environmental health training in emergency response special health concerns cdr william greim, ms,...

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?