environmental health training in emergency response special health concerns cdr william greim, ms,...
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Environmental Health Training in Emergency ResponseSpecial Health Concerns
CDR William Greim, MS, MPH, REHS/RS
CDC, Atlanta, GA
Richard Wellinghurst, RS.
Louisville Metro Health Department, Retired
Special Health Concerns
Biological
Chemical
Radiological
Intentional Non-intentionalTerrorism Accidents
Natural events
OBJECTIVES
• Discuss three areas of special health concerns from an environmental health perspective.
• Describe critical information needed to respond to these events.
• Discuss health and safety issues for responders.
• The techniques and strategies used today in public health emergency planning for the most part transcend terrorism and can be used in any public health emergency.
• Some differences can include:– Lead Agency – Size and Scope of Response – Risk Communication Messages– Evidence Issues
Terrorism and Public Health ResponseTerrorism and Public Health Response
Public Health Issues After a Disaster• Assessment of Health and Medical Care Delivery• Rapid Assessment of Community Health/Medical Needs• Delivery of Health and Medical Care• Pharmaceutical Supply• Potable Water, Safe Food, and Sanitation and Hygiene• Injury and illness Surveillance• Vector Control• Solid Waste• Hazardous Materials• Registry• Mental Health• Sheltering and Housing• Mass Congregation• Handling of the Deceased (humans and animals)• Staffing• Rumor Control• Public Service Announcements/Media
Environmental Health Roles
• Planning and exercising
• Health Educator
• Risk communicator
• Detection and monitoring
• Regulatory enforcement
• Health Assessment
• Exposure studies
Terrorism Attack and Environmental Delivery
Terrorism Attack and Environmental Delivery
Agents Biological
Chemical
Radiological
Environmental DeliverySystem
Air - Food -Water
Targets Public
Environment
Agriculture
Threats to Food SecurityThreats to Food Security
• Food distribution chain
• Employees
• Physical security
• Raw materials
• Food processing plants
• Packaging
• Imported foods
• Exposure to foods is universal• Complex nature of the food supply
– Foods are often widely distributed– Open food market system means many potential critical
control points– Many persons/organizations involved from farm to table
• Lab methods are directed at the usual suspects• “Agroterrorism” direct attack on plants and animals
Issues for Food Safety and Bioterrorism
• Strengthening the food safety infrastructure– Adequate staffing, training, facilities, laboratories,
communication• Developing an effective LRN for food
– Methods for select agents– Functional integration of public health, agriculture, and
regulatory labs that deal with clinical and food specimens• Exercising the partnerships between public health and food
safety with every foodborne outbreak• Expecting the unexpected
Addressing Foodborne Bioterrorism
Threats to Drinking WaterThreats to Drinking Water• Biological agents• Chemical agents --industrial,
natural toxins– Direct injection
– Secondary contamination
• Radiological agents• Damage, destruction of
physical infrastructure• Disruption to computer systems
Threats to the Air \ Environment
BioWatch
• Environmental monitoring• Collaboration with Homeland
Security, EPA and cities/states • LRN expedited assay
development, reagent production for high throughput real-time PCR testing
• 19 LRN/BioWatch facilities support air sampling in 30 US cities
An example of a BioWatch Monitor
Public Health ResponsePublic Health Response
Environmental Health
Laboratory Epidemiology
Public Health System
Laboratory Response Network 2005
The LRN and its partnerswill develop andmaintain an integratednational and internationalnetwork of laboratories
thatcan respond quickly to
actsof biological or chemical terrorism and other publichealth emergencies.
Classification of
Bioterrorism Laboratories
Level-A Labs - Assess Risks for Aerosols and Use Biosafety Cabinet
A - Adequate safety to rule-out
and forward organisms
Level B Lab Work at BSL-3 with BT agents
B - Safety and proficiency adequate to confirm & characterize susceptibility
Level C Lab BSL-3 C - Safety and proficiency sufficient
to probe, type, perform toxigenicity testing
Safety & proficiency to probe for universe of bio- and chemical agents in non-clinical specimen
D - High level characterization (seek evidence of molecular chimeras) and secure banking of isolatesLevel D Lab
BSL-4
Bioterrorism: Priority Agents
Most likely used Easily disseminated
or transmitted High mortality and
morbidity Special public health
preparedness Panic and social
disruption
Category A Agents: Anthrax Botulism Plague Smallpox Tularemia Viral Hemorrhagic
Fevers
Category B Agents
• Brucellosis• Epsilon toxin of
Clostridium perfringens
• Food safety threats• Glanders• Meliodosis• Psittacosis
• Q fever• Ricin toxin• Staphylococcal
enterotoxin B• Typhus fever• Viral encephalitis• Water safety threats
Category B Agents
• Moderately easy to disseminate
• Moderate morbidity rates and low mortality rates
• Require specific enhancements of diagnostic capacity and disease surveillance
Category C Agents
• Emerging infectious diseases such as Nipah virus and hantavirus
• Could be engineered for mass dissemination in the future because:
• Availability• Ease of production and
dissemination• Potential for high
morbidity and mortality rates and major health impact
Incubation Period
• Toxin weapons: minutes to hours to days
• Viral and bacterial weapons: days to weeks
• Fungal weapons: weeks to months
• Some other bio-agents: up to several years
Survivability of organisms• Anthrax: days and weeks in the air and years (on
surfaces)• Brucellosis: up to 2 days in the air• Coccidioidomycosis: days and weeks in the air• Ebola: 30 min (liquid) in the air and up to several hours
(dry)• Glanders: several hours in the air• Marburg: 30 min (liquid) in the air and up to several
hours (dry)• Plague: 1 to 2 hours in the air• Smallpox: up to 24 hours in the air• Tularemia: several hours to one day in the air• Q fever: up to several days in the air• H5N1 avian: room temperature 1-7 days
Time (days)
No.
A
ffec
ted
Seek Care
Infectious Disease Outbreak
Exposure
Symptoms
Exposure
Chemical Exposure
Acute symptoms
Chronic symptoms
No.
Aff
ecte
d
Time (in minutes or hours) Time (in years)
Specificity
Response
Pre-diagnostic………Diagnostic..…...…Laboratory
Public Health Information
Specificity and Response
Anthrax Gram positive spore forming bacterium Bacillus anthracis Spores highly stable Viable in soil for decades Viable/infectious in aerosol form
Zoonotic disease of herbivores
Infected herbivores and soil are reservoir
Direct contact and fly bites
Epidemiology of Transmission
Cutaneous anthrax
IngestionOropharyngeal and
gastrointestinal anthrax
InhalationPulmonary/mediastinal anthrax
Infection Control Anthrax
• No person-to-person transmission
• Use standard precautions
• Avoid direct contact with wound or wound drainage– Hand hygiene should be performed after any
contact with wound or wound drainage – Gloves should be worn when contact with
wound or wound drainage is necessary
Smallpox is caused by Variola virus in the genus Orthopoxvirus
Last naturally-acquired case on Earth in 1977
Smallpox was declared eradicated in 1980
Smallpox Introduction
Humans are the only natural reservoir
• Up to 30% mortality in unvaccinated persons
• Any case of smallpox would probably mean an intentional release
Smallpox Virus
Epidemiology of Transmission
Transmission via contact or aerosol
Infection Control Smallpox• Isolate patients - contact and airborne
precautions
• For single or few cases use hospital
with isolation rooms (negative
pressure preferred)
• If large outbreak, may need facility
designated only for smallpox cases
• Notify Public Health immediately
Plague Introduction
Severe bacterial disease of humans and animals produced by the gram negative nonsporulating bacillus Yersinia pestis• Bite of a rodent flea, or by handling
an infected animal• Millions of people died when human
dwellings were inhabited by flea-infested rats
• Modern antibiotics are effective, but without prompt treatment the disease can likely cause illness or death
Types of Plague
• Four types of plague• Bubonic plague• Pneumonic plague• Septicemic plague• Oropharyngeal plague
““Safety Pin” Y. Pestis in blood
Epidemiology of Natural Transmission
Flea vector such asXenopsylla cheopis
Enzootic and epizooticanimal reservoirs
Yersinia pestis Primary
bubonic plague
Primary septicemic plague
Primary pneumonic plague
AA
AA
Secondary plague cases
BB
BB
CC
CC
DDDD
Routes of Plague TransmissionA = Bite of Flea
B = Contact with animal or carcass
C = Inhalation of respiratory droplets
D = Contact with sputum or fluid
Infection Control Plague
Botulism: Overview Description of Spores
Spores can be found in• Soil (commonly) • Marine and Lake sediments • Intestinal tracts of animals including
fish
Can withstand extreme conditions• Resistant to UV light, irradiation• Survive boiling for up to 4 hours • Survive food processing procedures• Resistant to desiccation
Readily killed by chlorine
Epidemiology of Natural Transmission
Toxin production in foods prepared or stored at ambient temperature
Intestinal colonization and toxin production in susceptible
infants and adults
Colonization and toxin production in
an open wound
C. botulinum in the soil,
flora and fauna
Botulism:Acute, symmetric, descending flaccid
paralysis with bulbar palsies
Infection Control Botulism
• Rapid treatment of patients • Identify and eliminate source of outbreak• Determine if accidental or deliberate release vs.
endemic disease• Consider bioterrorism if:
• Large number of cases• Unusual toxin type• Multiple outbreaks with no common source
Tularemia Introduction
• Gram negative coccobacillius, Francisella tularensis
• Identified in 1911 in Tulare County, California
• Also known as Rabbit fever or Deer-fly fever
Tularemia Introduction• Organism persists in
environment
• Infections acquired by:• Bites • Handling infected materials• Ingestion of food, water, or
soil• Inhalation of infectious
aerosols • Laboratory exposures
Tularemia as a Biological Weapon
• Highly Infectious when aerosolized• Respiratory infectious
dose between 10 and 50 organisms
• Possible to produce vaccine-resistant and antibiotic-resistant strains
• Easily killed by heat and disinfectants
Epidemiology of Natural Transmission
Vector ticks, biting flies, mosquitoes
Enzootic and epizooticanimal reservoirs
Rabbits, muskrats, voles, etc.
Francisella tularensis
Ulceroglandular
Oropharyngeal
Pulmonary
A
B
CRoutes of Tularemia TransmissionA = Bite of infected arthropod
B = Contact with infected animals, tissues or fluids
C = Exposure to infectious aerosols
D = Ingestion of infectious materials
Glandular
Oculoglandular
B
C
D
A
Viral Hemorrhagic Fevers
• Crimean-Congo hemorrhagic fever(CCHF)
• Ebola hemorrhagic fever
• Hantavirus Pulmonary Syndrome
• Hemorrhagic fever with renal syndrome(HFRS)
• Lassa Fever
• Marburg hemorrhagic fever
VHFs• A severe multi-system syndrome in which the
overall vascular system is damaged, and the body's ability to regulate itself is impaired.
• Zoonotic, rodents and arthropods are the main reservoirs and vectors for viruses causing VHFs.
• With few exceptions, there is no cure, vaccine, or established drug treatment for VHFs.
• Some HTH transmission-Ebola, Marburg, Lassa
Prevention
• Avoiding contact with host species• Preventing further transmission from person to
person• Controlling rodent populations, safe cleanup of
rodent nests and droppings. • Arthropod vectors prevention efforts• Avoiding close physical contact with infected
people and their body fluids• Infection control techniques include isolating
infected individuals and wearing protective clothing.
Lassa Fever virus inactivated by:• heating to 56oC
• pH<5.5 or >8.5
• UV/gamma irradiation• Detergents, 1:100 bleach solution to
disinfect surfaces, medical equipment, patient bedding, reusable protective clothing
Emerging Diseases• Pandemic Influenza
• SARS
• West Nile Virus
• Monkeypox
• Chagas Disease
• Antibiotic/Antimicrobial Resistance e.g., MRSA, tuberculosis, malaria, head lice, typhoid fever
Pandemic InfluenzaAvian Influenza A Viruses
Infect respiratory and gastrointestinal tracts of birds• Natural reservoir is wild waterfowl - usually infections
do not cause disease (wild ducks and geese)• Genetic re re-assortment occurs
Viruses are present in respiratory secretions, excreted in feces
• Can survive at low temperatures and low humidity fordays to weeks
• Can survive in water• Disinfection of the environment is needed
Transmission
• Highly contagious• Primarily person-to-person• – Respiratory droplets: coughing and
sneezing• – Direct and indirect contact• – Airborne transmission occurs very rarely,
if ever• Incubation period: 1-4 days• Subclinical infection can occur
Factors in Infectious Disease Emergence• Ecological Changes• Human Demographics and Behavior• International Travel and Commerce• Technology and Industry• Microbial Adaptation and Change• Breakdown in Public Health Infrastructure• Human Susceptibility to Infection• Economic Development and Land Use• Climate and Weather• War and Famine• Lack of Political Will• Poverty and Social Inequality• Intent to Harm
• Trained and staffed public health workforce • Surveillance and epidemiology capability • Laboratory expertise, capacity, and coordination• Communication and information networks• Therapeutic and preventative capability• Partnerships, partnerships, partnerships
Preparedness for Bioterrorism Event
Po
ssib
le C
asu
alt
ies
* Per FBI Briefing, October 2, 2000
Likelihood of Occurrence*
Low High
10,000,000
1,000,000
100,000
10,000
1,000
100
10
Nuclear Weapon
Chemical Weapons
Pathogens
Conventional High
Explosives
Toxic Industria
l Chemical
s
Radioisotopes
Biotoxins
Tokyo Subway
Spanish Flu
Bhopal
Chernobyl
World Trade Center
Oklahoma City
Bulgarian Assignation
Hiroshima
Halabja poison gas attack Dalles,
Oregon
The Threat SpectrumAnd Historical Precedents
Environmental Health Effects TOXICITY• The relative ability of a substance to cause adverse
effects in living organisms,• “The Dose is the Poison”,
ROUTES OF EXPOSURE• Inhalation• Ingestion• Dermal
– Absorption– contact– Injection
Environmental Health Effects
• Exposure
vs.
• Contamination
Types of “Chemical Agents”
• Nerve Agents– Sarin (GB), tabun (GA), Soman (GD), VX
• Blood Agents, – Cyanides, a common chemical
• Blister agents or visicant– Sulfur mustard ( H, HD, and HT) Lewisite (L),
• Pulmonary agents– Phosgene (CG), chlorine
http://www.bt.cdc.gov/agent/agentlistchem-category.asp
Health Concerns of “Nerve Agents”
• ROUTES OF EXPOSURE – Liquid on skin
• Very small drop: twitching at site• Small drop: nausea, vomiting, diarrhea• Drop: Loss on consciousness, convulsions, respiratory arrest,
flaccid paralysis– Vapor in air
• Small: pupils, red conjunctiva, dim vision, nausea/vomiting, runny nose, salivation, shortness of breath
• Large: Respiratory and cardiac arrest
• TOXICITY– IDLH
GB (Sarin) = 0.03ppm (0.2mg/m3)GD (Soman) = 0.008ppm (0.07mg/m3)VX = 0.002ppm (0.02mg/m3)
Health Concerns of “Blister Agents”
• ROUTES OF EXPOSURE – Damage to eyes, skin, airways– Irritating, painful contact– Tissue damage– Lewisite effects appear within minutes– Sulfur mustard effects appear from 2-24 hours after
exposure. • TOXICITY
– Symptoms do not improve with time and fresh air– IDLH
• Mustard (HD) = 0.7mg/m3 • Lewisite (L) = 0.003mg/m3
Health Concerns of Pulmonary (Choking/Blood) Agents
• ROUTES OF EXPOSURE – Irritation of eyes, nose and airways– Inhalation primary hazard
• TOXICITY– Shortness of breath– Cough / asphyxiation– Effects begin up to 24 hours after exposure,– IDLH
Chlorine = 10 ppm (30mg/m3)
Cyanide (AC) = 50 ppm (60mg/m3)Phosgene = 2 ppm (10mg/m3)
Radiation, Potential hazards
• Major radiation sources and releases,
• Health concerns of radiation exposure,
Potential “Rad” Incidents
• Radiological– Laboratory– Medical– Transportation– Space– “Dirty” bomb / device
• Nuclear – Power Plant– Reactors– Weapons
There are 103 operating nuclear power reactors at 65 sites across the United States, using nuclear energy to generate electricity.
•Plant Security•Waste Generation and Disposal
Nuclear Power Plants
Potential incidents,
Possible Targets:
Nuclear Pharmaceuticals
• Nuclear Pharmacies located in many communities,
• Provide radioactive pharmaceuticals to hospitals and clinics,
• Results in radioactive waste in hospitals
Radiographic device
• May be present for a long period of time before discovery
• Could cause health concerns for many people
• Will cause widespread public concern
• IIncorporates nuclear materials designed to produce a nuclear explosion.
• Could consist of diverted nuclear weapon components, a modified nuclear weapon, or indigenous-designed device.
Improvised Nuclear Device (IND)
Faulty Improvised Nuclear Bomb design Faulty Improvised Nuclear Bomb design from an Al Qaeda reportfrom an Al Qaeda report
A Radiological Dispersion Device, RDD) • Any weapon that is designed
to spread radioactive material with the intent to kill, and cause disruption by psychologically and financially impacting
Radioactive material
Conventional explosive(e.g. fertilizer, semtex)
Time fuse
Detonator
Exposure With Medical
Care
Symptoms
100-200 R ≤ 5% will become ill
May Nausea Vomit
within 4 hours
200-300 R 15-30 % may Die
Nausea Vomit Quickly
30-50 % die no medical
600 50 %
may Die
95-100 % die with no
medical
>600 >90 %
May Die
All die in 2 weeks or sooner with no medical
Radiation ExposureRadiation ExposureHealth EffectsHealth Effects
Dose Limits for Emergency Workers
• Rem Condition• 5 General monitoring
– (no life safety involved)
• 10 Protection of a large population
• 25 Life saving – (once in a lifetime)
• >25 Life saving – (authorization required)
• Source: U.S. EPA 400 1994
Radiation, Annual Dose
Between 320 – 360 mr/yr
Toxic Industrial Chemicals (TICs)
• TICs are chemicals that are manufactured, stored, transported, and used throughout the world. – Routes of Exposure – ALL– Toxicity
• Can be chemical hazards (e.g., carcinogens, reproductive hazards, corrosives, or agents that affect the lungs or blood) or
• physical hazards (e.g., flammable, combustible, explosive, or reactive).
Chemical Hazard Classes
FY 2000 Most Common Chemicals involvedin Causing Deaths, Injuries, or Evacuations
Chemical Name Chemical Name Chemical Name Chemical Name
Ammonia Freon Heptanoic Acid Perchloroethylene
Chlorine Sulfur Dioxide Hydrazine Sodium Hypochlorite
Hydrogen Chloride Hydrofluoric Acid Hydrogen Cyanide Asbestos
Sulfuric Acid Carbon Monoxide Malathion Ethylene Glycol
Mercury Formaldehyde Methacrylic Acid Ethylene Oxide
Sodium Hydroxide Hydrogen Sulfide Methanol PCBs
Phosphoric Acid Mercaptans Phenol Propylene Glycol
Acetone Benzene Thioglycol Bromine
Butadiene Chromic Acid Sodium Ethanol
Radioactive Materials Oxides of Nitrogen
Based on reports to ATSDR from the National Response Center. No rank order intended
What are the potential “TIC” Threats?
• Use as a WMD / Weapon
• Accidental release (Haz Mat)– Total for 2006 = 36,855 (NRC)
• Environmental contaminant during and following natural disaster (i.e. Katrina)
Chemicals in Transport
• Roads
• Rails
• Water
Graniteville, SC. (Jan. 2005) Graniteville, SC. (Jan. 2005) Chlorine gasChlorine gas •9 fatalities•554 treated at hospitals•75 admitted•5,400 evacuated•$6.9 million property damage
Incendiaries \ Explosives
Principles of Radiation & Chemical Safety
• Selection and use of proper PPE
• Use available shielding– Sheltering,
• Use nearby buildings and structures
• Even a vehicle offers
some shielding
Potential Public Health Issues Following a Major WMD \ Haz Mat Event
• Emergency Support Function #8 includes:– Assessment of Health and Medical needs,– Medical Care, Equipment and Supplies– Victim evaluation– Food and Drug safety– Worker (Responder) Health / Safety– Radiological, Chemical and Biological Hazards– Public Health Information– Potable Water / Wastewater & Solid Waste management– Health Surveillance– Victim Identification and Mortuary Services
EH Issues at “Special Concerns” Response
• Health and Safety information regarding:• Airborne contaminants (may be intentional)
ChemicalsRadiologicalBiological
Worker SafetyContaminated watersFood and Water SafetyWaste Management
• Health and Safety information regarding:• Airborne contaminants (may be intentional)
ChemicalsRadiologicalBiological
Worker SafetyContaminated watersFood and Water SafetyWaste Management
EH Issues at “Special Concerns” Response
• Environmental assessment activities • Monitoring, Sampling and Inspection
plan, development and approval• Site Safety and Re-entry sampling• Food / Water safety inspections• Epidemiology activities
– Data collection and management– Mapping and Long-term trend analysis
• Community Education, Public Health Information
What do the Responders and Public Need to Know “ASAP”?
• What is the agent,• What are its hazards,• How to protect themselves
– Stay upwind of vapors, (Sheltering and or Evacuations,)
– Stay out of liquids and dust (what to be on the lookout for),
• What to do if they are exposed,• Who to contact for more information.
Initial Response Activities• Initiate Contamination Control
Immediately– Restrict access to contamination,– Assure Decontamination activities
conducted• Responders • victims
Contamination Control and Decontamination
• Advise responders and victims on initial decontamination
• External contamination can be reduced 80-90% by removal of outer clothing
• Washing the contaminated area with soap and water very effective
• Ensure all contaminated tools, clothing, equipment & other material that can’t be decontaminated are bagged, tagged & stored for later disposition
• Be prepared to refer questions on the contamination & control of exposed individuals to the “experts”,
Examples of Local Environmental Health
Response•Emergency Response activities & decision making, Emergency Response activities & decision making,
–Hazard identification and environmental monitoring,Hazard identification and environmental monitoring,–Inform responders and public about protective actions Inform responders and public about protective actions needed,needed,–Assist implementation of evacuation or Shelter in Place Assist implementation of evacuation or Shelter in Place instructionsinstructions–Assure regulatory compliance,Assure regulatory compliance,
•Assist with distribution of prophylaxis,Assist with distribution of prophylaxis,
Remember – Front Line Response
Begins at the Local Level
What do EH Practitioners bring to a response that is unique?
What do EH Practitioners bring to a response that is unique?
• Possess a Broad Science Base
• Understand Environmental Systems
• Working Field Familiarity
• Operational Surveys of Environmental
Systems
• Recognize Problems and Vulnerabilities
• Influence the Operation of the System
Public Health Issues Following a Major WMD \ Haz Mat Event
Initial Response (Early Phase: 1-7 Days)
• Sheltering, • Medical Care, including prophylaxes, • Monitoring and Decontamination of Responders and
Victims,• Environmental Contamination, monitoring and
control,• Handling & disposition of potentially-contaminated
remains,• Hazardous and solid (liquid) waste management,• Infrastructure disruption
– power outages, communication systems, water supply, waste water, food safety, others,
Public Health Issues Following a Major WMD \ Haz Mat Event
Intermediate Phase: Weeks to Months Recovery Phase: Months to Years
– Relocation of populations– Agricultural products, as crops and in transit– Contaminated air plume and later resuspension of
debris– remediation of land, waters and property– Health surveillance of exposed populations
– Response planning – Mitigation of Hazards
Resources available (free from CDC)
HSDB
Other Information Resources
World Wide Web
Partner Agencies
• 911• County Emergency
Management• Law Enforcement• Fire \ EMS• Hazmat• Local Health
Department• Local Hospitals• Other 1st Responders
• Regional WMD\Haz Mat Teams,
• State EOC \ Warning Point
• Federal Bureau of Investigation
State & Regional Response Resources
• Air National Guard, Weapons of Mass Destruction Civil Support Teams (WMD-CST),
• State Department of Health – Radiation Safety
• Environmental Protection, ERT• State Emergency Management
– EMAC, the Emergency Management Assistance Compact,
• Technological Disasters:- Radiation- Hazardous chemicals- Oil- Biologics
• Natural Disasters:- Hurricanes- Severe weather- Earthquakes- Volcanic eruptions- Floods- Extreme heat/cold
• Terrorism: - Biologic- Radiological- Chemical
CDC Emergency Assistance 24 \ 7
Emergency Operation Center #770-488-7100
CDC Emergency Assistance 24 \ 7
Emergency Operation Center #770-488-7100
CDC Emergency Assistance
• CDC Teams– Identify agent rapidly– Determine exposure
distribution– Evaluate long-term health
implications– Identify worried well
• National Center for Environmental Health Laboratory Response Team– Support collection of
clinical samples – 15 min response, 1 hr
arrival at CDC– Shipping/tracking
information – Work w/ Rapid Response
lab on analysis
Federal Notification, Response and Coordination
• National Response Center (800-424-8802)– FBI, Federal Lead Agency if Terrorism / WMD
incident• Resources include HMRT etc.
– EPA is Federal Lead Agency for Environmental Recovery Phase
• On Scene Coordinator • Remediation funds available via OSC
Remember
All disasters are local and require “local coordination”
Strong federal Strong federal “leadership” will be “leadership” will be evident.evident.
Special Concerns - Exercise • There has been a response, in your community, to a
large family planning clinic where a package has puffed out a cloud of unknown powder. Contained in the package is a letter indicating that the clinic staff will now die for their sins. A few of the clinic staff are beginning to complain of respiratory distress etc.
1. Based on your training and experience, what roles could\should you play, (e.g., 1st responder, environmental assessment, EOC liaison, etc?)
2. Assuming that role, what would be your next steps?
3. In that role, what information do you need?
4. Who would you be working with?
5. Where in the ICS would you likely be working?