Anthrax

[Dalmatian90]

msnbc and cnn are reporting the NBC (Television) network officials are reporting one of their NYC employees has tested positive for Anthrax exposure after handling suspicious mail this week.

I've been trying to find a good field-reference for handling anthrax scares for a couple days now, part of whipping together a quick "Awareness" overview for my fire company.

I haven't found it yet, but here is my track so far from various sources & regular fire training:

1. Don't Panic.
An exposure to Anthrax is not very fatal *if* treatment with the proper antibiotics is initiated soon after exposure.

Like any other Haz-Mat, we have to limit civilians and sworn personnel exposed -- in other words, send as few firefighters into the hot zone as absolutely neccessary.

2. Anthrax is not contagious.
Unlike other bio-weapons like Smallpox or even the common flu, Anthrax is spread by spores. It is not a "communicable" disease in the common sense of the word.

3. Anthrax is not immediately dangerous to life and health.
Unlike a chemical weapon exposure, someone isn't going to roll over and die from it.

What this means is: We can take our time to slowly and methodically handle an Anthrax scare.

Secure the scene to limit further exposure.

Call in the proper authorities -- which probably vary state to state. The Fire Service roll is to assist them.

Accountability is absolutely crucial. You need to know who your troops where on scene; and public health officials will want to know who else was in the building who may have been exposed.

4. Universal precautions remain our best ally.

One of the few references I found was this:
Prehospital Care: As with any potential epidemic biologic exposure, patients should be decontaminated in the field when possible, and paramedical health care workers should wear masks and gloves.

US Army Medical Research Institute of Infectious Diseases (USAMRID) recommends barrier procedures (ie, gown, gloves, surgical mask) with secretion precautions.

Emergency Department Care:

Workup includes isolation; barrier protection; resuscitation; sampling of blood, wounds, and cerebral spinal fluid (when applicable); radiography; and rapid initiation of intravenous antibiotic therapy.
If risk of exposure is considerable, initiate postexposure prophylaxis. This includes chemoprophylaxis and vaccination, if the vaccine is available.
Patients can be placed in a normal hospital room with barrier nursing procedures (ie, gown, gloves, mask) and secretion precautions (ie, special handing of potentially infectious dressings, drainage, and excretions). http://www.emedicine.com/emerg/topic864.htm

In other words --
-- Wear your gloves
-- Wear your jumpsuits (my Fire Company issues jumpsuits for use on the Ambulance)
-- If concerned, the Hepa masks you carry for TB are equal or better protection than the surgical mask mentioned above.
-- Wear safety glasses

If you need to do emergency decon of someone before authorities with more knowledge arrive, those should be the minimum your wearing -- remember, the most dangerous form of Anthrax is inhaled. Washing the powder off someone will keep it out of the air.

5. Like a Haz-Mat, don't just show up at the hospital.

Anthrax exposure alone isn't an emergency. Yes, contact your ER and let them know you have a possible exposure, you've removed the person from the immediate vicinity, sealed the room, and performed a field decon of the exposure. Your ER and the haz-mat/public health responders can make a determination if and when to bring an exposed person in.

If the exposed person has another life or health threatening condition, then the ER will need to make arrangements how the patient will be brought in, decontaminated again, and put in isolation.

======

In summary:
Don't Panic. You're not at immediate risk -- take things slow, calmly, and methodically. Where normal EMS protective equipment to protect yourself. If there's a high probability of an exposure (they got an envelope with suspicious stuff) take extra precautions like Hepa mask & eye protection. Seal the hot zone, remove the patient and field decon them. Contact the ER for medical direction, contact the appropriate Haz-Mat/Public Health agencies to evaluate if it's a real threat or hoax. Remember to decon yourself -- keep those spores from going airborne...wash them off!

And keep good track of how is allowed into and out of the area. If it is a real exposure, public health officials will want to monitor everyone and start precautionary treatments on everyone who was a good risk of being exposed.

Organization & Discipline -- they're our most valuable weapons in this...gloves and masks are important, but keeping organized is what will save lives.

Matt
p.s. -- anyone with better info, let us know!

[Eng47ine]

Try this link, hope it helps.
National Fire Rescue Mag.

[Capt.Mitch]

I found some good info at the fema website kind of general but still good info
www.fema.gov

[nonameFF]

Dal try:
http://www.chem-bio.com/resource/
http://www.stimson.org/cwc/
http://www.domesticpreparedness.com/
http://www.wmdfirstresponders.com/

are you looking to just do anthrax or WMD in general?

[Dalmatian90]

I think that all deals with your community's risk.

For Weapons of Mass Destruction like bombs, we are almost no risk. Other than an accident, there isn't any realistic targets in our area.

If you look at Chemical attacks, the risk is still extremely low.

As you get into Biological agents, we are probably a bit more at risk than large parts of this country, as we sit within two-three hours drive time of Boston and New York, as well as within an hour of Hartford, Worcester, and Providence.

That last point really exposes what our fire department's most reasonable scenario is -- dealing with either a contamanation problem coming from one of those metro areas, or in a major incident being involved in a move-up/coverage assignment.

=============
That size up is the "terrorism" size. Violence generally can be regarded as political (war & terrorism depending on target), or non-political. The distinction really only matters for planning purposes...

While we remain nearly nill as a direct target of political violence, and very small as an area potentially affected by political violence, the day-in day-out non-political violence of anthrax scares or Columbines are just as likely in our community as any other.

=================
Nor is my mentioning our fire company being at risk from contamination from one of the surrounding metro areas far fetched -- as I was beginning to right this, the word came out that we are now on mail-lockdown at least until Monday -- no outside mail is to be opened. I work at the Worcester Telegram & Gazette, which is a division of the New York Times and with the scare at HQ today and the incident at NBC near our HQ, the company is taking a cautious approach.

[nonameFF]

The FD response to a biological incident is likely to be minor. Generally speaking (with the exception of a few toxins), the biological agents take hours to days to weeks to develop and show outward symptoms. The FD (unless you run EMS) will not likely be called. The EMS will likely not recognize the incident as a biological attack until multiple victims present themselves. At this point, your EMS system has been compromised.

One exception will be an "announced" biological attack, such as the "Ha-Ha, you now have anthrax" type. This situation should be handled as you would any HazMat, with full protection, hot, warm and cold zones and full decon. Once samples are taken, they will be tested and treatment rendered.

I don't think that most of us need to worry about bin laden style terrorist attacks, but more so about the nuts out there who will use this as an opportunity to do stuff. I don't think that minor chemical attacks are out of the question for any FD at this time. You get some nut who puts together a chemical device and sets it to go off at his ex-girlfriends work or at the power company who just turned off his power, etc., you suddenly have an incident on your hands.

Also, remember that once one person feels ill, mass hysteria may set in. Several years ago we had a HazMat from someone spilling some cleaning chemicals together. Ultimately the mixture turned out to be non-toxic, but you couldn't tell the two dozen people already transported that they weren't dying. And the other 300 or so employees saw it as an opportunity to get the rest of the day off ("it still smells in there, my head is spinning, i feel sick").

[nonameFF]

http://www.chem-bio.com/anthrax/index.html

FEMA has:

Emergency Response to Terrorism Job Aid

Subject(s): Hazardous Materials,Terrorism,Training
Media: Job Aid
Online:
Description: This document is intended to support, not replace, the training messages of the ERT curriculum. It is not a training manual but a "memory jogger" for those who have completed the appropriate level of training. The ERT:JA is sized to fit into coverall or work jacket pocket, or the glove compartment or center console of response vehicles. (THIS PUBLICATION IS AVAILABLE TO U.S. RESIDENTS ONLY)
http://www.apic.org/bioterror/agentsheets.cfm http://www.anthrax.osd.mil/ http://www.bt.cdc.gov/DocumentsAPP/facts_about.pdf

[E_man9RFD]

Dalmation,

Your point that Brooklyn, CT is is relatively low threat, but there Are four nuke plants in CT. Millstone 1, 2, and 3 and CY. As for military targets, did you forget about Sikorsky, Pratt and Whitney, how about EB (General Dynamics) and the Sub Base? Pfizer?

Seems to me there are several targets in the nutmeg state. Granted That Sikorsky and Pratt and Whitney are west of Brooklyn, but due south are the others. If there is anything major that happens to any of those; Brooklyn will surly feel a ripple from the southeast corner (in terms of emergency services).

[ 10-12-2001: Message edited by: T_man6RFD ]

[WTFD10]

Thank you Brothers for all the info and links posted. Even though the chance of most of us being affected by this is small, it helps to have facts to go against rumors and hysteria. I think we all probably have a good chance of being affected by that

[Miltgf]

If the envelope or package is sealed, notify law enforcement (FBI), isolate the area and deny entry.
If the package is opened, activate your HazMat team and notify law enforcement. In our jurisdiction(Mass.)these are public health and law enforcement issues. If the package is unopened, hopefully, the FD shouldn't even be notified.
In either event, keep a low profile. Limit what you say on the radio.

[ 10-12-2001: Message edited by: Miltgf ]

[Adze39]

>Your point that Brooklyn, CT is is relatively low threat, but there Are four nuke plants in CT. Millstone 1, 2, and 3 and CY. As for military targets, did you forget about Sikorsky, Pratt and Whitney, how about EB (General Dynamics) and the Sub Base? Pfizer?

Don't forget Hamilton Standard, Kaman Aerospace, Bradley Airport, along with numerous national guard bases, yadda, yadda, yadda.

Unforunately, unlike Dalmation90, I live with in minutes of many different strategic targets. Not to mention exactly halfway between Hartford and Springfield, MA (about 15 min from both), and almost halfway between Boston and NYC (1.5 hrs and 2hrs respectively).

The threat of attacks in this area are very likely, although I doubt we'll se something here before other bigger places. However, I was just thinking about how when I was taking FF2 (HazMat Ops is part of it) how a few of us asked our officers why we don't have the adequate protection for handling hazmat situations. It was basically shrugged off by a bunch of LT's. However, I am thinking I am gonna go have a talk with the chief. We have 2 FD's in this town, neither of which could handle a severe or somewhat severe situation. I am thinking maybe we can create a Hazmat team between the two FD's. We have plenty of Ops and Techs in town to handle that type of stuff...

[Dalmatian90]

Your point that Brooklyn, CT is is relatively low threat, but there Are four nuke plants in CT. Millstone 1, 2, and 3 and CY. As for military targets, did you forget about Sikorsky, Pratt and Whitney, how about EB (General Dynamics) and the Sub Base? Pfizer?

Point well taken, but...

1) They're not physically closer to us than "soft" targets like Hartford, Providence, or Worcester.

2) They're not targets in a terrorist war -- attacks on military facilities aren't going to inspire the fear of a WTC.

3) The two remaining operational plants (Millstone 2 & 3) are very hard targets to hit, and knocking them out could be handled in New England during the winter without brownouts.

4) There is a lot of easier targets to go after that would have much more of an economic impact than military industries or hard targets like Nuclear plants.

Imagine the economic impact on the U.S. if the 20 terrorist had instead flown 20 cessnas into 20 oil refineries. We'd have $2-3 gasoline for six months or more.

Alternately, a coordinated attack on electric transmission lines could conceivably darken much of the northeast for weeks. The coordinate dynamiting some key transmission towers with a few minutes time, not only do the lines need repairs...but the power surge caused would severely damage substations and even the generators at the power plants themselves.

We gotta just be vigiliant and think outside of the box for what could be likely targets. Get mass fear in the cities; hit us economically where it's easy -- nuclear power plants not easy. Thousands of miles of transmission lines -- easy if people aren't paying attention to people in places they normally aren't.

Is the attack gonna happen here, no. But it is likely a major northeastern incident will impact us on the edges.

[mpeltier]

If you go to the CDC website they have a flow sheet and a 24 hour number to contact in the event you have to manage an event. The website isCDC

[Dalmatian90]

Can Anthrax be spread by say smearing spores onto a door handle then people touching it can get it. Also is it white powder like, or can it be clear and almost slick feeling? just curious

There are three ways of becoming infected with Anthrax.

1) Cutaneous -- means by skin, or most likely, through a cut in your skin. This could be spread by doorknob. However, it is seldom fatal without treatment, and rarely fatal if treated.

2) Gastrointenstinal -- from ingesting infected meat. I suppose if you don't wash your hands, it could go door knob to food. Again, seldom fatal without treatment and rarely fatal if treated.

3) Inhalation -- this is the dangerous manner of exposure, when you inhale the spores. Once in the lungs, the spores "hatch" and the bacteria move to the lymph nodes. Anthrax bacteria put out toxins that kill cells -- so all of a sudden, cells are dieing and rupturing in your chest...this is not good. Once symptoms occur, inhaled anthrax is 99% fatal untreated, 80% fatal with treatment.

The good news is not only is this difficult to catch, if exposure is known/suspected starting treatment *before* symptoms occur is very effective at preventing illness.

I can't see inhaled anthrax coming from the door knob -- we're not talking the common cold here!

4) Anthrax itself is invisible to the naked eye.

The "white soapy powder" described in the Florida incident was a medium (some other substance) which had spores included with it.

Those mediums can change, and can be important.

Anthrax as it naturally occurs is difficult to inhale -- not impossible, without terrorism we lost 18 people in the U.S. from inhaled anthrax in the 20th century. That compares to thousands who died from tens or hundreds of thousands of cutaneous and gastrointenstinal exposures especially in the early 20th century.

The weaponization programs had two aims. One, "breed" for Anthrax strains which had spore size particulary good to enter the body via the lungs. Second was to develop the proper "medium" to carry it -- such as an aersol spray that could carry the spores and keep them airborne and over a wide enough area to cause a lot of inhalation exposures.