As A Community We Face Many Types of Disasters……

1. As A Community We Face Many Types of Disasters……

2. Weapons of Mass Destruction

3. CBRNE Chemical Biological Radiological Nuclear Explosives WMD Weapons of Mass Destruction NBC Nuclear, Biological, Chemical MCI Mass Causality Incident Haz Mat Hazardous Materials Terminology

4. Hazardous Materials

5. Hazardous Materials • Over 18,500,000 chemicals • Over 250,000 hazardous chemicals • transportation accidents • bulk storage incidents • human element (to err is human) • Meth Labs

6. Identification of Haz Mat • Storage containers • Placards • Labels • “Biological indicators”

7. Hazardous Materials • Reference “bible” • NAERG • Transport related HM

8. UN or NA Identification • A specific identification number given to a specific chemical.

11. Actions • Distance & shielding ( 300’ ) • Isolate the area and deny entry to unauthorized personnel • Summon help

12. Terrorism • Definition • The FBI defines terrorism as, “The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives.” • The three elements of this definition are: • Terrorist activities are illegal and use force • Actions are intended to intimidate or coerce • Actions are committed in support of political or social objectives. • US Department of Justice 1999

13. Potential Targets • Government Buildings • Manufacturing Plant • Abortion Clinics • Arena/Convention Center • Animal Shelter • Research Facility • Hospitals • Schools • First Responders! • Major Freeways & Railroad Centers

16. Oklahoma City April 19 1995 169 dead 490 injured

18. Bioterrorism “The intentional use of microorganisms (bacteria, viruses, and fungi) or toxins to produce death or disease in humans, animals or plants” -American Medical Association

19. History of Biological Warfare • 400s BCE- Greeks and Romans polluted water wells, used poison arrows, and hurled venomous snakes at their enemies • 1300s- Tartar Army catapulted plague infected corpses at Kaffa • 1700s-French and Indian War Native Americans given small pox laden blankets • 1900s- WWI German army infected animals in Romania and France with anthrax

20. History of Bioterrorism • 1984: Rajneeshs Cult- Salmonella sprayed on food at buffet restaurants in Oregon with intent to sway an election, 751 people sick • October 2001: Anthrax attack by mail sent to media and government offices in Washington, Florida, and elsewhere; 5 deaths, 23 sick, 17,759 people treated for 60 days • October 2003: Two letters containing ricin were sent to Dept of Transportation and the White House, but were safely intercepted

21. History of Bioterrorism • Feb. 2, 2004: Ricin mail attack on Senate Majority Leader Bill Frist of Tennessee; 3 Senate office buildings shut down for several days and 2 dozen staff/Capitol police officers underwent decontamination • March 2005: Sensors at 2 military mail facilities in the DC area detected anthrax on two pieces of mail; follow up was conducted for 275 people as a precautionary measure; no illness occurred

22. Advantages Of Bioweapons • Virtually impossible to trace back to culprit • Initial symptoms mimic naturally occurring diseases (Nonspecific Flu Like Illness) • Long incubation periods • Cheaper than other WMD’s • Found in nature • Highly infectious & contagious • Can be colorless, odorless, and tasteless

23. Detection of Biological Attacks • Most likely a covert attack- look out for suspicious, unusual behavior/activities • Increase in unusual/unlikely disease incidence in humans and animals (Anthrax, Flu in Summer) • Increased 911, ER and Doctor visits, reports of illness from many people, presenting the same symptoms, and coming from one locality • Epidemiology is key

24. Epidemiology • Unusual illness in age group for season • Unusual/ unknown disease/ syndrome in a geographical region • Unusually large number of insects/ wrong time of year • Deaths/ illness in animals in the area

25. Routes of Entry Inhalation Gastrointestinal (Ingestion) Cutaneous- (Skin absorption) Injection

26. Category A Agents • Anthrax (Bacillus anthracis) • Botulism (Clostridium botulinum toxin) • Plague (Yersinia pestis) • Small Pox (Variola major) • Tularemia (Francisella tularensis) • Viral Hemorrhagic Fevers (filoviruses- Ebola, Marburg; arenaviruses- Lassa, Machupo

27. Biological Agents • Bacteria • Toxins • Viruses

28. Biological Agents • Bacteria • Anthrax • Plague • Tularemia • Others • Brucellosis • Cholera • Q Fever

29. Anthrax • Caused by Bacillus anthracis • Incubation 1-7 days • Transmission via aerosol inhalation, ingestion (gastrointestinal), or cutaneous contact • No person to person transmission

30. Anthrax • Symptoms: • Inhalation: Flu like symptoms, nausea, chest pain, vomiting, abdominal pain, fever, respiratory distress • Cutaneous: Initial itching papule, 1-3 cm painless ulcer, then necrotic center, fever • Gastrointestinal: Nausea, loss of appetite, vomiting, fever, abdominal pain, vomiting blood, severe diarrhea

31. Anthrax • Duration of illness depends on route and severity of exposure, flu-like symptoms last from a few hours to days and get progressively worse • Treatment: Mechanical ventilation may be needed along with antibiotic therapy: Ciprofloxacin or Doxycycline • Mortality: • Inhalation 75% despite treatment • Gastrointestinal- 25-60% despite treatment • Cutaneous- 20% without treatment, less than 1% with treatment

32. Plague • Bacteria: Yersinia pestis • Found in rodents and their fleas • Three Types: • Bubonic (Most Common) • Septicemic • Pneumonic • Depending on circumstances, these forms may occur separately or in combination

33. Bubonic • Incubation: 2-6 Days • Transmission: • Infected flea bites a person or when materials contaminated with Y. pestis enter through a break in a person's skin • Bubonic plague does not spread from person to person • Symptoms: • Swollen, tender lymph glands (called buboes) and fever, headache, chills, and weakness

34. Bubonic • Duration: 10-14 days • Treatment: • Antibiotic therapy (Streptomycin/Gentamicin) • Mortality: • 60% if untreated • 15% treated

35. Pneumonic • Incubation: 2-6 days • Transmission: • Breathing in aerosolized bacteria or respiratory droplets from a person with pneumonic plague (person to person transmission) • Bubonic or septicemic may progress to pneumonic plague • Symptoms: • Sudden onset of fever, chills, headache, Cough, chest pain, dyspnea, myalgia

36. Pneumonic • Duration: 2-5 days depending on severity • Treatment: • Early antibiotic treatment is essential, must occur within 18 hours of onset (Streptomycin/Gentamicin) • Mortality: • 50-90% untreated • 15% with treatment

37. Septicemic • Incubation: 2-6 days • Transmission: • Plague bacteria multiply in the blood after infection through bite or cut • Can occur by itself or as a complication to pneumonic or bubonic plague • No person to person transmission • Symptoms: • Fever, chills, prostration, abdominal pain, shock, and bleeding into skin and other organs

38. Septicemic • Duration: 2-5 days depending on severity • Treatment: • Antibiotic therapy (Streptomycin/Gentamicin) • Mortality: • 100% without treatment • 15% with treatment

39. Tularemia • Franciscella tularensis • Incubation 3-5 days • Transmission via inhalation, ingestion, contact with skin • No person to person transmission

40. Tularemia • Symptoms: • Fever, cough, chest tightness, cutaneous lesions • Pleuritic pain and hemoptysis rare

41. Tularemia • Duration of illness around 18 days • Treatment- antibiotic therapy with Streptomycin or Gentamicin • Mortality • Less then 4% with treatment • 33% without treatment

42. Biological Agents • Toxins • Poisons produced by living organisms • Plants • Ricin • Bacteria • Botulinumtoxin

43. Biological Agents • Ricin • Toxin produced by castor oil bean plant • Highly toxic, no known antidote • Treatment and symptoms vary by exposure route • Ingestion • Injection • Inhalation

44. Botulism • Neurotoxins produced by Clostridium botulinum • Incubation 12-72 hours • Transmission via aerosol inhalation and ingestion • No person to person transmission

45. Botulism Symptoms: • Difficulty swallowing • Difficulty speaking • Symmetric descending weakness • Respiratory dysfunction • Paralysis • No sensory dysfunction • No fever

46. Botulism • Paralysis caused by botulism may last for weeks and gradually improve in the following months, fatigue and shortness of breath may continue for years • Treatment: Intensive supportive care possibly including ventilation, administration of antitoxin if diagnosed early, induce vomiting, enemas, surgical excision of bacteria from wounds • Mortality rate is high if treatment is not immediate and proper • The disease can be fatal in 5 to 10% of cases

47. Biological Agents • Viruses • Much smaller than bacteria, structurally different • Reproduce only within specific types of cells • Do not respond to antibiotics, vaccines may prevent or reduce the effects of some viral infections • Types of Viruses • Smallpox • VHF’s • Others

48. Smallpox • 1967, health officials undertook a worldwide immunization program to eradicate smallpox • 1971, the western hemisphere achieved elimination of the disease • 1972, routine immunization ended • 1977, last known naturally occurring case was reported in Somalia • 1980, the world is declared free of naturally occurring smallpox

49. Caused by Variola major Exposure – inhalation or direct contact Any confirmed case of smallpox should be considered an international emergency! Smallpox

50. Smallpox • Severe, flu-like illness with fever and pustular rash • Rash on face, hands and feet • Later spreads to torso • Infectious before rash appears and until all scabs are healed • Often fatal, only supportive care available, vaccine must be done during the 1st sign of fever