For areas less than 19.5% Oxygen, unidentified
gas and vapor and low skin hazard.

Level C
Modest skin protection.
Full or half hooded APR, hooded chemical
resistive clothing.
For no skin hazards, no unknowns, and
sufficient oxygen.

Protection: Personal Protective Equipment
Level D
No respiratory or skin protection needed.
Ordinary work uniform.
May include coveralls, reinforced-toe boots,
and safety helmet.

Infectious Disease
Personal Protective Equipment
• Airborne precautions
– Particles < 5 μM
– Remain suspended in air, can be
dispersed by air currents
• Recommendation: Fitted respirators meeting
NIOSH N95 or better

Protection
Self
Personal Protective Equipment (PPE)
Others
Downwind Hazard ERG Green Pages
• Evacuate
• Shelter-in-place
• Decontamination

Protection Others
Downwind Hazard ERG Green Pages
Met Conditions:
Lapse
Cool/Warm
Inversion
Warm/Cool
Neutral
Cool/Cool

Chemical
Threats
Response
Protection
This is a Test
What is the
DWHD for:
Methyliodide
1005
Chlorine
Compare
small/large/day/
night

Chemical Threats
Response
Decontamination
The Hot Zone, also called
the Exclusion Zone, fully
encloses the Incident site --
the immediate scene of the
terrorist event.
The hot zone will extend
downwind depending on the
level of vapor hazard.
All personnel must be in
PPE.

Decontamination
The Warm Zone, also called
the Contamination Reduction
Zone, is located upwind and
preferably up gradient from the
Hot Zone. Rescue, decon, and
medical personnel are located
here and all must be in PPE.
A triage point is located near
the Hot Zone exit control point
for rapid assessment and
further disposition of
contaminated casualties.

Decontamination
The Cold Zone, also known as
the Support Zone, is located
upwind and up gradient from
the Warm Zone. All persons
working in the Cold Zone
should have respirators
available in the event of a wind
shift that would put them at
risk for downwind vapor
inhalation.
A second triage point and a
medical aid station may be set
up here to further evaluate
casualties for on-site treatment
or immediate evacuation to a
fully capable medical facility.

Contagious Disease: Isolation Rooms
• Patients housed in rooms under negative
pressure
• At least 6 to12 air changes/hour
• Air not re-circulated to other rooms

Notification (Also See ERG page 384)
Who ya gonna call?
• All major chemical releases must be reported to the State
Warning Point 800-320-0519. Suspected chemical
terrorism events, must also be reported to the FBI.
• The National Response Center maintains a one-stop point
of contact site and hotline number 800-424-8802 for
reporting oil and chemical spills -- to include chemical or
biological terrorism releases.
• CHEMTREC established by the chemical industry as a
public service hotline 800-424-9300 for fire fighters, law
enforcement and other emergency responders to obtain
information about emergency incidents involving toxic
chemicals and hazardous materials.

Chemical
Threats:
Commercial and
industrial
chemicals
Chemical warfare
agents

Chemical Threats: Chemical Warfare
Agents
Classifications:
Choking/Asphyxiation
• Phosgene
Blister/Vesicants
• Mustards, Lewisite, Phosgene oxime
Blood/Cytochrome oxidase inhibitors
• Hydrogen Cyanide, Cyanogen chloride
Nerve/acetylcholine esterace inhibitors
• Sarin, Soman, Tabun, VX

Agents Sarin (2810)
Military Designation GB
Physical State Liquid at 25o C/77o F
Odor/color None/colorless liquid
Symptoms Onset Seconds to minutes. If lethal dose is
absorbed, symptoms can progress to death in 15 minutes.
Vapor Toxicities in mg-min/m3 LCt50 100 ICt50 75
Skin Absorption LD50 1700 mg
Eye Injury (Miosis) in mg-min/m3 MCt50 3

Agents VX (2810)
Military Designation VX
Physical State Liquid at 25o C/77o F
Odor/color none/colorless to amber liquid
Symptoms Onset Seconds to minutes. If lethal dose is
absorbed, symptoms can progress to death in 15 minutes
or less.
Vapor Toxicities in mg-min/m3 LCt50 ICt35
50 50 Skin Absorption Toxicities Skin LD10 mg
50 Eye Injury (Miosis) MCtin mg-min/m3
< 1
50

Agents Sarin (2810)
Medical Management. Depending on the dissemination
method and the dose received, casualties may require
decon, administering of antidotes, ventilation, and
supportive care.
There are three therapeutic drugs used to treat nerve agent
exposure: atropine, pralidoxime chloride (2-PAMCl), and
anti-convulsive drugs such as diazepam.
In cases of severe nerve agent exposure, ventilation has
been required for up to three hours.
Long term supportive care will be required for those with
prolonged central nervous system effects.

Agents Sarin
Protection Because nerve agents can cause casualties from
exposure to both vapors and liquid contact, full respiratory
and non-permeable outer garment protection is required
(Level A – Level B).
Decontamination Nerve agents hydrolyze under conditions
of high pH. Hot soapy water solutions can be effective in
removing agent from skin, but complete hydrolysis occurs
over time and run-off from decon waters may still contain
sufficient agent to cause casualties among unprotected
people.
Skin decontamination is not needed for those who have only
been exposed to vapor only; however, clothing should be
removed because it may outgas trapped vapor.

Chemical Threats: Case Study
Tokyo Subway Attack
After numerous failed attempts to
disseminate anthrax spores and
botulinum toxin, in and around Tokyo, on
March 20, 1995, members of the Aum
Shinrikyo cult, led by Shoko Asahara
succeeded in releasing sarin in 5 trains
running on three major subway lines
converging in downtown Tokyo.
More than 5,500 people were affected.
There were 641 casualties resulting from
sarin inhalation that required medical
treatment and 12 deaths.

Tokyo Subway Attack

Tokyo Subway Attack
The Tokyo Fire Department transported 688 victims to
area hospitals. The remainder of the victims were
transported by police vehicle, taxicabs, or self-evacuated
to hospitals on their own.
The nearest medical facility in central Tokyo was St.
Luke’s International Hospital which treated 641
casualties on the morning of the attack with 349
follow-up cases seen during the next week.

Tokyo Subway Attack
The first EMS request was made at 8:09 a.m. Tokyo Fire
Department sent 340 units and a total of 1,364 personnel to
16 stations.
There was no attempt to
establish decontamination.
About 10% of the responding
personnel (a total of 135) were
among the injured after direct or
indirect sarin exposure.

Tokyo Subway Attack
There were 5 patients in critical condition. 3 arrived with
cardiopulmonary arrest; 2 were unconscious went into
respiratory arrest soon after arrival.
Three were successfully resuscitated. One patient did not
respond to cardiopulmonary resuscitation and died.
A second patient was resuscitated but died on day 28 after
the attack due to irreversible brain damage.
The other 10 deaths occurred at the attack scene. Those
who died included two station employees who had tried to
remove the bags of sarin.

Tokyo Subway Attack
106 casualties (43 men and 63 women, including 4 who were
pregnant) were triaged into the moderate severity category
and hospitalized for overnight observation.
Many complained of headache; dyspnea, nausea, vomiting,
muscle weakness, coughing, agitation, and fasciculation.
Hospitalized patients were treated initially with 2 mg of
intravenous atropine sulfate and 2 g of pralidoxime chloride
after the agent was confirmed as sarin. Intravenous
diazepam was administered for fasciculation.
The remaining 531 casualties had mainly with eye problems
(miosis). They were treated with intravenous atropine
sulfate, observed for six hours and released if no other
symptoms developed.

Tokyo Subway Attack
One month after the attack, St. Luke's mailed questionnaires
to 610 of those they treated. Of those responding nearly
60% reported post traumatic stress disorders. Many sought
the services of psychiatrists to relieve their psychological
symptoms.
•32% of the victims harbored phobias related to using the
subway.
•29% reported insomnia.
•16% still had flashbacks of scenes they witnessed on the
day of the attack.
•16% reported depression.
•10% reported vivid nightmares.

Tokyo Subway Attack – Lessons Learned
1. Attack Effectiveness. Although the sarin was not pure or
concentrated and the dissemination method was crude, it
created a mass casualty event.
2. Initially, there was no control possible at the scene.
Many of those affected self-evacuated to area hospitals.
Some with mild symptoms chose not to seek medical
attention.
3. Although Tokyo-area hospitals had emergency and
disaster plans because of the high incidents of earthquakes,
they were unprepared for a mass casualty incident where all
victims were exposed to the same toxic substance.

Tokyo Subway Attack – Lessons Learned
4. There was no attempt by on scene responders to alert the
hospital or communicate investigation results.
5. There was no attempt to decontaminate victims either at
the scene or at the hospital. Although the major threat from
sarin is vapor inhalation, some of the victims apparently
contacted the liquid sarin or had pockets of vapor trapped in
their outer clothing. Over 10% of first responders and 20%
of the St. Luke's staff who treated victims developed nerve
agent symptoms that included miosis, ocular pain,
headache, sore throat, dyspnea, nausea, dizziness, and
nose pain.
5. Mass psychogenic illness and post traumatic stress are
factors that must be considered in the treatment of weapons
of mass destruction attacks in addition to the treatment of
physical symptoms.

Chemical Threats
Questions?
Issues?
Discussion?

Jack Pittman
Director,
Public Health Preparedness
Leon CHD and NFRDSTF
Heather Lake
Division of Environmental
Health
Bioterror Threat

Bioterror Threat
Why Bioterror is an attractive option?
• Spectrum of effects
Dial an outcome – mild to lethal
Contagion vs. contamination
• Covert Ops
• Extremely high terror and psychological
consequences

Bioterror Threat
Emerging Diseases
Is mother nature the ultimate bioterrorist?
• HIV/AIDS
• WNV
• EEE
• SARS
• Monkeypox
• Malaria
• Antibiotic resistance
• Pandemic Flu
• Unknown unknowns

Bioterror Threat
Bioterror Defense
• Education and training
• Intelligence
• Surveillance
• Vaccination
• Isolation and quarantine
• Stockpile
• Responsive logistics
• Research

Bioterror Threat
Questions?
Issues?
Discussion?

Chemical response plan good

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