The Binomial Bookstore

PREPARING FOR BIOLOGICAL TERRORISM:
AN EMERGENCY SERVICE GUIDE
by George Buck, Ph.D.

“Preparing for Biological Terrorism is a brand-new book by George Buck, expert in
emergency services dealing with terrorism. As biological means of terrorism
become more
of
a real threat in our society, it is critical that anyone involved in emergency
response is
familiar with these issues. Completely up-to-date, this resource covers all of the
aspects of
biological terrorism that responders will need to know in order to properly protect
themselves
and others while working to manage incidents.”

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“Is your community prepared for a biological terrorism incident?

“While no community is fully equipped or funded for a major attack, it is possible to
develop
and implement effective local response plans, protocols, and guidelines. New from
Delmar,
Preparing for Biological Terrorism contains vitally important information to guide
local
agencies in their efforts to secure and coordinate the influx of state and federal
resources
before, during, and after an attack.

“Mandatory reading for emergency response teams, today's school administrators,
business
leaders, public utilities managers, media professionals, as well as the general
public, this
resource walks through the fundamental concepts of emergency planning – that is,
the
"DNA" of successful emergency management. Subsequent chapters enable
readers to
immerse themselves thoroughly in specific elements of successful emergency
planning,
including: passive, active, and medical surveillance; biochemical detection,
notification, and
diagnosis protocols; agent surety; mass prophylaxis; the national pharmaceutical
stockpile
program; and more! Knowing that they are arming themselves with the latest
information as
to what to look for and how to respond, all readers of this emergency services
planning guide
will be able to heighten their vigilance while going freely and confidently about their
daily
lives.”

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BENEFITS

- Sample plans, guidelines, and protocols focus on optimal deployment and
expansion
of community-based resources, including: emergency medical and hospital
services, search
and rescue operations, event security personnel, environmental cleanup teams,
and more!

- Lessons learned from the attacks at the World Trade Center in New York
City on
September 11, 2001 as well as other domestic and international terrorism
incidents, ensure
maximum preparedness.

- Psychological repercussions of terrorism are addressed in detail, enabling
communities to take active steps to restore public confidence following a
bioterrorist or
Weapons of Mass Destruction (WMD) attack.

- Commonly used acronyms and a comprehensive glossary are included to
ensure
accurate communication between local officials, emergency responders and the
general
public.

- Agency checklists, an anthrax threat field guide and pharmaceutical
needs for five
different types of biological agents, sample Domestic "Preparedness Certificate"
course
outlines, and more are contained in handy appendices.

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EXCERPT FROM THE FOREWORD

“The unprecedented terrorist attack on September 11, 2001, on American citizens
in New
York and Washington, D.C., reinforces the need to "Plan for the Unthinkable".

“No one wants to plan for a bioterrorism attack. The thought of dealing with tens of
thousands
of casualties is not a palatable task, but we must plan, we must prepare, we must
act as a
nation united to limit the effects of an intentional or naturally occurring
epidemiological
disaster.
This book should be a building block to develop an effective local, state, and
national
program
to deal effectively with biological terrorism.

“God Bless America.

- A.D. Vickery,
Deputy Chief Special Operations Seattle Fire Department

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EXCERPT FROM THE PREFACE

“There has always been a need for planning and preparedness for disaster
situations in our
country and we have been doing a good job. Large-scale disasters in other
countries may
have heavy casualties, while the same incident in the United States may only have
a few, as
in the case of the Seattle Earthquake. The many training and education programs
at the
federal, state, and university levels for first responder and related areas that exist
now have
led to an increase in the preparedness this country enjoys. However, on and after
September
11, 2001, the books, the plans, and the approaches to those plans have been and
are being
rewritten. What once was considered a possible but remote threat of biological
terrorism is
now a reality in many parts of the United States. Hazardous materials teams are
working
overtime to respond to multiple calls for suspicious packages; envelopes with
powder on or
in
them, and powder on cars, mail boxes, and other everyday items. Many of these
are hoaxes,
but unfortunately a few are not. The time is here to deal with the real incidents of
biological
terrorism and the associated public fear that has evolved from it.

“One outcome of these past few weeks has been the unification of emergency
services.
Barriers often associated with planning and preparedness between various
agencies have
dissolved. In the basic planning steps prior to September 11, 2001, battles would,
in some
cases, ensue over who is in charge of an emergency scene and who should write
emergency
plans. Now, in meetings throughout our country, the common good is the focus
and progress
is occurring faster than ever before. In times of crisis, emergency services come
together in
a
way like no other, making the public the major and foremost concern. Public
health, fire,
police, emergency management, hazardous materials, medical, and 911 agencies
are
working in virtually every city to review, revisit and revise their emergency response
plans.
This book will assist in those efforts. The book does not provide the answer, but is
designed
to stimulate the thought process to mitigate against, prepare for, respond to, and
recover
from a biological event.

“There are many people and agencies who can benefit from this book besides first
responders. School systems should look at their planning and response guidelines
for
biological situations, or for that matter, all their hazard emergency/disaster plans.
Anthrax
hoaxes today are the bomb scares of the 1990s. Are they prepared with current
and correct
information about risk and response? This book will help to write those plans.
Businesses
need information on planning for biological threats and events, as many of them
have
received
envelopes containing powder, some of which have tested positive for anthrax. Even
the
children of business workers could become victims of anthrax exposures simply by
visiting a
parent's work site. Public utilities and other local/county agencies should look at
plans for
these types of events and determine, based on lessons learned so far, how to
prepare and
respond if needed. Anyplace where there are large gatherings of people, such as
stadiums
and theme parks, should be prepared for even just the mention of a biological
event. A
concentrated, coordinated plan will allow these areas to maintain calm and
respond
appropriately when needed. The public has an overwhelming need for information to
calm
their concerns for their safety. How are their local agencies preparing and
responding? What
if there is an outbreak in their town? Will CDC respond with medicine? What is the
federal
government doing to assist local agencies with the threat of exposure? Much of
this
information is available in this book. I hope that it gives the general public a sense
that your
national, state and local community leaders are taking the safety and welfare of
you and their
communities as a top priority.

“This book was started before September 11 and is the second in a series of
terrorism
preparedness books. The World Trade Center attacks and the deaths of several
personal
friends created the need to complete this book. I know that emergency planners
are looking
closely at their plans during this time of crisis in our country and I hope that in
some way this
book will assist them, (you) in their efforts. This book is published in honor of the
first
responders and friends who died in the attacks on September 11, 2001. None of
the victims
will ever be forgotten. May God bless America.

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CONTENTS

FOREWORD
PREFACE
ACKNOWLEDGMENTS
1 OVERVIEW OF NATIONAL AND INTERNATIONAL TERRORISM
Overview
Types of Terrorists
Terrorist Targets
Recognizing Terrorist Events
An Overview of International Terrorism
A Brief History of Terrorism
Response Overview, Strategies, and Tactics
Emerging Response Planning and Controversial Issues
Summary

2 THE DNA OF EMERGENCY MANAGEMENT PLANNING: THE BASIC
CONCEPTS
OF EMERGENCY MANAGEMENT
Overview
Emergency Management Agencies
Fire Service Involvement
Factors that Affect Emergency Management
Threats Facing the United States
Types of Threats
Ranking of Threats
Potential Hazards
The Changing Context: A Window of Opportunity
The Emergency Manager
The IEMS Overview
The IEMS Concept
The IEMS Process
Starting the Real World Planning Process
Hazard (Risk) Analysis
The Planning Process
The Cascade Effect
Capability Assessment
Setting Goals
Getting Organized
Multi-hazard, All-Hazard, Functional Planning
History of Incident Command System
Summary Exercising
Summary

3 THE BASICS OF EMERGENCY MANAGEMENT:
Putting It All Together
Overview
Your Role as the Emergency Manager
Job Title and Organizational Chart
Hazard Identification and Planning
Staffing Issues
Office and Professional Duties
Resource Lists
Management
Information
Leadership
Professional Training
Non-Emergency Management-Related Duties
Responsibilities to Employer or Organization
Planning
Why plan?
The Case for Planning
Planning Guidelines
Writing the Plan
Planning vs. Improvisation
Plan Components
Technical Writing
What Your Local Emergency Operations Plan Should Include
Emergency Support Functions (ESFs)
Terrorism Consequence Management Plan
Summary

4 SYSTEM IMPLICATIONS
Overview
Interoperability and Self- Sufficiency
Responder Casualties
Treatment Roles and Responsibilities
Summary

5 EVENT MANAGEMENT
Overview
Incident Operations
Emergency Operations Center Operations
Metropolitan Medical Response System (MMRS)
Integration with Federal Government
Integration with State and Local Government
Medical Management
Medical Facilities
MMRS Organizational Chart
Hospital Emergency Incident Command System (HEICS) Summary

6 LOCAL PLANS AND RESOURCES
Overview
Local Emergency Operations Plan
Local Hazards Analysis
Vulnerability Analysis
Local Resources and Special Teams
Community Emergency Response Teams (CERTs)
Disaster Community Health Assistance Teams (DCHATs)

7 FEDERAL MEDICAL RESOURCES
Overview
Federal Response Plan Assumptions
The Plan's Concept of Operations
The National Disaster Medical Service
Historical Development of The NDMS
Recent Experiences of the NDMS
Other Resources from the Public Health Service
Federal Urban Search and Rescue Resources (US&R, USAR)
Task Force Leader
Search Team
Rescue Team
Medical Team
Technical Team
Summary

8 MEDICAL CONSEQUENCES
Overview
Introduction
B-NICE
Patient Care Mainstays
Physiological Effects of Terrorist Weapons
Nervous System
Blood, The Mediator of Inflammation
Mass Patient Decontamination

9 GENERAL BIOLOGICAL TERRORISM CONCEPTS
Overview
Biological Response
Integrating Federal, State, County, and Local Responses
Concept of Operational Management Issues
Emergency Operations Center
Crisis Management
Situation and Threat Background
Incident Types: Package, Covert Release, Threat
Threatened Use
Confirmed Presence
Actual Release
The Agents
Planning Strategies
Administration
Plan Maintenance
Outline of Biological Response Operations
Conduct Internal Notification
Determine the Course of Action
Action Planning
Conduct Public Notifications
End Event
Stages of Severity
Strategies and Actions
Decision Factors
Specific Treatment Models
Biological Terrorism Operations
Suspicious Outbreak of Disease Notifications
In the Event of an Alert
In the Event of a Warning
In the Event of an Actual Incident (Response)
Threatened Use
Confirmed Presence
MMRS Biological Agents
The Historical Biological Agent Scenarios as a Baseline Treatment vs. Prophylaxis
Discovery of Agent Prior to Release
Actual Release
Initial Response Concerns
Suspicious Outbreak of Disease
Synopsis of BW Agent Characteristics
BW First Responder Concerns
BW Agent Dissemination
Weather Effects
Decontamination (Decon) Considerations
Recovery Concerns
Site Decontamination and Restoration
Oversight
Investigation
Summary

10 PLANNING AND ACTION GUIDELINES
Overview
Passive Surveillance
Active Surveillance (Epidemiological Services)
Biological Terrorism Stakeholders Group
Detection
Agent Surety
Notification
Diagnosis
Mass Prophylaxis
Medical Response Expansion Program
Logistics for the National Pharmaceutical Stockpile Program
EMS Resources
Hospital Plan
Emergency Support Function #8 (ESF#8), Health and Medical
Mass Fatality Management Implementation
Medical Examiner Expansion Program
Environmental Clean Up
Summary

BIOPLAN REFERENCES
APPENDIX A CHECK LIST FOR AGENCIES
APPENDIX B PUBLIC SAFETY PRECAUTIONS/ACTIONS
APPENDIX C PUBLIC HEALTH ANTHRAX THREAT ADVISORY
APPENDIX D COMPLETE AGENT DESCRIPTIONS
APPENDIX E AREA HOSPITAL LISTINGS
APPENDIX F COUNTY PUBLIC HEALTH CLINICS/CENTERS
APPENDIX G AN ANTHRAX THREAT FIELD GUIDE
APPENDIX H PHARMACEUTICAL NEEDS FOR THE FIVE TYPES OF
BIOLOGICAL
AGENTS
APPENDIX I PHARMACEUTICAL PUSH PACKAGE CONTENTS
APPENDIX J BIOLOGICAL AGENT SIGNS AND SYMPTOMS
APPENDIX K ISRAEL'S FIXED HOSPITAL DECONTAMINATION SYSTEM
APPENDIX L SAMPLE DOMESTIC PREPAREDNESS TRAINING COURSES:
PUBLIC
HEALTH FOCUS
APPENDIX M BIOLOGICAL INCIDENT PREPAREDNESS TRAINING
APPENDIX N SAMPLE SCHOOL EMERGENCY PLAN
APPENDIX O INTERNET RESOURCES FOR TERRORISM/DISASTER
PLANNING
ACRONYMS
GLOSSARY
INDEX

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ABOUT THE AUTHOR

“GEORGE BUCK has been involved in the fire/rescue service and emergency
management
for more then 20 years. He is presently the Director/Professor at the University of
South
Florida's Center for Disaster Management and Humanitarian Assistance and The
Center for
Biological Terrorism Defense. George was previously with St. Petersburg College
as
Director/Professor of the Institute of Emergency Administration and Fire Science,
and the
National Terrorism Preparedness Institute. George has served as a Fire
Management
Specialist with the United States Fire Administration in Emmitsburg, Maryland.
Previously,
he served more than fourteen years with Addison (Dallas County), Texas Fire
Department in
the Operations Division.

“He is a Principal member of the Technical Committee for "Emergency
Management, NFPA
1600" and has been serving on the committee since 1992. He has spoken at many
national
and international conferences. George has also published many articles,
manuscripts, white
papers, etc., both nationally and internationally. George is also the author of
Delmar's
Preparing for Terrorism, an Emergency Services Guide, and soon to be released
Preparing
for Biological Terrorism, an Emergency Services Planning Guide.”

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2002, 379 pages. Order #DR659.
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Terrorism; Workplace Violence, Crime

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