INCIDENTS INVOLVING WEAPONS OF MASS DISTRUCTION
BY PETER M. STUEBE
By now, these names should be familiar to anyone who even occasionally reads a newspaper, watches the evening news, or keeps up with developments in the fire service–sarin, VX, anthrax, botulism toxin, tabun, plague. Since the sarin nerve agent attack in the Tokyo subway system in 1995, emergency services in this country have undergone a transformation. What if a chemical or biological terrorism attack had happened here first? At all levels, the question was posed, “Are we capable of handling a nerve or biohazard agent incident in our own communities?” The answer, as we are well aware by now, was a resounding NO.
What are we doing about our lack of preparation? Thankfully, we are doing a lot. Immediately after the details started coming out of Tokyo three years ago, fire departments around the country examined their response capabilities and took action. All of the elements of a response needed to be analyzed: identification, evacuation, personal protection, incident command, decontamination, transport of victims and patient care, and evidence collection–to name a few.
In response to these analyses, response protocols have been improved and updated, and new protocols have been put into place throughout the fire service. New equipment that will vastly improve our operations has been purchased. Perhaps more importantly, a tremendous effort is being made nationwide to train personnel in responding to such emergencies. All these efforts have been supported from the highest levels to the local level: the President and Congress, the military, the National Fire Academy, state and local governments, and individual fire departments are providing resources and support to help improve our readiness.
CHEMICAL INCIDENTS
If a chemical terrorism incident were to occur (and remember, according to some congressional testimony, it is a question not of “if” but “when”), I think our fire and police departments are in a much better position to save lives and handle a situation than they were in the past.
I`m not saying that such an incident would go smoothly–just the opposite. There could be a major number of casualties, and we emergency responders could certainly be among them. But we are vastly more prepared than in the past. At the very outset, and this is extremely important, our first responders have been made aware that such incidents can and do happen. There is no longer any reason to believe it could not happen here. People across the nation have been made aware that we are no longer immune from terrorism occurring here in our own communities, buildings, transportation systems, and parks.
Our plans for operating at a chemical terrorism incident in New York City are based on the same plans we use for every haz mat incident but on a larger scale and for materials that are much more toxic. My counterpart in the Chicago Fire Department, Captain Gene Ryan of the Hazardous Materials Response Team, calls the commonly known chemical agents “haz mats with an attitude.”
The strategic goals at such incidents remain the same: notification, isolation, identification, protection, leak control, spill control, fire control, and incident termination and recovery–all done within our incident command system. Some components of our hazardous materials response plans, however, have changed based on our analyses of agents, procedures, and recent training. For example, New York City now has many more firefighters qualified to wear chemical protective clothing available for each tour than we had before Tokyo. Additional detection devices are in use and are spread strategically throughout the city. Mass decon capabilities are being established. Most importantly, all 12,000 first responders have been trained specifically in responding to such incidents. All of this has vastly improved our capabilities.
If we should have a chemical terrorism incident, I know we`ll have some problems. Even with the most diligent preparation, some problems just cannot be foreseen. The key is that now a plan is in place, along with new equipment and training, that provides a framework for an organized response. Importantly, first responders now have some information that will initially help identify such an incident and assist the casualties and will have the responders think in terms of a terrorist event, thus reducing the possibility that they will become victims themselves.
Most chemical agents have a relatively short time frame from exposure to exhibition of symptoms, usually seconds. An exception to this is the vesicant category, or mustard agents; it could take hours for the associated blisters to develop. Because of the short time frames involved, chemical agents would clearly involve the emergency services. Response to such an incident would be similar to that for chlorine, ammonia, carbon monoxide poisoning, or other chemical incidents fire departments have responded to for years–except that the source may not be readily apparent, the products are potentially much more toxic, and there will be many more victims. Although it is an oversimplification, the point is that the basic goals of the response remain the same for a chemical terrorist incident as for a haz mat incident with toxic chemicals. I do not think the same can be said for biological terrorism.
BIOLOGICAL TERRORISM
Since Tokyo, discussions and training programs involving terrorism in the haz mat arena always seem to link chemical and biological terrorism. One area I`m not clear on is the role of the fire service in responding to incidents of biological terrorism.
Consider one of the few known (somewhat successful) acts of biological terrorism that has actually occurred in the United States in recent years. In September and October of 1984, in the town of The Dalles, Oregon, a religious cult purposely contaminated salad bars in area restaurants with salmonella. The intent was to influence a local election. About 751 cases of salmonella were diagnosed, a particularly significant number considering that The Dalles had 10,500 residents.
How were these cases diagnosed, and how was it determined to be an act of terrorism and not just simply bad food? As people eventually sought medical attention, they were diagnosed as having salmonella poisoning. Doctors are required to report salmonella incidents to the local and state public health authorities, who from the combined reporting information realized that this number of cases of salmonella was far out of proportion to the normal, or endemic, rate of the disease. An outbreak was thus identified, and an epidemiological investigation was begun using what are known as cohort and case-control studies.
People showing symptoms of an illness are interviewed to establish what they may have in common. In this case, the investigations were conducted among groups of restaurant patrons and employees to attempt to identify the exposures associated with salmonella. The investigation was aided by a public information campaign. People were then asked what they ate and did not eat at the various restaurants. Most of the cases were found to be associated with 10 restaurants. The evidence implicated eating from the salad bars as the major risk factor for infection. Normally, some common factor would be identified, such as the water supply, a food supplier, or a distributor that delivered to all three restaurants involved. This investigation turned up negative.
A subsequent criminal investigation resulting from a tip that members of a religious sect, the Rajneesh cult, had caused the outbreak identified a strain of salmonella found at the cult`s commune as the same type used in contaminating the restaurants. Two members of the cult were subsequently sent to prison for their part in the poisonings.
Because of the incubation times (the time from exposure to an agent to the onset of symptoms) involved with the “conventional” diseases that could be spread by terrorism, I do not see such incidents as emergency response issues but as issues for the medical community and public health service. People are not going to become immediately sick the moment they are exposed, as would happen in a chemical incident.
In the case of the salmonella bacteria, gastroenteritis is usually associated with a 12- to 24-hour incubation period, with symptoms of nausea, vomiting, abdominal cramps, and diarrhea. The average person stricken with such symptoms will not suspect a biological terrorism attack but will probably assume he has a touch of the flu.
According to the American Journal of Epidemiology (February 1, 1998), most people do not seek medical attention in the early stages of such cases. At most, bad food might be suspected, but there would be no reason to suspect other than natural causes. Even if medical attention is sought, there is still a time lag for the type of illness to be identified, notification to be made to the city or county public heath officials, and these officials to identify an outbreak. At this point, an epidemiological investigation would begin in an attempt to identify the source.
The only role for emergency services, as I see it, would be in those cases where people felt so sick that they would call an ambulance for transport to a hospital for severe flu-like symptoms. If EMS personnel noticed an extraordinary number of runs for victims with flu-like symptoms, they could possibly have the first indication that something is out of the ordinary. However, it is more likely that quickly identifying any outbreak would be done based on astute observations that would have to be made by local hospital and private-practice physicians and public health officials.
The other “conventional” biological agents have incubation times of up to 20 days. Importantly, the initial symptoms do not give any indication of the lethality of such diseases. Anthrax, frequently mentioned in discussions of biological terrorism, has an incubation period of one to six days. Its symptoms are fever, fatigue, malaise, cough, and mild chest discomfort–to me, not indicative of exposure to some terrorism incident.
Cholera has an incubation period of 12 to 24 hours. Initial symptoms include vomiting, headache, cramping, and diarrhea.
Of the plagues, pneumonic has an incubation period of two to three days, with symptoms of fever, chills, and headache. Bubonic plague`s incubation period is two to 10 days; its symptoms are malaise, fever, and tender lymph nodes.
Tularemia`s incubation period is two to 10 days, and that of Q fever is 10 to 20 days; both have symptoms of common illnesses.
In general, all of the conventional biologic weapons have incubation periods ranging from hours to days, and all have symptoms that could initially be mistaken for common illnesses. Also, their nature allows dissemination methods that can be undetectable. The agents can be dispersed as aerosols in particles ranging from one to 10 microns, which can penetrate directly into the alveoli when inhaled. These particles can remain suspended for hours in air. The aerosols can be delivered by simple means, such as sprayers with nozzles from an airplane, boat, or truck. If they were allowed to be carried on the winds or if they were placed in ventilation systems and inhaled undetected, people would have no idea that they had been exposed to any sort of disease. Unless some threat or warning preceded the attack, the increased number of patients eventually presenting with the signs and symptoms caused by the disseminated disease agent would most likely be the first indication of any type of biological agent attack. This is part of the terror of these agents: Nobody knows they have been exposed until the disease manifests itself.
Importantly for the emergency response community, there are currently no good detection devices in use to warn of a release or quickly identify a biologic agent in the field. No city is currently capable of continuously analyzing air samples for the presence of biological agents. Should it be within the capability of firefighters to take serum samples, purify them, and perform a series of diagnostic procedures to identify a virus or bacterium, hours or days after an exposure? I think these procedures are best left to medical laboratories. Unless responders stumbled across a facility where such weapons were being made or perhaps an incident similar to the B`nai Brith hoax in Washington, D.C. in 1997 (a package was delivered that had written on it the Latin names for plague and anthrax and anti-Semitic statements), there would most likely be no material on which to perform any type of diagnostic test anyway.
Air sampling, collection, and analyses can be done, but it would be time-consuming and difficult and should be done by a lab. It is difficult enough for us to collect air samples and test for asbestos. How do we collect and test for scores of different possible diseases? What about combinations of diseases? New detection capabilities are being formulated, but I do not foresee that they are likely to be used. The incubation times involved, the near impossibility of obtaining samples in the street, and the number of possible diseases make field detection devices currently extremely limited in their use.
The threats of chemical and biological warfare, I think we would agree, are real. Emergency responders must be on guard against both. However, our roles will differ greatly in each type of incident. In chemical incidents, we have an immediate and active role. In a biological incident, accurate diagnosis and timely treatment by the medical community will be the keys to saving lives.
PETER M. STUEBE is a 20-year veteran of the Fire Department of New York (FDNY), the captain of Hazardous Materials Company 1, a member of the Westchester County (NY) Hazardous Materials Response Team, and a former haz mat instructor at the FDNY Bureau of Training. He has a bachelor`s degree in business from Marist College, a master`s degree in economics from Pace University, and a master of public health degree in environmental science from Columbia University. He is an adjunct instructor at the National Fire Academy and an editorial advisory board member of Fire Engineering.
