Emergency Response to Terrorism: Operations A Safe Response for Public Safety Personnel

1. Emergency Response to Terrorism: Operations A Safe Response for Public Safety Personnel The International Association of Fire Fighters General President Harold A. Schaitberger General Secretary-Treasurer Vincent J. Bollon

2. UNIT 5: Biological Agents

3. BIOLOGICAL AGENTS Introduction • Group Activity

4. Objectives • By the end of this unit, you will: • Recognize the threat characteristics of biological agents • Determine possible types of harm posed to First Responders at biological WMD incidents • Describe the use of First Responder PPE and its limitations at biological WMD incidents • Identify First Responder protective actions at incidents involving biological hazards

7. Background • May seem unlikely • Availability greater • 20+ Countries with Active CW Programs • 12+ Countries with Active BW Programs • 30+ Countries with Nuclear Capabilities • At home - FBI • 37 cases - 1996 • 74 cases - 1997 • 181 cases - 1998 • 2001 + - ???

8. The Worst Source of Contagion …Your Fingers Did you know that80 % of all infectious illnesses, from the common cold, to flesh eating bacteria, to lethal viruses (i.e. EBOLA), are transmitted by touch?

9. The Secret Life of Germs Grand Central Station Hidden Camera • 60% of people observed did not wash their hands after using the restroom • 90% of those who did wash their hands did not wash them effectively

10. New York Observer Swipe Study • Tested random headsets and found: • E Coli; Fecal germ • Tested a bar glass at an exclusive hotel and found: • Group D Strep; Fecal germ • Tested public telephone on Madison Avenue and found: • Hemolytic Strep A; Flesh eating bacteria

11. Bathroom • Potential Sources • Toothbrush • Soap Bars • Hand Towels Flushing a toilet spreads contamination…… everywhere in YOUR bathroom

12. Stomach Viruses • 80% of all are foodborne • Found often on cruise ships • Doctors call them stomach viruses • ie; E Coli, Shigella Coli • Transmitted via Fecal-Oral route

13. What’s In a Sneeze? • Aerosolized dispersion • Particles may travel up to 20’ • Coughs can also spread bacteria

14. Identify Responder Issues SM 5-5 • Determine the following: • Team 1: Threat Characteristics • Team 2: Types of Harm • Team 3: PPE Considerations • Team 4: First Responder Protective Actions

15. Team 1 • Threat Characteristics • Exposure/Contamination • Secondary devices • Other hazardous materials

16. Team 2 • Types of Harm • Illness • Death

17. Team 3 • Personal Protective Equipment • Self Contained Breathing Apparatus (SCBA) • Body Substance Isolation (BSI)

18. Team 4 • First Responder Protective Actions • Establish Command • Isolate/Assess • Prepare for Decon

19. WMD Biological Pathogen Toxin(poison)

20. WMD Biological Pathogen Bacteria or Viruses Living organisms Can be contagious Symptoms are often delayed Examples Bacillus anthracis Ebola virus Hepatitis B HIV

21. WMD Biological Toxin (poison) Non-living Not contagious Symptoms may develop in minutes to hours Examples Botulinum Ricin SEB (staphylococcal enterotoxon B)

22. Biological Pathogen Toxin (poison) Bacteria or Viruses Non-living Living organisms Not contagious Can be contagious Symptoms may develop in minutes to hours Symptoms are often delayed Examples Botulinum Ricin SEB (staphylococcal-enterotoxon B) Examples Bacillus anthracis Ebola virus Hepatitis B HIV

23. Threat Characteristics • Pathogens • Are living organisms • Multiply once released into the environment or host (carriers) • Symptoms are often delayed from days to weeks • Bloodborne and airborne

24. Threat Characteristics • Toxins • Are not living organisms • Do not multiply once released into the environment or host • Not transmitted by carriers • Symptoms may happen within minutes to hours

25. Threat Characteristics

27. Workbook Task SM 5-7 List three ways First Responders can contract diseases in the course of their work. • Inhalation of pathogens spread through coughs or sneezes of sick patients • Ingestion of pathogens spread through food and water • Injection/needle sticks with infected blood/body fluids

28. Threat Characteristics • Dissemination • Needs to contact as many as possible • Aerosols most effective • Others?

29. Dissemination

30. Discussion - Recognizing a Problem In the 1980s, members of a cult in Oregon contaminated several salad bars with salmonella bacteria in an effort to affect the outcome of a local election. As a result, 751 people became ill; 45 were hospitalized. • Unusually high number of sick patients • Numerous patients with similar symptoms • Unusual number of patients within the same neighborhood/s • First Responders may have asked and discovered that patients recently ate at the same restaurants

31. What is the Threat? SM 5-7 Bloodborne/Body Fluid Bloodborne/Body Fluid Airborne Airborne Not usually transmitted Bloodborne/Airborne Airborne Not usually transmitted Airborne

32. Threat CharacteristicsKey Point • Importance of BSI • Use Protective Clothing • Use Respiratory Protection

33. Types of Harm SM 5-15 • Fill in the blanks on page 5-15

34. Symptoms are often delayed for years; eventually may be noticed as skin lesions and respiratory infections occur Liver Fever, headache, body aches, cough, malaise Systemic, beginning with respiratory Respiratory Initial symptoms resemble the flu—sudden onset of fever, headache, malaise Early symptoms resemble the flu Respiratory Systemic, beginning with skin Page 5-15

35. PPE • Review Routes of Entry • Absorption • Inhalation • Injection • Ingestion • Types of PPE • Fire • EMS

36. PPE • How to enhance PPE Effectiveness • Open building windows • Open ambulance windows • Increase air flow in the area of the patient • Put a mask on the patient • Avoid blood and body fluids • Limit crew exposure • Review Workbook Activity – SM 5-19

37. PPE • First Responder Protective Actions • Establish Command • Isolate hazard/assess situation • Evaluate rescue • Decon • Call for technical assistance • Does the ERG help?

38. ERG 2004 ERG 2004 25 meters (75 feet) in all directions

39. First Responder ActionsQuestion to Consider SM 5-21 • How do you protect yourself if encountering a patient who has been exposed to a biological release? • Wear appropriate PPE (SCBA, barrier materials) • Utilize Back-up team • Victims must be viable • Victims can be quickly removed

40. Decontamination • Removing contaminated clothing may remove up to 80% of contamination • Use of hypochlorite is controversial • Use on equipment • Technical Assistance

41. Team Activity: Identify Responder Issues SM 5-25 • Determine the following: • Team 1: Threat Characteristics • Team 2: Types of Harm • Team 3: PPE Considerations • Team 4: First Responder Protective Actions

42. Team Activity SM 5-25 Your department has been called to assist law enforcement personnel at a self-storage facility. They have gathered information that leads them to believe that evidence, including biological materials, may be stored inside the self-storage unit. Three days following your response to this situation, your department conducts a post-incident analysis. The stored product was tested and has been identified as Ricin.

43. Team 1 • Threat Characteristics • Exposure/Contamination • Secondary devices • Other hazardous materials

44. Team 2 • Types of Harm • Illness • Death

45. Team 3 • Personal Protective Equipment • Self Contained Breathing Apparatus (SCBA) • Body Substance Isolation (BSI)

46. Team 4 • First Responder Protective Actions • Establish Command • Isolate/Assess • Prepare for Decontamination

47. Case Study • Answers are basically the same • Good, basic protective actions --- used all the time --- protect against hoaxes and real incidents