prepandehhazards

Slide1 : Preparedness and Environmental Hazards Jack Pittman Director, Public Health Preparedness Leon CHD and NFRDSTF Heather Lake Preparedness Coordinator Division of Environmental Health


Slide2 : Preparedness and Environmental Hazards What is Terrorism? Is an unlawful act of violence Intimidates governments or societies Its goal is to achieve political, religious or ideological objectives Uses Asymmetric Warfare - unexpected, unconventional destructive tactics as leverage against society (Craig, 1998).


Typical Methods of Terrorism : Typical Methods of Terrorism Firearms Explosive and Incendiary Devices Chemical Agents Biological Agents Nuclear Weapons Preparedness and Environmental Hazards


Added Dimension =Environmental Terrorism  : Added Dimension = Environmental Terrorism   the unlawful use of force against in situ environmental resources so as to deprive populations of their benefit(s) and/or destroy other property. Preparedness and Environmental Hazards


Environmental Terrorism  Eco-Terrorism   : Environmental Terrorism  Eco-Terrorism   Define Eco-Terrorism: violent destruction of property perpetrated by the radical fringes of environmental groups in the name of saving the environment from further human encroachment and destruction Environmental terrorism involves targeting natural resources to affect populations Eco-terrorism involves targeting built the environment such as roads, buildings and trucks, ostensibly in defense of natural resources. Preparedness and Environmental Hazards


Environmental Terrorism  : Environmental Terrorism   Expressed as a “choice of target” Leveraging resource and environmental problems - predictive of political tension, or even war and peace As the value and vulnerability of resources increases, so does their attractiveness as terrorist targets. Preparedness and Environmental Hazards


Environmental Terrorism : Environmental Terrorism Hypothesis – Environmental Change predicates social effects….these social effects may cause instability and violent conflict Environmental Terrorism utilizes this modality Vulnerabilities to terrorism are embedded in our natural and built environments, such as….. ~ Air – Water – Food – Agriculture – Waste ~ Preparedness and Environmental Hazards


Terrorism in an Environmental Context is Not New : Terrorism in an Environmental Context is Not New 14th c. – Kaffa (City on Crimean Peninsula) Hurled plague infested corpses over walls of city to infest it 18th Century French and Indian War - British Officers gave blankets from smallpox victims to Indians aligned with French Preparedness and Environmental Hazards


Terrorism – Environmental or Other… : Terrorism – Environmental or Other… Terrorism is an ancient tactic. Terrorism is a mode of communication. Terrorism is a special type of violence and Asymmetrical warfare. Terrorism is used in times of peace, conflicts and war. Terrorism is designed to make a point, through psychological means, fear. Terrorism is a political act. Preparedness and Environmental Hazards


Slide10 : Historical Context & Environmental Preparedness Anthropology supports that: Mankind is a herd animal Highly social Congregates in large units This creates an ideal environment for: spread of diseases asymmetrical warfare Preparedness and Environmental Hazards


Slide11 : Environmental Context of Preparedness Population Explosion : Population growth increased through history Often in ecological areas ill-suited for maintaining large populations. Environmental degradation increased at a similar exponential rate   Ecological Disruption & Population Growth: ….An engine of epidemic illness  ….Evolution is the Fuel ….Can modern terrorism provide the Ignition? Preparedness and Environmental Hazards


Slide12 : Environmental Context of Preparedness   Ecological Disruption ? Population Convergence ? Population Growth ? Social Conflict ? Evolving pathogens ? ….An engine of epidemic illness  ….Evolution is the Fuel ….Can modern terrorism provide the Ignition? Preparedness and Environmental Hazards


Environmental Health Professionals - Modern Sentries to Global Threats : Environmental Health Professionals - Modern Sentries to Global Threats *State of the World Atlas (1997), ** Marq de Villier (Water), John Heidenrich and Greg Stanton (Genocide), Michael Klare et al (Resources), all others from PIOOM Map 2002 Preparedness and Environmental Hazards


Slide14 : Bacteria-Viruses-WMD Nations Citizens Public Health Industry Modern Context - Prevention & Detection of Environmental Terrorism Environmental Health Programs & Surveillance Preparedness and Environmental Hazards


Slide15 : Incident Command System (ICS) Jack Pittman Director, Public Health Preparedness Leon CHD and NFRDSTF Heather Lake Preparedness Coordinator Division of Environmental Health


Slide16 : Incident Command System (ICS) Training Objectives: To provide an overview of Basic ICS Principles Organization Terminology


Slide17 : Incident Command System (ICS) What is ICS? ICS is a formal management system used to ensure command, control, and coordination of an emergency response.


Slide18 : Incident Command System (ICS) ICS Goal Stabilize the emergency incident Establish one person in charge with chain of command and support staff


Slide19 : Incident Command System (ICS) Examples of incidents Wildfires Major Structure Fires Rescue Missions Transportation Accidents Major Storm Damage Public Health Emergencies


Slide20 : Incident Command System (ICS) How does it work? Outside Response Personnel Internal Response Personnel


Slide21 : Incident Command System (ICS) ICS Organization Command Staff Incident Commander Safety Liaison PIO General Staff Operations Chief Planning Chief Logistics Chief Admin/Finance Chief


Slide22 : Incident Command System (ICS) ICS Organization Incident Commander Roles and Responsibilities Manages overall operation of emergency incident Analysis Magnitude of Situation (Sizing) Assigns staff responsibilities Implements the response plan Requests additional assets as needed


Slide23 : Incident Command System (ICS) ICS Organization Command Staff Incident Commander Liaison PIO Safety


Slide24 : Incident Command System (ICS) ICS Organization Command Staff Roles and Responsibilities Safety Officer - Assures safety of responders and bystanders. Checks PPE. LNO - Coordinates with external response teams PIO - Single point of contact for responding to media and the general public


Slide25 : Incident Command System (ICS) ICS Organization General Staff Operations Chief Planning Chief Logistics Chief Admin/Finance Chief Incident Commander ALPO OPAL FLOP


Slide26 : Incident Command System (ICS) ICS Organization General Staff Roles and Responsibilities Operations Chief - Coordinates all “hands-on” activities. Manages hazardous exposures and evacuation requirements. Plans Chief – Maintains the status of all human and equipment resources. Logs incident developments Logistics Chief – Coordinates requirements for facilities, tools, equipment, and supplies, and the security perimeter. Admin/Finance Chief - Captures, maintains, and records all incident costs.


Slide27 : Incident Command System (ICS) ICS Organization Other Commands and Considerations Area Command Unified Command Crisis Management Consequence Management The Florida Incident Field Operations Guide (FOG)


Slide28 : Incident Command System (ICS) ICS Organization Emergency Support Chain Local – IC County – County Emergency Management/EOC/ESF RDSTF – Terror Events Only State – SERT/SEOC/EFS Federal – FEMA/EFS/other Feds


Slide29 : Incident Command System (ICS) ICS and Public Health This is a Test Give Examples of Public Health Emergencies where ICS should be implemented. Who would be the IC? Who would be on his/her staff?


Slide30 : Incident Command System ICS Questions? Issues? Discussion?


Slide31 : WMD and All Hazards Response Jack Pittman Director, Public Health Preparedness Leon CHD and NFRDSTF Heather Lake Preparedness Coordinator Division of Environmental Health


Slide32 : WMD and All Hazards Response 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


Slide33 : WMD and All Hazards Response Weapons of Mass Destruction: BNICE Biological, Nuclear, Incendiary, Chemical, Explosive CBRNE Chemical, Biological, Radiological, Nuclear, Explosive


Slide34 : WMD and All Hazards Response Explosive and Incendiary Threats: Favorite Terrorist weapon Mass casualty trauma: - Crushing - Fragmentation - Burns Relatively cheap High visibility High terror


Slide35 : WMD and All Hazards Response Chemical Threats: Industrial chemicals Chemical warfare agents


Slide36 : WMD and All Hazards Response Chemical Threats: Industrial chemicals FBI: Most Likely chemical terrorism event -- A Deliberate Industrial Chemical Release -- Rail -- Road -- Fixed Facility -- Pipeline


Slide37 : WMD and All Hazards Response 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.  


Slide38 : WMD and All Hazards Response 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.


Slide39 : WMD and All Hazards Response 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.


Slide40 : WMD and All Hazards Response Chemical Threats: Response Recognition Isolation Protection Notification


Slide41 : WMD and All Hazards Response 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.  


Slide42 : WMD and All Hazards Response Chemical Threats Response 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


Slide43 : WMD and All Hazards Response Chemical Threats Response 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


Slide44 : WMD and All Hazards Response Chemical Threats Response 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


Slide45 : WMD and All Hazards Response Chemical Threats Response Recognition – Clue 4 Shipping Papers (ERG inside cover)


Slide46 : WMD and All Hazards Response Chemical Threats Response 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)


Slide47 : WMD and All Hazards Response Chemical Threats Response Recognition – Clue 5 Markings and Colors Container colors are not standardized National Fire Protection Association 704 Diamond Military markings


Slide48 : WMD and All Hazards Response NFPA 704 Diamond


Slide49 : WMD and All Hazards Response Chemical Threats Response Recognition – Clue 6 Human Senses SMELL SIGHT SOUND TOUCH TASTE


Slide50 : WMD and All Hazards Response Chemical Threats Response Recognition Isolation Protection Notification


Slide51 : WMD and All Hazards Response Chemical Threats Response Isolation Contain the immediate hazard Explosion Fire Contamination See ERG Yellow, Blue, and Green Sections


Slide52 : WMD and All Hazards Response Chemical Threats Response This is a Test Match the chemical with its ID number? 3065 2015 1005 What are Hazards associated with each?


Slide53 : WMD and All Hazards Response Chemical Threats Response Recognition Isolation Protection Notification


Slide54 : WMD and All Hazards Response Chemical Threats Response Protection Self Personal Protective Equipment (PPE) -- OSHA 29CFR.1910.120 Others Downwind Hazard -- ERG Green Pages Evacuate Shelter-in-place Decontamination


Slide55 : WMD and All Hazards Response Chemical Threats Response Protection: Self Portals of Entry Respiratory System Eyes Skin Ingestion System


Slide56 : WMD and All Hazards Response 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.


Slide57 : WMD and All Hazards Response Chemical Threats Response Protection: Personal Protective Equipment 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.


Slide58 : WMD and All Hazards Response Chemical Threats Response Protection: Personal Protective Equipment Level C Modest skin protection. Full or half hooded APR, hooded chemical resistive clothing. For no skin hazards, no unknowns, and sufficient oxygen.


Slide59 : WMD and All Hazards Response Chemical Threats Response Protection: Personal Protective Equipment Level D No respiratory or skin protection needed. Ordinary work uniform. May include coveralls, reinforced-toe boots, and safety helmet.


Slide60 : WMD and All Hazards Response 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


Slide61 : WMD and All Hazards Response Chemical Threats Response Protection Self Personal Protective Equipment (PPE) Others Downwind Hazard ERG Green Pages Evacuate Shelter-in-place Decontamination


Slide62 : WMD and All Hazards Response Chemical Threats Response Protection Others Downwind Hazard ERG Green Pages Met Conditions: Lapse Cool/Warm Inversion Warm/Cool Neutral Cool/Cool


Slide63 : WMD and All Hazards Response Chemical Threats Response Protection This is a Test What is the DWHD for: Methyliodide 1005 Chlorine Compare small/large/day/night


Slide64 : WMD and All Hazards Response 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.


Slide65 : WMD and All Hazards Response Chemical Threats Response 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.


Slide66 : WMD and All Hazards Response Chemical Threats Response 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.  


Slide67 : WMD and All Hazards Response 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


Slide68 : WMD and All Hazards Response Chemical Threats Response Recognition Isolation Protection Notification


Slide69 : WMD and All Hazards Response Chemical Threats Response 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.


Slide70 : WMD and All Hazards Response Chemical Threats: Commercial and industrial chemicals Chemical warfare agents


Slide71 : WMD and All Hazards Response 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


Slide72 : WMD and All Hazards Response Chemical Threats: Chemical Warfare 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


Slide73 : WMD and All Hazards Response Chemical Threats: Chemical Warfare 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  50    ICt50  35 Skin Absorption Toxicities   Skin LD50   10 mg Eye Injury  (Miosis)  MCt50in mg-min/m3   < 1


Slide74 : WMD and All Hazards Response Chemical Threats: Chemical Warfare 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.


Slide75 : WMD and All Hazards Response Chemical Threats: Chemical Warfare 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.  


Slide76 : WMD and All Hazards Response 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. 


Slide77 : WMD and All Hazards Response Chemical Threats: Case Study Tokyo Subway Attack


Slide78 : WMD and All Hazards Response Chemical Threats: Case Study 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.  


Slide79 : WMD and All Hazards Response Chemical Threats: Case Study 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.


Slide80 : WMD and All Hazards Response Chemical Threats: Case Study 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.


Slide81 : WMD and All Hazards Response Chemical Threats: Case Study 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.  


Slide82 : WMD and All Hazards Response Chemical Threats: Case Study 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.


Slide83 : WMD and All Hazards Response Chemical Threats: Case Study 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.  


Slide84 : WMD and All Hazards Response Chemical Threats: Case Study 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. 


Slide85 : WMD and All Hazards Response Chemical Threats Questions? Issues? Discussion?