Introduction, Roles & Responsibilities

BCTA Technical Assistance Team

References & Acronyms

Protocol

Incident Response Quick Guide

Threat Level Assessment Criteria

911 Operators

Communication Centers

Incident Command (IC)

Unified Command Structure (UCS)

National Incident Management System (NIMS)

Emergency Notification Numbers

Suspicious Mail/Package Handling

UHL Sampling Guidelines

Critical Information Reporting Form

Exposure Reporting Templates

Public Information/Media

BCTA Quick Guides & References

PPE & Decontamination

Disposition/Termination

of Incident

Public/Private Business

Policy and Procedure Example

Order of BCTA Notebook Contents – Version 1.1 March 2005

The BCTA technical assistance team has included a CD with all contents of the revised BCTA Protocol Model Version 1.1 March 2005. Also included in this packet are copies of all color documents and those documents that required lamination. Hopefully this will assist you in replacing the contents of the previous protocol model. Please note that a new tab section “911 Operators – Communication Centers” has been added changing all tab sections from Tab #3 through Tab #12. The following information is an outline of the order in which the Protocol Model should be assembled. Please do not hesitate to call any of the team members if you have questions or need assistance.

Cover Page – included in packet

Table of Contents

Tab Dividers #1-12

Tab 1

Introduction, Roles and Responsibilities

Technical Assistance Team

Glossary of Acronyms

References and Resources

Tab 2

Operational Procedures for Handling BCTA

Threat Level Assessment Criteria – long

Incident Response Quick Guide – laminated and included in packet

Threat Level Assessment Criteria (short) – laminated and included in packet

Tab 3

Telecommunications – Communication Centers

Tab 4

All contents of this tab are included in packet and laminated

Local Incident Command

Resource Management and Coordination Structure

Federal Multi-level Interagency Scheme for Incident Resource Management Coordination

Tab 5

Emergency Notification Numbers

Tab 6

Suspicious BCTA Letter/Package Handling

Tab 7

UHL Sampling and Shipping Guidelines – laminated and included in packet

Chemical Terrorism Specimen Collection – laminated and included in packet

UHL Chain of Custody Form

UHL Duty Officer Call in Form

UHL Emergency Sample Information Form

CDC Shipping Instructions

Tab 8

Instructions for use of BCTA Exposure Reporting Templates

Template Threat Level 1, 2, or 3

Template Threat Level 4 & 5

Critical Information Reporting Checklist

Tab 9

Public Information and Media

USPS – Press Release Sample

Tab 10

BCTA Quick Reference Guide – laminated and included in packet

Summary of diagnosis and Treatment Information for Exposure to Select Bio Agents

Summary of Diagnosis and Treatment Information for Exposure to Select Chem Agents

Decontamination Flow Chart

Directed Self Decontamination – English

Directed Self Decontamination – Spanish

Trash Bag Decontamination List

Suggested Mass Decontamination Supply List

Memo from DNR

EPA Article – “First Responders Environmental Liability Due to Mass Decontamination”

Mass Decon Operations

Tab 11

Fact Sheet – Instructions after release from an incident – English

Fact Sheet – Instructions after release from an incident – Spanish

Tab 12

Business Policy and Procedure Example

Back Cover Page (Endorsements) – laminated and provided in packet

Glossary of Acronyms

ATF Alcohol Tobacco Firearms

BCTA Biological Chemical Threat Agent

BT Biological Terrorism

CDC Center for Disease Control and Prevention

CDR Commander

CT Chemical Terrorism

CP Command Post

CST Civil Support Team

DCI Department of Criminal Investigation

DHHS Department of Health and Human Services

DHS Department of Homeland Security

DMPD Des Moines Fire Department

DMPD Des Moines Police Department

DNR Department of Natural Resources

DPD Department of Public Defense

DOD Department of Defense

DOT Department of Transportation

DPS Department of Public Safety

DPH Department of Public Health

ED Emergency Department

EMS Emergency Medical Services

EOC Emergency Operation Center

EPA Environmental Protection Agency

FEMA Federal Emergency Management Agency

FBI Federal Bureau of Investigation
HEPA High-Efficiency Particulate Air

HLSEM Homeland Security Emergency Management

HVAC Heating Ventilation and Air-Conditioning

IC Incident Command

ICS Incident Command System

IHMTF Iowa Hazardous Material Task Force

ISP Iowa State Patrol

JIC Joint Information Center

JOC Joint Operation Center

LE Law Enforcement

MCI Mass Casualty Incident

NIMS National Incident Management System

PAPR Powered Air Purifying Respirator

PIO Public Information Officer

PPE Personal Protective Equipment

SCBA Self-Contained Breathing Apparatus

SEOC State Emergency Operation Center

SLAP Shape Look Address Packaging

TIM Toxic Industrial Materials

UCS Unified Command System

UHL University Hygienic Laboratory

USPIS United States Postal Inspection Service

USPS United States Postal Service

WMD Weapons of Mass Destruction

BCTA Protocol Model Introduction, Roles and Responsibilities

Contents

This protocol model is being provided in a three-ring notebook to facilitate regular updates, revisions and or additions. The protocol itself is divided into two operational sections and is located behind Tab #2. Section 1 of the protocol covers Threat Level 1, 2, and 3 (WMD, Credible Threat, and Potential Threat) procedures for a BCTA and Section 2 of the protocol covers Threat Level 4 and 5 (minimal threat and no threat) procedures. In addition to the protocol there are a set of attachments located behind Tabs (#3-12) that support the protocol and provide more specific guidance and operational policy and procedure recommendations.

Tab #1 Introduction, Technical Assistance Team, References and Acronyms

Tab #2 Protocol, Incident Response Quick Guide, and Credible Threat Assessment Criteria

Tab #3 911 Operators/Communication Centers

Tab #4 Incident Command (IC), Unified Command (UC), National Incident Management System (NIMS) and Resource Management Table of Organization

Tab #5 Emergency Notification Numbers

Tab #6 Suspicious Mail/Package Handling Guidelines

Tab #7 University Hygienic Laboratory (UHL) Sampling Guidelines

Tab #8 Critical Information Reporting Form & Exposure Reporting Templates

Tab #9 Public Information/Media Guidelines, USPS Press Release Example

Tab #10 Biological & Chemical Threat Agent (BCTA) Quick Guides & References, PPE & Decontamination

Tab #11 Disposition/Termination of Incident

Tab #12 Private/Public Business Policy and Procedure Example

Throughout the protocol you will be referred to the various tab sections. Many of the policies and procedures recommended should be carried out simultaneously, thus the need for multi-agency response, communication and coordination. Refer to Tab #4 for local incident/unified command structure, communication, and resource coordination with the Homeland Security and Emergency Management Division (HLSEM) and other state and federal agencies.

Introduction

Numerous activities to improve preparedness for and response to biological and chemical terrorism across multiple disciplines at local, state, and federal levels remain ongoing. The potential threat or actual attacks such as in October 2001 when the U.S. mail became contaminated with Anthrax still exists. No community is immune from these types of threats. Emergency response services continue to be called to assess hoaxes and suspicious substances that may or may not be associated with letters/packages. In order to protect the health and safety of the citizens of Iowa and to deal with hoaxes and suspicious substances it is imperative that multilevel interagency coordination and resource management be achieved through the use of unified command (UC) under the incident command structure (ICS) and that uniform protocols and operating procedures are understood and carried out by all disciplines. Additionally, implementation of the National Incident Management System will be necessary across the state.

All Iowa emergency services should have protocols and operating procedures developed, exercised and in place to determine the credibility of and to manage biological and or chemical threat agents. Development of the following protocol model is the result of multiple local and state agencies coming together to improve multilevel interagency communication, coordination and resource management in response to Biological/Chemical Threat Agents (BCTA) in Iowa that may or may not be associated with letters/packages. Lessons learned from exercises, drills and “real” life experiences have been incorporated. Ongoing review and updates will need to occur to keep pace with changing technology, additional lessons learned and “real” life experiences.

Purpose

The purpose of this protocol is to provide guidance on safe, efficient and effective assessment, response and mitigation during an incident involving or possibly involving a BCTA. In consideration of the unique resources, needs, population, and geography associated with these types of incidents in Iowa, local and or state authorities may enhance portions of this protocol to meet local needs. However, if modification is going to occur, it is STRONGLY recommended that appropriate response agencies (disciplines) and authorities are actively involved in the decision making process and that modifications of the protocol be communicated and shared with all response partners.

This protocol model takes an “incident-based” approach for biological or chemical threat agents (i.e. powder, liquid, solid) following the incident/unified command structure and NIMS.

The Iowa Legislature passed a state law which requires the Administrator of the Homeland Security and Emergency Management Division to develop, implement, and support a uniform incident command system for use by state agencies to facilitate efficient and effective assistance to those affected by emergencies and disasters. This system shall be consistent with the requirements of the United States occupational safety and health administration and a National Incident Management System (NIMS). Please refer to Code of Iowa 29C.

In addition to building a standard multi-jurisdictional response capability in Iowa, the Biological and Chemical Threat Assessment (BCTA) Protocols have been developed to comply with the National Incident Management System (NIMS), as defined by Homeland Security Presidential Directives 5 and 8. In Homeland Security Presidential Directive-5 (HSPD-5), the President called on the Secretary of Homeland Security to develop a national incident management system to provide a consistent nationwide approach for federal, state, tribal, and local governments to work together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity.

The NIMS document is available on www.fema.gov/nims

Code of Iowa 29C addresses the key components outlined in NIMS. These are the Incident Command System (ICS) and Mutual Aid. This law requires all state resources be deployed through the ICS functions know as command, operations, planning, logistics, and finance. In addition, Code of Iowa 29C.11, 21, and 22 allows for the creation of intrastate and interstate mutual aid agreements. Local and state officials from all disciplines are encouraged to adopt NIMS through the development of Executive Orders, operational plans/procedures, training, and exercises.

Intended Audience

This protocol model has been developed for use by fire service, hazmat, law enforcement, dispatchers, public health, emergency management, emergency medical services, and hospitals.

Definitions

Biological Threat Agent: any biological material capable of causing death, disease, or other biological malfunction in a human, an animal, a plant, or another living organism; deterioration of food, water, equipment, supplies or material of any kind; or harmful alteration of the environment. An expression of intention to use any such material for destructive purposes.

Chemical Threat Agent: any chemical material capable of causing death, illness, or other malfunction in a human, an animal, a plant, or another living organism; deterioration of food, water, equipment, supplies or material of any kind; or harmful alteration of the environment. An expression of intention to use any such material for destructive purposes.

Emergency Service: the industry comprised of fire/Hazmat, law enforcement and emergency medical service (EMS) providers who respond to an emergency. For purposes of this protocol model the 71^st Civil Support Team (CST), emergency management and public health shall be considered an emergency service.

First Responder: an emergency worker who responds to an incident bringing specific resource assets. Traditionally this term has been specific to fire/Hazmat, law enforcement and EMS. For purposes of this protocol model local emergency management and public health will be considered first responders. Additionally, and as appropriate other subject matter experts may be included.

Individual/Agency/Discipline Roles and Responsibilities Defined

In order to ensure that the multiple disciplines responding have a clear understanding of the roles and responsibilities of each other the following tables have been included.

LOCAL
Agency/Discipline	Roles and Responsibilities: *Ensure proper PPE for all first responders*
County Emergency Management	Determine the need for a local government emergency proclamation and activation of the county multi-hazard plan. Facilitate incident assessment to determine response resource needs through local Iowa Mutual Aid Compacts and state resources. Assist with dissemination of the general public protective action recommendations or reassurance information. Serve as ICS liaison to state HLSEM for information and state/federal resources.
Communication/911 Centers	Communication/911 centers play a vital role in receiving and dissemination of public warning, receiving initial notifications of incidents and are largely responsible for communications between law enforcement, first response units and other agencies.
Emergency Medical Services (EMS)	Provide medical assistance to first responders as needed. Provide triage of patients as appropriate, provide treatment and transportation of ill or injured to nearest appropriate hospital or alternate care facility.
Fire	Local fire service, upon notification, will immediately respond to the scene providing scene security, assessment of the situation, and address concerns regarding the health and safety of the victims and first responders. They will function as or share the incident commander responsibilities with local police. As more emergency response services arrive incident command may transition to unified command. They will participate in the Joint Information Center (JIC) regarding dissemination of information to the media and public.
Hazmat Teams	Is an organized group of employees, designated by the employer, who are expected to perform work to handle and control actual or potential leaks or spills of hazardous substances requiring possible close approach to the substance. The team members perform responses to releases or potential releases of hazardous substances for the purpose of control or stabilization of the incident. A hazmat team may be a separate component of a fire brigade or fire department.
Hospitals	Provide triage, diagnosis and treatment for individuals potentially or actually exposed and or contaminated by a biologic or chemical agent as they arrive at the hospital. Provide medical consultation to the local incident as requested.
Law Enforcement	Local law enforcement, upon notification, will immediately respond to the scene providing scene security, assessment of the situation, and address concerns regarding the health and safety of the victims and first responders. They will function as or share the incident commander responsibilities with local fire. As additional emergency response services arrive, incident command may transition to unified command. They will participate in the Joint Information Center (JIC) regarding the dissemination of information to the media and public. They will assist in the Joint Operations Center (JOC) regarding law enforcements investigation into the biological/chemical threat agent.
Public Health Agency	Local agencies respond and participate in unified incident command, coordinate isolation/quarantine, recommend PPE/infection control measures, provide epidemiology and surveillance actions as appropriate and request state public health assistance and or response as needed through the incident liaison. Provide PIO for JIC. Provide technical assistance and consultation to the local incident command on prevention and control measures for exposure to biological and or contamination by chemical agents ensuring protection and safety of first responder personnel and any potentially or actual exposed/contaminated individuals. Provide treatment and or prophylaxis to exposed persons when appropriate for biologics.
Public/Private Business	Public/private businesses should have standing operating policies and procedures in place regarding preparedness for and response to biological/chemical threat agents. A point of contact (POC) from the business should be identified, usually a high level administrator or resource management administrator, should serve under the Planning Section of the incident command structure. Communication, coordination and collaboration between the business and incident command are imperative.

STATE/FEDERAL
Agency/Discipline	Roles and Responsibilities
71^st Civil Support Team (CST)	The 71^st CST’s mission is to support civil authorities at a WMD incident site by identifying WMD agents/substances, assessing current and projected consequences, advising on response measures and assisting with appropriate requests for additional support. In response to a WMD incident, the 71^st CST provides a well-trained assessment team to support the State response as a lead element for the National Guard. Their knowledge of the emergency management system, expertise in emergency response operations, and technical capabilities may provide tremendous assistance to the local Incident Commander. The 71^st CST provides assessment of the damage, consultation on logistics, medical, chemical and biological defense, and transmission of the situation to higher headquarters to facilitate follow-on military and civilian assets. The 71^st CST is available 24/7 for rapid deployment in response to a WMD threat, once requested through HLSEM channels. The 71^st CST is available for direct consultation with the Incident Commander at anytime.
Communication/911 Centers	Communication/911 centers play a vital role in receiving and dissemination of public warning, receiving initial notifications of incidents and are largely responsible for communications between law enforcement, first response units and other agencies.
Federal Bureau of Investigation (FBI)	The FBI’s response to a biologic/chemical agent, often with some type of articulated threat, would prompt the local FBI JTTF to be notified and dispatched to the scene. The response protocol would involve securing the crime scene and initiating the FBI’s interagency threat assessment process. The FBI’s Counterterrorism Division at FBI headquarters coordinates this threat assessment which determines the credibility of the threat received, the immediate concerns involving health and safety of the responding personnel, and the requisite level of response warranted by the Federal Government.
Homeland Security and Emergency Management (HLSEM)	Provide the state and federal structure for overall operational coordination, communications, and resource management. Activate the emergency provisions within Code of Iowa 29C through a Governor’s State of Emergency Proclamation. Activate the State Emergency Operations Plan in order for state agencies to engage their resources such as subject matter experts, equipment, materials and supplies. Establish forward command posts. The Forward Command Post is an extension of the State Emergency Operations Center. Based on the needs of the local Incident Commander, the mission of the FCP facility and personnel is to stage and manage federal/state personnel, equipment, and supplies as authorized through the State Emergency Operations Center. Normally, the FCP is located outside the impacted area. Deploy appropriate state support, coordination, and assessment teams. Activate the interstate Emergency Management Assistance Compacts. Activate the State Emergency Operations Center.
Department of Natural Resources (DNR)	Responsible for communication, education and training of first responders and county emergency management officials. Responsible for providing technical assistance and consultation regarding prevention and control measures relating to contamination by biologic/chemical agents, providing operational policy and procedure recommendation and feedback to the council. Provides prevention and control recommendations and directives to minimize impact to the environment. DNR regional field staff may respond to the site to provide planning support and assistance to minimize environmental impacts. DNR will make its monitoring equipment available to hazmat teams as appropriate. The role of the DNR is complimentary to, and at times parallels that of DPH during a WMD incident.
Department of Public Health (DPH)	DPH is responsible for consultation and technical assistance regarding prevention and control measures relating to exposures/contamination by biologic/chemical agents to local incident/unified command through HLSEM and to local officials as requested. Duty officers are available 24/7 through HLSEM channels or by calling 1-866-834-9671. This provides direct access to the state/deputy state epidemiologist, toxicologist and medical director for the Poison Control Center. DPH is responsible for providing resources at the local level upon request such as deployment of regional/state epidemiologists, regional EMS coordinators, IA-DMAT teams, and request, storage, and distribution of assets from the Strategic National Stockpile (SNS). DPH is responsible for communication with local public health agencies, hospitals, EMS ambulance programs and other agencies through the Health Alert Network (HAN). The role of the DPH is complimentary to, and at times parallels that of DNR during a WMD incident.
Department of Public Safety (DPS)	The DPS has a variety of roles and responsibilities associated with its response to a BCTA incident. The DPS is a support organization who, upon request, works with local jurisdictions on any threatened, suspected, or confirmed terrorist incident. This support may include assistance with crime scene processing, evidence gathering, and investigation, bomb detection and disposal, communications interoperability, crime scene security, traffic direction and control, tactical operations, crowd control, and emergency transport of suspected Bio/Chem sample to UHL for confirmation testing. The DPS will participate in unified incident command, joint operations center (JOC), joint information center (JIC), to assist with operations, investigations, and determining the proper threat level associated with the incident.
University Hygienic Laboratory (UHL)	The primary responsibility of UHL is for testing samples and confirmation of other test results in accordance with the CDC National Laboratory Response Network protocols and procedures. Also responsible for communication, education and training of laboratorians, HazMat Teams, 71^st Civil Support Teams, DMAT teams, and health care providers on sampling and shipping policies and procedures. Works closely with the Iowa Department of Public Health , HLSEM, 71^st CST, Law Enforcement, and DNR on reporting results.
United States Postal Service (USPS)	U. S. Postal Inspectors will respond to and investigate any suspect substance found at a postal facility, which cannot be identified. If it is not feasible to respond (i.e. a remote location), an Inspector will coordinate and monitor a response with local authorities or HAZMAT. In the event a suspect substance involving mail is discovered off postal property, an Inspector will monitor the situation with the responding agency. If there is a positive field test, an Inspector will respond to the location and notify/coordinate with the FBI.

About Biological Agents

People usually do not become ill immediately after an exposure to a biological agent. Most biological agents have an incubation period that ranges from days to weeks. When an unknown material is being analyzed to determine if it is a biological threat agent, the final confirmatory tests must be done by a Laboratory Response Network (LRN) laboratory which, in Iowa, is the University Hygienic Laboratory (UHL). Due to the high rate of false positive test results from biological field assays the Association of Public Health Laboratories (APHL) and CDC do NOT recommend the use of any of the rapid technology field assays for biological testing. Recommendations have been made to the Department of Homeland Security (DHS) to establish a system to validate these field assays.

Confirmatory test results will usually be completed within 24 to 72 hours from the time the samples are received at UHL. If a confirmatory test is positive, there should be enough time to initiate antibiotic prophylaxis and/or begin treatment before symptoms appear. Managing the consequences of a biologic agent release will be an ongoing operation since biological agents have long incubation periods, require confirmatory laboratory testing, and present insidiously. This delay in positive identification and definitive management contrasts with chemical agents that quickly produce symptoms and require immediate medical intervention and environmental containment. There are effective therapies for many of the biological agents.

Some response actions such as closing or evacuating a large building, may not be performed until confirmatory testing is complete. However, closing areas of a building where there is a biological threat agent and controlling access to that area are appropriate actions during the time when tactical decisions are made and laboratory testing is performed (level 1, 2, or 3 – refer to Tab #2).

When laboratory tests are positive, decisions and actions regarding containment, prophylaxis, treatment, isolation, quarantine etc. must be made as an integrated process through unified incident command.

Biological Threat Agents/Diseases

The U.S public health system and primary healthcare providers must be able to manage outbreaks caused by various biological agents, including those that are rarely seen in the U.S. The following table identifies potential biological threat agents by category.

Category A - Highest priority agents include organisms that pose a risk to national security because: q can be easily disseminated or transmitted from person to person; q result in high mortality rates and have the potential for major public health impact; q might cause public panic and social disruption; and q require special action for public health response.
Anthrax (Bacillus anthracis)	Smallpox (variola major)
Botulism (Clostridium botulinum toxin)	Tularemia (Francisella tularensis)
Plague (Yersinia pestis)	Viral hemorrhagic fevers (filoviruses [e.g. Ebola, Marburg] and arenaviruses [e.g. Lassa, Machupo])
Category B - Second highest priority agents include those that: q are moderately easy to disseminate; q result in moderate morbidity rates and low mortality rates; and q require specific enhancements of diagnostic capacity and enhanced disease surveillance.
Brucellosis (Brucella species)	Q fever (Coxiella burnetii)
Epsilon toxin of Clostridium perfingens	Ricin Toxin (Ricinus communis) castor beans
Food Safety - Salmonella species, Escherichia coli 0157:H7, Shigella	Staphylococcao enterotoxin B
Glanders (Burkholderia mallei)	Typhus fever (Rickettsia prowazekii)
Melioidosis (Burkholderia pseudomallei)	Viral encephalitis ( alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis])
Psittacosis (Chlamydia psittaci)	Water Safety Threats (e.g., Vibrio cholerae, Cryptosporidium parvum
Category C - Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because: q availability; q ease of production and dissemination; and q potential for high morbidity and mortality rates and major health impact.
Nipah virus	Hantavirus

About Chemical Agents

Chemical warfare agents are hazardous chemicals designed for use by the civilian population and/or military which irritate, incapacitate, injure, or kill. Some have local effects on the eyes, skin, or airways (riot control agents, chlorine), some have only systemic effects (hydrogen cyanide), and some have both local and systemic effects (nerve agents and vesicants). Some chemical warfare agents have characteristic odors. However, odors are not adequate warning signs for the purpose of protecting oneself against adverse health effects associated with exposure.

Chemical agents usually produce signs and symptoms within minutes or exposure requiring immediate decontamination and medical treatment. While some agents (mustard agents and phosgene) may not produce symptoms for several hours after exposure, people exposed to those agents still need immediate decontamination and medical evaluation.

Traditional Military Chemical Threat Agents	Name
Nerve Agents	Tabun, Sarin, Soman, VX
Vescants (blister agents)	Mustard, Lewsite
Blood Agents	Cyanide, Hydrogen Cyanide, Cranogen
Pulmonary Irritants	Phosgene, Chlorine, Ammonia
Riot Control Agents	Mace7, Pepper Spray

Nerve agents (organophosphates – liquid/vapor)

These are the most toxic of all the weaponized military agents. A large exposure to a nerve agent results in sudden loss of consciousness, seizures, apnea, and death. Nerve agents may be either vapors or liquids, depending upon air temperature and humidity. When fresh, nerve agents are clear colorless liquids. Liquid agents are heavier than water, and their vapors are heavier than air. This means they will sink to low terrain, towards ground levels and flooring surfaces. Vapors cause toxicity when inhaled or when they come in contact with skin and mucous membranes. Liquids cause toxicity when absorbed through the skin. These chemicals are easily absorbed through the skin, eyes, and lungs.

Vesicants (blister agents – liquid/vapor)

These agents cause blistering when they come in contact with the skin. Chemical warfare vesicants include sulfur mustard, nitrogen mustard, and lewisite. Lewisite causes pain and blistering within minutes of skin contact, while the mustards typically do not produce symptoms until several hours after exposure. Immediate decontamination is essential for both types of vesicants.

Blood agents (cyanide)

Cyanide is a less potent toxin than nerve agents and causes death by preventing the body from using oxygen. Cyanide can be a liquid, solid, or a gas. It has the odor of bitter almonds, but only 60 percent of the population can detect this odor.

Hydrogen cyanide (AC) and cyanogen chloride (CK) can be either liquid or a gas. Cyanogen chloride ha a pungent odor, and causes irritation of the eyes, nose, and throat. This is in distinct contrast to hydrogen cyanide, which has no irritant properties. Cyanide salts are solids, but easily dissolve in water, and can liberate hydrogen cyanide gas when mixed with a strong acid. When ingested, cyanide salts produce symptoms more slowly than inhaled cyanide, but the duration of symptoms can last much longer.

Pulmonary Irritants

Some chemicals may cause severe life‑threatening lung injury after inhalation. These effects can be immediate or delayed several hours after exposure, depending upon the chemical and the amount inhaled. Treatment is usually supportive and a severe exposure may require intensive unit care. Pulmonary irritants include are phosgene and chlorine.

Riot Control Agents

Irritating agents, frequently referred to as tear gas are a group of aerosol‑dispersed chemicals that produce eye, nose, mouth, skin, and respiratory tract irritation. The irritant effect of there chemicals causes significant tearing, nasal discharge, and involuntary eye closure. The irritant effects are usually transient, lasting approximately 30 minutes.

Toxic Industrial Chemicals

The security of toxic and hazardous industrial chemicals is of great concern. These chemicals pose a substantial hazard to human health and the environment when release either accidentally or deliberately. Toxic materials are located in many rural and urban areas. The chemicals that pose the greatest risk to the civilian population are irritant gases, especially chlorine, sulfur dioxide, ammonia and hydrogen chloride. These substances have relatively high toxicity when inhaled and they are produced, stored and transported in large volumes. Most toxic industrial chemicals are released as vapors. These vapors travel downwind from the release point and tend to concentrate in low-lying areas such as valleys, ravines, and man-made underground structures. Toxic chemicals are used by industries which manufacture batteries, paint, pharmaceuticals, rubber, plastics, paper and machinery. Some processes that use toxic chemicals include electroplating, textile dyeing and finishing, paper printing and finishing, metal mining, and agriculture.

The most common types of Toxic Industrial Materials (TIM) are listed below.

Irritants	acids, ammonia, acrylates, aldehydes, and isocyanates
Choking agents	chlorine, hydrogen sulfide, and phosgene
Flammable industrial gases	acetone, alkenes, alkyl halides, amines
Water supplies contaminants	aromatic hydrocarbons, benzene, toluene, chloroform, vinyl chloride, petroleum distillates
Metals	arsenic, cadmium, lead, mercury, thallium, bismuth
Chemical asphyxiates	aniline, nitrile, and cyanide compounds
Incendiary gases	compressed isobutane, liquefied natural gas, propane
Incendiary liquids	liquid hydrocarbons, gasoline, diesel, jet fuel
Industrial compounds (blister-like)	dimethyl sulfate
Organophosphate pesticides	parathion, TEPP, malathion, mevinphos

A study by the US Environmental Protection Agency, analyzing over 7,000 large scale releases of industrial chemicals, found that four chemicals accounted for almost 30 percent of all the deaths and serious injuries. These were:
Chlorine

q Hydrochloric acid

q Sulfuric acid

q Anhydrous ammonia

TECHNICAL ASSISTANCE TEAM

Purpose

Representation from a group of state agencies and other organizations came together to address the need for development and implementation of a protocol model, operational policies and procedures for response to biological/chemical threat agents (BCTA) in the State of Iowa. The following list identifies those on the team at the time of development and that are responsible for ongoing updates, coordination, education and training and communication with local, regional, state and federal partners as appropriate. All state agency representatives are responsible to ensure appropriate and timely review and approval by agency directors and to ensure collaboration with and feedback from local partners. Additionally, a panel of medical/science experts has been assembled and agreed to review the contents of the BCTA Protocol Model and provide recommendations for change, enhancements resulting in approval of the protocol model.

Team Facilitators

Mary J. Jones, Iowa Department of Public Health (DPH)

Jerry Ostendorf, Homeland Security Emergency Management (HLSEM)

Agencies and Representatives

71^st Civil Support Team - Contact: LTC Plagman

Responsible for working directly with the Hazmat Team Association and respective teams, UHL, and law enforcement. Responsible for providing technical assistance and consultation to Hazmat Teams and providing operational policy and procedure recommendations and feedback to the council. Assists with education and training.

Department of Natural Resources (DNR) - Contact: Kathy Lee

Responsible for providing technical assistance and consultation to the Hazmat Teams in Iowa on chemicals and feedback to the council. Provides operational policy and procedure recommendations and feedback to the council. Assists with education and training.

Department of Public Health (DPH) - Contact: Mary J. Jones

Responsible for communication, education and training with local public health agencies, hospitals and EMS programs. Responsible for consultation and technical assistance regarding prevention and control measures relating to exposures/contamination by biologic/chemical agents, providing operational policy and procedure recommendations and feedback to the council. Serves as co-facilitator for the council.

Department of Public Safety (DPS) - Contact: Steve Bogle, John Quinn, or Doug Mollenhauer

Responsible for communication, education and training of local and state law enforcement agencies, operational policy and procedure recommendations and feedback to the council. Provide technical assistance and consultation on credible threat assessments and crime scene management. Assist with education and training.

Des Moines Fire Department (DMFD) - Contact: Greg Chia or Bob Cox

Responsible for working directly with the Hazmat Team Association, making operational policy and procedure recommendations and providing feedback to the council. Assist with education and training.

Des Moines Police Department (DMPD) – Contact: Len Murray

Responsible for working with law enforcement agencies, organizations, and associations making operational policy and procedure recommendations and providing feedback to the council. Assist with education and training.

Iowa Hazardous Materials Task Force (IHMTF) - Contact: Bob Platts

Responsible for communication with all Hazmat Teams in the state, making operational policy and procedure recommendations and providing feedback to the council. Assist with education and training.

Homeland Security and Emergency Management (HLSEM) - Contact: Jerry Ostendorf or Joyce Winningham

Responsible for overall coordination and management of resources provided by state agencies, communication, education and training of local emergency managers and providing feedback to the council. Additionally, provides operational technical assistance and consultation. Assist with education and training. Serves as facilitator for the council.

University Hygienic Laboratory (UHL) - Contact: Bonnie Rubin

Responsible for communication, education and training of laboratorians, Hazmat Teams, 71^st Civil Support Team on sampling policies and procedures. Works closely with DPH on reporting test results.

Contact Information

BCTA Technical Assistance Team	Office Phone	Email
Joyce Winningham (HLSEM)	515-323-4210	Joyce.allsup@iowa.gov
Steve Bogle (DCI)	515-281-8709	bogle@dps.state.ia.us
Greg Chia (DMFD)	515-979-8176	gmchia@dmgov.org
Bob Cox (DMFD)	515-283-4091	rjcox@dmgov.org
Mary Jones (DPH)	515-281-4355	mjones@idph.state.ia.us
Kathy Lee (DNR)	515-725-0384	Kathy.Lee@dnr.state.ia.us
Doug Mollenhauer (DPS)	515-281-8715	mollenha@dps.state.ia.us
MAJOR Len Murray (DMPD)	515-237-1521	llmurray@ci.des-moines.ia.us
LTC Kevin Plagmann (CST)	515-334-2803	Kevin.plagman@ia.ngb.army.mil
Jerry Ostendorf (HLSEM)	515-323-4210	Jerry.Ostendorf@iowa.gov
Bob Platts (HMTF)	641-421-3640	bplatts@masoncity.net
John Quinn (DCI)	515-725-0035	jquinn@dps.state.ia.us
Bonnie Rubin (UHL)	319-335-4861	bonnie-rubin@uiowa.edu
CPT Michael Simpson (CST)	515-334-2827	Michael.simpson@ia.ngb.army.mil

Medical/Science Advisors

Dr. Charles Barton: State Toxicologist
Iowa Department of Public Health

Dr. Ed Bottei: Medical Director for the State Poison Control Center
Iowa Department of Public Health

Dr. Aileen Buckler: Deputy State Epidemiologist and Medical Director for the
Center for Acute Disease Epidemiology,

Iowa Department of Public Health

Dr. Claudia Corwin: Healthcare Services Medical Director for Public Health

Iowa Department of Public Health

Dr. Mary Gilchrist: Director for the University Hygienic Laboratory
University of Iowa, Hygienic Laboratory

Dr. Patricia Quinlisk: State Epidemiologist and Public Health Medical Director
Iowa Department of Public Health

References and Resources

“Mail Center Security Guidelines,” United States Postal Service, Publication 166, September 2002.

“Terrorism Agent Information and Treatment Guidelines for Hospitals and Clinics,” County of Los Angeles, Department of Health Services, Public Health, June 2003.

“Suspicious Package/Letter Concept of Operations,” Suwannee County Department of Emergency Services, Division of Emergency Management, October 18, 2001.

State of Iowa Guidelines “How to Handle Suspected Biological Agents (ANTHRAX),” August 6, 2003.

Federal Bureau of Investigation “CONPLAN United States Government Interagency Domestic Terrorism Concept of Operations,” January 2001

www.fbi.gov/publications/conplan/conplan.pdf.

“Model Procedures for Responding to a Package with Suspicion of Biological Threat,” International Association of Fire Chiefs, FBI Hazardous Materials Response Unit, FBI Laboratory, January 2004.

“REPORT Assessment of Protocols Involving Unknown Samples,” Chemical and Biological Defense (CBIAC) Information and Analysis Center, January 2004.

“USAMRID’s Medical Management of Biological Casualties Handbook,” Appendix C: BW Agent Characteristics, www.vnh.org/BIOCASU/26.html.

Minnesota Department of Health, Emergency Sample Information Form, February 27, 2004.

“WMD Agent Quick Reference Guide”, Center for Biological Defense, October 28, 2003, www.bt.usf.edu

“Responding to Detection of Aerosolized Bacillus anthracis by Autonomous Detection Systems in the Workplace”, CDC, MMWR April 30, 2004 / 53 (Early release);1-11.

“Access Mass Decontamination Protocol” State of Connecticut Rapid

National Institute of Standards & Technology, Special Publication 981

U.S. Army Research, Development and Engineering Command, Edgewood Chemical Biological Center

“Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident” U.S. Army Soldier and Biological Chemical Command (SBCCOM)

“Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Incident” U.S. Army Soldier and Biological Chemical Command (SBCCOM)

OSHA 29 CFR 1910.120

“Firefighters’ Quick Reference Guide for Responding to Chemical and Biological Terrorist Incidents,” Department of Justice, Office of Justice Programs, June 2002

Internet Resources

Centers for Disease Control and Prevention (CDC), www.cdc.gov.

Department of Homeland Security, www.dhs.gov

Federal Bureau of Investigation, www.fbi.gov.

Federal Emergency Management Agency, www.fema.gov

Morbidity and Mortality Weekly, www.cdc.gov/MMWR/

National Response Team Technical Federal Response Plan (FRP), www.NRT.org

NIOSH, www.cdc.gov/niosh/homepage.html

Occupational Safety and Health Administration (OSHA), www.osha.gov

US Army Research Institute of Chemical Defense, http://ccc.apgea.army.mil/

US Army Research Institute of Infectious Disease, http://usamridd.detrick.army.mil/

US Department of Health and Human Services, Bioterrorism and Response Page: www.hhs.gov/hottopics/healting/biological.html

USPS Postal Inspection Service, www.usps.com/postalinspectors

Berkeley Lab – Safe Buildings: http://securebuildings.lbl.gov

OSHA, www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html

Threat Level Assessment Criteria Guideline

The following assessment criteria is intended to serve as a guide for law enforcement personnel to analyze a set of circumstances, which may indicate the need for further investigation and deployment of additional resources. It must be recognized that no set of guidelines can cover every possible contingency associated with a terrorist attack. Every report/incident will have unique features and responders must use their own judgment in applying the guidelines. The decision on the initial credibility of a threat rests with the law enforcement officials at the scene. Technical advice is available from the 71^st CST (515) 201-8998/8997 to assist with the decision to deploy additional BCTA resources. or:

If the following questions are negative, then the likelihood of a potential threat would be minimal:

Y N

c c Is there an explicit or implied threat?

c c Is there any unidentified or suspicious material or residue present?

c c Is the intended target a potential vulnerability or strategic significance?

If the following questions are affirmative, Iowa BCTA resources will be deployed as necessary:

Y N

c c Is the incident considered a potential crime scene by law enforcement?

c c Has HAZMAT and/or the 71^st CST determined a suspicious substance/ situation exists that

cannot be explained by circumstances that would rule out a potential WMD incident?

The format below represents a series of questions to stimulate thought and to assist responders in the threat assessment process. Please keep in mind that a “Yes” response to one or more questions does not necessarily indicate an imminent threat to life or that a terrorist attack has occurred. However, multiple positive indicators should serve as an indication that additional resources may be required to mitigate the potential threat and assist in conducting the investigation.

First, responders need to direct their immediate attention towards a potential improvised explosive device (IED) and a secondary explosive device, and take appropriate action. The following factors may indicate the potential of an IED that may require additional analysis by a certified bomb technician:

Improvised Explosive Letter / Package Assessment:

Y N

c c Excessive postage, no postage, or non-canceled postage

c c No return address or obvious fictitious return address

c c Packages that are unexpected or from someone unfamiliar to the recipient

c c Improper spelling of addressee names, titles, or locations

c c Package addressed to someone no longer with your organization or are otherwise outdated

c c Unexpected envelope or package from foreign countries

c c Suspicious or threatening messages written on package

c c Postmark showing different location than return address

c c Distorted handwriting or cut and paste lettering

c c Unprofessionally wrapped packages or excessive use of tape, strings, etc.

c c Packages marked "Fragile, “Handle with Care", "Rush”, "Personal" or "Confidential"

c c Rigid, uneven, irregular, or lopsided package

c c Package that are discolored, oily, or have an unusual odor or ticking sound

c c Package with soft spots, bulges, or excessive weight

c c Protruding wires or aluminum foil

c c Visual distractions

c c Suspicious objects visible when the package is x-rayed

Based on the reconnaissance and scene survey by hazardous materials or 71^st Civil Support Team, additional information may be gathered to further assist in making the credible / non-credible threat decision. The following factors may indicate the potential of a biological or chemical agent that may require sampling by hazardous materials or 71^st Civil Support Team for analysis by the University Hygienic Laboratory:

Biological / Chemical Threat Assessment– Letter or Package Borne: (Previous explosive plus)

Y N

c c Unopened package / letter with a powdery, granular or liquid substance on the outside

c c Opened package / letter containing a powdery, granular or liquid substance inside

c c Package / letter designed with a mechanism to intentionally disperse the material when opened

c c Written information stating or implying hazardous contents or intent to harm the recipient

c c Specific target of particular vulnerability or controversy (e.g., Government agency, public official, large business office or other critical infrastructure)

c c Not associated with mass or bulk mailings, e.g., advertisements, fund raising, religious tracts, etc. (Note: various substances are typically applied to letters to prevent pages from sticking together)

c c Unable to verify the mailing or contents through interview / contact with the sender

c c Field analysis by certified hazardous materials or 71^st Civil Support Team indicates the material present may be a biological or chemical agent

c c A symptomatic patient without known exposure to biological / chemical agent is discovered

c c Hospitalized patients with symptoms compatible with biological / chemical agent exposure

c c Law enforcement intelligence information or communicated tips from the public support the attack

c c Known, claimed or highly suspected release of a biological / chemical agent exists

Biological / Chemical Threat Assessment– Not Letter or Package Borne:

Y N

c c Explosive device that does little damage

c c Finding abandon spray and aerosol cans

c c Crop-dusting aircraft operation over populated areas

c c Trucks, vans or other vehicles discharging mist or smoke as they travel

c c Suspects carrying gas masks

c c Large numbers of sick people or animals

c c Non-marked vehicles carrying biohazard marked containers

c c Abandon vehicles with biohazard placards

c c Clandestine laboratories with respiratory protective equipment

c c Suspects with petri dishes or cultures flasks in their possession

c c Unusual clouds or mists that don't arise from the weather

IOWA Threat Level Assessment Criteria Guideline

If the following questions are negative, then the likelihood of a potential threat would be minimal:

Y N

c c Is there an explicit or implied threat?

c c Is there any unidentified or suspicious material or residue present?

c c Is the intended target a potential vulnerability or strategic significance?

If the following questions are affirmative, Iowa BCTA resources will be deployed as necessary:

Y N

c c Is the incident considered a potential crime scene by law enforcement?

c c Has HAZMAT and/or the 71^st CST determined a suspicious substance/ situation exists that

cannot be explained by circumstances that would rule out a potential WMD incident?

Improvised Explosive Letter / Package Assessment:

Y N

c c Excessive postage, no postage, or non-canceled postage

c c No return address or obvious fictitious return address

c c Packages that are unexpected or from someone unfamiliar to the recipient

c c Improper spelling of addressee names, titles, or locations

c c Package addressed to someone no longer with your organization or are otherwise outdated

c c Unexpected envelope or package from foreign countries

c c Suspicious or threatening messages written on package

c c Postmark showing different location than return address

c c Distorted handwriting or cut and paste lettering

c c Unprofessionally wrapped packages or excessive use of tape, strings, etc.

c c Packages marked "Fragile, “Handle with Care", "Rush”, "Personal" or "Confidential"

c c Rigid, uneven, irregular, or lopsided package

c c Package that are discolored, oily, or have an unusual odor or ticking sound

c c Package with soft spots, bulges, or excessive weight

c c Protruding wires or aluminum foil

c c Visual distractions

c c Suspicious objects visible when the package is x-rayed

Tab 2.

Operational Procedures for Handling Biological/Chemical Threat Agents (BCTA)

Procedures outlined in this protocol are intended for use by law enforcement, fire, EMS, public health and hospital officials. These procedures are considered general in nature, thus each responding agency must develop standing operating procedures (SOP) in order to implement this protocol.

If at anytime assistance or additional resources are needed in responding to a BCTA contact HLSEM (Refer to Tab #4) who will in turn contact the appropriate state agencies/organizations to immediately respond to your request.

Threat Levels Defined

The primary responsibility for determining the threat level rests with law enforcement and fire/hazmat. Threat levels generally will not be instantaneous and additional intelligence gathering and investigation need to be accomplished and further analyzed to determine the appropriate threat level. This requires “TIME” to allow the situation to develop before mobilizing and deploying additional resources that may or may not be required to respond to the incident. As the threat level is determined incident command will request resources as necessary.

Threat Levels	Definitions
Level 1 (WMD Incident)	A WMD incident has occurred or the incident has resulted in mass casualties and requires immediate multiple local, state and federal agency notification and response.
Level 2 (Credible THREAT)	Law enforcement based on the threat assessment determines that the potential threat is credible and either confirms or is highly suspicious of WMD activity. This level of threat requires local, state and federal agency notification and involvement as deemed appropriate.
Level 3* (Potential THREAT)	Law enforcement based on intelligence or an articulated threat indicates there is potential for a terrorist incident. This threat however, has not yet been assessed as credible. The incident shall be treated as a credible threat until directed otherwise by unified command. Unified command may request laboratory testing by UHL.
Level 4 (Minimal THREAT)	Law enforcement has determined that the received threats associated with the BCTA do not warrant actions beyond normal liaison notifications or placing assets or resources on a heightened alert, agencies and organizations resume or continue to function under normal day-to-day operations.
Level 5 (NO THREAT)	Law enforcement has determined there is no threat associated with the BCTA or incident.

* Initial response to a BCTA report/incident shall be treated as a level 3 threat until determined otherwise by unified command.

The protocol is divided into two sections:

Section 1: Threat Level 1, 2, and 3 (WMD, Credible Threat, and Potential Threat).

Section 2: Threat Level 4 and 5 (MINIMAL Threat and NO Threat).

SECTION 1: Threat Level 1, 2, and 3 (WMD, Credible Threat, and Potential Threat)

Ö	Procedures
ASSESS SITUATION
	1. Upon receipt of call for suspicious BCTA simultaneous dispatch of local law enforcement and fire/hazmat is recommended. Notify appropriate response agencies (CST, EMS, county emergency management and public health). Based on current information notify state agencies as appropriate (Refer to Tab #5). Make one call to HLSEM and they will notify other state agencies as requested. Contact 71^st Civil Support Team for technical assistance as required at (515) 201-8998/ 8997.
	2. It is imperative that 911 Operators and or dispatchers gather pertinent information, recommend precautionary measures to potential victims, send an appropriate response, provide updated response information and be prepared to support the unified command system during any BCTA incident. Refer to Tab # 3 for 911 Operator and or Communication Center Protocol Guidance.
	3. Personnel safety is the number-one priority in handling any suspicious biological/chemical threat agent. Implement appropriate Personnel Protective Equipment (PPE) and decontamination guidelines. For PPE and Decon, refer to Tab # 10.
SECURE THE AREA
	4. The following activities will be carried out simultaneously by appropriate agencies. Scene Safety: Upon arrival at the scene immediately perform a scene survey that includes a risk assessment of the threat for an improvised explosive device (IED) and secondary IED. If an explosive threat exists contact your local bomb squad and State Fire Marshall’s Office at (515) 281-5821 (Refer to Tab #5). If an explosive threat exists, it will take precedence over any biological/chemical threat until rendered safe. Secure the area to deny entry/exit to area BCTA located and preserve health and evidence. Establish hot, warm and cold zones, determine appropriate PPE, identify Incident Command and establish Unified Incident Command (law, fire/Hazmat, public health) as appropriate. (Refer to Tab #4 Incident/Unified Command and Tab #10 for PPE).
	5. If suspicious BCTA is associated with letter/package ensure that letter/package is set down, minimize handling and isolate. Do not attempt to open a suspicious package or letter. Only appropriately trained and equipped personnel should open suspicious letters and packages (e.g. Hazmat Team/Bomb Squad). Refer to Tab #6 for additional information on “Mail/Package Handling.”
	6. If sink is immediately available in room/area have those individuals in room/area of suspicious BCTA wash exposed/contaminated skin with mild soap and water. Refer to Tab #10 for decontamination guidelines.
	7. Be prepared for immediate media response and establish a Joint Information Center (JIC) – if you need assistance with public information contact HLSEM (Refer to Tab #9 for public information and media examples).
DETERMINE THREAT LEVEL
	8. A significant number of tactical operations will depend upon the threat level (1-5) determined by law enforcement/unified command (refer to Threat Levels above). The remainder of the general operations described in this section is recommended as precautionary measures until the threat level is determined and/or confirmatory laboratory testing is completed when necessary.
	9. Use official “IOWA” Threat Level Assessment Criteria Guideline and determine if there is a credible threat associated with the BCTA and or incident. The official “IOWA” threat assessment criteria are located at the end of this protocol. If local law enforcement needs assistance in conducting a BCTA assessment/investigation notify the Iowa State Patrol Communication Center (Refer to Tab #5) and DPS will notify appropriate personnel for assistance.
	10. Upon determination of threat level, the County Emergency Management Coordinator or designee will notify HLSEM at 515-281-3231. HLSEM is responsible for notifying DPS, DPH, DNR, UHL, DPD, and other state agencies as appropriate. The incident location is a crime scene thus preservation of evidence and chain of custody procedures must be followed. A. If not already done immediately notify FBI. B. If suspicious agent is associated with letter/package immediately notify the USPIS (Refer to Tab #5). C. Unified Command should request deployment of 71^st CST if not previously coordinated. (Refer to Tab #5). D. HLSEM should be established as the point of contact (POC) for the local unified command requesting support and or state agency assistance and response. The state liaison (Refer to Tab #4) shall serve as the POC for communication from the incident location to HLSEM and other state agencies. This liaison may be the county emergency manager or state assigned liaison. E. Incident Command Critical Information Reporting Checklist will need to completed and reported as soon as possible to HLSEM (Refer to Tab #8). Reporting should be done by phone or fax and will require ongoing communication between the state incident liaison or county emergency manager (Refer to Tab #4) and HLSEM. Reporting should occur every hour during the incident or more often if the situation changes and or conditions warrant. This report is the responsibility of unified command at the local level. F. It is the responsibility of each state agency to notify respective federal partners as appropriate. (Refer to Tab #4)
	11. Upon determination of threat level 4 or 5 refer to Section 2 of the protocol to close out the incident. Refer to Tab #11 for Disposition/Termination of Incident.
	12. Upon determination of threat level 1, 2, or 3 proceed below.
STABILIZE THE INCIDENT
	13. When incident deals with private/public business, work closely with the Human Resource Director or Occupational Safety Director in providing information to workers/clients at the business and to families. Public health should fulfill this responsibility.
	14. If not already done, make sure the area/room where BCTA is located is secure. Avoid additional exposure/contamination from the suspicious BCTA. Shut down ventilation system of room/building as appropriate. Evacuation of the entire building is not necessary unless an immediate threat is evident or has been identified by unified command.
	15. If not already done move all individuals in room/area of suspicious BCTA who have been exposed or possibly exposed to nearest secure room/area. Shelter in place during threat assessment/investigation. If washing of exposed/contaminated skin of those exposed with soap and water has not been done, do so at this time.
	16. Unified command will determine all other protective action measures. Unified command may contact DPS, DPH, and DNR for technical assistance regarding protective action recommendations.
	17. Unified command will identify individuals for decontamination. If any victim is showing signs of exposure or complaining about being sick, decontamination must be completed immediately and prior to medical treatment on scene and transportation to a medical care facility. It is important to brief the victims regarding the need for and process of decontamination. (Refer to Tab #10 for Decontamination guidelines.)
	18. Once initial response activities are complete in addressing immediate public health/safety concerns, every effort must be made to preserve evidence necessary for law enforcement threat assessment/investigations and public health investigations.
	19. Create list of persons and contact information for those who handled the suspicious BCTA, were in the room or area when the BCTA was discovered or who may have been exposed in some other way. On the list identify the location of the persons when the BCTA was discovered, when the exposure occurred, exposure time and length of exposure. (Refer to Tab #8 for Exposure Reporting Templates for Threat Level 1, 2, or 3). Public health should fulfill this responsibility.
STABILIZE: Field Detection and Sampling – Laboratory Testing by UHL
	20. Upon identification of a credible threat (threat level 1, 2, or 3) BCTA field detection and/or agent sampling may be indicated. Appropriately trained and equipped personnel (e.g. Hazmat Team, 71^st CST or appropriate federal response unit) will perform necessary detection, sampling, and testing. (Refer to Tab #7 for UHL sampling information form and Tab #10 for PPE).
	21. Field detection and testing by Hazmat Teams are not recommended at this time for Biological Threat Agents (BTA). Chemical Threat Agents (CTA) is appropriate. Hazmat Teams should follow local protocol when conducting CTA field testing.
	22. The operations of screening, sampling, packaging, and preparation for transport of the BTCA must be accomplished ONLY by appropriately trained and equipped personnel in cooperation with UHL. (Refer to Tab #7 for UHL sampling/packaging guidelines).
	23. The law enforcement agency, FBI, or Unified Command that determined credible threat (level 1, 2, and 3) is responsible for transporting the BCTA sample(s) to the UHL. All samples must be appropriately labeled and must include Sample Information and Chain of Custody Form (Refer to Tab #7). Once the sample(s) are properly packaged, decontaminated and prepared for delivery, person(s) transporting the samples are not required to wear or use personal protective equipment (Refer to Tab #7).
	24. HLSEM by way of the state liaison officer will notify UHL regarding sample departure from the incident and ETA at the laboratory.
	25. DO NOT contact UHL for test results. UHL will report test results as soon as available to HLSEM and DPH and other agencies as appropriate (CST, DPS, DNR). HLSEM and or CST will be responsible for reporting test results to Unified Command. Notification of other response partners of test results will be directed by unified command.
	26. Public and media release regarding test results and action plans will come from the local JIC.
PREVENTION, CONTAINMENT & CONTROL
	27. An action plan will be formulated by unified command in collaboration with state/federal agencies based on the test results. This action plan should include prevention/treatment of those exposed/contaminated, decontamination of building/area as appropriate and other mitigation and recovery procedures.
	28. The action plan formulated and carried out regarding prevention/treatment of exposed or potentially exposed individuals will involve local unified command, multiple local, state and federal public health and healthcare agencies.
	29. The action plan formulated and carried out regarding the ongoing criminal investigation and crime scene preservation will require involvement from unified command, multiple local, state and federal law enforcement agencies.
	30. The action plan formulated and carried out regarding further environmental sampling, testing and appropriate decontamination of the building (as appropriate) will require the involvement of multiple local, state and federal agencies.

SECTION 2: Threat Level 4 and 5 (MINIMAL or NO THREAT)

Ö		Procedures
Operations - General
	1. When law enforcement assessment/investigation results in determination of a Threat Level 4 or 5 associated with the BCTA and incident, laboratory testing is not recommended. When incident involves local public/private business their respective polices and procedures should be followed. (Refer to Tab #12 for example)
	2. Upon determination of threat level 4 or 5 Unified Command will terminate incident operations. Owners of homes, businesses and government buildings or any other establishment may resume normal occupancy and day-to-day activities at their discretion. Private/Public businesses may contact the UHL (Refer to Tab #4) and request testing however, these arrangements are to be made between UHL and the private/public business. UHL will provide consultation on packaging the sample and delivery process to the laboratory.
	3. Create list of persons and contact information for those at the incident site who handled the suspicious BCTA, were in the room or area when the BCTA was discovered or who may have been exposed in some other way. (Refer to Tab #8 for Exposure Reporting Template Threat Level 4 or 5).
	4. Local officials (law, fire, Hazmat) should follow local protocols/procedures for handling Threat Level 4 and 5 items [clothing, jewelry etc. (discard, return to owner, place in storage)]. If individuals possibly exposed/contaminated with the Threat Level 4 and 5 BCTA feel ill they should consult with their local physician. (Refer to Tab #11 for Disposition/Termination of Incident Instructions). These instructions are intended to be distributed to the victims.
	5. Consider location and well-being of those not exposed or unlikely exposed – may need to gather together or provide written statement to these individuals from public health and law enforcement officials to inform and allay fears. Work closely with private/public business to accomplish this task as appropriate.

Telecommunicators - Communication Centers

Contents of this tab are based on the Firefighters’ Quick Reference Guide for Responding to Chemical and Biological Terrorist Incidents, Department of Justice, Office of Justice Programs, June 2002 with modifications for Iowa’s BCTA Protocol Model.

Communication Centers are generally the first public safety contact during an emergency. Telecommunicators may have the first opportunity to identify a potential biological or chemical incident. It is imperative that emergency communications centers develop procedures to assist in identifying potential biological or chemical agent incidents, local protocols and resource lists necessary to support the response.

Through close scrutiny of the information provided, asking appropriate questions and crosschecking other reports, the telecommunicator should be alerted to the possibility that a biological or chemical incident may have occurred. These types of incidents will most likely yield a number of requests for assistance and additional resources from multiple disciplines. Properly identifying the incident, describing appropriate precautionary measures to potential victims and relaying vital information to responding units, are among the keys to minimizing the adverse impact of a biological or chemical event on the lives of victims and responders.

Telecommunicator - Roles and Responsibilities

It is imperative that telecommunicators gather pertinent information, recommend precautionary measures to potential victims, send an appropriate response, provide updated response information and be prepared to support the unified command system during the response.

Pertinent Information

If the telecommunicator is the direct recipient of a threat, the following should be noted:

q Incoming phone line information (ANI/ALI, caller ID, incoming phone line)

q Caller identifiers (sex, age, race, voice qualities, demeanor, sobriety)

q Exact language used (catch phrases, profanity or declaration of responsibility)

q Any specifics related to the threat (target, type of agent, delivery time or method)

q Background (people talking, music, traffic, construction, sirens, train whistles, or other noises that may assist in identifying where the call originated)

If the caller is the person who received the purported threat, witnessed the event or discovered evidence following an attack, the telecommunicator should ask questions that will assist in determining the response to be sent and provide precautionary information to the caller to minimize the spread of the potential threat agent.

q Conformation of the caller’s identity, location and contact information

q Determine whether the caller or others are experiencing signs or symptoms of illness

q Determine whether the attack is in progress or if a suspect is present or in the immediate area (description of the suspect, vehicles and direction of travel)

q Method the threat was transmitted (via telephone, mail, e-mail, or personal delivery)

q Suspicious letter or package is involved (Refer to Tab #6).

q Why the caller believes a biological or chemical threat agent is involved (presence of suspect or unknown powders, liquids, vapors or odors, or specific agent identified in threat)

q Identify the specific location where the event initially occurred and where the suspect material is currently located (outside, inside, specific floor or office, or if it has traveled)

q Determine if the caller discovered a dissemination device or other delivery mechanism

q Compare information with other reports of similar threats or activity to establish a developing pattern or possible connection between events or other major crimes

Precautions and Warnings

q Recommend that no additional people come in contact with the suspect item or others who may have already been contaminated by the suspect item or substance

q Recommend the suspect item and related packaging be immediately laid down and secure the room where it is located, to minimize the spread of potential contamination

q Recommend all persons who came in contact with the suspect item, evacuate to the nearest safe location. Try to minimize the spread of contamination by avoiding contact with others.

q If experiencing symptoms, recommend the person or persons remove their outer clothing and wash their hands, these actions should remove 80% of the contamination

q Reassure potential victims that assistance is on the way and responders will require several minutes after arrival to evaluate the circumstances, prepare to make entry, conduct preliminary monitoring and prepare to receive the people affected by the event

q Encourage the caller to immediately call back, should anyone experience a change in their health conditions

Common Indicators of a BCTA Incident

Telecommunicators should be trained in terrorism awareness and be familiar with possible indicators of a possible terrorism event or attack.

Possible Indicators of a Biological Threat Agent

Initial intelligence, threats or reports of exposures to powders, liquids or infectious diseases, that are suspect or unexplained, may indicate the occurrence of a potential biological event. Fortunately, if the event is discovered and reported immediately, there is generally time to conduct laboratory testing and to prescribe appropriate medication or treatment, if necessary. Initial test results are generally available from the University Hygienic Laboratory within 6 hours of receipt of a test sample.

Unfortunately, it is difficult to identify a covert biological incident. Signs and symptoms of illness may not appear for days to weeks after an exposure. Senior citizens, children, or those who are immuno-suppressed (due to HIV, leukemia, cancer, for example) may begin to experience signs and symptoms before others, due to a decreased immune defense system.

Telecommunicators may begin to receive an increase in the numbers of calls for patients with flu-like symptoms, respiratory complaints or rashes. If this early recognition occurs, telecommunicators should notify their command staff of their observations and recommend local public health, emergency medical services and law enforcement investigators be notified.

Possible Indicators of a Chemical Threat Agent

The effects of chemical events are generally immediate and often severe. Among the possible indicators are:

q Multiple calls of sick or injured persons from the same general geographic area, venue or a specific large gathering of people, without explanation

q Signs and symptoms indicative of chemical threat agent exposure may include: drooling, tearing, shortness of breath, difficulty breathing, irritation of the eyes, nose, or throat, skin redness or itching, nausea, muscle twitching, seizures, or sudden heart failure.

q Report of an explosion with little or not structural damage

q Reports of unexplained liquids (e.g., droplets, oily substances)

q Reports of unusual odors (e.g., mowed grass, garlic, bitter almonds, peach pits)

q Reports of a released spray (e.g., hissing sounds, presence of a mist or vapor)

q Suspicious devices/packages (e.g., spray devices, damp/wet packages or bags, small explosive device that expelled a material)

q Unexplained dead wildlife or domestic animals.

q Discarded personal protective equipment (PPE) such as masks, gloves, or gowns.

The pertinent information and possible indicators should be relayed to all responding units. It is also crucial that all responding agencies are aware of the event and each other’s response to the event.

Notifications

Initial Response

Notifications should be based on local protocols and resources. Initial response to a potential biological or chemical incident should include:

q Following your agency’s policies and procedures

q Local law enforcement

q Local fire department, and local or regional hazardous materials team

q Local Emergency Medical Service

Determination of Credible or Non-credible Threat

First priorities include securing the scene, conducting a preliminary scene assessment, and the decontamination and treatment of victims, if warranted. Representatives of responding agencies will form incident or unified command on scene, conduct initial and ongoing assessments, review the facts and circumstances surrounding the event, and render a determination regarding the credibility of the threat or incident. (Refer to Tab #2)

After the declaration that the threat or event is credible or non-credible, the decision will be made to escalate or de-escalate the response. If the threat or event is declared to be non-credible, the response will likely result in de-escalation with units demobilizing and returning to service. If the threat or event is declared to be credible, the response will likely escalate and additional resources and notifications will likely be requested by incident or unified command.

Additional Resources and Technical Assistance

Communication Centers should have 24-hour contact numbers on file to notify additional resources and technical assistance, when incident / unified command determines the threat is credible and requests any of the following resources be notified or deployed (Refer to Tab #5):

q Surrounding Mutual Aid Resources

q 71^st Civil Support Team

q County and State Emergency Management Agencies

q County and State Public Health

q Iowa Department of Natural Resources

q Local Public Works and Water Treatment Plant

q Local or Regional Bomb Squad

q United States Postal Inspection Service

q Federal Bureau of Investigation – Regional Joint Terrorism Task Force

q University Hygienic Laboratory

Coordination should be made to ensure local hospitals are notified of the potential for receiving contaminated or exposed patients. Emergency Management, Public Health or Emergency Medical Service Commander may perform this function.

Recommended Updates to Responding Units and Agencies

Additional reports and information may be provided by callers, witnesses or initial responders that should be communicated to incoming units, agencies and field commanders. Responders and command may also request the receipt or relay of specific information to aid in facilitating the response. The following are examples of such information or requests:

q Current weather conditions and updates, with wind direction and speed

q Special response directions, routes of travel, upwind and upgrade of the incident

q Location of Incident Command Post, Staging Area and Casualty Collection Point

q Special instructions or precautions concerning the agent and recommended personal protective equipment (PPE)

q Information regarding number of victims, their signs, symptoms and location

q Notifications from medical centers receiving patients who self evacuated

q Warnings of potential contamination/exposure or secondary devices

q Information of found dissemination devices, packages or envelopes

q Any new information related to the response as it becomes available or information on other nearby, similar or other major events

SAMPLE Telecommunicator Question Checklist for Callers (BCTA)

√	Questions	Response
	1. What is your name, address and the telephone number you’re calling from?
	2. Where did the incident occur (address), describe the type of structure or name of the business involved?
	3. When did the incident occur? If there was a delay in reporting the incident, why?
	4. Is there a fire or was there an explosion? (Consider dispatching fire equipment at this time)
	5. Why do you believe that a potential biological or chemical event has occurred? (Presence of a threat, powder, liquid, vapor, odor, discoloration or a number of ill or injured people?)
	6. Is the incident still in progress and are the perpetrator(s) present?
	7. If in progress or witnessed, can you describe the perpetrator, getaway vehicle or a direction of travel?
	8. Is the incident inside or outside the building? Can you provide a specific location to include what floor and room, if inside?
	9. Is anyone sick or injured? If so, how many and what are their symptoms or chief complaints?
	10. How was the threat or substance delivered? What type of vehicle, container or device is involved and where is it now?
	11. What form is the substance? (Powder, granular, liquid, solid, gas, vapor or unknown?)
	12. Did you notice or can you confirm the presence of a spilled powder, liquid, vapor, mist, smoke, unusual odors, or any hissing / spraying noises?
	13. Did you see anyone or anything suspicious? If so, who or what?
	14. Did you see anyone wearing protective clothing (e.g., mask, gloves, chemical suits)?
	15. If you received a telephoned threat, can you describe any type of background noises that may indicate the perpetrators’ location?
	16. Where can the responding units meet with the person reporting the incident?
	17. Complete EMD Protocols if applicable.

Initial Local Incident Command

(Local law enforcement and/or fire)

Unified Command –may include -

DPS, EMS, FBI, Hazmat, CST, and Public Health

County Emergency Management or State Liaison Officer(s)

(Designated by HLSEM)

Two way communication – receive and report information to and from unified command, SEOC, state, and federal agencies.

Joint Operations Center (JOC)

Lead local, state and federal law enforcement

(Local law enforcement, DPS, FBI)

Suspect Biological/Chemical Threat Agent (BCTA) Local Incident/Unified Command Structure

THREAT LEVEL 1, 2, and 3 January 2005

Suspect Biological/Chemical Threat Agent (BCTA) LOCAL Incident/Unified Command Structure

THREAT LEVEL 1, 2, and 3 January 2005

DEFINITIONS

Local Incident/Unified Command: the incident command should be established by first arriving emergency service; either law enforcement or the fire service. Based on type of incident the incident commander should be a law enforcement officer or from the fire service who is fully qualified to manage the response. The incident commander is in charge of on-scene management until command authority is transferred to another person, who then assumes the Incident Command. The unified incident command structure will need to be established as emergency service agencies arrive. As emergency service agencies arrive each should be represented in incident command under the unified incident command structure. This shall include but not be limited to, law enforcement, fire, hazmat, 71^st CST, and public health. Refer to Tab #4.

State Liaison Officer: this individual is to be designated by HLSEM and will serve as the direct communication link between HLSEM and other state agencies when requesting assistance on scene, consultation and or technical assistance from the state and or federal agencies. This individual shall establish a regular briefing with HLSEM for reporting and receiving “critical” information regarding the incident. The concept of deploying a State Liaison to the scene or county EOC is to report to and assist the Local County Emergency Management Coordinator, if requested or needed. The State Liaison must be an operations person. The personnel selected for this position are hand selected from HLSEM and other state agency personnel. The type of personnel selected will be determined by type of incident.

Joint Operations Center (JOC): is established to carry out the criminal investigation and ongoing threat assessment with local, state and federal law enforcement agencies. This shall include but not be limited to local law enforcement, DPS and FBI.

Joint Information Center (JIC): should be established at a location away from the incident and is responsible to carry out public information releases and to work directly with the media. At minimum PIOs from law enforcement, hazmat/fire and public health should be present in this center to develop and present uniform messages. This center assures timely and accurate information release and assures delivery of unified messages.

Safety Officer: is designated by incident command and is responsible for the oversight and monitoring of safety conditions at the incident and developing measures for ensuring the safety of all assigned emergency service personnel.

County Emergency Manager and/or Liaison Officer: is designated by incident command and is responsible for ensuring coordination and communication between agencies in unified command and others authorized to be on-scene.

Public/Private Business: if the incident involves a private/public business a responsible and authoritative point of contact (POC) should be established for direct communication between incident command and the business through the incident command planning section.

Operations: the operation section is responsible for carrying out all response activities and has primary responsibility for receiving and implementing action plans as directed from incident/unified command. Refer to Tab #1 for roles and responsibilities defined.

Logistics: the logistics section is responsible for providing facilities, services, and materials including personnel to operate the requested equipment for the incident. This section supports the incident responders.

Planning: the planning section may to used to collect, evaluate disseminate information about the incident and status of resources. This may include the development of an Incident Action Plan. This section is responsible for assuring direct communication and coordination between public/private businesses POC as appropriate. Refer to Tab #1 for roles and responsibilities defined.

Finance: the finance section is responsible for tracking incident costs and reimbursement accounting.

Suspect Biological/Chemical Threat Agent (BCTA) State Resource Management and Coordination Structure

THREAT LEVEL 1, 2, and 3 January 2005

Suspect Biological/Chemical Threat Agent (BCTA) STATE Resource Management and Coordination Structure

THREAT LEVEL 1, 2, and 3 January 2005

DEFINITIONS and National Incident Management System (NIMS)

Governor: state commander in chief.

The NIMS document is available on www.fema.gov/nims

State Resource Management and Coordination – Executive Team (SEOC): the HLSEM Advisor and/or designee are responsible for the coordination of information and functional oversight of state asset allocation and utilization while working directly with the Executive Team. The Executive team shall include, but not be limited to, the directors/designees from HLSEM, DPD, DPS, DPH, DNR, and DOT. Direct communication with the governor will occur through the Executive Team at SEOC or at another designated location. The Executive Team provides the avenue to assure joint decisions on asset distribution strategies, priorities, plans, state operational procedures and public information dissemination across multiple state agencies.

Readiness and Response Bureau: through the Chief of Operations and/or designee is responsible for the coordination and management of state asset distribution to local incident sites through multiple state and/or federal agencies serving at the SEOC or alternate location. The State Liaison Officer will report direct to the SEOC Chief of Operations who in turn will report to state and federal agencies.

State Agencies: roles and responsibilities are defined under Tab #1.

Local/State/Federal Multi-Level Interagency Scheme for Incident Resource Management and Coordination

Emergency Notification (Support, State and Federal Agencies)

When dealing with any suspicious biological/chemical threat agent please notify HLSEM. Advise as to the need at the local level for consultation, technical assistance, additional resources and or capabilities from state agencies. HLSEM will in turn notify state agencies as appropriate.

Homeland Security and Emergency Management (HLSEM)

24-Hour Number

(515) 281-3231

Department of Public Health (DPH)

24 Hour Emergency Hotline – Duty Officer	1-866-834-9671
24 Hour Disease Reporting Hotline	1-800-362-2736

Department of Public Safety (DPS)

Iowa State Patrol Communication Centers
Atlantic	(712) 243-3854
Cedar Falls	(319) 277-4761
Cedar Rapids	(319) 396-4414
Des Moines	(515) 323-4360
Fairfield	(641) 472-5001
Storm Lake	(712) 732-1341
Division of Criminal Investigation (DCI)
Headquarters Des Moines	(515) 281-5138
State Fire Marshal’s Office
Headquarters Des Moines	(515) 281-5821
Iowa State Patrol (ISP)
ISP	(515) 281-5824

Iowa National Guard 71^st CST

Commander

(515) 201-8998/8997

Federal Bureau of Investigation (FBI)

Omaha Office

(402) 493-8688

Department of Natural Resources (DNR)

Ask for Emergency Response Unit

(515) 281-8694

United States Postal Inspection Service (USPIS)

USPIS – after hours answered by Postal Police

(515) 253-9060

University Hygienic Laboratory (UHL)

UHL – Emergency Response	(800) 421-4692
24 hour Duty Officer	(319) 530-5981

Iowa Poison Control Center

Poison Control Center – Sioux City

(800)-222-1222

Emergency Notification Numbers - LOCAL

County Emergency Management

24-Hour Number

City/County Public Health

Law Enforcement

City

County

Fire Service/Hazmat

Fire

Hazmat

Emergency Medical Services

Hospital(s)

Other

Iowa Hazardous Materials Task Force (IHMTF)

Teams 24 Hour Numbers	Number
Iowa public hazardous materials teams may only be activated by local officials such as the fire department or county emergency management coordinator.
Ames	515-239-5133
Bettendorf	563-344-4015
Burlington	319-753-8373
Cedar Rapids	319-286-5491
Council Bluffs	712-328-5737
Davenport	563-326-7979
Des Moines	515-283-4550
Dubuque	563-589-4415
La Crosse, WI	608-785-5947
Linn County	319-398-3911
Johnson Co	319-356-5275
Mason City	641-421-3640
Muscatine	563-263-9922
Newton	641-792-1547
NE Iowa Response	319-291-2515
Region V Hazmat	515-573-2323
Sioux City	712-279-6960
SE Iowa Response	641-683-0666

Team and Contact General Numbers	Number
Ames Fire Department - Scott Siberski	515-239-5108
Bettendorf Fire Department - Thom Sheetz	563-344-4148
Burlington Fire Department - Gene Wilkerson	319-753-8396
Cedar Rapids Fire Department - Mark English	319-286-5225
Council Bluffs Fire Department - Brad Nocita	712-328-4648
Davenport Fire Department - Ed Grothus	563-326-7914
Des Moines Fire Department - Greg Chia/Bob Cox	515-283-4768
Dubuque Fire Department - Rick Steines/Jay Imhoff	563-589-4160
Johnson County Hazmat- - Ron Stutzman	319-356-5262
Linn County Hazmat - Tom Ulrich	319-363-2671
Mason City Fire Department - Bob Platts/Jerry Bergdale	641-421-3640
Muscatine Fire Department - Gary Lee/Darrell Janssen	563-263-9233
Newton Fire Department - Dennis Curtis	641-792-3347
Ottumwa Fire Department - Dave Sertterh	641-683-0666
Region V Emergency Response Hazmat - Bruce Ahrens	515-573-2871
Sioux City Fire Department - James Clark	712-279-6022
Waterloo Fire and Rescue - Roger Carr/Mike Moore	319-2914275

Suspicious BCTA Letter/Package (Mail) Handling

These guidelines were developed to provide mail center supervisors, employees, co-workers and first responders with an overview of how to handle a “suspicious” Biological/Chemical Threat Agents (BCTA) associated with a letter/package. The guidelines provided may be applicable for many situations involving possible mail threats; however they are intended as guidance only.

If there is any type of written, verbal or other threat associated with the suspect letter/package, do the following:
1. Notify local law enforcement to conduct assessment/investigation to determine “threat level”

2. Notify local fire/Hazmat

3. Notify county emergency manager

4. Notify local public health

Characteristics of Suspicious Letters/Packages “SLAP”

Is the letter/package and Unusual Shape?

Rigid, uneven, irregular or lopsided package
Package with soft spots, bulges or excessive weight

Does the letter/package have an Unusual Look, Odor or Sound?

Discoloration, oily stains or an unusual odor
Crystals, powder or powder-like residue on the package or spilling out from the package
Protruding wires or aluminum foil
Ticking or other sound coming from the letter or package

Does the Letter or Package have any Unusual Address Features?

Suspicious language on the outside of the letter/package
Post mark that doesn’t match the return address or no return address
Restrictive endorsements such as “Personal” or “Confidential”
Distorted handwriting, blocked-printed or poorly typed addresses
Excessive postage
Title but no name or incorrect title
Misspelled addressee’s name, title or location
Addressee in position of authority: government, executive, political figure
Addressee in controversial business: family planning, abortion, chemical industry
Misspelled common words
Addressee unknown or no longer with organization
Unexpected mail from a foreign country

Is there Unusual or Excessive Packaging?

§ Excessive tape or string

Letters and or Packages

Ö	Procedures
	What to look for: § Powder on, or leaking from letter or package, oily stains or suspicious discolorations or powder on package – refer to previous page – SLAP. § NO RETURN ADDRESS, foreign, or fictitious address, written threat or warning.
	Agency/Business Response: § Contact the addressee. Is he/she expecting such a letter or package? § Contact the sender if possible. Is there an explanation for the characteristics(s) giving rise to the suspicions? § Notify local law enforcement, fire/hazmat and public health. If mail processing center for US mail, notify USPIS (Refer to Tab #5). § Do not open, smell, touch or taste. § If possible place in clear plastic bag or container and seal. If not possible, immediately set letter/package down and isolate, and if possible cover with a sheet of clear plastic or other suitable material. Do not handle more than absolutely necessary, do not shake. § Minimize number of handlers and notify immediate supervisor. § Have all handlers wash exposed/contaminated skin surfaces with warm water and soap at nearest location. § Move all people who handled or were in close proximity of the suspicious letter/package to the nearest secure room and compile list of names, contact information (to include home and cell phone numbers) and identify their location of for all potentially exposed or contaminated persons. § Secure the area/room and avoid contamination to other locations as much as possible. Do not allow entry into secure area until emergency service arrives and determines appropriate. § If at anytime an individual complains about feeling ill or has symptoms of illness request assistance from local EMS agency. *As emergency response agencies begin to arrive be prepared for working with the media.* (Refer to Tab #9). § Initiate communication with employees as appropriate, working with human resource director of business/agency. If necessary establish a mechanism to communicate with families of affected employees. § Local law enforcement will conduct an assessment/investigation to determine the threat level associated with the letter/package. Response will vary based on this determining factor. § Do not try to clean up the powder or agent. § It is not necessary to evacuate the entire building at this time. Emergency service agencies will assist you in making decisions regarding building evacuation. § Based on the threat level determined by law enforcement refer to Section 1 or 2 of the BCTA protocol for further guidance (Tab #2).

Procedures

What to look for:

§ Powder on, or leaking from letter or package, oily stains or suspicious discolorations or powder on package – refer to previous page – SLAP.

§ NO RETURN ADDRESS, foreign, or fictitious address, written threat or warning.

Agency/Business Response:

§ Contact the addressee. Is he/she expecting such a letter or package?

§ Contact the sender if possible. Is there an explanation for the characteristics(s) giving rise to the suspicions?

§ Notify local law enforcement, fire/hazmat and public health. If mail processing center for US mail, notify USPIS (Refer to Tab #5).

§ Do not open, smell, touch or taste.

§ If possible place in clear plastic bag or container and seal. If not possible, immediately set letter/package down and isolate, and if possible cover with a sheet of clear plastic or other suitable material. Do not handle more than absolutely necessary, do not shake.

§ Minimize number of handlers and notify immediate supervisor.

§ Have all handlers wash exposed/contaminated skin surfaces with warm water and soap at nearest location.

§ Move all people who handled or were in close proximity of the suspicious letter/package to the nearest secure room and compile list of names, contact information (to include home and cell phone numbers) and identify their location of for all potentially exposed or contaminated persons.

§ Secure the area/room and avoid contamination to other locations as much as possible. Do not allow entry into secure area until emergency service arrives and determines appropriate.

§ If at anytime an individual complains about feeling ill or has symptoms of illness request assistance from local EMS agency.
As emergency response agencies begin to arrive be prepared for working with the media. (Refer to Tab #9).

§ Initiate communication with employees as appropriate, working with human resource director of business/agency. If necessary establish a mechanism to communicate with families of affected employees.

§ Local law enforcement will conduct an assessment/investigation to determine the threat level associated with the letter/package. Response will vary based on this determining factor.

§ Do not try to clean up the powder or agent.

§ It is not necessary to evacuate the entire building at this time. Emergency service agencies will assist you in making decisions regarding building evacuation.

§ Based on the threat level determined by law enforcement refer to Section 1 or 2 of the BCTA protocol for further guidance (Tab #2).

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

________________________________________________________________________

Centers for Disease Control

and Prevention (CDC)

Atlanta, GA 30341-3724

Shipping Instructions for Specimens Collected from People

Potentially Exposed to Chemical Terrorism Agents

Collecting specimens

Required specimens

Unless you are otherwise directed, collect the following specimens from each person who may have been exposed:

· Urine—Collect at least 25 mL. Use a screw-capped plastic container. Please do not overfill. Freeze as soon as possible (−70^○C or dry ice preferred). If possible, ship the specimen on dry ice. If dry ice is not available, you may ship frozen specimens with freezer packs. For pediatric patients, collect urine only, unless otherwise directed by CDC.

· Whole blood—Use three 3-, 5-, or 7-mL purple-top (EDTA) tubes, vacuum-fill only (unopened). If collecting in 3 mL purple top tubes, please collect a fourth tube.

· Whole blood—Use one 3-, 5- or 7-mL gray-top or one 3-, 5- or 7-mL green-top tube, vacuum-fill only (unopened).

Order of collection

Please mark the first purple-top tube of whole blood collected with a “1” using indelible ink. The first purple-top tube of whole blood collected will be used to analyze for blood metals.

Blanks

For each lot number of tubes and urine cups used for collection, please provide two empty unopened purple-top tubes, two empty unopened green- or gray-top tubes, and two empty unopened urine cups to serve as blanks for measuring background contamination. Note: Although blanks do not have to be labeled, please secure their container tops in the same fashion described below for collected blood tubes and urine cups.

Labeling

Label specimens with labels generated by your facility. These labels may include the following information: medical records number, specimen identification number, collector’s initials, and date and time of collection. Follow your facility’s procedures for proper specimen labeling. The collector’s initials and date and time of collection will allow law enforcement officials to trace the specimen back to the collector should the case go to court and the collector is needed to testify that they collected the specimen.

Information provided on labels may prove helpful in correlating the results obtained from the Rapid Toxic Screen and subsequent analysis with the people from whom the specimens were collected.

Place a single, unbroken strip of waterproof, tamper-evident forensic evidence tape over each specimen top, being careful not to cover the specimen ID labels. This tape must make contact with the specimen container at two points. The individual placing the evidence tape must identify themselves by writing their initials ½ on the container and ½ on the evidence tape.

Maintain a list of names with corresponding specimen identification numbers at the collection site to enable results to be reported to the patients.

Packaging

Packaging consists of three components: primary receptacle (blood tubes or urine cups), secondary packaging (materials for protecting primary containers, absorbent material, and waterproof, 95 kPa pressure resistant packaging), and an outer container (Styrofoam-insulated corrugated, fiberboard containers).

Pack and ship these specimens as diagnostic specimens.

Secondary packaging

Blood Tubes—

· Separate each tube of blood collected from other tubes, or wrap tubes to prevent contact between tubes; this may be accomplished in a variety of ways such as a gridded box wrapped with absorbent material and sealed inside a plastic bag, sealable Styrofoam container, blood tube shipment sleeve and transport tube, and individually wrapped tubes sealed inside a plastic bag. Secondary packaging must have its closure secured with a single strip of tamper-evident forensic evidence tape initialed ½ on the container and ½ on the evidence tape by the individual making the seal.

· Place absorbent material between the primary receptacle and the secondary packaging. Use enough absorbent material to absorb the entire contents of primary receptacles. According to 49 CFR 173.199(b), if specimens are to be transported by air, either the primary receptacle or the secondary packaging used must be capable of withstanding without leakage an internal pressure producing a pressure differential of not less than 95 kPa (0.95 bar, 14 psi). Verify in advance that the manufacturer of either the blood tube or secondary packaging used in your facility is in compliance with the pressure differential requirement.

· To facilitate processing, package blood tubes so that similar tubes are packaged together (e.g., all purple-tops together) and not mixed (i.e., purple-tops and green/gray-tops in the same package).

Urine Cups—

· Separate each urine cup from other urine cups or wrap urine cups to prevent contact between urine cups.

· Place urine cups in secondary packages. A variety of secondary packages may be used, for example, gridded box wrapped with absorbent material and sealed inside a plastic bag or individually wrapped urine cups sealed inside a plastic bag. In either case verify that the urine cup or secondary container complies with the requirements stated in 49 CFR173.199(b). Secondary packaging must have its closure secured with a single strip of tamper-evident forensic evidence tape initialed ½ on the container and ½ on the evidence tape by the individual making the seal.

Outer containers

Use Styrofoam-insulated corrugated fiberboard containers (may be available from your transfusion service or send-outs department). Do not ship frozen urine cups and blood tubes in the same package.

Blood tubes— Ship at 4°C

· For cushioning, place additional absorbent material in the bottom of the outer container.

· Add a layer of frozen cold packs.

· Place secondary containers on top of the cold packs.

· Place additional cold packs or absorbent material between the secondary containers to reduce their movement within the outer container.

· Place a layer of frozen cold packs on top of the secondary containers.

Urine cups— Ship to ensure specimens remain frozen or freeze while in transport

· For cushioning, place additional absorbent material in the bottom of the outer container.

· Add a layer of dry ice. Note: Do not use large chunks of dry ice for shipment, because large chunks have the potential for shattering urine cups during transport.

· Place additional absorbent material between wrapped urine cups to reduce their movement within the outer container.

· Add an additional layer of dry ice.

Preparing documentation

Since blood tubes and urine cups are shipped separately, prepare a separate shipping manifest for each. Place each shipping manifest (with specimen identification numbers) in a plastic zippered bag on top of the specimens before closing the Styrofoam lid of the corrugated fiberboard container.

Chain of custody forms do not need to be transported with specimens. Each entity/organization handling the specimens is responsible for the specimens only during the time that they have control of the specimens. Each entity/organization receiving the specimens must sign-off on the chain of custody form of the entity/organization relinquishing the specimens to close that chain. When receiving specimens, each new entity/organization must begin their own chain of custody and have the entity/organization relinquishing the specimens sign their chain of custody to start the chain and indicate that they have transferred the specimens. When specimens are transferred between entities/organizations, each entity/organization retains their chain of custody forms.

Note: When the individual relinquishing the specimens (relinquisher) and the individual receiving the specimens (receiver) are not together at the time of specimen transfer, the relinquisher will document on their chain of custody that the receiver is FedEx Tracking Number or have the individual transporting the specimens sign the chain of custody to indicate that they have taken control of the specimens. Likewise, when the receiver receives the specimens, they will document on their chain of custody that the relinquisher is FedEx Tracking Number or the have the individual transporting the specimens sign the chain of custody.

Preparing containers for shipment

· Secure outer container tops and bottoms with filamentous shipping/strapping tape.

· Affix labels and markings adjacent to the shipper’s/consignee’s address that appears on the package.

· Place a UN 3373 diamond label on the outer package.

· Ensure that two orientation “up” arrows are located on two opposite sides of the outer container.

· Place a label on the outer container that indicates the proper name, “Diagnostic Specimens.”

· For those containers with dry ice, place a class 9 label on the outer container. This label must indicate the amount of dry ice in the container, the address of the shipper, and the address of the recipient (in the absence of a shipper’s declaration of dangerous goods). This label must be placed on the same side of the container as the “Diagnostic Specimens” label.

Shipping specimens

· Follow the guidance provided in your state’s chemical terrorism comprehensive response plan.

· If you are directed to ship the specimens to CDC, please ship the specimens to the following address:

CDC

Attn: Dr. Richard Meyer

1600 Clifton Road, NE

Bldg. 8/9

Atlanta, GA 30333

(888) 374-1764

Questions

If you have any questions or problems with specimen packaging or shipment, please e-mail or call one of the following contacts at the CDC’s National Center for Environmental Health, Division of Laboratory Sciences (DLS):

· Charles Buxton, DLS Chemical Terrorism Field Laboratory Coordinator

cbuxton@cdc.gov, 7243001194@pagebb.com (text), or 888-461-6713 (voice or numeric)

· Dr. John Osterloh, DLS Chief Medical Officer, 770-488-7367

· DLS administrative office, 770-488-7950

UHL Sampling and Shipping Guidelines for Biological/Chemical Threat Agents

General Guidelines

Samples are to be collected, decontaminated and double Ziploc bagged according to the guidelines provided by the 71^st CST Sample Collection Training Program.
The quantity of sample(s) that the laboratory requires for analysis is a minimum of t1 (one) tablespoon (solids). Contact UHL for specific sample volume guidance
UHL will treat all unidentified samples as an “all-hazard” specimen, and will perform both biological and chemical testing analyses to identify and/or rule-out organisms, toxins and chemicals
Place the sample(s) in a biohazard container with a hard outer container or in a hard plastic cooler. The intent is to assure that samples are in a hard shell, puncture-proof container.
A completed “UHL Emergency Sample Information Form” MUST accompany each sample
Samples must be screened for explosive and radiological threat prior to delivery; otherwise UHL cannot accept the sample.

Credible Threats (Threat Levels 1, 2, 3)

Transportation of the sample(s) to the laboratory will be the responsibility of the law and local agencies to coordinate with UHL. Once the sample(s) are properly packaged (placed in a rigid container such as a paint can or cooler), decontaminated on the outside and prepared for delivery, person(s) transporting the samples are not required to wear or use personal protective equipment. If transporting by vehicle, the sample container should be placed in the trunk.
A Chain-of-Custody form and Sample Information Form MUST accompany each sample.
Testing - Samples will be treated as emergency work, received and analyzed on a 24/7 basis.
Based on the incident, all BT/CT samples will be immediately tested for:

Biological agents, and/or

Chemicals, and/or

Microscopic Examination for crystal/substance identification

Results will be available within 6 hours of receipt of the sample. Further testing may require 72 hours

All results will be verbally reported to IDPH, HLSEM and other agencies as appropriate (71^st CST, DCI, LPHA and DNR). Positive results will also be verbally reported to the CDC LRN.
Hard copy results will be sent to the HLSEM, IDPH, DCI and the affected site.

Non-Credible Threats (Threat Levels 4, 5)

Transportation of the sample(s) to the laboratory will be the responsibility of the private organizations to coordinate with UHL. UHL is contracted with a courier for 24/7 on-demand services. Samples should be properly packaged (double zip-lock bag and placed in a rigid container). Person(s) transporting the samples are not required to wear or use personal protective equipment. As a safety precaution, samples should be placed in the trunk of vehicles for transport.
A Sample Information Form MUST accompany each sample.
Testing - Samples will be treated as routine work and received and analyzed during normal UHL working hours.
The tests performed will be based on the incident, sample type and possible suspected agent.
Significant results will be verbally reported to IDPH, HLSEM, and other agencies as appropriate (71^st CST, DCI, LPHA and the CDC LRN).

Hard copies of all results (regardless of positive or negative) will be sent to HLSEM, IDPH, DCI and the submitting facility.

Instructions for use of BCTA Exposure Reporting Templates

Introduction

The BCTA Exposure Reporting Template forms on the following pages are to be completed in accordance with the BCTA Protocol located in Tab #2.

Purpose

Developing a record of the persons exposed to or possibly exposed to a BCTA allows public health practitioners and healthcare providers the ability to quickly locate persons to initiate prophylaxis, treatment or other public health control measures if presence of a BCTA is confirmed. Prompt initiation of prophylaxis, treatment, and other public health control measures is essential to limiting morbidity and mortality among those exposed and possibly reducing the spread of a disease to others.

Use of the Forms

The BCTA Exposure Reporting Template forms may be completed by the entity deemed most appropriate by unified command. Completion of these forms will often be a task delegated to a responding local public health agency representative to perform once decontamination has been completed. Complete and accurate information should be collected for every field listed for every person determined to be exposed/potentially exposed to the BCTA.

This responsibility should rest with public health. The reason for public health completing these forms and establishing a relationship with exposed or possibly exposed persons is that follow-up interview and or surveys and epidemiological investigations will be carried out by public health.

BCTA EXPOSURE REPORTING TEMPLATE Threat Level 1, 2, or 3

This reporting template may be used to list the persons and contact information for those who handled the suspicious BCTA, were in the room or area when the BCTA was discovered or who may have been exposed in some other way.

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

NAME (print)	HOME PHONE #		CELL PHONE #

Location of exposure [Where was individual when exposure occurred]		Length of Exposure (How long was the individual exposed?)
Time of exposure (What time did the exposure occur?)		Nature of exposure (e.g. Skin contact, inhalation, in room where BCTA found, other?)

PERSON TRACKING FORM TEMPLATE for Threat Level 4 & 5

This reporting template may be used to document contact information for persons present at the site.

NAME (Please print)	HOME PHONE #	CELL PHONE #






































NAME (Please print)	HOME PHONE #	CELL PHONE #

Incident Command Critical Information Reporting Checklist

Incident Date: Incident Time:

Incident/Unified Command: Local/State Liaison Officer: Contact Number:

Critical Information	þ	Report as soon as possible. *(It is recognized that not all information* *will be immediately available)*	Time & Date Reported	From	To Whom
Assessment Information – Initial ---- Collect as much of this information as possible and report.
1. Description of the incident [circumstances under which the agent was found, (inside or outside), location, and type of business and description of the business as appropriate].
2. Who or what agency is in charge (Incident Command) agency, contact name and title?
3. Who has jurisdictional authority?
4. How and by whom was the agent found?
5. Any unusual activity that preceded this incident that could be related?
6. Has a credible threat been determined by law enforcement? If YES, contact name, agency and telephone numbers.
7. Has the site/area been contained/secured? If so, how and by whom? Size of area contained/secured.
8. Have hot, cold, isolation zones/boundaries been established? If so what are they and is there a map available?
9. How many people have potentially been exposed/contaminated and estimated numbers of people who may still be being exposed/contaminated?
10. Of those potentially exposed/contaminated what if any signs or symptoms of illness are they presenting. How many people are presenting with these signs and symptoms?
11. Are people who have been or potentially been exposed being quarantined and or is movement being restricted?
12. Have all people potentially exposed/contaminated been decontaminated? If so with what, how and at what time?
13. Who is responsible for tracking all potentially exposed/contaminated individuals, and how is this being done?
14. If indoors, have the ventilation systems been shut off?
15. What other agencies have been notified and are at the scene or enroute to the scene (e.g. EMS, Hazmat, law enforcement, public health)?
16. Provide ALL contact names, titles and phone numbers for agencies at the scene and identify whom the LIAISON (name and contact number) for Incident Command and Resource Management.
Assessment Information ---- during the course of the incident updates should be reported to HLSEM at least hourly
17. How close were people to the agent when exposed/contaminated?
18. Describe the area that exposures/contamination occurred (e.g. inside, outside, closed room).
19. Describe the suspicious agent: What does it look like – color (e.g. white, red) and what consistency (e.g. powder, liquid, solid, crystal) and does it have a noticeable odor (e.g. garlic).
20. How much agent (quantity) is there (e.g. 1 tsp. or 1 gallon) and/or weight (e.g. grams).
21. Prior to field testing, have you discussed sample needs with UHL? If no, contact UHL prior to field testing.
22. What field testing (at incident site) was used if any, to determine the chemical/biological agents (e.g. Smart Tickets, APD 2000)?
23. What is the name/identity of the chemical/biologic agent(s) from field testing? How many field tests have been conducted and results of all tests?
24. Are there any patients being treated by EMS at the incident site? If so, what treatment is being provided and what are the results?
25. Are there any patients being transported by EMS to hospitals/clinics for evaluation/treatment? If so, where are they being taken?
Samples
26. How many samples (bags/containers) are being shipped to UHL?
27. Transportation mode and agency to be used to get samples to UHL, and contact information.
28. Estimated time samples will be shipped to UHL; actual time samples are shipped to UHL and estimated time of arrival of sample to UHL.
29. Are each of the samples (bags/containers) properly identified/labeled if so, how and is the chain of custody seal on each bag/container?
30. Is there a chain of custody form for each bag/container?
31. Have three (3) separate samples been obtained 1) UHL, 2) 71^st CST, and 3) archival?
32. Have photographs been taken of the agent prior to sampling, and after placement in bag/container?
Termination/Disposition of Incident
34. Provide contact names and telephone numbers for public health to report results of UHL testing (e.g. law enforcement, hazmat, hospitals, agency/business).
35. Provide termination/disposition instructions to those at the scene as appropriate.
36. Ensure appropriate debriefings are established and provided to emergency workers.

PUBLIC INFORMATION AND THE MEDIA

These guidelines were developed to provide those in command with procedures that will assist in responding to public information needs at an incident. The guidelines provided will be applicable in many, but not all, situations and are intended to serve as guidance only.

INTRODUCTION

Actions taken to communicate in the first moments of an incident will substantially impact the response and post-incident recovery. The single most important factor is the audience trust in the communicator. Delays in communicating information, gaps in information, and not having information that should be readily available all impact trust and credibility and can lead to future important messages being downplayed or completely disregarded. An appropriate public information response can ultimately reduce injury hazards and anxiety levels to allow a quick return to normalcy. A terrorist aims to cause feelings of uncertainty and fear. Your response can either serve the terrorists goals or oppose it. Agency and business response plans need to have a public information component with defined roles and responsibilities.

INITIAL RESPONSE

Most communication response plans focus on dealing with a media, or external, response to an incident. However, a plan must also be in place to internally communicate information to employees and other customers. Those groups will still be with you long after media have left the scene. If the incident is still covered by the media after the initial response, those media stories may focus on employees or customers who weren’t kept as informed as they thought they should have been. Timely, credible information is the best weapon against destructive rumors.

Most responses to a Bio/Chemical Threat Agent (BCTA) are not transparent. Employees, surrounding businesses and homes, and daily customers will notice responders. As quickly as possible as the incident begins, employees should be given notice of the situation. Such notice need not be lengthy, but should serve as the opportunity to truthfully reassure and inform.

“This morning, a _________________ was discovered in _____________. The department/agency plan for dealing with the incident has been activated. In accordance with that plan, response crews have been notified. The ___________ has been isolated and there is no danger to others in the building/area. As more information becomes available, we will make it available to you. Please watch your email or listen for PA announcements.

As the situation develops, employees and customers should be provided with regular timely updates. Even with updates, employees and customers will turn to other sources, such as mass media, for information. If employees don’t have access to media such as computers, radio and televisions at their work stations, others can and will relay information from the outside. Any information provided to the media should be shared with employees and customers first, or at least simultaneously, to reinforce official channels for information.

INITIAL MEDIA RESPONSE

You should be prepared for a media response to a BCTA that will be as quick, if not quicker, than first responders. In accordance with the Incident Command System (ICS), the designated public information officer should be prepared to serve as a liaison between management and the media. The quicker an initial statement can be delivered to the media, the less likely it becomes that the media will rely on unofficial sources for information. An initial statement need not be lengthy, but should convey to the public and the media a sense of stability.

This is an evolving emergency/situation and I know that, just like we do, you want as much information as possible right now. While we work to get your questions answered as quickly as possible, I want to tell you what we can confirm right now:

At approximately (time) (a brief description of incident) .

At this point we do not know the number of (persons ill, injured, exposed, etc.)

We have a system in place for and we are being assisted by as part of the plan.

The situation is and we are working with (local, state, federal) authorities to .

We will continue to gather information and release it to you as soon as possible.

I will be back to you (time) to give you an update. As soon as we have more confirmed information, it will be provided. We ask for your patience as we respond to this emergency/situation.

The media statement should be shared with employees and most importantly, staff who answer general phone lines for your agency or business.

Promise, and provide, regular updates to the media. Such action will serve to reduce media attempts to look elsewhere to unofficial sources for information.

At the conclusion of the incident, provide a final statement for media and employees summarizing the response.

The environmental samples taken _____ of the powdery substance found _____ have tested negative for biological or chemical threats. The ____ Lab, in cooperation with ______, conducted the tests.

The safety of our employees has been our primary concern and, out of an abundance of caution, testing was initiated following the discovery of _______.

Additionally, no employees or public that may have been exposed to the substance before it was discovered have reported any symptoms of illness.

As such, regular operations of ______ have resumed.

Biological/Chemical Threat Agent (BCTA) Quick Reference Guide

Emergency Contact Phone Numbers: CDC BT Response: (404) 639-0385

IA Dept. Public Health 24/7 Hotline (866) 834-9671 CHEMTREC (800) 424-9300

IA Poison Control Center (800) 222-1222 Chem/Bio Hotline (800) 424-8802

BIOLOGICAL AGENTS * = person to person transmission
Agent	Incubation	Signs & Symptoms	Transmission	Treatment
BACTERIA
Anthrax Inhalation Cutaneous	1 – 6 days	Fever/chills, fatigue, cough (flu-like symptoms) Black painless sore on skin	Aerosol Direct Contact	Antibilotics (Cipro, Doxycycline or Penicillin) Same as above
Brucellosis	1 – 2 months	Fever/chills, headache, muscle & joint aches	Aerosol	Antibiotics (Doxycycline + Rifampin)
Plague (Inhalation)	2 – 3 days	Fever/chills, headache, bloody cough LATE: respiratory failure, shock	Aerosol*	Antibiotics (Cipro or Doxycycline)
Tularemia (Inhalation)	3 – 5 days	Fever/chills, headache, general discomfort	Aerosol	Antibiotics (Gentamycin or Cipro)
Q Fever	2 – 40 days	Fever/chills, cough, chest pain, gastrointestinal symptoms	Aerosol	Antibiotics (Tetracycline or Doxycline)
VIRUSES
Smallpox	10 – 12 days	Fever/chills, headache, backache, general discomfort LATE: rash develops to widespread pox	Aerosol*	Supportive
Viral Hemorrhagic Fevers	4 – 21 days	Fever/chills, headache, muscle aches LATE: Bleeding, bruising, low blood pressure, shock	Aerosol* (direct)	Supportive
BIO TOXINS Symptoms begin
Botulinum Toxin (Inhalation)	12 – 72 hours	Symmetrical descending paralysis (droopy eyes, difficulty swallowing) LATE: Respiratory failure	Aerosol Ingestion	Supportive – Antitoxin available for some strains through CDC
Staphylococcal enterotoxin B (Aerosol)	3 – 12 hours	Fever/chills, headache, muscle aches, cough	Aerosol Ingestion	Supportive
Ricin Inhalation Ingestion	8 – 24 hours dose dependent Few hours	Fever/chills, cough, malaise, difficulty breathing LATE: Pulmonary edema & respiratory failure Nausea, vomiting, abdominal cramps – severe diarrhea, necrosis of internal organs	Aerosol Ingestion	Supportive Supportive
Tricothecene Myotoxins (T2)	2 – 4 hours	Affected tissue dies and sloughs off LATE: collapse, shock	Aerosol, skin, eye, ingestion	Supportive

PPE: standard personal protection for all bio WMD includes N95 disposable mask type respirator, gloves, and gown. More substantial negative air or supplied air HEPA filtered respirators may be warranted for known agents transmitted by inhalation.

CHEMICAL AGENTS
Agent (NATO Codes)	Signs & Symptoms		Decontamination	Treatment
Nerve Agents
Tabun (GA)		Drooling, tearing, vomiting, loss of bowel & bladder, pinpoint pupils, seizures, weakness Onset: vapor seconds; liquid minutes to hours	Remove contaminated clothing, flush with soap & water for people and flush with large amounts of 5% bleach & water solution for objects	Field: MARK I Kit Hospital: Atropine & Pralidoxime Chloride, Benzodiazepines if having seizures
Sarin (GB)
Soman (GD)
V agents (VX)
Vesicants (Blister Agents)
Sulfur Mustard (H)		Acts first as a cell irritant, then as a cell poison Delayed onset of reddened skin & eyes, blisters, inflamed/irritated nose, throat, lungs	Remove contaminated clothing, flush with soap & water for people and flush with large amounts of 5% bleach & water solution for objects	Immediate decon & supportive care Antidote (BAL/British Anti-Lewisite or Dimercaprol) for Lewisite exposure with systemic symptoms – available at larger hospitals
Distilled Mustard (HD)
Nitorgen Mustard (HN 1,3)
Mustagen (HN 2)
Lewisite (L)		Immediate pain with blisters later
Phosgene Oxime (CX)		Immediate pain with blisters later – necrosis equivalent to second & third degree burns
Asphyxiants (Blood Agents)
Hydrogen Cyanide (AC)		Difficulty breathing, gasping for air, seizures prior to death – effect is similar to asphyxiation, but is more sudden	Remove contaminated clothing, flush with soap & water for people and flush with large amounts of 5% bleach & water solution for objects	Cyanide Antidote Kit (small hospitals may not carry) large hospitals may carry up to 2 kits – one kit treats 1 person
Cyanogen Chloride (CK)

PPE Levels:

Standard personal protection for all unknown chemical WMD agents is Level A

Level A – Fully encapsulated suit with SCBA (Nerve Agents)

Level B – Non-encapsulated suit with SCBA (Blister and Blood Agents)

Level C – Splash suit (Tyvex® coveralls) – with or without a cartridge respirator

Summary of Diagnosis and Treatment Information for Exposure to Select Biological Threat Agents

Agent	Incubation Period	Symptoms	Signs	Diagnostic Tests	Transmission Precautions[1]	Treatment	Prophylaxis
Anthrax (inhaled & cutaneous)	Range: 1 day to 8 weeks – up to 60 days 2-6 days	Inhalation: Flu-like symptoms, fever, respiratory distress Cutaneous: Initial itching papule, fever	Inhalation: Fever followed by respiratory failure, confusion, widened mediastinum on chest x-ray (adenopathy), bloody pleural effusions, atypical pneumonia Cutaneous: Initial itching papule, 1-3 cm painless ulcer then necrotic center, lymphadenopathy, edema	Gram stain (“boxcar shape”); gram positive bacilli in blood culture; ELISA for toxin antibodies to help confirm; chest CT, while not specific for inhalational anthrax, may assist in diagnosis	Aerosol inhalation; no person-to-person transmission; standard precautions. Cutaneous anthrax may be transmitted person to person.	Inhalational Anthrax: Mechanical ventilation; antibiotic therapy. Cutaneous anthrax: antibiotic therapy	Antibiotic therapy.
Botulism	12-72 hours; Range: 2 hrs to 8 days	Difficulty swallowing or speaking (symmetrical cranial neuropathies); symmetric descending weakness; respiratory dysfunction; no sensory dysfunction; no fever	Dilated non-reactive pupils; drooping eyelids (ptosis); double vision (diplopia); slurred speech (dysarthia); descending flaccid paralysis; intact mental state	Mouse bioassay in public health laboratories (5-7 days to conduct ELISA for toxin)	Aerosol inhalation; food ingestion; no person-to-person transmission; standard precautions.	Mechanical ventilation; parenteral nutrition; trivalent botulinum antitoxin available from state health depts. and CDC.	Experimental vaccine has been used in laboratory workers.
Plague	1-3 days by inhalation	Sudden onset of fever, chills, headache, myalgia Pneumonic: cough, chest pain, dyspnea, fever Bubonic: painful lymph nodes; may progress to pneumonic form	Pneumonic: Hemoptysis, radiographic pneumonia—patchy cavities, confluent consolidation, cyanosis Bubonic: typically painful, enlarged lymph nodes in groin axilla, and neck	Gram negative coccobacilli and bacilli in sputum, blood, CSF, or bubo aspirates (bi-polor, “closed safety-pin” shape on Wright, Way-son’s stains; ELISA DFA, PCR	*Person-to-person* transmission in pneumonic forms; droplet precautions until patient treated for at least three days. Person to person transmission may occur with open or draining buboes	Antibiotic therapy.	Antibiotic therapy.
Tularemia (pneumonic)	2-5 days Range: 1 to 21 days	Fever, cough, chest tightness, pleuritic pain; hemoptysis rare	Community-acquired, atypical pneumonia; Radiographic: bilateral patchy pneumonia with hilar adenopathy, and pleural effusions (may look like TB); Diffuse, varied skin rash; may be rapidly fatal	Gram negative bacilli in blood culture on BYCE (Legionella) cysteine- or S-H-enhanced media; serologic testing to confirm; ELISA, microhemaggultin-ation; DFA for sputum or local discharge	Inhalation of agents; no person-to-person trans-mission but laboratory personnel at risk; standard precautions	Antibiotic therapy.	Antibiotic therapy. Experimental live vaccine.
Smallpox	12-14 days Range: 7-17 days	High fever and myalgias, back pain, itching; abdominal pain; delirium; rash on face, extremities; confused w/chicken-pox which has a less uniform rash	Maculopapular then vesicular rash – first on muscosal surfaces and face, then forearms, spreading to trunk and legs. Rash then becomes hard firm pustules; rash is synchronous on various segments of the body	Electron microscopy or pustule content; PCR; public health lab for confirmation; rule out chicken pox with DFA	*Person-to-person* transmission; air-borne precautions; negative pressure; clothing and surface decon	Supportive care; vaccination.	Vaccination (vaccine available from CDC).

[1] See Bio-agent Infection Control Guidelines for more detailed information.

Summary of Diagnosis and Treatment Information for Exposure to Select Chemical Threat Agents

Agents	Symptom Onset	Symptoms	Signs	Clinical Diagnostics	Decon	Exposure/ treatment	Differential Diagnosis
*Nerve* *Agents* Tabun GA) Sarin (GB) Soman (GD) V Agents (VX)	Vapor: seconds Liquid: minutes to hours	Moderate exposure: muscle cramping, runny nose, difficulty breathing, eye pain, dimming of vision, sweating, diarrhea Severe exposure: The above plus sudden loss of consciousness Salivation Lacrimation Urination, Defecation Gastric disturb, Emesis	Moderate Exposure: Pinpoint pupils, muscle twitching and rippling under the skin, sweating, hyper-salivation, diarrhea Severe Exposures: bradycardia, seizures, apnea, flaccid paralysis, seizures	Red blood cell or serum cholesterase (whole blood),¹ collect urine for later confirmation and dose estimation	Rapid disrobing, water wash with soap and shampoo	Inhalation & dermal absorption: Atropine 2-6 mg IV or IM; 2-PAMCl 600-1800 mg injection or 1 gram infusion over 20-30 min. Additional atropine 2 mg q 3-5 min to decrease secretions. One additional 2-PAMCl 600 mg injection or 1 gram infusion over 20-30 min at one hour if needed. Diazepam or lorazepam to prevent seizures or if > 6 mg atropine given. Ventilatory support	Pesticide poisoning from organopho-sphate agents and carbonates cause identical syndromes. Nicotine overdose can also present with this syndrome.
Cyanide	Seconds to minutes	Moderate exposure: dizziness, nausea, headache; eye irritation with aerosol exposures Severe exposure: loss of consciousness, seizures	Moderate exposure: non-specific findings Severe exposure: convulsions, no respiration	Cyanide (blood) or thiocyanate (blood/ urine) levels in lab^[1]	Remove clothing, water wash with soap and shampoo	Inhalation & dermal absorption: Oxygen; amyl nitrate; sodium nitrate (300mg IV) & sodium thiosulfate (12.5 g IV)	Similar symptoms may results from: CO (gas or diesel exhaust in closed spaces) H₂S (sewer gas, industrial)
*Blister* *Agents* Mustards Lewisite Phosgene Oxine	Minutes (Lewisite and phosgene oxime) to 48 hours	Burning, itching, or red skin; mucosal irritation (prominent tearing; burning and redness of eyes); shortness of breath; nausea and vomiting	Skin erythema and blistering; conjunc-tivitis & eyelid swelling; upper airways sloughing, pulmonary edema; bone marrow suppression (mustard agents)	Garlic, horse-radish, and/or mustard odor; oily droplets on skin[2]	Remove clothing, rinse with large amounts of water	Inhalation, dermal absorption & and oral ingestion: Thermal burn type treatment; supportive care. For Lewisite and Lewisite/ mustard mixtures: British anti-lewisite (given IM for systemic Lewisite toxicity)	Diffuse skin exposure with irritants, (caustics, sodium hydroxide, ammonia, etc) may cause similar syndromes; NaOH from trucking accidents
*Pulmonary* *agents*	1 to 24 (and rarely up to 72) hours	Upper airway irritation, cough, shortness of breath	Non-cardiogenic pulmonary edema, mucosal irritation, sputum production with severe exposure	No tests available; Source assessment may help identify exposure characteristics[3]²	None usually needed	Inhalation: Supportive care; specific treatment depends on agent(s)	Inhalation exposures are the most common industrial exposure; effects are agent-specific
*Ricin*	4 (inhalation) to 24 (injection) hours	Inhalation: shortness of breath, cough. Injection: pain at injection site. Ingestion: nausea, vomiting diarrhea.	Acute lung injury (inhalation);GI injury (ingestion); circulatory collapse and shock (all exposures)	ELSIA (from com-mercial labs) using respiratory secretions, serum, and direct tissue	Remove clothing, rinse with water	Inhalation and ingestion: Supportive care; for ingestion, activated charcoal might be beneficial if given <1hr after ingestion	Tularemia, plague, Q fever, Staph enterotoxin B & phosgene may cause similar syndromes
*T-2* *mycotoxin*	2 to 4 hours	Red skin, blistering, tearing, salivation	Mucosal erythema and hemorrhage, red skin, blistering, tearing, salivation, pulmonary edema, coma	ELSIA (from com-mercial labs), gas chromatography/ mass spectroscopy in specialized labs	Remove clothing, rinse with water	Inhalation and dermal contact: supportive care; for ingestion: activated charcoal might be beneficial if given <1hr after ingestion, possibly high does steroids	Pulmonary toxins (O₂, NO₂, phosgene) may cause similar syndromes though with less mucosal irritation; blister agents may cause a similar dermal syndrome

[1] IMPORTANT: Treat immediately based on signs and symptoms, using lab results for confirmation purposes.

[2] No specific diagnostics tests are available.

[3] Most trucking incidents causing human exposure to this type of agent have chemical ID labels on the vehicle.

DECONTAMINATION FLOW CHART

First Responders MUST wear appropriate PPE

START HERE

Directed Self Decontamination

TO THE PATIENT:

You may have been exposed to a hazardous substance. For your own health and safety as well as others, you must be thoroughly cleaned before we can safely treat you.

This is what you must do. Please read all the steps. Then proceed to follow them. We will be waiting for you at the end with towels to dry you off.

1. Go to the designated area.

2. Prepare to undress behind the privacy curtain.

3. Open the plastic bags.

4. Place all of your valuables (wallet, etc.) into the small plastic bag and seal it. If you have prescription glasses or hearing aids, keep them with you. Keep a house key and car key with you.

5. Remove ALL your clothing.

6. Put clothes into the large plastic bag.

7. Put the small valuables bag and large clothes bag in the designated place.

8. Put on the wristband or neck identification.

9. Now step into the shower / tub area.

Shower Area

10. Wet yourself all over in the shower.

11. Thoroughly wash with soap and water, paying special attention to hair, ears, etc.

12. Rinse for at least one minute.

13. Step out of the shower area. We will have a towel and temporary clothing for you. We will keep you covered.

14. Then we will take you to the treatment area.

15. If it is safe, we will give you back your clothes and valuables.

Descontaminación Dirigida

PARA EL PACIENTE:

Es posible que usted haya estado expuesto a una sustancia peligrosa. Por su salud y seguridad y la de otros, usted tiene que estar completamente limpio antes de que podamos tratarlo.

Esto es lo que tiene que hacer. Por favor lea todas las medidas antes de seguirlas. Al final estaremos esperándolo con una toalla para secarlo.

1. Proceda al área designada.

2. Prepárese para desvestirse detrás de una cortina.

3. Abra las bolsas plásticas.

4. Ponga todas tus cosas valiosas (billetera, etc.) en la bolsa plástica pequeña y séllela. (Si tiene anteojos de prescripción o aparato auditivo, manténgalos con usted. También guarde la llave de su casa y del auto.)

5. Quítese TODA su ropa.

6. Ponga la ropa en la bolsa plástica grande.

7. Ponga la bolsa pequeña con objetos de valor y la bolsa grande con ropa en el sitio designado.

8. Póngase la pulsera o collar de identificación.

9. Ahora, entre a la ducha/área del baño.

Área de la ducha

10. Mójese completamente en la ducha.

11. Lávese de manera minuciosa con jabón y agua, especialmente el cabello, orejas, etc.

12. Enjuáguese por lo menos un minuto.

13. Salga del área de la ducha. Le tendremos una toalla y ropa provisional, para mantenerlo cubierto.

14. Después lo acompañaremos al área de tratamiento.

15. Si todo esta bien, le devolveremos su ropa y objetos de valor.

Mass Decontamination Operations

Introduction:

Decontamination is the process of rapidly and effectively removing or rendering harmless poisonous or toxic substances from personnel and equipment.

The objective of this outline is to identify technical and operational issues associated with mass decontamination after a terrorist incident involving chemical, biological, or radiological weapons of mass destruction (WMD) and to recommend the most efficient and effective techniques and procedures to best cope with a large-scale decontamination operation.

This Mass Decontamination system is developed to enable local fire departments to gain control of mass-casualty contamination incidents by initiating immediate definitive measures. Upon implementation of this system, fire departments will be able to reduce or prevent the effects of chemical agent contamination by rapid gross decontamination.

These actions are not intended to supersede any existing plans currently in place but offers additional technical advice on conducting large scale mass decontamination. Nor does it supersede the more traditional technical decontamination processes employed by fire department hazardous response teams while conducting operations on a hazardous material site.

1. The Weapons of Mass Destruction (WMD) Threat

A. Chemical Agents

Chemical agents that are commonly used as weapons of mass destruction fall into four categories: nerve agents, blister agents, blood agents, and choking agents. The dispersal of these agents can be by air, ingestion, or simple contact. Most often, the release of chemical agents can be characterized by rapid symptom onset (minutes to hours) and may produce other environmental clues such as dead animals/insects, dead foliage, pungent odors and residues. The three most common routes of exposure are inhalation, skin contact, and ocular contact.

B. Biological Agents

Biological agents can be dispersed in air, ingested, or spread through surface contact. Detection of a biological agent may not occur until days after the exposure when the first medical symptoms begin to manifest. The first indications of a release of a biological agent may be from a rise in the sick and dying within a community, among animals as well as humans. Without some type of forewarning, first responders may become easy victims to these agents. Given the generally extended incubation periods and associated lack of timely detection of potential exposures, patient decontamination in most cases is not possible.

C. Radiological Threats

Nuclear accidents, terrorist attacks using nuclear devices, or radiation dispersal devices (dirty bombs) pose significant threats to human life due to the release of ionized radiation, specifically from alpha and beta particles, gamma rays and neutrons. The capability to detect a radiological release is a must for all first responders. Time, shielding and distance have always been the best ways to guard against the threat of exposure from radiation. Alpha particles can be easily stopped by a sheet of paper, but they can cause damage if the exposure is too long, or too close, with no shielding. The greatest danger from alpha particles results from ingestion, inhalation, or penetration through openings in the skin. Beta particles penetrate deeper into the skin and move faster than alpha particles. If allowed to penetrate clothing, beta particles can cause injury to the skin and some radiation damage. As with alpha particles, the greater threat is through ingestion, inhalation, or penetration through openings in the skin. The external threat from beta radiation is to the skin and eyes. The layers, or shielding, provided by a fire fighter’s standard structural PPE (turnout gear) is considered adequate protection from both alpha and beta nuclear radiological hazards. Gamma rays can easily penetrate and pass through the human body, being absorbed by tissues as it passes through the body. Without proper shielding (lead, or several feet of concrete), gamma rays pose a serious health hazard due to the effects of the radiation on internal organs and radiation sickness.

2. Mass Decontamination Theory of Operation

The Mass Decontamination System is intended for specific circumstances involving large numbers of contaminated persons. It should be considered for use and incorporated into local procedures for large-scale chemical exposure from industrial or transportation accidents, or for the intentional release of chemical, radiological, or biological WMD agents. The following conditions are considered appropriate for implementation of Mass Decontamination procedures:

§ 8 or more persons

§ Who are ambulatory and self-extricated

§ Who are suspected to be contaminated

§ Where existing local decon resources are expected to be exceeded

While technical decontamination can be accomplished by many local fire departments and is considered a hazardous materials first responder operational-level skill, most departments lack the specialized equipment or training to manage technical decontamination for a large number of persons. The features and advantages of this Mass Decontamination method are listed below:

§ Can be accomplished by any fire department without special equipment

§ Functions through low water pressure (30 - 50 PSI) deluge application

§ Run-off water is of minimal concern during the “rescue” process.

The combination of simplicity, lack of specialized equipment and training needed, and the resulting speed of delivery, make this method a truly viable “first response” to mass casualty contamination incidents.

The general principles identified to guide emergency responder policies, procedures, and actions after a chemical/biological/radiological incident are:

§ Expect at least a 5:1 ratio of unaffected to affected casualties

§ Decontaminate victims as soon as possible

§ Disrobing is the first stage of decontamination; head to toe, the more removed the better

§ Water flushing is generally the best mass decontamination method

§ After a known or suspected exposure to a liquid chemical agent, individuals and responders should be decontaminated as soon as possible to avoid serious effects.

Decontamination Operational Considerations:

Prior to, or concurrent with, the establishment of Mass Decontamination operations, actions not specifically covered in this outline need to be carried out. Such measures should be conducted based upon established local procedures and or accepted practices.

These actions include the following:

§ Identify event as a chemical/ biological/or radiological incident – A relatively high suspicion exists that a hazardous material has been released in such a manner as to contaminate persons.

§ Establish control and Isolation zones – Set up standard hazardous materials control and isolation zones; hot, warm and cold zones must be established and entry into those zones denied to unprotected personnel.

§ Initiate appropriate responses – Initiate notification actions based upon local procedures for follow on support (HazMat - Police - EMS – National Guard Civil Support Team - etc.) and other resources commensurate with incident requirements.

§ Determine the potential number of persons contaminated – Attempt to ascertain the maximum number of persons requiring decontamination, and arrange for follow-up medical and or quarantine attention as indicated.

§ Determine the manning and relief requirement for your operation – A long decontamination operation will be physically taxing on personnel and equipment. A relief and re-supply system needs to be in place.

§ Water Supply – To be effective, an adequate water supply needs to be planned for. Either through the use of municipal water supply sources (fire hydrants) or by Fire department water tanker shuttles, the water supply should be one of your top priorities. Estimated water flow for a mass decontamination operation is 700-1000 GPM.

§ Modesty Concerns – If your decon plan incorporates undressing of victims as part of your decon procedure, then a plan must me implemented to address victim modesty concerns. Without a plan in place, you will more than likely not receive the cooperation that you need to process individuals through the decon corridor.

B. Decontamination Site Setup Considerations:
Mass Decontamination is deployed in the warm zone of the incident. Hence it is necessary to consider its location relative to the hot zone to prevent the encroachment of contamination into the decon area. Also, as part of a larger operation, attention must be paid to the effect of the decon location and runoff upon other aspects of the operation, such as medical care, staging and incident facilities.

Generally, the following rules for selection of the decontamination site should be applied:

§ Wind Direction – Set up your decon line up-wind so that the wind blows from the decon corridor toward the hot zone

§ Uphill – This is a consideration for both the placement of the decon line as it relates to the hot zone and as it relates to the placement of post-decon collection points and treatment areas. You want to avoid the potential of contaminated water flowing back into the “cold” zone.

§ Runoff – The EPA has stated that, in accordance with the limits of liability in CERCLA, the run-off is not a primary concern. However, run-off is a definite consideration in the placement of post-decon collection and treatment areas

§ Warmth and shelter for victims – Regardless of the time of year, decontaminated victims will need to be sheltered and warmed after decon in order to reduce the severity of illness or injury from cold and to maintain control over the incident site.

C. Dry vs. Wet Decontamination (see also “Special Decontamination Considerations”)

Dry decontamination operations should never be conducted in place of wet decontamination for simple convenience. This option should be used out of necessity only. Wet decontamination should always be your first choice.

Removing gross contamination can be achieved by blotting with disposable towels or by applying large amounts of powdered activated charcoal which will bind with the liquid contaminant and make removal easier. The simple act of undressing can reduce contamination by as much as 80%. It must be remembered that hair will trap a large amount of contamination so washing with high flow/low pressure water will be the only way of removing contamination effectively. No one decontamination method should be used by it self but in conjunction with several techniques. (i.e. clothing removal, blotting, water deluge)

The type of decontamination process chosen should be based on the following considerations:

§ The physical state of the contaminant: Solids and liquids require a more aggressive decontamination approach. In contrast, gases or vapors usually have a minimal residual contaminating effect.

§ Water solubility: If the agent is water-soluble, a simple flushing or wash/rinse is very effective. If the material is not water-soluble, or not as easily removed by water, then some form of emulsification is required.

§ Vapor Pressure: If the vapor pressure is high enough and quickly evaporates the agent, then it demonstrates minimal persistency vs. a lower vapor density agent that can remain a contaminant for days.

3. Legal Issues of Enforcing Decontamination

The legal authority to require decontamination is unclear at best. Based upon related issues such as medical care and evacuation, it is believed that emergency personnel cannot force a victim to undergo decontamination procedures. It is recommended that the following procedures be used in the event of a refusal:

§ If a potentially contaminated victim refuses decontamination, assess the risk posed to others by cross- contamination.

§ Record the names and addresses if possible of anyone refusing to be decontaminated. This tracking information may be needed later if the severity of contamination is found to warrant further care, or to warn and protect responders if these patients later request medical assistance.

§ Department of Public Health should be notified immediately and provided with the names and addresses of those individuals.

4. Contamination vs. Exposure

There is a significant difference between contamination and exposure. Consider this comparison:

From contamination:

§ Product is transferred or deposited on person and/or on clothing

§ Dose and effect increase as long as contaminant remains

§ Cross-contamination may be possible

§ Off-gassing may occur

From exposure only:

§ No product is transferred

§ Dose is discontinued after exposure ends, but effects may continue

§ No cross contamination or off-gassing hazard exists except with biologics

Mass Decontamination Response Actions

A. Decision/Action Flow Chart

Following these steps will lead to a coordinated and controlled response to a mass- contamination incident:

§ Identify the need for a decontamination procedure

§ Communicate your intent - Advise victims and responders of your intent to establish a decontamination process at the site.

§ Establish a decontamination plan - Identify locations to assemble victims prior to decontamination, the location for the decontamination line, location of staging area and triage point after decontamination, and hazardous waste collection point.

§ Communicate your plan - Define and identify hot/warm/cool zones and the decon process. Inform victims and emergency personnel

§ Assemble victims - Contain and control victims to prevent dispersion or re-entry into the “hot zone”.

§ Set-up decontamination corridor – Insure that your site is upwind and up hill from the hazard.

§ Initiate decontamination procedure

EMERGENCY DECONTAMINATION CORRIDOR SYSTEM (EDCS)

B. TWO ENGINE RESPONSE:

The following details the procedures used for the Mass Decon system assuming a first response of two (2) engine companies. While this response is minimal, the Mass Decon system can be applied to nearly any combination of this response. It is also possible to utilize deck guns and additional hand lines to achieve the desired water flow and pattern. More important than the precise combination of responding apparatus, the steps taken to initiate the system will assure that the objectives of control and decontamination are achieved.

EMERGENCY DECONTAMINATION CORRIDOR SYSTEM (EDCS)

Figure 1 Two Engine Response

LADDER PIPE DECONTAMINATION SYSTEM (LPDS)

C. TWO ENGINE AND ONE LADDER CONFIGURATION

Using the response of two engines and one ladder, the apparatus can be positioned to establish the decontamination corridor and provide the least possible exposure of firefighters to victims.

§ Position apparatus to create a corridor, operator panels to the outside – Engine companies should be positioned facing in opposite directions, 20’ – 30’ apart to create a corridor with the pump operator panel to the outside of the corridor

§ Limit exposure of personnel and equipment – The ladder company should be positioned on the exit side of the corridor or, if space allows, on the outside of one of the engine companies

§ All personnel operating within or forward of corridor must be in FFPE – pump operators, fire fighters on hand lines and those serving as entry or exit guides should be in full fire fighter protective ensemble including SCBA

Figure 2 Two Engines and One Ladder Configuration

D. CREATING THE WASH PATTERN

§ Affix nozzles to discharge and/or use deck gun – Use 2 ½” fog nozzle attached directly to the side-mounted discharge on each engine. If preferable, a deck gun may be used, but may require greater distance between the engines to achieve proper coverage

§ Use wide fog patterns that intersect between apparatus – the pattern should cover as much of the decon corridor as possible. Be certain that the patterns of both fixed nozzles will overlap in the middle of the corridor

§ Position ladder pipe to over-spray the corridor – Position the ladder pipe over the center of the corridor and adjust the pattern so as to cover as much of the corridor as possible. Remember, pump pressure will be below 50 psi, so normal patterns will be reduced.

Figure 3 Fog Nozzle Placement

E. ESTABLISH THE DECON PATH

§ Use a section of hose to create an “S” pattern in the corridor – A single section of hose should be laid out as a path for victims to follow. This path should make a full and wide “S” shape.

§ Pattern should cause victims to have maximum 360 degree exposure to water spray – The 360 degree coverage is necessary to achieve the best possible decontamination. This will also slow the passage of victims to insure that they are in the pattern long enough to be decontaminated.

Figure 4 Decon Path

F. POSITIONING PERSONNEL

§ Position a hand-line at each end of the corridor diagonally across from each other – The hand lines fill gaps in the pattern and can also be used to concentrate a wash on persons that are not following the hose line.

§ Position a “guide” at each end of the corridor to direct victims in and out of decon – A guide should be placed at the entrance to direct victims into decon.

§ This direction will be achieved largely using hand signals, as the guide will be in FFPE with SCBA. A second guide must be placed at the exit to direct victims to triage or holding areas.

Figure 5 Personnel Positioning

G. BEGINNING THE MASS DECONTAMINATION PROCESS

§ Once all lines and appliances have been charged, observe and adjust pattern and flow to insure full coverage of the corridor. Hand-lines can be moved or added to cover any “holes” in the pattern and eventually replaced with monitors as needed. Direct victims into the corridor and instruct them to follow the hose to the other end.

§ Decontamination for chemical agents can be further facilitated by the application of PPV Fans blowing air across ambulatory persons waiting for water-based decontamination. This does not apply to biological or radiological contamination.

H. RELIEF PROCEDURES FOR PERSONNEL

Though this Mass Decontamination system provides rapid processing of victims, all victims will not arrive at the decontamination site simultaneously. This may require a prolonged operation of the decon corridor. Provisions must be made to relieve personnel “on air” with sufficient opportunity for them to undergo decontamination, retreat to the cold zone, doff their SCBA and process through rehab.

§ Monitor on-air time – Personnel shall be relieved with at least five (5) minutes of air remaining.

§ Adequate personnel for relief – Have sufficient personnel ready and in FFPE and SCBA to replace personnel on the line before they are due to rotate out.

§ Assign personnel to positions – Relief personnel should know where they are going in the decon corridor before entering.

§ Deploy relief personnel – Relief personnel shall be directed where possible to access their assigned positions by walking around the outside of the corridor

§ Relieve personnel – A “hand-off” shall take place between personnel on the line and relief personnel to ensure continuity

§ Decon-relieved personnel – Relieved personnel shall fall into line and pass through the Rapid Mass Decon line. Because they have not entered the hot zone, and have not had direct contact with victims, there should be no contamination. This step of decon serves only as an absolute precaution.

§ Relieved personnel to rehab as indicated – Personnel who have been relieved and undergone decontamination should be rehabbed, have their air bottle replaced and stand by to relieve their relief, unless other duties are assigned. Their FFPE can continue to be worn.

Special Decontamination Considerations

Cold Weather Decontamination

The mean temperature most comfortable for standard outdoor decontamination processes is approximately 65° F. Below this temperature, persons may be reluctant to follow the standard process.

If the outdoor temperature is 35° F to 65° F, then moving persons directly to a warmer environment ASAP after outdoor decontamination is critical. These areas can be strategically deployed heated tents, office buildings, hospitals, gymnasiums, warehouses or shelters.

If the temperature is below 35°F, attempts shall be made at indoor decontamination in such places as indoor shower facilities, car washes, or swimming pools. An Olympic-sized pool can decontaminate approximately 800,000 persons contaminated with VX gas before the pool will show any effects of the contaminant. As there are other associated risks, this option requires very close supervision.

Other tools available to assist you in decontamination are as follows:

PPV Fans - For gaseous substances such as anhydrous ammonia and chlorine, persons can be thoroughly decontaminated using Positive Pressure Ventilation Fans set up approximately 10 - 15 feet away from the individuals being decontaminated.

Automatic Sprinkler Systems - Use one or more building sprinkler heads to decontaminate persons moving into a building or out of a contaminated building.

Wetting a Person in Cold Weather – Cold-weather decontamination shall be done incrementally vs. having the person immediately drenched. Special attention must be paid to cardiac patients and the elderly if there is absolutely no alternative to outdoor wet decontamination. If no indoor facilities can be accessed, the following Dry Decontamination procedures can be employed:

1. Remove outer clothing and blot with paper towels

2. Persons can assist each other

3. Transport to warm area for wet decontamination

Soap - Baby shampoo is the most effective soap agent for decontamination purposes at this time. Mixing of approximately 8 oz. of soap with water in a standard 2.5-gallon garden sprayer should yield an effective soaping agent.

Sea / Salt Water - The National Institute of Standards and Technology reports that, due to its ph level, sea water has been proven to be a more effective wetting decontamination agent than “normal” water.

Waste Water Runoff / Disposal - Decontamination shall not be delayed while setting up appropriate procedures for waste- water containment, as the saving of lives is your primary function. However, once adequate containment resources are available, the following procedures shall be followed:

In the event of an emergency response to a possible anthrax or other biological agent contamination incident, emergency personnel often utilize water and disinfecting agents to wash down protective equipment, including but not limited to containment suits. For the purpose of protecting waters of the state from pollution, the following procedures should be followed at each site where such activities occur. These procedures apply only to instances of cleanup activities where it has been verified through appropriate testing that no anthrax or other biological agent is present. Where testing confirms that anthrax or other biological agents are present, wash waters must be transported by licensed contractors. Due to the toxic nature of chlorine and other disinfecting agents which may be used, and the need to minimize the release of any potential pathogens, every possible precaution must be taken to effectively contain all wash waters generated from these procedures in order to prevent any releases to surface waters or groundwater used for drinking.

Procedures for Disposal of Cleanup Wash Waters Verified Not Contaminated With

Biological Agents:

§ Minimize Use

Ø Use only those quantities of bleach and water that are needed for full cleanup.

§ Containment

Ø During decontamination activities, contain all wash water within a watertight container away from any storm drain, catch basin, stream, swale or other direct access to surface water.

§ Disposal

Ø Carefully dispose of the wastewater only to a municipal sanitary sewer or via a licensed contractor licensed to transport the waste. The Iowa Department of Natural Resources can assist you in locating a qualified contractor.

SUMMARY

While effective mass-decontamination has been placed at the forefront of planning because of concern for weapons of mass destruction, the principles and procedures developed here serve to increase our capacity for other emergencies as well, as long as they are utilized appropriately and viewed as a part of a larger response system. Keep in mind the limitations of the Mass Decontamination System as listed below:

Designed for emergency decon of large numbers of victims
Not a substitute for HazMat team response
Must establish and maintain control of victims and responders

Additionally, fire resource configurations for Mass Decontamination can take other forms not illustrated here. The same concepts can be employed with single apparatus companies using multiple hand lines or monitors.

References

State of Connecticut Rapid Access Mass Decontamination Protocol

National Institute of Standards & Technology, Special Publication 981

U.S. Army Research, Development and Engineering Command, Edgewood Chemical Biological Center
“Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident” U.S. Army Soldier and Biological Chemical Command (SBCCOM)
“Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Incident” U.S. Army Soldier and Biological Chemical Command (SBCCOM)
OSHA 29 CFR 1910.120

Suggested Mass Decontamination Supply List

A set of written instructions written in English and Spanish that can be handed to victims while they are waiting to be decontaminated.

Portable spray bottles (garden sprayers) for application of decon agents

Liquid anti-bacterial soap or baby shampoo

Disposable absorbent towels for blotting agents

Soft bristle brushes for removal of gross contamination (on clothing only)

5 gallon buckets

Gallon size jars of activated charcoal (Dry decon application)

M-291 Decontamination Kits (may be purchased commercially)

Large 32 gallon or larger thick mil plastic bags for hazardous waste collection.

Large “Zip Ties” to secure Haz-waste bags

55 gallon drums for waste collection - optional

Tarps (To be used as a wind break and/or for privacy)

Redress (“Modesty”) packs which includes a “Tyvek” type suit (varying sizes), slippers, towel, soap, and plastic bag to collect personal items

Water diversion or collection equipment

Point of Contact listing of local and state support assets (provided in protocol)

Indelible black markers for marking victims belonging and hazardous waste bags

Caution or Fire Line Tape to mark off parameters and areas of operation

Gallon size “Zip Lock” bags for victim belongings. (i.e. wallets, purse contents, jewelry)

Trash Bag Decontamination List

CONTENTS OF EACH TRASH BAG:

1. Armband for patient (pre-numbered) – taped to the outside of the bags or near the inside top.

2. Medium Zip-lock bag (gallon sized, pre-numbered) for valuables (i.e. watch, keys, jewelry, wallet) - Have the patient keep glasses on; may need to keep hearing aid also. Keep a house key and car key out too.

3. Large Zip-lock bag (at least 24” X 24”, pre-numbered) for clothing.

4. Large Zip-lock bag ( 24” X 30”, pre-numbered) to place all these items in – This will be used to double-bag the clothes and valuables.

5. Black lawn-type trash bag (at least 59 gallon, larger better, 2.0 mil thickness) - Cut a hole in the top, big enough for a head and arm holes in the side.

- This will be used for patients to use as a covering if no other shelter is available. They can disrobe under the bag and rinse under it.

Notes:

- Each kit should be pre-numbered with the same number, for tracking purposes.

- Optional: Can include a Tyvek-type covering or hospital patient gown.

Fact Sheet: General Public

Instructions after release from an incident.

________________________________________________________

Recommendation: General cleaning processes may be used when an exposure to substance is determined as a “Minimal or No threat” event. This includes personal hygiene steps, cleaning personnel items and environment, and reporting any abnormal physical sign and symptoms to your doctor.

· Personal Hygiene: We recommend that you go directly home, go directly to the bathroom, and take a good cleansing shower with mild soap and water and shampoo your hair. You should consider exposed skin surfaces and cloths as dirty, and minimize touching anything with them until you have showered. This step is considered precautionary.

· Cleaning personal items: We recommend that you go home and clean any personal items that may have substance on them, by washing in a washer and dryer, or by using with standard household cleaning products. This step is considered precautionary.

· Cleaning the environment: We recommend that you wipe down any surface or item that has come into contact with the substance with standard home cleaners, as you would have done if dirty with normal dirt. This step is considered precautionary.

· Signs and Symptoms (feeling ill) Contact your physician: As a general rule you should call you doctor if you are sick. If you become ill or develop any unusual physical symptoms in the next 24 to 48 hours (or longer if specifically instructed), you should report this to your physician or local health department. Explain that you were exposed to a substance.

Question and Answers:

Why use general cleaning recommendations when exposed to a substance that has been to be determined to be a non- threat?

Answer: General cleaning recommendations should be used as a precaution measure”. This would apply to everyone exposed.

Why do you have to go directly home and shower after a non-threat event?

Answer: It will minimize the time you are exposed to the substance. Following the general cleaning recommendations does minimize exposure time.

What symptoms would I develop if I were exposed to a harmful substance?

Answer: We would not know initially what the substance is in an event. Therefore we cannot educate you what symptoms to expect if you were exposed. The health recommendations include reporting to your doctor if you become sick or experience abnormal symptoms. Be sure to let the doctor know that you were exposed to an unknown substance.

If you have more questions contact your local public health agency at ________________.

Hoja de Informes: Para el Público en General

Instrucciones para después de un incidente

_____________________________________________________________

Recomendación: Se pueden usar los procesos generales de limpieza cuando se determina que una sustancia no es amenaza o es una amenaza mínima. Estos incluyen medidas personales de higiene, limpieza de artículos personales y el ambiente y el reporte al doctor de cualquier señal o síntoma anormal.

· Higiene personal: Recomendamos que usted vaya directamente a la casa y se lave bien en la ducha con agua y jabón suave, usando champú en el cabello. Debe presumir que la piel y la ropa están sucios y debe evitar el contacto con otras cosas hasta que se haya bañado. Esta será una medida de precaución.

· La limpieza de artículos personales: Recomendamos que vaya a la casa a limpiar cualquier artículo personal que pueda tener sustancias peligrosas. Puede limpiarlo usando la lavadora y secadora o usando productos corrientes de limpieza. Esta será una medida de precaución.

· Limpiando el ambiente: Recomendamos que limpie con productos corrientes de limpieza cualquier superficie o artículo que ha estado en contacto con una sustancia peligrosa, igual como lo haría con suciedad normal. Esta será una medida de precaución.

· Señales y síntomas (sintiéndose mal). Contacte a su doctor. Por regla general, usted debe llamar al doctor si esta enfermo. Si se enferma, o aparecen algunos síntomas raros dentro de 24 a 48 horas después del incidente (o dentro de un periodo más largo si recibe dichas instrucciones), debe informarlo al doctor o al departamento local de salud pública. Explique que usted estuvo expuesto a una sustancia peligrosa.

Preguntas y Respuestas:

¿Por qué debe usar recomendaciones de limpieza general cuando ha estado expuesto a una sustancia que no es un riesgo?

Respuesta: La recomendación general para la limpieza debe ser usada como una medida de precaución. Se aplica a todos los expuestos a la materia de riesgo.

¿Por qué uno tiene que ir directamente a la casa y tomar una ducha después de un evento que no fue un riesgo?

Respuesta: Es posible que disminuya la exposición a la sustancia. Siguiendo las recomendaciones generales de limpieza disminuirá el período de exposición.

¿Qué síntomas aparecerían si yo hubiera estado expuesto a una sustancia peligrosa?

Respuesta: Inicialmente en un evento, no podríamos identificar una sustancia peligrosa. Por lo tanto no podemos informarle cuales son los síntomas que puede esperar si hubiera estado expuesto. Las recomendaciones de salud incluyen informarle a su doctor si se enferma o tiene síntomas anormales. Es importante avisar a su doctor que estuvo expuesto a una sustancia no conocida.

Si tiene preguntas, hable con su agencia local de salud pública. El número es ________________.

This document is to serve as an example only and does not necessarily reflect recommendations from the BCTA Technical Assistance Team.

If an employee discovers a suspicious substance/item, they are to the best of their ability to decide if this protocol is to be implemented. Do not bring anyone else closer to the substance.

Announce for the whole room to hear “Isolate the room”.
The person who made the discovery will contain and isolate the item/substance.
Employees within the room will:

Step away from the employee making the announcement.
All employees will wash their hands with the anti-bacterial hand wash and don facemasks.
The employee who found the substance will stay where they are and the charge person will bring supplies to that person, after the charge person has put on their mask and gloves. This person will hold open a plastic Ziploc style bag for the employee to place the envelope/substance within.
- The employee who first discovered the substance will take this bag with them to the isolation area by the emergency fire exit.
- The employee will hold open a clear plastic Ziploc style bag for the employee to place the envelope/substance within. “The charge person will place the first Ziploc bag into a second clear Ziploc bag.”
- The employee who first discovered the substance will “leave this bag at the site” until it is determined whether the event is determined to be credible or non-credible.”
Secure the doors. Place signage, from the inside, indicating no one is allowed entry. No one is to enter or leave. (This includes any delivery personnel).
Turn off fans in area.
Cover the letter-opening machine with a plastic drop cloth.
The charge person will contact the lead administrative assistant. If not available, the front desk administrative assistant, or any available Collection Manager 2 or above. Once this contact is made that person will follow the “Out of Room” Protocols.
No other phone calls are to be made from within the room until advised it is permissible.
- When advised by Senior Management or the corporate Emergency Critical Incident Management Team (ECIMT), employees may contact their families to:
  - Advise of situation, so as to not worry if local media broadcasts the event.
  - Advise family members to not come to the facility.
  - Advise family members to not speak to local media of the event, as per corporation media communication policy.
The Charge Person should record the persons who are in the room and their contact information using the BCTA Exposure Reporting Template (See Tab #8).
The Charge Person should refer to the BCTA Incident Command Critical Information Reporting Checklist (Tab #8) to summarize critical information for corporate security and emergency responders.

The person who made the discovery will go to the area by the emergency exit and have a seat there and await further instruction from the Corporate Security representative.
1. Place the bag with the substance into an EMPTY trashcan.
2. This area is to have material for this person to wash their hands and don an isolation mask.
3. Any person who was wearing gloves, needs to remove them and place them in a Ziploc type bag and place them in the trashcan by the emergency exit
4. This person will need to obtain writing material and record what had happened prior to the discovery. Do not discuss the event with anyone other then the corporate security representative and/or those individuals he/she instructs you to do so.

Out of Room Protocols

The person who is contacted by the Operational Support Staff that an isolation event has occurred will:

Call Corporate Security representative
Once contact with the above is made, seek advice on the necessity of disabling the card readers to the building.

If unable to make immediate contact with the above, call 911.

Call home office security to advise of the event and to disable the card readers to prevent any employees outside of the building from entering.

The remaining actions will be done regardless of the above outcomes:

Attempt to get the attention of an Executive Management team member to assist with the remainder of the notifications:

1. Contact Administrative Assistant in building 2.

o This person will contact all in-house CM1 or higher managers and advise of the situation. This is to include the management of the Retailer Operations, housed in building 2.

o The building 2 management (with the exception of one person to remain at building 2 as a point of contact) will proceed to building 1 to:

§ Prevent anyone, other than emergency response personnel, from approaching the building. This is to include all the card reader access controlled doors.

§ Secure a perimeter, using yellow barricade tape.

§ Ensure that employees outside the building do not communicate with any media who might arrive.

§ Maintain this posture until relived/instructed by corporate security and/or corporate public relations staff. EXCEPTION: DO NOT DO ANYTHING CONTRARY TO THE REQUEST OF THE EMERGENCY RESPONSE PERSONNEL.

§ Advise the building 1 administrative assistant whom the building 2 contacts are securing the exterior and the means in which to make contact, i.e. cell phone number.

2. Contact the Executive management and advise of the isolation event.

3. Contact Corporate Public Relations.

4. Contact the building landlord to advise other building tenants.

The charge person for this event within building 1 will be the management person responsible for facilities, or if unavailable their designee. This charge status will end once relieved by Corporate security representative.

The following will take place:

The area immediately next to the Operational Support room will be evacuated. This will include all the workspaces west to the hallway that provides egress from the north/south sides of the building.
The southeast exit door is to be manually locked.
The area is to be cordoned off with yellow barricade tape.
The fire doors that are in the north/south hallway will be closed.
Management staff will remain in the portions of the building their offices are located. They will be responsible for:
- Preventing the exterior doors being opened.
- Turning off/on circuit breakers to the HVAC system.
- Monitoring of the computer related equipment within those rooms. Issues/concerns are to be communicated with the building facilities manager.
- Communication with staff, as directed by the corporate response team.
- Work continues as normal for those employees not affected. This is to include monitoring of employees to not make external contact/discussion of the incident is not occurring.

For all management to follow:

DO NOT call for updates; updates will be provided as appropriate.

DO inform employees of the status of the incident as you become aware of developments, this will alleviate tension and gossip.

Medical follow up shall be in effect for all personnel involved.

These procedures will be practiced at a minimum of quarterly by all staff that as their primary or ancillary duties has responsibility for opening mail. All staff will be included in bi-annual training.

Introduction, Roles & Responsibilities

Protocol

911 Operators

Communication Centers

Unified Command Structure (UCS)

National Incident Management System (NIMS)

Emergency Notification Numbers

Suspicious Mail/Package Handling

UHL Sampling Guidelines

Exposure Reporting Templates

Public Information/Media

BCTA Quick Guides & References

PPE & Decontamination

Public/Private Business

Policy and Procedure Example

Introduction

Riot Control Agents

BCTA Technical Assistance Team

Y N

Y N

Y N

Y N

Y N

Telecommunicator - Roles and Responsibilities

Precautions and Warnings

Common Indicators of a BCTA Incident

Possible Indicators of a Biological Threat Agent

Possible Indicators of a Chemical Threat Agent

Initial Response

Determination of Credible or Non-credible Threat

Additional Resources and Technical Assistance

√

Questions

DEFINITIONS

Team and Contact General Numbers

Instructions for use of BCTA Exposure Reporting Templates

Purpose

Use of the Forms

INTRODUCTION

INITIAL RESPONSE

INITIAL MEDIA RESPONSE

Biological/Chemical Threat Agent (BCTA) Quick Reference Guide

BIOLOGICAL AGENTS * = person to person transmission

Agent

Transmission

BACTERIA

Summary of Diagnosis and Treatment Information for Exposure to Select Biological Threat Agents

Anthrax (inhaled & cutaneous)

Botulism

Plague

Antibiotic therapy.

Tularemia (pneumonic)

Antibiotic therapy.

Smallpox

Summary of Diagnosis and Treatment Information for Exposure to Select Chemical Threat Agents

Cyanide

Out of Room Protocols