EMERGENCY RESPONSE TO CHEMICAL AND BIOLOGICAL AGENTS - CHAPTER 5 potx

5 ©2000 CRC Press LLC Federal Agencies and Response Teams “There is a need for an organization — manned, trained, and equipped — to counter the growing biological/chemical terrorist threat. The Marine Corps will have such an organization… manned with properly skilled and trained personnel… equipped with state-of-the-art detection, monitoring and decontamination equipment… suited for operations in a wide range of contingencies.” General Charles C. Krulak, 1995 INTRODUCTION More than 200 state and local officials were invited to the federal capital in Washington, D.C. in August of 1998 by the Department of Justice, Office for State and Local Preparedness Support created in May, to assist cities and states to better prepare for terrorism. The key message from the local officials was that the federal government still has no coherent system for deterring or responding to terrorism. They asked the Clinton Administration to put a single government agency in charge of developing a new national plan within six months as the present system is often duplicative, frequently chaotic, confusing, and overly bureaucratic. An 8-page summary of comments was given to Attorney General Janet Reno. Only half the state and local officials on one panel said they knew that the President had revamped the terrorism system, and fewer than half had ever heard of Richard A. Clarke, the national federal coordinator for antiterrorism. The local officials seemed infuriated about the number of federal antiterrorism units including the Army’s SBCCOM, the Marine’s CBIRF, the F.B.I.’s DEST, the State Department’s FEST, the Energy Department’s NEST, and the Department of Health and Human Services’ MMST. At least 40 different federal agencies or offices are to “assist” state and local response officials responding to weapons of mass destruction (WMD) and terrorist actions involving nuclear, biological, and chemical weapons. This chapter examines several of these units. U.S. MARINE CORPS CHEMICAL BIOLOGICAL INCIDENT RESPONSE FORCE The truism that superior thinking can overwhelm superior force has been the guidon for 350 young men and women with special talents who form the U.S. Marine Corps Chemical Biological Incident Response Force (CBIRF) based at Camp Lejeune, NC. In a terrorist incident in the United States or overseas that features chemical agents or biological substances, CBIRF will attempt to turn victims into patients through mass casualty decontamination. For chemical agents, CBIRF personnel have to be ©2000 CRC Press LLC able to deal with blister agents (vesicants), blood agents such as hydrogen cyanide, nerve agents such as sarin, tabun, soman, GF and VX, and pulmonary agents like phosgene. Biological substances may include bacteria (anthrax, cholera, plague, typhoid fever, etc.), rickettsiae (epidemic typhus, Q-fever, Rocky Mountain spotted fever, etc.), chlamydia (psittacosis, etc.), viruses (dengue fever, eastern equine encephalitis, Ebola fever, lassa fever, smallpox, etc.), or toxins (botulinum, ricin, staphylococcal enterotoxin B, etc.). The strategic mission of CBIRF is consequence management and force protec- tion while the organization’s operational mission is to turn victms into patients. Consequence management addresses the consequences of an incident, and involves measures to alleviate damage, loss, hardship or suffering. CBIRF has a command element with command and control of the organization during incident response, training and liaison. It is assisted by a group of consultants, called the “Electronic Reachback Advisory Group,” who provide advice on organization, equipment, and required capabilities during the formation of the CBIRF and who act as a “virtual” staff of experts in support of CBIRF upon its activation. Eight nationally and internationally recognized civilian experts in science and medicine form the “Reach- back” group. Reporting to the command element are recon, decon, medical, security, and service support elements. The recon element handles agent detection and identifi- cation, chemical/biological sample collection, hazard area identification, and deter- mination of a down wind hazard area. The decon element decontaminates personnel and equipment, including ambulatory and non-ambulatory victims, and can engage at multiple sites and depths of operations. The medical element consists of stabili- zation, collection and evacuation, and unit support sections and advises and assists local medical authorities, performs triage and emergency treatment, provides organic medical support, and undertakes initial epidemiological investigation. The security element provides incident area security and isolation, site evacuation, critical per- sonnel and government property security, crowd control, and similar operations as required. The service support element provides advice and assistance to the on- scene commander, supports organic services, and mans limited emergency services. The men and women who are CBIRF personnel come from a variety of military occupational specialties (MOS) selected from throughout the Marine Corps and the Navy, and are immunized against select weaponized biological agents. The MOS’s represented include officer-in-charge, operations representative, NBC representative, clerk, intelligence representative, communicator, hazard coordinator, decontamina- tion specialist, medical, supply, security, reconnaissance, medical officer (medical doctor or physician’s assistant), corpsmen driver, engineer, contractor, and embar- kation specialist. There is a 4-hour alert for a 120 person, limited-capability, “rapid response force,” which is reinforced by the total force within 24 hours. The concept of CBIRF is task organized, formed, standing and ready, self-sustaining, and inter- active with other organizations such as federal, local, foreign, academic, and indus- trial, resulting in a synergistic effect that features the joint action of organizations increasing each other’s effectiveness. Equipment costs for the CBIRF are expected to total $5 million, while annual operating expenses are projected to be $2 million. The Chemical Biological Incident ©2000 CRC Press LLC Response Force also is a testing unit for chemical and biological related equipment, techniques, procedures, and doctrine in the Marines Corps. CBIR E QUIPMENT FOR NBC D ETECTION AND I DENTIFICATION Radiological Detection and Identification Equipment AN/PDR-75, DT-236 : The DT-236 radiac detector is worn like a wrist watch and contains two detector elements. One measures total neutron radiation, and the second measures total gamma and X-ray radiation. The AN/PDR-75 computer indicator provides a readout of the total dosage of gamma and neutron radiation recorded on the radiac detector. Each radiac detector has a unique serial number to identify it to only one individual for the life of the detector. AN/VDR-2 : The AN/VDR-2’s main feature is the detector probe, which contains beta and gamma sensing devices for radiological monitoring. The radiac meter can also integrate the dose rate count and display cumulative dose on command. It can automatically range through the system’s entire range (0.01 uGy/hr to 9999 cGy/hr) and includes the following features: audio alarms, self-test circuitry, low-level beta monitoring, and high accuracy and reliability. Chemical Detection and Identification Equipment ABC-M8 VGH Chemical Agent Detector Paper : M8 paper detects and identifies liquid V- and G-series nerve agents and H-series blister agents. It comes in booklets of 25 sheets, which are impregnated with chemical compounds that turn dark green, yellow, or red upon contact with a liquid chemical agent. A color chart in the cover of the booklet helps determine the type of agent. M256A1 Detector Kit, Chemical Agent : The M256A1 kit consists of a carrying case, 12 sampler detectors, instruction cards, and ABC-M8 VGH chemical agent detector paper. The sampler detector is used to test for nerve, blood, and blister agent vapors in air. The M8 paper is used for detecting nerve, blood, and blister agents in liquid form. The kit is normally used to determine when it is safe to unmask after a chemical agent attack. M-18A2 : This item is a chemical test kit using colorimetric tubes to detect and identify toxic chemical agents in the air and vapors from liquid chemical agent contamination on exposed surfaces. The kit is also used to collect and forward samples of unidentified toxic material agents to a technical intelligence team or laboratory for classification. Agents detected by the M18A2 are cyanogen chloride, mustards (H, HD, HN, and HT), phosgene oxime, hydrocyanic acid, phosgene, lewisite, ethyldichloroarsine, methlydichloroarsine, and V and G types of nerve agents. pH Meter : The pH meter is a hand-held, man-operated device for identification of the acidity level, the alkalinity level, temperature reading, and conductivity of an unknown liquid source. CAM : The CAM is a hand-held device for monitoring chemical agent contamination on personnel and equipment. The CAM can detect nerve (G series) and blister (H series) vapors by sensing molecular ions of specific mobilities (time of flight), uses ©2000 CRC Press LLC timing and microprocessor techniques to reject inferences, and displays the relative concentration. The CAM is strictly a post-attack surveying/monitoring instrument. Due to the radiological source, Ni-63, the CAM requires a Nuclear Regulatory Commission license. The CAM’s response time is less than 60 seconds for 0.1 mg/m of agent. XM88 ACADA : The Alarm, Chemical Agent Detection, Automatic, detects and warns against the presence of chemical warfare agent vapor in the surrounding air in real time. It indicates G-series nerve and H-series blister agents and the hazardous level of agent vapor. It is capable of clearing itself and responding to another agent within five minutes and can be operated on the move. Due to the radiological source, the ACADA requires a Nuclear Regulatory Commission license. M21 RSCAAL : The Remote Sensing Chemical Agent Automatic Alarm is a two- man portable, automatic scanning, passive infrared sensor which detects nerve and blister agent vapor clouds based on changes in the infrared energy emitted from remote objects, or from a cloud formed by the agent. The RSCAAL is a stand-alone, tripod-mounted, chemical agent overwatch system to be used in a defensive role. It consists of a detector, tripod, M42 remote alarm unit, transit case, power cable assembly, and standard military power source. It can be used for reconnaissance and surveillance missions. It will search areas between friendly and enemy forces for chemical agent vapors, and provide advanced detection and warning of chemical hazards. Where possible, the RSCAAL will be employed in pairs (two reconnais- sance teams) so that one RSCAAL can be used in the overwatch position when the other reconnaissance team is moving. The RSCAAL’s detective range is 1.86 to 3.1 miles. PPID : The ToxiRAE Pocket Photo Ionization Detector continuously monitors haz- ardous and toxic gases or vapors in low part-per-million (ppm) concentrations. The PPID provides fast response and real time readings compared to operator program- mable alarms. It is available through a direct link with a PC and provides datalogging for history/survey missions. The PPID can operate continuously for 12 hours with a rechargeable Ni-Cd battery. HNu : The HNu is a powerful microprocessor-based photoionizer/data logger that has low-end sensitivity. Users may store calibration data, eliminating the need for individually calibrated probes. Advanced data storage provides data storage for up to 256 sites with data logging of date, time, concentration, and site information. Draeger Tube System : The tube(s) measure air concentrations of toxic chemicals. The system draws air through the tube with a mechanical or hand pump. The tube will then change colors to show the concentration level of the agent detected. The system uses colorimetric tubes specific to each agent. There are currently 160 different tubes that detect and identify chemical agents. Draeger Multi Pac : The Draeger Multi Pac gas personal monitor continuously and simultaneously measures ambient levels of oxygen, combustible gases, and two pre- selected toxic gases. The CBIRF currently has CO (carbon monoxide), NO (nitrous oxide), SO 2 (sulfur dioxide), NO 2 (nitrogen dioxide), Cl 2 (chlorine), H 2 S (hydrogen sulfide), NH 3 (ammonia), HCN (hydrogen cyanide), and a broad band toxic sensor. The gases being monitored are displayed concurrently on the alpha-numeric backlit LCD. If any of the gases reaches the preset safety limit, the audible and visible ©2000 CRC Press LLC alarms are activated immediately. The Multi Pac has an internal datalogger for storing all gas and instrument configuration parameters. All information can be downloaded to a PC for analysis. All data, including graphics, can be printed to create a permanent record. HAZCAT : The Hazardous Categorization Chemical Identification System is based on a series of field tests which are used to identify liquid and solid unknowns. The HAZCAT system can identify over 1000 agents. Most unknowns can be identified or categorized by hazard class with as few as four to five tests. The reagents are stable in most environments and have a shelf life of at least one year, although many will last indefinitely. Viking Gas Chromatograph/Mass Spectrometer (GC/MS) : A two-man, portable chemical detection and identification platform, the Viking is capable of a one touch operation even in gloves and protective clothing. Data is logged both electronically and as a hard copy if printed. Software developed specifically for chemical warfare agent identification is included for identifying a chemical threat. An industrial chemical library containing approximately 75,000 compounds can be used to analyze compounds other than chemical warfare agents. M93 FOX NBCRS : The FOX Nuclear Biological Chemical Reconnaissance System is a field detection and protection platform, equipped with a mobile mass spectrom- eter capable of detecting, identifying, and quantifying up to 60 chemical agents simultaneously. This system is also capable of collecting biological samples of solids and liquids. FOX vehicles are equipped with an overpressure system, six-wheel drive, seats for a crew of four, and are capable of both land and water operation. The FOX is equipped with an industrial chip that allows detection of 115 industrial chemical agents. Biological Detection and Identification Equipment Hand-Held Assay (HHA) ticket : The HHA tickets use immunochromatographic reactions to determine the type of biological agents present. There are currently several tickets available, with more in the research phase. Agents include anthrax and botox. A sample is collected, mixed in a buffer solution, then placed on the ticket. Operators will see either a positive or negative reaction within five minutes. Biological Sampling Kit : The BSK is required to perform three types of biological sampling: surface, liquid, and solid. The kit contains the required equipment for monitor/survey teams in the field to collect and forward biological samples needed by medical facilities. Forma Scientific Biological Dry Shipper : The shippers are designed for transport- ing small quantities of biological materials at cryogenic temperatures through the use of liquid nitrogen. Storage temperatures inside the shipping cavity can remain at –300°F for up to 30 days. Smart Air Sampling System (SASS) : The SASS is an air sampler designed to collect and concentrate biological aerosols into a liquid media for subsequent anal- ysis. The collected liquid sample is then provided to a bio-detection field device to determine whether biological warfare agents are present. The SASS can take a 5 to 7 cc sample in 10 minutes, and is battery-operated for up to 8 hours. ©2000 CRC Press LLC Recently Procured Equipment Mobile Modular Laboratory : The MML provides the capability for positive iden- tification, within 20 to 25 minutes, for either an air or liquid sample. Once a positive identification is made, the MML will provide information on medical treatment, decontamination, containment, and the potential change in force protection require- ments. The MML has an infiltration system that allows it to perform its mission in a non-contaminated environment. Inficon : This instrument is designed for easy, on-site analysis of industrial chemical agents, weighs about 35 pounds with batteries, is completely automatic, is based on Windows software, and has the capability to detect 78,000 volatile organic com- pounds (VOCs). Cascade System : The cascade system is capable of filling multiple SCBA cylinders. Litton Rebreathers : The system provides a duration of use for up to two hours, weighs only 30 pounds, and is both NIOSH and OSHA approved. The Rebreather system has positive pressure which will always keep gases away from the user’s face. LSCAD : The lightweight, standoff chemical agent detector is an interferometer designed for on-the-move detection of chemical vapors. The LSCAD is capable of detecting known nerve and blister agent vapors at a distance of 5 km. Portal Shield : This device is a biological detection system that is placed strategically around a working area and can work as an entire system remotely linked to one computer. An integrated weather system allows the portal shield to determine the difference between biological dissemination and an isolated alarm trigger. The unit can identify very specific biological agents. Captain Jeff Schwager is an intelligence officer with CBIRF who deals with maps, imagery, the terrorist threat, and support to the operations sector. He works with a number of different agencies such as counter intelligence and the Federal Bureau of Investigation. “We have computers where we can download classified information. If I needed information on a terrorist group, it would be of a classified nature, so I would have to use a classified database to pass on that information. The intelligence in CBIRF is a lot different from basic Marine Corps intelligence oper- ations because we have a domestic mission as well as an overseas mission. A lot of what we do is force protection. When we talk about terrorism and counter terrorism, one of the things we worry about is the safety of our troops. You have the initial incident, but there could be a secondary incident set up specifically to injure our personnel. We try to keep track of hostile groups that could try to thwart our attempts to affect their mission.” Chief Warrant Officer W3 Douglas Davis is the decon element commander. “We have a thorough mass casualty decontamination process which means we take the victims out of all their clothing, scrub them down, and prepare them for transport to local hospitals in a condition where they would not contaminate the hospital or the patients within it. First, they are triaged (the sorting of and allocation of treatment to patients, particularly in warfare or disasters, according to a system of priorities according to the urgency of their need for care designed to maximize the numbers of survivors) in the hot zone. There is another triage in front of the decon area so we always see the worst case scenarios first. We run three lines simultaneously for ©2000 CRC Press LLC ambulatory patients, non-ambulatory patients, and first responders or our own per- sonnel. “The decon site(s) take about 16 people to run and can be set up in seven minutes. For one decon site, we’ve estimated that we have the capacity to handle 25 to 35 non-ambulatory patients per-hour, between 70 and 100 ambulatory patients per-hour, and our force personnel line will go faster than that. That’s just one site. We have two sites that are exactly the same that can be set up if needed. When we come to a large city, we have five of what we call ‘hospital sites,’ each of which can be staffed by five Marines who have been decon trained with a small site that is able to do ambulatory and non-ambulatory decon at a hospital site for those victims who make it out of the incident site and come straight to the hospital without being decontaminated. We have a roller system in a 21-foot movable shelter for non-ambulatory patients, and two shower systems. The local hospitals will close down their emergency rooms when word is received that there has been a chemical or biological attack and won’t allow anyone into the emergency room until they have been decontaminated. Our whole purpose is to work with the local hospital staff to ensure that the emergency room is not contaminated. “I have a platoon of one officer and 32 enlisted. These Marines have been trained at the Nuclear, Biological, Chemical Defense Specialist School operated by the Army at Fort McClellan, AL. They have a good background in weapons of mass destruction and decon when they come to Camp Lejeune. It’s important to realize that when we go to an incident scene, we will be working for and with local emergency responders. We train with a lot of civilians including a SORT team (special operations response team) from Charlotte, NC. They are civilians who work for the federal Public Health Service under the direction of Dr. Lou Stringer. We also have SORT teams in Denver, CO and Los Angeles, CA. “When we come into an incident scene, we work for the civilian incident commander. We don’t come to take over the site. The local people tell us where they need us, and that’s where we set up. We have two sites and five hospital sites, so we can be pretty flexible as to where we go and whatever the needs are. We practice decontamination training all the time. This is our full time job, so we are good at it because that’s all we do. There is a lot of synergy within CBIRF. With 32 people, my group is going to get tired at a major incident so we cross-train with the security platoon. We cross-train with everybody in the 350-person CBIRF so everybody has a basic knowledge of decon and can come up here and replace the force as needed. “We’re chartered to go to all Department of Defense facilities anywhere in the world. Our 120-person Rapid Response Force is on call 24 hours a day and within 4 hours we can be ready to fly out, although we can often move faster than that. When we travel, we are self sufficient and have the ability to tap into civilian water sources. We bring all wrenches we may need and about 1000 feet of hose we can run from a hydrant or a standing water supply such as a swimming pool. “We developed the decon sites with certain ideas in mind. I told the Marines that their families might have to go through decon. ‘How would you like your mother treated; how would you like your family to be treated?’ We separate the males and the females; the children go with their mothers. We have curtains to hide ©2000 CRC Press LLC the people being decontaminated from view; the tents are heated. We provide gowns when they come out of the decon site, and blankets as necessary, before the patients go back to medical holding. All the decon processing is done inside a tent so nothing is seen by outsiders.” At one of the first anthrax hoaxes, the April 17, 1997 incident at B’nai B’rith, a national Jewish service organization in Washington, D.C., the firefighter responders put up tarps around the patients to shield them from the eyes of onlookers, but a television crew had climbed to the second or third story of a building and filmed the potential victims getting undressed for the world to see. “That is not going to happen here,” according to Doug Davis, “not on our decon site.” David Shoemaker is the preventive medicine officer for the CBIRF. “One of my jobs is epidemiology,” he says. “Another is looking at the different agents involved in symptomology and trying to determine what agent(s) are involved when we are at an incident site. I am also a liaison officer where I travel around dealing with all the federal agencies involved with consequence management. Together, we have become a major part of the federal response plan, and we want to continue that. “Regarding epidemiology, if we did not know what was happening at an incident site we were called to, I could do an epidemiological investigation, study various factors, and try to identify the agent(s), and the time of onset,” continues Shoemaker. “If we could tell early enough what was going on, we could possibly start immu- nization or prophylaxis. We can also do detection for biological agents; I can’t say which ones or how many, but we can detect with a number of different active or passive means. However, we do air sampling and suck in several liters of air and check for aerosols. We also have equipment to detect biological agents in soil, water, on the skin, and on mucous membranes on direct reading instruments so we can get a ‘yes’ or ‘no’ on the spot. We do have to send samples in for confirmation just to make a double check, but we can get a pretty good idea on what’s going on immediately. To keep our own personnel free of disease, we run an active immuni- zation program. We also have a prophylaxis program (protective or preventive treatment); if we were going into a certain area, we could pull up the proper drugs and start the Marines on them while they are enroute to ensure that they are protected. We do have such programs, but (for security concerns) I can’t say what we’re immunized against or which prophylactics we carry.” Marine Staff Sergeant Jeff Toohei is a meteorologist with CBIRF, and was building plume models based on different agents when the writer talked with him on a training exercise at an old auxiliary airfield in Atlantic Beach near the Cape Lookout National Seashore on the outer banks of North Carolina. Sergeant Toohei entered the Marine Corps in 1987, and spent three years as an air traffic controller. He spent two years as a weather observer at Cherry Point Marine Corps Air Station, went to weather forecaster school at Chanute Air Force Base, and returned to Cherry Point as a weather forecaster for 3 1 / 2 years. During this period, he served two six- month tours in Italy forecasting for the pilots flying over Bosnia, and has been with the CBIRF for over two years. “I am employing a plume modeling program provided through the Defense Special Weapons Agency located in Alexandria, VA. On this model, you incorporate the local weather including service base weather, upper air winds, temperature, ©2000 CRC Press LLC humidity, and boundary layers. I’m running the biological agent anthrax at the present time to learn if the anthrax agent plume would or would not reach nearby Morehead City. “A plume will take a few minutes to appear depending on which agent you may be using. For the anthrax plume we are using now, the buoyancy works in conjunc- tion with the local area air. The red or pink area observed on the computer screen is the percentage of the lethal content of the plume within that specific area. In that lethal area, as many as 90% of the people could die. This is just an estimate. We try to work with a worst case scenario; in this manner we have an idea of what could happen. We have both high resolution and low resolution maps of Morehead City which can be depicted on the computer screen. At the current time, this anthrax plume is showing winds coming from the northwest at 7 knots. “This computer is part of a different weather system, called the Oceanographic Support System, that is not on this exercise site where we are today. It consists of a receiver that gives us chart data and some satellite pictures; we also have two satellites that go with the system. We receive direct satellite pictures pretty much anywhere in the world, so we have a large capability to get weather information. Just prior to your coming in, I was getting ready to export the file to a PowerPoint graphics program so I could make an overlay to put on the map over there so that we can show everybody what the present circumstances are.” Navy Chief Petty Officer Brad Grandy is a medical administrator with CBIRF. He keeps track of how many casualties are removed from an incident site, when they came through decon, if they were ambulatory or non-ambulatory, and other information when they arrive at medical stabilization. “We keep track of the casu- alties and consider what assets we have available from the local community; we call the local emergency medical system for transport of casualties to local hospitals or military base hospitals. Keeping track of such statistics allows us to know how many people go down because of exposure or injury, where the victims are at different stages in care or treatment, and how many casualties we have.” H.W.R. Dalton, M.D. with the Navy, is an emergency medical physician who explained the multiple triage performed on patients who have been contaminated by chemical or biological agents. “The majority of patients complain of burning eyes; often they can’t see where they are going, they just lose control. Because of reduced eyesight, patients are instructed to grab the shoulder of the patient in front of them when they walk. We do three triages at the incident site. When a patient is first seen, somebody is making the decision about his or her condition. Next, when a patients gets to the decon line, staff are taking another look. If that patient is destabilized — he or she may be 200 to 300 yards from the incident site by now — we don’t want to put that person on the decon line and have him or her crashing. There may be five or ten patients behind the destabilized patient who could be saved if they went immediately through decon. We want to prioritize who’s going through and in what order. Triage works this way everywhere. Once the patients get to me, I look at them again. The people doing the triage down range may say that this patient is a ‘2’ but by the time he gets to me, the agent has kicked in more and now he is in worse shape, and I may say, ‘No, he’s not a 2, he is now a 1.’ In the case of a different patient, the antidote may be kicking in and this guy who was having ©2000 CRC Press LLC a lot of respiratory problems at the start of his contamination now is doing fine, so I’m going to have to say he is a candidate for a delay in treatment. We certainly need to get him in, but there are other people who are more urgent that we will ship in ahead of him. That is, down range, the people doing triage are deciding who gets to go to decon first; at decon the people doing triage are deciding who goes through the decon line first; and here, we are deciding the order that we will ship them off to local hospitals, and to an extent, the hospital each patient will be going to. Hopefully, we’re going to be interacting with the civilian side, saying things like ‘These guys are really serious and they need to be transported to an acute care center; these other patients can go to a community hospital since they have some mild eye and/or air way irritation.’ “We have three physicians with CBIRF, and depending on how many are on scene we think the physicians are most useful back here where we can do the most. There’s a limit to what we can do down range. To start with, at the triage line we have an emergency nurse who is very good at triage. If he has somebody who needs to be assisted by a physician, he is going to yell for us. That is part of the reason I am dressed in MOPP gear (mission oriented protective posture, the protective clothing used by members of the U.S. military who engage in nuclear, biological, and chemical warfare. MOPP gear provides a flexible system requiring personnel to wear only that protective clothing and equipment appropriate to the threat level or work rate imposed by the mission, temperature, and humidity) even though we are in a safe area. All I have to do is put on a mask, run down to the triage nurse’s area, and help out. Generally, the triage line is the first place those who are con- taminated are actually going to see a physician. “Here in this safe area, a physician will do basic life saving techniques. My specialty is emergency medicine, so I start with treatment that can make a difference right now. We could provide niceties that don’t make any difference right now, but we take care here of things that should be done immediately or the patient is going to get worse. The other thing we are doing here is further triage. Triage falls into two categories. Triage in the ER (emergency room) is based on the concept that we have adequate capability of taking care of everybody who is coming to our door, so people are then triaged on the basis that the most urgent patient is seen first. Everybody will be seen, but we take care of the worst ones first. However, in a mass casualty situation where you’ve got more people than you can reasonably take care of, triage means doing the most good for the most people. If you have somebody who is so acutely ill or traumatized that it’s going to take all your facilities for the next half hour, while you have other patients who can be saved by a 10-minute procedure, the very ill patient is going to be set aside while we take care of these other people. At the end of a half hour, if the very ill patient is still with us, then that patient moves up in priority because then we have the resources to expend on him or her. It all depends on what’s still coming down the line. “One of the other decisions that we are making here, particularly if the ambu- lances are not here and ready to go, is who we are spending our energy on at that point,” says Dr. Dalton. “A bad trauma case would occupy my full attention in a normal ER for a considerable amount of time. If I’ve got 20 patients lying here who are having respiratory symptoms and depending on me for help, I may not be able [...]... collection or detection means, and I had no means to detect industrial chemical agents We call them ‘tics,’ toxic industrial chemicals Today, we have the ability to analytically identify about 1 35, 000 chemical agents We also have the ability to collect and identify a variety of biological agents We can actually class type biological agents into spores, vegetative bacteria, or toxins We still have problems... response for escorting, rendering-safe, disposing, verifying samples, mitigating hazards, and identifying weaponized and non-weaponized chemical, biological, and hazardous materials Soldiers and civilians who work for the Technical Escort Unit may be trained in explosive ordnance, identification and handling, radiography, military and commercial chemical handling, chemical and biological detection and. .. mg/m3 0. 05 ppm (qualitative) 3.0 mg/m3 0.1 ppm 1.0– 15 ppm 5. 0 50 ppm 0.02–0.6 ppm 0.04–1 .5 ppm 0. 25 15 ppm 1 5 mg/m3 The unit also uses the PINS Chemical Assay System to nonintrusively identify the elements within a liquid-filled container; a Microtip IS-3000 which is a handheld microprocessor-controlled air monitor/photoionization detector (PID) that measures the concentration of airborne photoionizable... chloride 0.25a Blue band tube M 256 Hydrazine 0.2a Hydrazine 0.25a Hydrocyanic acid 2a Yellow band tube Phosphoric acid esters 0.05a Organic arsenic and arsine Organic arsenic and arsine Carbon tetrachloride 1a Carbon tetrachloride 5c Phosgene 0.02a Phosgene 0.05a Phosgene 0.25b Sulfuric acid 1a Concentration 2.0–10 ppm 1.0– 15 ppm 2.1– 15 mg/m3 0. 25 ppm 0 .5 mg/m3 3.0 mg/m3 0 .5 10 ppm 0. 25 3 ppm 2.0–30... Street, Norfolk, VA 2 355 1; 757 88 9-1 58 1; 80 0-6 0 4-4 734 (pager) DEPARTMENT OF DEFENSE CHEMICAL/ BIOLOGICAL RAPID RESPONSE TEAM Public Law 10 4-2 01 signed in 1996 directs the Army to train local emergency responders in tactics and procedures in response to chemical and biological weapons, conduct training exercises to improve federal/state/local operations and cooperation, and provide expert assistance including... Affairs Officer, U.S Army Soldier and Biological Chemical Command, Technical Escort Unit, Edgewood Area, Building 51 01, Aberdeen Proving Grounds, MD 21010; 41 0-6 7 1-4 3 45; 41 0-6 7 1 -5 297 (Fax) ©2000 CRC Press LLC FEDERAL BUREAU OF INVESTIGATION HAZARDOUS MATERIALS RESPONSE UNIT Started in 1996, the F.B.I.’s Hazardous Materials Response Unit (HMRU) is meant to be a response to potential terrorist action involving... cross-trained in both hazardous materials response and explosives.” Contact: Steven G Patrick, Haz Mat Officer, Program Manager, Emergency Response and Training, HMRU, ERF, F.B.I Academy, Quantico, VA 221 35; 70 3-6 3 0-6 55 6; 70 3-6 3 0-6 784 (Fax) DEPARTMENT OF ENERGY NUCLEAR EMERGENCY SEARCH TEAM The U.S Department of Energy Nuclear Emergency Search Team (NEST), like the Army Technical Escort Unit, locates and. .. domestic and international organizations Within the total organization of the HMRU, are the following divisions: research and information systems, nuclear program, biological program, chemical environmental crimes program, operations and logistics program, emergency response and training program, and the health and safety program The main concentration in this chapter will be on the emergency response and. .. easy way to dispose of a chemical agent or ordnance “Not when it comes to chemical warfare material,” he states emphatically “If it’s an ordnance item and it is fused, and the firing train is in a position where it’s unsafe to store, there are protocols you must go through to get permission to destroy it It can go all the way to the Pentagon, and the Department of Health and Human Services has to approve... provides public works and engineering support, includes technical advice and evaluations, engineering services, construction management and inspection, emergency contracting, and emergency repair of wastewater and solid waste facilities Transportation element supports the incident commander in accordance with state and local emergency response plans and the Federal Response Plan to satisfy the requirements . a variety of chemical and biological weapons. “The unit specializes in recovery of chemical and biological agents and muni- tions, and members are approximately 50 % civilian and 50 % military Battalion, 5th Marines at Camp Pendle- ton, CA and had just finished a deployment to Okinawa. I came to Camp Lejeune, NC to join the Chemical Biological Incident Response Force and was promoted to Captain. site, we’ve estimated that we have the capacity to handle 25 to 35 non-ambulatory patients per-hour, between 70 and 100 ambulatory patients per-hour, and our force personnel line will go faster than