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151

Weapons of Mass Effect— Radiation Hank T. Christen Paul M. Maniscalco Harold W. Neil III

• Describe the differences between a radiation incident and a traditional hazardous materials incident.

• Define the three types of radiation.

• Differentiate between the terms dose and exposure.

• Describe the distinction between acute and delayed effects of radiation exposure.

• Explain the difference between radiation exposure and contamination.

• Outline the first responder considerations in a radiological terrorism incident.

Objectives

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Introduction

Radiation is effective as a weapon of mass effect be- cause of its long-term consequences and psychological effect on victims and the community. The word radiation immediately generates mental images of hideous and doomed casualties. This chapter provides an explana- tion of radiation and the types and hazards of radiation exposure. First responders need to understand the basics of radiation physics and protective measures to operate safely and effectively at a radiation attack or accident. Additional topics include the use of radiation as a terror- ism weapon, the medical effects of radiation, and tactical considerations and critical factors related to an effective response to a radiation incident.

Radiation incidents are a special type of hazardous materials incident because of several common factors, including internal exposure pathways, contamination concerns, decontamination techniques, and personal pro- tective equipment (PPE) requirements. These factors share commonality with chemical and biological threats.

Basic Radiation Physics Radiation travels in the form of particles or waves in bun- dles of energy called photons. Some everyday examples are microwaves used to cook food, radio waves for radio and television, light, and X-rays used in medicine.

Radioactivity is a natural and spontaneous process by which the unstable atoms of an element emit or ra- diate excess energy in the form of particles or waves. These emissions are collectively called ionizing radiation. Depending on how the nucleus loses this excess energy, a lower energy atom of the same form results, or a com- pletely different nucleus and atom are formed.

Ionization is a particular characteristic of the radia- tion produced when radioactive elements decay. These radiations are of such high energy that they interact with materials and electrons from the atoms in the material. This effect explains why ionizing radiation is hazardous to health and provides the means for detecting radiation.

An atom is composed of protons and neutrons contained in its nucleus. The only exception is the natu- rally occurring hydrogen atom, which contains no neu- trons. Protons and neutrons are virtually the same size. Electrons, which are much smaller than protons and neutrons, orbit the nucleus of the atom. The chemical behavior of an atom depends on the number of protons, which are positively charged, and the number of elec- trons, which are negatively charged. Neutrons, which have no electric charge, do not play a role in the chemical behavior of the atom.

Special placards are required when transporting certain quantities or types of radioactive materials. In

facilities that use radioactive materials, the standard radioactive symbol is used to label the materials for identification (CP FIGURE 10-1). Placard information is useful when responding to an accident involving ra- dioactive materials. However, in a terrorist attack, there are no labels or placards to identify the hazards involved.

Alpha, beta, and gamma energy are forms of radiation (FIGURE 10-1). Because alpha particles contain two protons, they have a positive charge of two. Further, alpha particles are very heavy and very energetic compared to other com- mon types of radiation. These characteristics allow alpha particles to interact readily with materials they encounter, including air, causing much ionization in a very short dis- tance. Typical alpha particles travel only a few centimeters in air and are stopped by a sheet of paper.

Beta particles have a single negative charge and weigh only a small fraction of a neutron or proton. As a result, beta particles interact less readily with material than alpha particles. Beta particles travel up to several meters in air, depending on the energy, and are stopped by thin layers of metal or plastic.

Like all forms of electromagnetic radiation, the gamma ray has no mass and no charge. Gamma rays interact with material by colliding with the electrons in the shells of atoms. They lose their energy slowly in material and travel significant distances before stopping. Depending on their initial energy, gamma rays can travel from one to hundreds of meters in air and easily go through people. It is important to note that most alpha and beta emitters also emit gamma rays as part of their decay processes.

Radiation is measured in one of three units as noted. A roentgen is a measure of gamma radiation. A radiation-absorbed dose (RAD) is a measurement of absorbed radiation energy over a period of time. Radiation dose is a calculated measurement of the amount of energy deposited in the body by the radiation to which a person is exposed. The unit of dose is the roentgen equivalent man (REM). The REM is derived by taking into account the type of radiation producing the exposure. The REM is approximately equivalent to the RAD for exposure to external sources of radiation. Detecting and measuring external radiation levels are critical at the scene of a radiation incident.

Radiation Measurements

It is equally important to develop an understanding of the dangers associated with different levels of exposure. Response agencies should develop policies regarding PPE and acceptable doses for emergency responders.

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These policies should be consistent with agency risk assessments and PPE standard operating procedures.

Radiation levels are measured with survey instru- ments designed for that purpose (FIGURE 10-2). Survey instruments usually indicate units of R/hr where R stands for either RAD or REM. The unit R/hr is an exposure (or dose) rate. An instrument reading of 50 R/hr means re- sponders exposed for 1 hour will receive a 50-RAD dose. Dividing the unit determines the exposure for shorter or longer periods of time (e.g., a 30-minute exposure results in a 25-RAD dose). An exposure (or dose) rate can be compared to a speedometer. A speed of 80 miles per hour means traveling 1 hour to go 80 miles. Traveling for half an hour at that rate covers a distance of 40 miles.

Some instruments measure radiation dose over a period of time. These instruments are comparable to an odometer, which measures total miles traveled regardless of the speed. Handheld survey instruments may have this capability, but they are more useful in an emergency situation for measuring the exposure rate. Radiation do- simeters are useful for measuring the exposure received over time (FIGURE 10-3).

Responders must wear dosimeters during opera- tions in any radiation hot zone or suspected radiation environment. Dosimeters should be checked frequently to determine the exposure received by on-scene first responders. Medical personnel should conduct final

dosimeter checks during postdecontamination medical evaluation.

Survey instruments and dosimeters have limitations because some instruments measure only beta and gamma radiation, not alpha radiation. The capability to measure alpha radiation is a requirement. It is important to de- velop a maintenance and inspection program that ensures instruments and dosimeters are properly functioning. Survey instruments, like all electronic devices, require inspection and recalibration by certified technicians at specified intervals. Survey instrument batteries must also

FIGURE 10-1 Alpha, beta, and gamma radiation.

Gamma

Alpha

Beta

FIGURE 10-2 A radiation detection device.

FIGURE 10-3 Dosimeters stay on the responder throughout an incident.

It is critical that responders detect and measure radia- tion levels and exposure at an attack or accident.

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be checked and replaced when necessary. Dosimeters must be zeroed and checked on a regular basis.

Internal Radiation Exposure

For internal radiation exposure, the terms RAD and REM are not synonymous. It is important for first responders to know whether an internal exposure hazard exists and how to protect themselves by using PPE, including respirators. However, first responders should not be concerned with measuring internal radiation because internal exposure assessment is complicated due to the large number of factors involved. Some of these factors are the chemical form of the material, the type of radiation emitted, how the material entered the body, and the physical charac- teristics of the exposed person. Months of assessment may be required to determine an internal dose. Common methods for assessing internal exposure are sampling of blood, urine, feces, sweat, and mucus for the presence of radioactive material. Special radiation detectors measure the radiation emitted by radioactive materials deposited within the body. By considering the results of these mea- surements along with the characteristics of the material and the body’s physiology, a measurement of radiation dose from internal sources is made.

Characteristics of Radiation

Despite the similarities to hazardous materials incidents, radiation incidents have a unique characteristic that first responders must understand. Namely, radiation expo- sure may occur without coming in direct contact with the source of radiation, which is a primary difference between chemical and biological incidents. A chemical or biological agent exposure occurs when a material or agent is inhaled, ingested, injected, absorbed through the skin, deposited on unprotected skin, or introduced into the body by some means.

Radioactive materials are naturally occurring or manufactured and emit particle radiation and/or elec- tromagnetic waves. Contrary to popular science fiction, radioactive materials do not glow and do not have spe- cial characteristics making them readily distinguishable from nonradioactive materials. This means responders cannot detect or identify radioactive materials using the five human senses.

Radiation emitters may be liquid, solid, or gas. For example, radioactive cobalt, or cobalt-60, has the same chemical properties and appearance as nonradioactive cobalt. Radioactive water, known as tritium, cannot be readily distinguished from nonradioactive water. The difference lies in the atomic structure of the mate- rial, which is responsible for the characteristics of the material.

To understand the mechanism for radiation ex- posure, an explanation of radiation is necessary. Radiation is often incorrectly perceived as a mysterious chemical substance. Radiation is simply energy in the form of invisible electromagnetic waves or extremely small energetic particles. Waveforms of radiation are X-rays and gamma rays. Radiation is emitted by X-ray machines and similar equipment commonly found in medical and industrial facilities (FIGURE 10-4). Alpha, beta, and gamma are different types of radiation that have different penetrating abilities and present differ- ent hazards.

FIGURE 10-4 Radiation is emitted by medical equipment such as com- puted tomography scans.

Responders must wear personal dosimeters when op- erating in or near any radiation hot zone.

Radiation exposure can occur without direct contact with a radioactive source.

Radiation cannot be detected by human senses.

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Medical Effects of Radiation

Radiation energy can be deposited in the body during the exposure process regardless of the form or source. The amount of energy deposited in the body by a radiation source varies widely. It depends largely on the energy of the radiation, its penetrating ability, and whether the source of radiation is located outside or inside the body. Radiation exposure from a source outside the body is known as external exposure. Radiation exposure from a source within the body is known as internal exposure.

Consider the example of the radioactive cobalt, or cobalt-60, source discussed earlier. A person located within a few meters (the distance depends on the strength of the source) of the cobalt-60 source is exposed to the gamma radiation emitted from the source without di- rectly touching the source. This is an external exposure. If the source becomes damaged, the cobalt-60 could leak from the container. In order to cause an internal expo- sure, the cobalt-60 has to enter the body via inhalation, ingestion, or some other means.

Another important concept involving radioactive materials is demonstrated with the cobalt-60 source. Radioactive contamination is the presence of radioactive material in a location where it is not desired. Radioactive contamination results from the spillage, leakage, or other dispersal of unsealed radioactive material. The presence of radioactive contamination presents an internal expo- sure hazard because of the relative ease of radiation en- tering the body. There may also be an external exposure hazard depending on the radioactive material involved. Any location where radioactive material is deposited becomes contaminated. The contamination spreads by methods including air currents, water runoff, and per- sons touching the source and cross-contaminating other objects and areas by touch or walking.

The effects of radiation exposure on responders vary depending on the amount of radiation received and the route of entry. Radiation can be introduced into the body by all routes of entry and through the body by irradia- tion. Victims can inhale radioactive dust from nuclear fallout or a dirty bomb, or they can absorb radioactive liquid through the skin. In the body, radiation sources

irradiate the person internally rather than externally. Some common signs of acute radiation sickness are listed in TABLE 10-1. Additional injuries such as thermal and blast trauma, trauma from flying objects, and eye injuries occur from a radiological dispersal device (dirty bomb) detonation or a nuclear blast.

First responders should be aware of radiation’s health effects and risks because a radiation incident presents both internal and external exposure hazards that may be significant. The fundamental question is how much radiation is too much? A substantial number of scientists and academics argue that any exposure is dangerous and extraordinary precautions are necessary to minimize exposure. At the other end of the spectrum, many scientists and academics argue that some radiation exposure is necessary to life and perhaps even beneficial. In essence, responders must have a healthy respect for radiation and its associated dangers.

High levels of radiation exposure cause serious health effects to occur. These effects are called prompt or acute effects because they manifest themselves within hours, days, or weeks of the exposure. Acute effects in- clude death, destruction of bone marrow, incapacitation of the digestive and nervous systems, sterility, and birth defects in children exposed in utero. A localized high exposure can result in severe localized damage requir- ing amputation of the affected area. These effects are clearly evident at high exposures such as an atomic bomb detonation or serious accident involving radioactive ma- terials. These effects are seen at short-term exposures of about 25 RAD and above. The severity and onset of the effect are proportionate to the exposure. Effects of radiation exposure that are not manifest within a short period of time are called latent or delayed effects. The most important latent effect is a statistically significant increase in the incidence of cancer in populations ex- posed to high levels of radiation.

The health effects of low exposures are not obvious and subject to debate in scientific and academic circles. Low exposures do not cause obvious bone marrow dam- age, digestive effects, nervous system effects, cancer, or birth defects. To minimize risks, occupational dose lim- its for persons working with radiation are 5 REMs per

TABLE 10-1 Common Signs of Acute Radiation Sickness

Exposure Effects

Low exposure Nausea, vomiting, diarrhea

Moderate exposure First-degree burns, hair loss, death of the immune system, cancer

Severe exposure Second- and third-degree burns, cancer, death

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year. This is not a dividing line between a safe and unsafe dose; it is a conservative limit set to minimize risk. This is why scientists and safety professionals advocate an approach based on a healthy respect for radiation.

Radiation Accidents

Most radiation accidents encountered by emergency medical personnel generally involve transported radio- active materials or radiation-emitting devices used in an industrial or institutional setting. Other incidents include the accidental or deliberate misuse of radioactive materi- als. Industrial accidents cover a range of situations from activities within nuclear power plants, isotope production facilities, materials processing and handling facilities, and the widespread use of radiation-emitting measurement devices in manufacturing and construction.

Institutional accidents generally involve research laboratories, hospitals and other medical facilities, or academic facilities. Generally, the victim was directly involved in handling the material or operating a radi- ation-emitting device. Transportation accidents occur during the shipment of radioactive materials and waste. However, due to stringent regulations and enforcement governing the packaging and labeling of radioactive ma- terial shipments, few of these incidents pose any serious threat to health and safety.

Commercial and private aircraft accidents may in- volve radioactive materials that are usually radio-phar- maceuticals carried as cargo or radioactive instrument components, but these sources seldom pose a serious exposure risk. Accidents involving military aircraft gen- erally pose no increased risk because radioactive weap- ons are sealed, shielded, and protected against accidental detonation or accidental release.

There have been several international incidents where radioactive materials were unknowingly re- leased by individuals who were unaware of the hazards. Improperly or illegally discarded radiation sources have been opened by scrap dealers and others, causing serious contamination and lethal exposure to many people.

EMS and fire/rescue agencies responding to a radia- tion incident must remember that expedient delivery of appropriate victim medical treatment, including trans-

port to a hospital, is a priority. Treating the victim’s medical condition is a priority.

Responders usually learn that radiation is involved by the following:

1. They are advised by dispatchers based on caller information.

2. They are advised on arrival by other respond- ers such as police or fire officials that radioactive materials are present at the scene.

3. They are advised by victims that they were con- taminated or exposed.

4. They determine from observations of the incident site that contamination or exposure is a possi- bility. Visual sources include signs, placards, or documents such as shipping papers.

Information regarding the source of the radia- tion, type of radioactive material, and exposure time is valuable data that should be gathered at the scene. It is important that EMS personnel consider the distinc- tion between exposure and contamination. Responders should remember there is a minimal chance of encoun- tering a radiological incident that is a serious threat to their health and safety. While accidents involving small amounts of radioactive material may occur in industry or commerce, incidents involving high levels or danger- ous amounts of radiation are unusual and rarely occur outside the surveillance of qualified experts.

Contaminated victims should be treated using ap- propriate medical protocols. These victims are not radio- active, but they present a hazard to medical personnel if they are not decontaminated. EMS responders should take steps to minimize personal and vehicle contamina- tion by using agency-approved decontamination proce- dures when radiation is known or suspected. Receiving medical facilities must also initiate appropriate decon- tamination procedures prior to the victim entering the emergency department to ensure that buildings and oc- cupants are not contaminated.

External Radiation Exposure Victims exposed to a high dose of radiation generally present no hazard to other individuals. The victim is not radioactive and is no different than a patient exposed to diagnostic X-rays. An exception to this rule is victims ex- posed to significantly high amounts of neutron radiation because persons or objects subjected to neutron radiation may become radioactive. Such activation is extremely rare and this is noted for information purposes only.

External Contamination Externally contaminated victims present problems simi- lar to encounters with chemical contamination. External

Treating a victim’s medical condition is a priority.

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contamination usually means the individual has con- tacted unconfined radioactive material such as a liquid or powder or airborne particles from a radioactive source. Containment of the material to avoid spreading the contamination is important. People or objects coming in contact with radiologically contaminated victims or objects are considered contaminated until proven oth- erwise. Implementing isolation techniques to confine the contamination and protect personnel is a primary objective.

Internal Contamination Externally contaminated victims may receive inter- nal contamination by inhalation, by ingestion, or by absorption through open wounds. However, internal contamination is not usually a hazard to the individu- als around the victim. The most common type of inter- nal contamination is inhalation of airborne radioactive particles deposited in the lungs. Absorption through the skin of radioactive liquids or the entry of radioac- tive material through an open wound is also possible. There may be little external contamination, but the vic- tim suffers the effects of exposure from the ingested or absorbed radioactive material. This means an injured person contaminated both internally and externally with radioactive material should be decontaminated, treated using universal precautions, transported, and evaluated for exposure by qualified medical experts.

External contamination may be eliminated or re- duced by removing clothing and using conventional cleansing techniques on body surfaces, such as gentle washing and flushing that does not abrade the skin surface. However, internal contamination cannot be removed or treated at the incident scene.

Radiological Terrorism

The Oklahoma City federal building and World Trade Center bombings, the subway poison gas attack in Japan, the use of chemical and biological agents during the Gulf War, and other incidents highlight awareness of the potential for terrorist acts involving weapons of mass effect. The deliberate dispersal of radioactive material by terrorists is another potential source of contamination and/or exposure that must be considered.

A weapon of mass effect incident in which chemi- cal, biological, or radiological materials are released by explosives can cause significant numbers of casualties and create widespread panic. Such situations require that steps are taken to protect responders and facilities against unnecessary exposure. In any terrorist incident that produces mass casualties and extensive damage, the first consideration should be determining whether a chemical, biological, or radiological agent was involved. The presence of a hazardous material with the accompa- nying prospect of contamination and exposure drasti- cally alters the approach that should be taken by medical service personnel.

A radiological dispersal device is any container that is designed to disperse radioactive material. Dispersion is usually by explosives, hence the nickname, “dirty bomb.” A dirty bomb has the potential to injure victims by radioactive exposure and blast injuries. A radiological dispersal device creates fear, which is the ultimate goal of the terrorist. In reality, the destructive capability of a dirty bomb is based on the explosives used. The outcome may be long-term injuries and illness associated with ra- diation and long-term environmental contamination.

The destructive energy of a nuclear detonation sur- passes all other weapons. This is why nuclear weap- ons are kept generally in secure facilities throughout the world. There are nations aligned with terrorists that have nuclear weapons. Yet the ability of some nations to deliver nuclear weapons such as missiles or bombs is debatable. Unfortunately, after the collapse of the former Soviet Union, the security of nuclear devices is question- able. Other nonfriendly nations such as Pakistan, North Korea, and Iran also have nuclear weapons.

Injured victims should be triaged, treated, moni- tored, and decontaminated, if possible, at the scene (FIGURE 10-5). The movement of contaminated or exposed victims to medical facilities poses the substantial risk of contaminating transportation resources, treatment facilities, and staff, which renders these resources unfit for treating other victims. EMS protocols should clearly outline the critical steps when there is notification of a terrorist incident involving a radioactive material. The considerations are the following:

• Dispatching on-shift and off-shift emergency staff to establish on-scene triage, treatment, and transport capabilities.

• EMS collaboration with local and regional med- ical facilities.

• Notification of the state warning point (usually the state emergency operations center) that a radiation attack or accident has occurred. This notification may initiate a federal response.

Victims must be decontaminated if they are externally contaminated by radioactive materials.

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• Non–law enforcement responders must re- member that a terrorist incident is a criminal act and interaction with law enforcement of- ficials is an integral part of the response contin- uum. No physical evidence should be handled, moved, or discarded without authorization from law enforcement officials. All activities and observations should be carefully and thor- oughly recorded because responders are poten- tial witnesses in criminal proceedings.

Responder Tactical Actions

Refer to Chapter 13, “Personal Protective Equipment,” and review local agency PPE procedures to ensure re- sponders are adequately protected. Note that there are no protective ensembles designed to completely shield responders from radiation. Protective clothing with ap- propriate respiratory protection is effective for protec- tion from alpha or beta radiation; however, there are no ensembles that provide shielding from gamma radiation. The most effective procedures for gamma protection are time, distance, and shielding such as concrete walls.

Time Radiation has a cumulative effect on the body over time. This means that reducing the time of radiation exposure reduces the overall exposure or dose. Every effort must be made to minimize working time in radiological hot zones.

Distance Radiation travel is limited by distance. Doubling the distance from a radiation source reduces the effects to one quarter of the original exposure. For example, a gamma exposure of 100 REM/hr at 5 meters is reduced to 25 REM/hr at 10 meters. Increasing distance from the source is effective with alpha radiation because alpha particles do not travel more than a few centimeters.

Shielding As discussed earlier, the path of all radiation can be stopped or reduced by specific objects called shields. Responders to a radiation incident should always assume they are exposed to the strongest form of radiation and use concrete shielding such as buildings or walls (if practical) to shield themselves. Remember that vehicles and traditional residential/com- mercial construction do not provide adequate shielding against gamma radiation (CP FIGURE 10-2).

Tactical Actions Units responding to a suspected or confirmed radiation incident should initiate the following tactical actions:

1. Observe explosive protection procedures for ra- diological dispersion devices.

2. Don appropriate ensembles with respirator pro- tection.

3. Use the principles of time, distance, and shielding for protection.

4. Notify the appropriate local and state agencies that a radiation incident is in progress.

5. Immediately establish a hot zone and enforce safe site entry and egress procedures.

6. Establish a decontamination corridor with medi- cal surveillance for personnel exiting the hot zone.

7. Establish a security perimeter a safe distance around the incident scene.

8. Observe crime scene preservation procedures and collaborate with law enforcement efforts.

FIGURE 10-5 Victims should be triaged, treated, monitored, and decon- taminated, if possible, at the scene.

Time, distance, and shielding are protective measures that reduce radiation exposure.

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Chapter Summary

Radiation is effective as a weapon of mass effect be- cause of its long-term consequences and psychologi- cal effect on victims and the community. Radiation travels in the form of particles or waves in bundles of energy called photons, and alpha, beta, and gamma energy are all forms of radiation. Survey instruments and dosimeters have limitations because some instru- ments measure only beta and gamma radiation, not alpha radiation.

Radiation is measured in one of three units. A roentgen is a measure of gamma radiation. A RAD is a measurement of absorbed radiation energy over a period of time. Radiation dose is a calculated measure- ment of the amount of energy deposited in the body by the radiation to which a person is exposed. The unit of dose is the REM.

Despite the similarities to hazardous material inci- dents, radiation incidents have a unique characteristic that first responders must understand. Namely, radiation exposure may occur without coming in direct contact with the source of radiation, which is a primary difference be- tween chemical and biological incidents. Radiation expo- sure from a source outside the body is known as external exposure. Radiation exposure from a source within the body is known as internal exposure. High levels of radiation exposure cause serious health effects to occur.

The Oklahoma City federal building and World Trade Center bombings, the subway poison gas attack in Japan, the use of chemical and biological agents during the Gulf War, and other incidents highlight awareness of the potential for terrorist acts involving weapons of mass effect. It is important to remember that there are no protective ensembles designed to completely shield responders from radiation.

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Wrap Up Chapter Questions

1. How does a radiation incident differ from a tra- ditional hazardous materials incident?

2. List and define the three primary types of radia- tion.

3. Define and differentiate the terms dose and ex- posure.

4. List and discuss at least five tactical actions at a radiation incident.

5. Discuss basic medical treatment procedures for each of the following radiation exposures:

External radiation exposure – External contamination – Internal exposure –

6. Define the protection principles of time, distance, and shielding.

Chapter Project

There is a major international festival in your commu- nity with 50,000 attendees. A bomb detonation gen- erates 95 trauma casualties. An immediate assessment by the hazardous materials team reveals the explosive device was combined with a radioactive material caus- ing radiation exposure and contamination to 50 victims and 20 responders. Discuss the following questions in detail:

1. What emergency response operational procedures are in effect in your jurisdiction that address this scenario?

2. Based on this chapter, what protocols and oper- ating procedure should be added to community response plans?

3. What role does hospital preparedness play in this incident? Consider that many victims will self-present at hospitals or immediate care cen- ters, which circumvents the traditional EMS system.

4. What are the contamination issues in this inci- dent?

5. What are the state and federal support agencies available for assistance to your locale in a major radiation incident?

Vital Vocabulary

Alpha particles Heavy and energetic radiation particles consisting of two protons; alpha particles interact readily with materials they encounter, including air, causing much ionization in a very short distance. Atom The smallest unit of an element that contains a nucleus of neutrons and protons with electrons orbiting the nucleus. Beta particles Negatively charged radiation particles that weigh a small fraction of a neutron or proton; beta particles travel up to several meters in air, depending on the energy, and are stopped by thin layers of metal or plastic. Dosimeters Radiation measuring instruments that mea- sure radiation over time. Electrons Negatively charged particles that orbit the nucleus of the atom. Gamma rays High-energy radiation rays that travel significant distances; gamma rays can travel from one to hundreds of meters in air and readily travel through people and traditional shielding. Ionization A characteristic of the radiation produced when radioactive elements decay. Neutrons Particles in the nucleus of an atom that are neutrally charged. Photons Bundles of radiation energy in the form of particles or waves. Protons Positively charged particles in the nucleus of an atom. Radiation A natural and spontaneous process by which the unstable atoms of an element emit or radiate excess energy in the form of particles or waves. Radiation-absorbed dose (RAD) Measurement of ab- sorbed radiation energy over a period of time. Radioactivity A characteristic of materials that produce radiation because of the decay of particles in the nucleus. Radiological dispersal device A device using con- ventional explosives to physically disperse radioactive materials over a wide area. Roentgen A unit of radiation exposure. Roentgen equivalent man (REM) A radiation dose that takes into account the type of radiation producing the exposure and is approximately equivalent to the RAD for exposure to external radiation.

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161

Weapons of Mass Effect—Explosives Hank T. Christen Paul M. Maniscalco

• Discuss the significance of explosive devices in terrorism and tactical violence events.

• List the categories of explosives and their characteristics.

• Outline the basic elements in the explosive train.

• Describe the basic initiating elements in explosive devices.

• Outline the critical safety steps that must be utilized when operating in an environment where explosive devices are suspected or present.

Objectives

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162 Homeland Security: Principles and Practice of Terrorism Response

Introduction

One of the first explosives, black powder, was invented by the Chinese in A.D. 600. History has not recorded the first use of explosives for terrorism, but there is little doubt that soon after the invention of black powder, someone used it as a weapon.

Today there are many types of explosives designed for industrial use, military operations, and entertain- ment. All of these explosives are available to people through various means (legal and otherwise) for clan- destine use. Some explosives are made at home with common chemicals using recipes easily accessible to anyone seeking the information.

Explosive devices are effective as weapons of mass destruction or weapons of mass effect for the following basic reasons:

1. Explosives create mass casualties and property destruction.

2. Explosives are major psychological weapons because an explosion instills terror and fear in survivors and the unaffected population.

3. Secondary explosive devices increase the threat level at incidents and complicate law enforce- ment, medical, rescue, and suppression efforts.

4. The charges can be planted for timed or remote detonation.

5. Explosives are easy to obtain or manufacture. There are many historical examples of the ter-

rorist use of explosives. Factions throughout Europe, the Middle East, Asia, and Africa have initiated long- term bombing campaigns. The United States Bomb Data Center reported 2,772 explosive incidents, with 60 injuries and 15 fatalities in 2007. There are several detonations per week and numerous bomb-disarming incidents that are not covered beyond the local media. In the United States, responders experienced the hor- ror of the abortion clinics, World Trade Center, and Oklahoma City explosions. The 1993 bombing of the World Trade Center in New York killed 6, injured 1,042, and caused $510 million in damage. The 1995 bombing of the Murrah Federal Building in Oklahoma City took the lives of 168 innocent people, injured 518 people, and caused $100 million in damage (FIGURE 11-1). Some bombers were able to elude police for years. Theodore Kaczynski, known as the “Unabomber,” killed three

people and injured 22 others with 16 package bombs over a period of 18 years. Eric Rudolph, convicted for the Olympic Park bombing during the 1996 Olympic Games in Atlanta, eluded an intensive law enforcement manhunt until 2003.

There are indications that emergency responders in the United States may see an increase in explosive terror- ism from international and domestic sources. The Internet abounds with information about simple explosives and timing devices that can be made at home. In addition, commercial explosives are readily available, and military explosives are accessible in world black markets.

Explosive Physics

How do explosives function? How do explosives differ? What causes some explosive devices to fail? The answers to these questions fall under the general category of ex- plosives physics (the science of explosives). Explosive physics is important to emergency responders because

FIGURE 11-1 Search and rescue workers gather in the rubble at the Alfred P. Murrah Federal Building on April 26, 1995. The Oklahoma City bombing killed 168.

Explosives are very effective weapons for creating mass casualties and fear.

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the laws of explosive physics kill and injure people and determine whether responders will survive an incident.

An explosive material is a substance capable of rapidly converting to a gas with an extreme increase in volume. This rapid increase in volume causes heat, noise, pressure, and shock waves that travel outward from the detonation. Chemists and physicists note that an explosion is not instantaneous. Academically, they are correct because explosives require several nanoseconds to develop. However, explosions appear as instantaneous to observers. More importantly, significant injury and property damage also occur instantly.

The most damaging by-product of an explosion is the shock wave. The shock wave is a supersonic wave of highly compressed air that originates at the origin of deto- nation, travels outward in all directions and dissipates with distance. It behaves much like ripples on the surface of wa- ter when a pebble is dropped into a pond. The wave travels the course of least resistance, reflects off hard objects such as strong walls or buildings, and becomes concentrated in spaces such as hallways or areas between buildings. Shock waves can be reflected back to the source.

The strength and characteristics of explosives are measured by the speed of the shock waves they produce. Shock wave is measured in feet per second (fps) or me- ters per second. For example, a shock wave traveling at 24,000 fps has a velocity exceeding 16,000 miles per hour. The velocity of detonation determines the dividing line between low explosives and high explosives. A more precise and scientific definition is that a low explosive is one that deflagrates into the remaining unreacted ex- plosive material, at less than the speed of sound. A high explosive is an explosive that detonates into the remain- ing explosive material faster than the speed of sound. Confinement and initiation also affect explosive char- acteristics. For example, black powder, when burned in an open area, will not detonate. However, when black powder is confined in a container such as a pipe bomb, the outcome is very different. The same applies with the initiation of high explosives. When C4 is ignited, it will burn without detonating, but if a shock is introduced to C4 via a blasting cap, there is an explosive detonation.

Explosive detonations also generate extreme heat near the point of origin called a thermal wave. Thermal temperatures are at 1,000 degrees Fahrenheit or more, depending on the type and quantity of explosives. Thermal waves do not travel long distances.

Some explosive shock waves produce a pushing ef- fect. This pushing effect is caused by detonation or de- flagration. Deflagration is a very rapid combustion that is less than the speed of sound. Deflagrating explosives push obstacles and are commonly used for applications

such as quarrying, strip mining, or land clearing. Black powder, smokeless powder, and photoflash powders are examples of deflagrating or low explosives. A de- flagrating effect or low explosive effect is analogous to the pressure felt when standing near deep bass speakers at full volume.

High explosives have a sharp, shattering effect. This shattering effect is called brisance and is comparable to an opera soprano’s high-pitched voice that causes crystal glass to shatter. High explosives are very brisant and pro- duce shock waves greater than the speed of sound. For example, military explosives such as C4 produce a shock wave of 24,000 fps (high brisance) with a very sharp and shattering effect. These explosives cause extensive damage with severe injuries and a high percentage of fatalities.

The devastating effect of land mines or Claymore mines (FIGURE 11-2) is a product of brisance. The shock wave literally pulverizes bone and soft tissue in the lower extremities. In improvised explosive devices (IEDs), the shock wave causes severe pressure injuries (barotrauma), major internal organ damage, head injuries, and trau- matic amputations. A lethal secondary effect is fragmen- tation. Concrete, glass, wood, and metal fragments are expelled at ballistic speeds. The effect causes multiple fatalities and critical injuries.

FIGURE 11-2 Claymore mines cause extensive damage through brisance, the shattering effect of shock waves that move faster than the speed of sound.

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An explosive shock wave creates another effect called blast overpressure. Air in the vicinity of the explosion is compressed and expands, creating a pressure higher than atmospheric pressure. Blast overpressure causes barotrauma damage in the form of air embolisms and damage to tethered organs. Blast overpressure also causes severe structural damage to buildings. A blast pressure of 5 pounds per square inch does not sound high. However, the total impact force is 12,000 pounds on a door that is 30 by 80 inches. The impact force is 57,600 pounds on a wall that is 8 feet high and 10 feet long.

Explosive devices are often designed to produce shrapnel injuries by including objects such as nails, ball bearings, or nuts/bolts embedded in the IED. For example, nails were used in the Atlanta Olympics bombing to cause penetrating injuries. At detonation, these objects become high-speed projectiles causing severe injuries. Evidence of shrapnel injuries, especially from unusual metal objects, may be an indication that an explosion was intentional.

In summary, the physics of explosives explain the ef- fects that kill people and severely damage property. The most damaging by-product is an unseen shock wave that travels very fast. The shock wave causes fragmentation, blast overpressure, and barotrauma injuries.

Types of Explosives

Explosives are designed to detonate with maximum power when initiated, yet be extremely stable when stored or transported. The invention of dynamite was a major breakthrough in explosive technology. Today, dy- namite is the most widely known nonmilitary explosive. The prime ingredient in dynamite is nitroglycerin (nitro), an extremely unstable liquid that detonates violently with even minor shocks. In dynamite, the nitro is mixed with sawdust and other ingredients to stabilize the nitro.

Dynamite is a high explosive that generates a shock wave of 14,000 to 16,000 fps. It is readily available and legally procured in states that issue a blaster’s permit. Quantities of dynamite are stored on construction sites and are frequently stolen (CP FIGURE 11-1). Dynamite is also used in agriculture for digging, land clearing, and stump re- moval. Dynamite is a popular choice for IEDs because of its availability, ease of use, stability, and explosive power.

Black powder and smokeless powder are also popular IED explosives. Powder explosives are easily purchased in small quantities in gun shops that cater to ammunition reloading hobbyists and are frequently used in pipe bombs. Black powder is a deflagrating ex- plosive that detonates with extreme force when stored in a confined container. Pipe bombs were used in the

Atlanta Olympics bombing and in many abortion clinic bombings.

Ammonium nitrate is another common civilian ex- plosive. Ammonium nitrate fertilizer, when mixed with a catalyst, detonates with violent force. This explosive is frequently used in agricultural operations and was used in the Oklahoma City bombing.

Military explosives are extremely powerful, even in small quantities. C4 is the most well-known type of plastic explosive. It is soft, pliable, resembles a block of clay, and can be cut, shaped, packed, and burned with- out detonating. When detonated, C4 explodes violently and produces a very high-speed shock wave. A mere 2 pounds of C4 can totally destroy a vehicle and kill its occupants. C4 is not easily obtained but is illegally available on the black market. Similar plastic explosives are available on foreign markets. Semtex, a military ex- plosive, was used to make the IED that caused the Pan American airplane crash in Lockerbie, Scotland. Other military explosives include trinitrotoluene, tritonal, RDX, and PETN.

All explosives (civilian and military) require an initial high-impact and concentrated shock to cause detonation. A small explosive device called an initiator produces this initiating shock. Initiators are a key step in a chain of events called the explosive train (also called explosive chain) (CP FIGURE 11-2). The most common type of initiator is a blasting cap.

The first step in the explosive train is a source of energy to explode the initiator. This source is usually electrical, but it can be from a thermal source, a mechani- cal source, or a combination of the three sources. The initiator contains a small amount of sensitive explosive such as mercury fulminate. The detonation of the ini- tiator produces a concentrated and intense shock that causes a high-order detonation of the primary explosive. The explosive train is diagramed as follows:

Initiating energy = initiator explosion = main explosive detonation

All elements of the explosive train must function properly for the detonation to occur. Any malfunction or separation of the elements breaks the explosive train, resulting in a failed detonation.

Improvised Explosive Devices

An improvised explosive device (IED) is an explosive device that is not a military weapon or commercially pro- duced explosive device. In essence, IEDs are homemade devices that vary from simple to highly sophisticated.

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When an IED is placed in a vehicle, it is sometimes referred to as a vehicle-borne improvised explosive device. IEDs and vehicle-borne IEDs are often sophis- ticated devices and should not be perceived as simple high school devices constructed from Internet bomb recipes.

Each year thousands of pounds of explosives are stolen from construction sites, mines, military facilities, and other locations. It is not known how much of this material is stolen by terrorists. They can also use com- monly available materials, such as a mixture of ammo- nium nitrate fertilizer and fuel oil, to create their own blasting agents.

Most IEDs are made from smokeless powder or dy- namite. Devices made from C4 or Semtex are rare and usually lead investigators to suspect foreign sources. A crucial element in an IED is a timing device. For many reasons, bomb makers do not want to be present when the device is initiated. Because of security and scope, this text does not cover timing devices in detail. Timers are chemical, electrical, electronic, or mechanical. Simple timers include watches or alarm clocks that close an electrical circuit at a preset time. Electronic timers oper- ate in a similar fashion but are more reliable and precise. Some electronic timers or initiating devices are activated by radio signals from a remote site. In most cases, timers cause electrical energy to be routed from batteries to an initiator (usually an electric blasting cap).

Other devices have no timer and are designed to detonate when civilians or emergency responders trigger the detonation. These devices are called booby traps. A trip wire or mechanical switch initiates the detonation in simple booby trap devices. An explosion occurs when the wire is touched or the device is tampered with. In more sophisticated devices, an invisible beam is inter- rupted by people walking through it, causing the detona- tion. Other high-tech booby traps include light, sound, vibration, pressure, or infrared triggering systems.

Chemical, Nuclear, and Biological IEDs

An IED may be used to initiate a chemical, biological, or radiation event. In these cases, the improvised explo- sive is used to scatter a chemical, biological pathogen, toxin, or radiation source. The history of such devices is

scarce, but increased use of these devices is anticipated. An especially dirty weapon is an improvised nuclear device (IND). In an IND, conventional explosives are used to scatter radioactive materials (see Chapter 10). The device is considered dirty because the radioactive contamination renders an area radioactively hot for possibly thousands of years. An IND does not involve a nuclear explosion like a military nuclear weapon. Presently, there is no history of an IND incident, but the potential is there.

Pipe Bombs

The most common IED is the pipe bomb. A pipe bomb is a length of pipe filled with an explosive substance and rigged with some type of detonator. Most pipe bombs are simple devices made with black or smokeless pow- der and ignited by a hobby fuse. More sophisticated pipe bombs may use a variety of chemicals and incor- porate electronic timers, mercury switches, vibration switches, photocells, or remote control detonators as triggers.

Pipe bombs are sometimes packed with nails or other objects to inflict as much injury as possible on people in the vicinity. A chemical, biological agent, or radiological material can be added to a pipe bomb to create a more complicated and dangerous incident.

Suicide Bombings

Suicide bombings are an effective terrorism tactic used throughout the world. Suicide explosive devices can be concealed in a vehicle (FIGURE 11-3) or on an individual (CP FIGURE 11-3). There is no common age or ethnic profile for suicide bombers. In recent years, women have joined their ranks. Precautionary suicide bombing surveillance and protective measures include:

1. Look for signs of suspicious behavior. 2. Note unusual dress such as coats in the sum-

mer. 3. Control vehicle entry into critical areas. 4. Avoid directly approaching suspicious people or

vehicles—call for help.

Improvised explosive devices vary in the type of explo- sive, form of initiation, and degree of sophistication.

Conventional explosives can be used to disperse bio- logical, chemical, and radiological agents.

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Secondary Devices

High threats to emergency responders are second- ary devices (review Chapter 6, “Terrorism Response Procedures”). Secondary devices are timed devices or booby traps that are designed and placed to kill emer- gency responders. The initial objective is to create an emergency event, such as a bombing or fire that gener- ates an emergency response. After first responders arrive on the scene, the secondary device explodes and causes more injuries than the original event. A secondary device in a trash bin exploded after EMS, fire, and law enforce- ment responders arrived in one of the Atlanta abortion clinic bombings. In the Columbine High School shoot- ing, multiple devices scattered throughout the school greatly restricted the tactical operations of EMS units and special weapons and tactics teams.

Secondary devices can be used to create an entrap- ment situation. Responders must beware of a situation that lures responders into narrow areas with only one escape route. A narrow, dead-end alley is a classic ex- ample. An incident such as a fire or explosion at the end of the alley is the initial event that causes emergency responders to enter the area. The secondary device (a booby trap or timed IED) is placed in the alley. When the IED detonates, there is only one narrow escape route that lies in the path of a concentrated shock wave.

A key to surviving an entrapment situation is to recognize the scenario by surveying the overall scene. A narrow focus (called tunnel vision) obscures the big pic- ture. Responders should maintain situational awareness and not concentrate on a small portion of the incident

scene. Responders must look for trip wires, suspicious packages, and objects that appear to be out of place. Trash containers or abandoned vehicles may contain a secondary device. Responders should question bystand- ers familiar with the area if possible and enter suspicious areas by an alternate route.

Safety Precautions

Many of the safety precautions for explosive devices were discussed in Chapter 6. Several safety steps bear repeti- tion, including the following:

1. Avoid radio transmissions within at least 50 feet of a suspected device. Electromagnetic radiation from radio transmissions can trigger an electric blasting cap or cause a sophisticated device to detonate. The 50-foot distance is based on U.S. Air Force procedures; local protocols may exceed this distance.

2. Avoid smoking within 50 feet (or further) from a suspicious device.

3. Do not move, strike, shake, or jar a suspicious item. Do not look in a suspicious container or attempt to open packages.

4. Memorize and later note clear descriptions of suspicious items.

5. Establish an outside hot zone of at least 850 feet around small devices and at least 1,500 feet around small vehicles (TABLE 11-1). (Large zones may not be practical in congested urban areas.) Maintain the required hot zone until bomb tech- nicians advise otherwise.

6. Stay upwind from a device because explosions create toxic gases.

7. Take advantage of available cover such as ter- rain, buildings, or vehicles. Remember that shock waves bounce off surrounding obstacles.

FIGURE 11-3 Members of the force protection team at Camp Eggers, Afghanistan, assess damage resulting from an explosion near the gate. A vehicle-borne improvised explosive device exploded near the German Embassy and a U.S. base.

Beware of secondary devices. Avoid tunnel vision by carefully surveying the entire incident scene.

Bomb technicians are the only personnel qualified to clear an area or remove/disarm an explosive device.

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Basic Search Techniques

Emergency responders often conduct primary searches or assist bomb experts in conducting a thorough search for explosive devices. Remember that emergency re- sponders are not trained to clear an area of explosive devices; only bomb technicians perform this function.

In building searches, responders always search from the outside in. Building occupants are an excel- lent source of information because they know what ob- jects are supposed to be in a given location. Occupants can tell responders that a trash basket has always been there or that a paper bag is someone’s lunch. Likewise, building occupants can state that the innocent looking newspaper machine was never there before. Custodians can assist in unlocking areas and pointing out obscure storage areas in building interiors.

The search team searches from the floor to the ceil- ing. Often objects above or below eye level are unseen. Responders should make a floor-level sweep, followed by an eye-level sweep, and finally a high wall and ceiling sweep.

Searchers begin vehicle searches from the outside (just like buildings). If the driver is present, they assign one per- son to distract the driver from observing advanced search techniques. They leave the trunk and doors closed and concentrate on the outside. They must avoid touching the vehicle because touching can activate motion switches. Only trained technicians should open the vehicle. If the driver is present, he or she should open doors, the trunk, and dash compartments.

Responders must always emphasize the safety precau- tions previously discussed in this chapter. First, they must establish a hot zone and ex- ercise effective scene control, and then wait for experienced bomb technicians before tam- pering with a device or search- ing the interior of a vehicle.

Tactical Actions • Call for immediate assistance and give a brief

description of the device including location, general appearance, type/size and time/method of detonation if known. This information should be obtained only from a safe position and distance.

• Evacuate the area in accordance with evacua- tion guidelines in Table 11-1.

• Maintain a security perimeter. • Never touch, remove, or examine a suspected

explosive device. • Do not touch or search suspicious vehicles. • Maintain situational awareness; look for sec-

ondary devices from a distance. • Follow instructions from bomb experts.

TABLE 11-1 Terrorist Bomb Threat Stand-off

Courtesy of NCTC.

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Chapter Summary

The use of explosives for terrorism goes back many cen- turies. Explosive devices are very effective weapons of mass effect. Bombings create mass fatalities and casualties. Bombs are also effective psychological weapons because they create fear in survivors and the community at large.

An explosive is a material that converts to a gas al- most instantly when detonated. This detonation creates a shock wave, which is a measure of the explosive power of a given material. In a low-order detonation, a shock wave travels through the remainder of the unexploded material at a speed less than the speed of sound. High order explosives create shock waves greater than the speed of sound. High explosives have a sharp, shattering effect called brisance.

There are many types of explosives, with black pow- der being the earliest type. Black powder has consider- able explosive force when confined in a device such as a pipe bomb. The first commercial type of explosive was dynamite, which produces a shock wave of 14,000 to 16,000 fps. Ammonium nitrate (fertilizer), when mixed with a catalyst, is a low-order explosive. Military explo- sives are extremely powerful and have high brisance, which creates shock waves as fast as 24,000 fps.

IEDs are homemade weapons that contain an ex- plosive material, a power source, and a timer. The explosives are usually dynamite or black powder. The timing devices can be chemical, electrical, or elec- tronic. Special devices called booby traps contain a triggering mechanism such as a trip wire. Booby traps are secondary devices designed to injure emergency responders.

Secondary devices are effective in entrapment situa- tions where a device is concealed in a narrow area such as an alley with no escape route. A key prevention step is to survey the entire scene before entry and look for trip wires or other initiation devices.

Key safety steps in an unsecured area are: • Avoid radio transmissions or smoking within

50 feet of a suspected device. • Do not move, strike, or jar a suspicious item. • Establish a hot zone 500 feet around a small

device and 1,000 feet around a large device or vehicle. (These distances may not be practical in urban areas.)

Emergency responders often assist in searching an area for suspicious devices. Bomb disposal experts are the only personnel who can clear an area or safely re- move an explosive device.

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Wrap Up Chapter Questions

1. Name three reasons why explosives are effective weapons of mass destruction or weapons of mass effect.

2. Define and discuss the most damaging product of an explosion.

3. What is blast overpressure? What are the injury and damage effects of blast overpressure?

4. Name and briefly describe at least three types of explosives.

5. List four types of explosive timers. 6. List and discuss safety precautions relating to

secondary explosive devices. 7. What is the role of emergency responders in a

basic search for explosive devices?

Chapter Project I

Research the previous year’s history of explosive attacks in the United States. Ascertain trends in the types of ex- plosives used and their effectiveness (casualties). Include the primary motives for major attacks. What was the number of explosive detonations in the United States last year? (Note—sources can include publications, news articles, or Web sites for the Bureau of Alcohol, Tobacco, Firearms and Explosives, Federal Bureau of Investigation, Department of Justice, and other law en- forcement sources.)

Chapter Project II

Develop a standard operating procedure for an explo- sive device response for your agency. Include tactical procedures, safety, evacuation policies, and procedures for coordinating response actions with bomb disposal experts.

Vital Vocabulary

Ammonium nitrate A common civilian deflagrating explosive that detonates with great force when mixed with a catalyst.

Black powder A deflagrating explosive that detonates with extreme force when stored in a confined con- tainer.

Blast overpressure Air in the vicinity of an explosion is compressed and expands, creating a pressure higher than atmospheric pressure that causes barotrauma dam- age in the form of air embolisms and damage to tethered organs as well as structural damage to buildings.

Brisance A sharp and shattering effect produced by an explosive.

C4 A military explosive with high brisance.

Deflagration A very rapid combustion that is less than the speed of sound.

Dynamite A high explosive that generates a shock wave of 14,000 to 16,000 fps.

Explosive train A chain of events that initiate an ex- plosion.

Improvised explosive device (IED) An explosive device that is not a military weapon or commercially produced explosive device.

Improvised nuclear device (IND) An improvised ex- plosive used to scatter a chemical, biological pathogen, toxin, or radiation source.

Pipe bomb A length of pipe filled with an explosive substance and rigged with some type of detonator.

Secondary device Timed device or booby trap that is designed and placed to kill emergency responders.

Shock wave A supersonic wave of highly compressed air that begins at the origin of detonation, travels out- ward in all directions, and dissipates with distance.

Thermal wave A short-distance extreme heat wave near an explosive point of origin.

Vehicle-borne improvised explosive device An ex- plosive device that is not a military weapon or commer- cially produced explosive device and is placed inside a vehicle.

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Mass Casualty Decontamination Paul M. Maniscalco Andrew Wordin Hank T. Christen

• List the four stages of decontamination.

• Describe several methods used by fire departments for gross decontamination.

• Recognize several considerations for setting up a decontamination area.

• Discuss the general principles of hospital decontamination.

• Outline the principles of mass casualty decontamination.

• Recognize the decontamination requirements for various agents.

• List features of biological agents that affect decontamination for biological agents.

• Describe weather factors that affect decontamination.

• Discuss considerations in local protocols for the establishment of triage procedures for contaminated victims.

Objectives

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172 Homeland Security: Principles and Practice of Terrorism Response

Introduction

Decontamination is defined as the process of removing or neutralizing a hazard from the environment, prop- erty, or life form. According to the Institute of Medicine National Research Council, the purpose of decontamina- tion is to prevent further harm and enhance the poten- tial for full clinical recovery of persons or restoration of infrastructure exposed to a hazardous substance.

This chapter is an overview of the subject matter and provides emergency responders with a macroview of the decontamination strategies, science, and operational/ tactical processes. Military decontamination principles are discussed because in many communities, emergency responders frequently train, exercise, and respond with military fire departments, the National Guard, and active military units. For example, in the Fort Walton Beach, Florida area, the Okaloosa County Special Operations Unit commonly responds with U.S. Air Force fire departments from Hurlburt Field and Eglin Air Force Base. It is impor- tant that civilian emergency responders understand the basic language and principles of military decontamination and the differences between military and civilian practices. It is also important to consider that the Environmental Protection Agency, and later the Occupational Safety and Health Administration, initially designed civilian decontamination standards as safe worksite procedures. Civilian procedures did not consider terrorism agents until NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction, was adopted. Decontamination has evolved into an impor- tant and highly technical function that surpasses the old simple mantra of “the solution to pollution is dilution.” Responders are advised that there are additional sources and educational opportunities that provide greater depth, cognitive ability, and operational competency for decon- tamination operations—especially at large incidents with unusual substances as the physical offender.

This chapter focuses on mass casualty decontamina- tion and discusses these areas:

• The traditional decontamination process used by fire departments and hazardous material re- sponse teams

• The decontamination capabilities of hospitals or healthcare facilities

• Military types of decontamination • Methodology and principles applied to a mass

casualty incident resulting from weapons of mass effect or an accidental release of a harmful substance

• Containment procedures • Mass casualty decontamination, including de-

contamination requirements for victims with conventional injuries

• Site selection and environmental, weather, and responder requirements during the decontami- nation process

Basic Principles of Decontamination

The management and treatment of contaminated casu- alties varies with the situation and nature of the con- taminant. Quick, versatile, effective, and large-capacity decontamination is essential. Responders must not force casualties to wait at a central point for decon- tamination. Decontamination of casualties serves two purposes; it prevents their systems from absorbing ad- ditional contaminants, and it protects healthcare pro- viders and uncontaminated casualties from becoming cross-contaminated. Review of after-action reports and videotapes of the Tokyo subway incident in 1995 em- phasizes this requirement.

The four types of decontamination, as defined in NFPA 472, are emergency, mass, gross, and technical. Emergency decontamination focuses primarily on the rapid removal of most of the contaminated material from an exposed individual. Mass decontamination is the emergency removal of contamination quickly from large numbers of victims. Commonly, fire fighters use fire- fighting hose lines or mounted appliances off an engine company to form a mass decontamination corridor and move victims into the flowing water to begin the washing process. This decontamination tactic is useful with large numbers of ambulatory victims. Ladder companies can also set up showers for large numbers of victims. Shower systems with provisions for capturing contaminated wa- ter runoff are commercially available and may provide a degree of victim privacy in a decontamination corridor. These systems also provide a method to decontami- nate nonambulatory victims. Gross decontamination is performed in a decontamination corridor by trained and certified responders after emergency teams exit a hazardous environment. Technical decontamination (FIGURE 12-1) is part of the gross decontamination process and is a thorough cleaning procedure usually performed with cleaning materials and scrubbing equipment after individuals have been prewashed. Technical decontami-

Life-threatening medical conditions are priorities that should be addressed before decontamination when such treatment does not threaten the safety of medi- cal practitioners.

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nation also involves the cleaning of equipment used by the entry teams. There are other forms of decontamina- tion restricted to the hospital setting that are beyond the scope of this text.

Emergency decontamination is less common than gross decontamination because emergency decon- tamination is typically performed by first responders or hazardous material teams who encounter contami- nated victims. Self-decontamination and team de- contamination may be part of emergency or gross decontamination.

Note that the main limitations when performing de- contamination are availability of equipment and person- nel. For example, an effective decontamination corridor requires personal protective equipment (PPE) for the decontamination team, a water supply, victims’ clothing bags, privacy facilities (if possible), cleaning materials, scrubbing equipment, and replacement clothing such as disposable garments or scrubs. Decontamination requires trained personnel to direct individuals to the decontamination corridor, perform decontamination procedures, and direct victims to other areas.

Fire departments are equipped and structured for rapid and effective emergency decontamination (FIGURE 12-2). In some communities, law enforcement and EMS agencies are also trained and equipped to perform de- contamination. Many fire departments have developed procedures that use existing equipment to perform de- contamination. A common practice is using two engines

parked 20 feet apart with an aerial ladder positioned over the top. The aerial ladder can have a water supply spraying from an overhead fog nozzle or it can have tarps suspended from the ladder for male and female separa- tion and privacy. Hand lines, fog nozzles, and/or engine discharges are supplied with water with low pressure (60 pounds per square inch). This is important to avoid causing additional pain to victims or forcing chemicals into the skin from the water pressure. In most cities, common hydrant pressure is sufficient to supply water to the hand lines, fog nozzles, and side discharge gates. Decontamination crews do not commonly use engine pumps to boost pressure. Hydrant pressure is usually satisfactory. Additionally, engine pumps add unneeded noise to an already chaotic environment.

Stages of Decontamination Mass Decontamination

Mass decontamination calls for the following steps: 1. Evacuate the casualties from the high-risk area

(FIGURE 12-3). With limited personnel available to conduct work in the contaminated environ- ment or hot zone, a method of triage needs to be established. First, decontaminate those victims who can self-evacuate or evacuate with mini- mal assistance to decontamination sites, then decontaminate individuals who require more assistance.

2. Remove the exposed person’s clothing. It is es- timated that the removal and disposal of cloth- ing remove 70 to 80 percent of the contaminant (Cox, 1994); others estimate 90 to 95 percent (NATO, 1991).

3. Perform a 1-minute, head-to-toe rinse with water.

FIGURE 12-1 Technical decontamination is a more thorough cleaning pro- cess that often involves the use of specific tools and equipment including brushes and chemical-specific cleaning solutions.

FIGURE 12-2 Fire departments are equipped and structured for rapid and effective emergency decontamination.

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Gross/Technical Decontamination

Gross decontamination requires the following steps: 1. Perform a quick, full-body rinse with water for

nonwater-reactive contaminants (FIGURE 12-4). Remove water-reactive substances by dry decon- tamination using air pressure or dry wipes.

2. Wash rapidly with a cleaning solution from head to toe. A fresh solution (0.5 percent) of sodium hypochlorite is an effective decontamination so- lution for persons exposed to chemical or bio- logic contaminants. Undiluted household bleach is 5.0 percent sodium hypochlorite. Plain water is equally effective because of ease and rapidity of application. With certain biological agents, the sodium hypochlorite solution may require more than 10 minutes of contact. This is not pos- sible in a mass casualty incident requiring rapid decontamination.

3. Rinse with water from head to toe. 4. Monitor the victim for signs of further contamina-

tion. If meter readings indicate contamination or victim symptoms are found or develop, have the

victim continue to secondary decontamination to ensure the contaminants are cleaned from the victim.

Definitive Decontamination

In definitive decontamination, complete the following steps:

1. Perform a thorough head-to-toe wash until the victim is clean. Rinse thoroughly with water.

2. Dry the victim and have him or her don clean clothes (FIGURE 12-5).

Methods of Initial Decontamination A first response fire company can perform gross decon- tamination by operating hose lines or master streams with fog nozzles at reduced pressure. The advantage of this is that it begins the process of removing a high percentage of the contaminant in the early stage of an incident. The fire company must address methods to provide privacy and decontamination for nonambula- tory casualties.

To set up decontamination procedures, consider- ations include:

1. Prevailing weather conditions (temperature, precipitation, etc.), which affect site selection, willingness of the individual to undress, and the degree of decontamination required.

2. Wind direction. 3. Ground slope, surface material, and porosity

(grass, gravel, asphalt, etc.). 4. Availability of water. 5. Availability of power and lighting.

FIGURE 12-3 Direct victims out of the hazard zone and into a suitable location for decontamination.

FIGURE 12-4 Flush victims with water from head to toe. FIGURE 12-5 Dry victims and direct them to don clean clothes.

The stages of decontamination are emergency, mass, gross, and technical.

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6. Proximity to the incident. 7. Containment of runoff water if necessary or fea-

sible. The Department of Mechanical and Fluid Engineering at Leeds (U.K.) University has de- termined that if a chemical is diluted with water at the rate of approximately 2000:1, pollution of water courses will be significantly reduced (Institute of Medicine Research Council, 1998). Examples of containment devices or methods include children’s wading pools, portable tanks used in rural firefighting, hasty containment pits formed by tarps laid over hard suction hoses or small ground ladders, and dikes with loose earth or sandbags covered with tarps. Remember that NFPA 472 does not mandate material contain- ment at emergency incidents.

8. Supplies, including PPE and industrial-strength garbage bags.

9. Clearly marked entry and exit points with the exit upwind and uphill, away from the incident area.

10. A staging area at the entry point for contaminated casualties. This is a point where casualties can be further triaged and given self-decontamination aids, such as spray bottles with a 0.5 percent so- lution of sodium hypochlorite or a solution of fuller’s earth.

11. Access to triage and other medical aid upon exit, if required.

12. Protection of personnel from adverse weather. 13. Privacy of personnel. (Decontamination is a media-

intensive event where clothing removal by vic- tims occurs in public, such as the B’nai B’rith incident, Washington, DC, 1997).

14. Security and control from site setup to final cleanup of the site.

Decontamination and Triage In a mass casualty event, decontamination of chemi- cally exposed victims must be prioritized before triage is performed. The objective is to first decontaminate salvageable victims who are in immediate need of medi- cal care. Deceased victims should not be immediately decontaminated. Victims who are ambulatory and non- symptomatic are the lowest decontamination priority. Again, the primary objective is to immediately decon- taminate exposed, salvageable victims.

The U.S. Army Soldier and Biological Chemical Command (SBCCOM) published a guide in January 2000 called Guidelines for Mass Casualty Decontamination During a Terrorism Chemical Agent Incident. The SBCCOM guidelines suggest that casualties are determined using several factors when assigning decontamination and tri- age priorities. First, casualties closest to the point of re- lease should be top priority. Second, casualties exposed to vapor or aerosol should be next priority. Those with liquid deposition on their clothing or their skin are the third priority. Finally, casualties with conventional in- juries should come last. Note that life-threatening medi- cal conditions are treated before decontamination and remember that civilian responders are not subject to the SBCCOM guide.

The major factor in triage in hazardous environ- ments is the criteria for determining where or when not to treat/decontaminate a nonambulatory victim who is symptomatic. Emergency response agencies must adopt a local protocol that should be based on the following issues:

• The nature of the incident. Severe exposure to nerve agents with major symptoms usually re- sults in death.

• Sufficiency of antidotes available. For example, nerve agents require very high doses of atro- pine and valium (for seizures).

• Available personnel for moving and treating mass numbers of nonambulatory victims. A single nonambulatory victim requires two to four responders.

• Ambulatory victims who are symptomatic or were severely exposed. These victims should be im- mediately decontaminated.

• Ambulatory victims who are nonsymptomatic. These victims should be moved to the minor treatment area for possible clothing removal and medical evaluation.

• Nonambulatory victims. These victims should be evaluated in place while further prioritization for decontamination occurs.

• Victims in respiratory arrest, grossly contaminated with a liquid nerve agent, having serious symptoms, or failing to respond to atropine injections. These victims should be considered as critical (red tri- age level) and closely monitored for changes in status. If one of these victims dies on the scene, the victim’s triage tag is updated (red to black) to reflect deceased.

• Extreme cases that require treating a victim in a hot zone prior to decontamination. Treatment usually consists of immediate antidote administration

First decontaminate victims who are severely exposed, yet salvageable.

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and airway maintenance. Clothing removal is the only expedient method of field decontami- nation, with decontamination by showering or flushing later, if appropriate.

Hospital Decontamination Standards The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to be prepared to respond to disasters including hazardous materials accidents. The majority of hospitals that have decontami- nation capabilities utilize existing indoor infrastructure and do not have the ability to expand to accommodate mass casualties. Outside the standard universal protec- tion procedures followed by the medical community, required protective equipment and trained personnel are limited in most hospital systems.

A common hospital practice, especially in subur- ban or rural areas, is to call the fire department for a hazardous materials response. Some hospitals may have in-house decontamination teams that do not require fire department assistance. Due to the stress placed on the response system mitigating the effects of a large inci- dent, hazardous materials teams will not be available. Hospitals that depended on fire departments are at risk when the response system is stressed to the point that victims start self-referring or independent sources de- liver victims to the hospital.

The military has identified two types of decontam- ination—personnel and equipment. It has divided per- sonnel decontamination into two subcategories—hasty and deliberate. Specialized units within the military (U.S. Marine Corps Chemical Biological Incident Response Force and the National Guard’s Civil Support Teams) have further subdivided deliberate decontamination to encompass ambulatory and nonambulatory personnel.

Hasty decontamination is primarily focused on the self-decontaminating individual using the M258A1 skin decontamination kit. This kit is designed for chemical decontamination and consists of wipes containing a so- lution that neutralizes most nerve and blister agents. Another type of kit, the M291 decontamination kit, uses laminated fiber pads containing reactive resin, which neutralizes and removes the contaminant from a sur- face by mechanical and absorption methods. These kits require user training and are not usually available for civilian emergency response organizations.

The procedure of removing and exchanging (don- ning and doffing) personal protective clothing is also considered a component of hasty decontamination. Deliberate decontamination is required when indi- viduals are exposed to gross levels of contamination or for individuals who were not dressed in personal protective clothing at the time of contamination. The established process is to completely remove the indi- vidual’s clothing, apply a decontamination solution (0.5 percent sodium hypochlorite or water) followed by a fresh water rinse, then use a chemical agent monitor (CAM) to detect the presence of nerve and blister agents or M8 paper to validate the thoroughness of the decon- tamination process. If the CAM or M8 paper detects the presence of a chemical agent, the victim must be put through the decontamination process again. At the end of this process, the individual is provided replace- ment clothing and PPE if appropriate. If the individual presents symptoms, he or she will be processed through the healthcare system.

Decontamination Site Setup The decontamination site should be established with the following considerations:

1. Upwind from the source of contamination 2. On a downhill slope or flat ground with provi-

sions made for water runoff 3. Water availability 4. Decontamination equipment availability 5. Individual supplies 6. Healthcare facilities 7. Site security

Mass Casualty Decontamination Specialized military units have developed rapidly de- ployable personnel decontamination facilities that pro- cess large numbers of contaminated personnel, both ambulatory (FIGURE 12-6) and nonambulatory (FIGURE 12-7). These systems are portable and capable (agent dependent) of processing up to 200 ambulatory or 35 nonambulatory personnel per hour depending upon the agent(s) involved. The facilities are incor- porated in tents or inflatable enclosures that utilize a shower system that sprays a decontaminant, followed by a rinse.

Step one of this process is removal of the victim’s clothing. Ambulatory victims use a process similar to that used by military personnel during their doffing pro- cedures. Nonambulatory casualties’ clothing is cut off by decontamination specialists.

Step two is to place clothing into disposable bins, which are sealed.

The Joint Commission, an entity for hospital accredita- tion, requires hospitals to have decontamination pro- cedures and equipment.

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Step three is to remove personal effects, tag them, and place them into plastic bags. Disposition of the per- sonal effects will be determined later. These items may be crime scene evidence.

Step four is to apply a decontamination solution. For ambulatory casualties, this is done through a shower system. Nonambulatory casualties are rinsed and sponged down.

Step five is for individuals to use brushes to clean themselves or for a decontamination specialist to do so for nonambulatory victims. This step aids in the removal of the contaminant and allows for a 3-minute contact time for the decontaminating solution.

Step six is a freshwater rinse. Step seven is to monitor for the agent or contaminant.

This is conducted using a CAM or M8 paper for chemical agents, or using a radiation meter for radiation.

Step eight is to don dry clothing. Step nine is medical monitoring. Individual docu-

mentation is developed. Step ten provides for individuals’ release or trans-

port to a medical facility. Both ambulatory and nonambulatory victims follow

these steps, but while ambulatory victims can complete most steps unassisted, nonambulatory victims are moved along a series of rollers and cleaned by decontamination specialists. Care must also be taken at the nonambula- tory site to decontaminate the roller surface with a 5 per- cent solution of sodium hypochlorite between victims. These sites are self-contained, require a water source, and provide the following:

• Heated water (if required; warm water opens the pores of the skin and could accelerate der- mal exposure)

• Water runoff capture • Decontamination solution • Protection from the elements • Privacy • Continuous medical monitoring during the de-

contamination process • Postdecontamination checks • Clothing • Site control The specialized decontamination assets just de-

scribed are from prepositioned military units and are not usually available for rapid response to civilian incidents. These units are highly competent and professional, but they are limited by numbers and location. The military re- fers to them as low-density, high-demand assets. The U.S. Public Health Service has developed a similar capability resident in the Metropolitan Medical Response System and the National Disaster Medical Response Teams.

FIGURE 12-6 A mass decontamination configuration for an ambulatory victim.

FIGURE 12-7 A mass decontamination configuration for a nonambulatory victim.

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Radiation Decontamination Radiation injuries do not imply that the casualty presents a hazard to healthcare providers. Research has demon- strated that levels of intrinsic radiation present within the casualty from activation (after exposure to neutron and high-energy photon sources) are not life threatening. If monitoring for radiation is not available, respond- ers must conduct decontamination for all casualties. Removal of the casualty’s clothing reduces most of the contamination, with a full-body wash further reducing the contamination.

Wearing surgical attire or disposable garments such as those made of Tyvek reduces the potential exposure of healthcare providers. Inhalation or ingestion of par- ticles of radioactive material presents the greatest cross- contamination hazard. Responders must minimally don filter respirators to mitigate this inhalation and ingestion threat. They must take care to capture runoff or retrieve the material. Industrial vacuum cleaners are commonly used. The vacuum cleaner should use a high-efficiency particulate air filter to prevent rerelease of the material into the air.

Decontamination Requirements for Various Agents Decontamination requirements differ according to the type of chemical agent or material to which individuals were exposed. Water is the accepted universal decon- taminant for nonwater-reactive materials. The importance of early decontamination cannot be overemphasized due to the mechanism of injury with organophosphorous compounds (nerve agents). Nerve agents are absorbed through any surface of the body. Decontamination of the skin must be accomplished quickly to limit effects of the agent. Liquid agents may be removed using fuller’s earth. Persistent nerve agents pose the greatest threat to healthcare providers. Once a victim is decontaminated or the agent is fully absorbed, there is a limited risk of cross contamination to responders.

Responders do not always notice exposure to a vesi- cant (blister agent) immediately because of the latent effects of the agent. This may result in delayed decon- tamination or failure to decontaminate at all. Mucous membranes and eyes are too sensitive to be decon- taminated with normal skin decontaminant solutions. Vesicants have an oily consistency and are persistent

in the environment. Affected sensitive surfaces should be flushed with copious amounts of water, or, if avail- able, isotonic bicarbonate (1.26 percent) or saline (0.9 percent). Physical absorption, chemical inactivation, and mechanical removal should decontaminate skin. Chemical inactivation using chlorination is effective against mustard and lewisite and ineffective against phosgene oxime. If water is used, it must be used in copious amounts. If the vesicant is not fully removed, the use of water will spread it.

Choking agents do not remain in liquid form long due to their extremely volatile physical properties. Decontamination is not required except when used in very cold climates. Choking agents are readily soluble in organic solvents and fatty oils. In water, choking agents rapidly hydrolyze into hydrochloric acid and carbon dioxide.

Blood agents do not remain in liquid form very long due to their extremely volatile physical properties. Decontamination is not required.

In the case of incapacitants, responders complete total skin decontamination with soap and water at the earliest opportunity. Symptoms may appear as late as 36 hours after a percutaneous exposure, even if the individual is decontaminated within 1 hour of exposure.

Responders should move personnel exposed to riot control agents to fresh air, separate them from other casualties, facing into the wind with their eyes open, and tell them to breathe deeply. Exposed individuals should remove their clothes, which should be washed to preclude additional exposure from embedded residue.

Biological Agents Biological agents are unique in their ability to inflict large numbers of casualties over a wide area by virtually untraceable means. The difficulty in detecting a biologi- cal agent’s presence prior to an outbreak; its potential to selectively target humans, animals, or plants; and the difficulty in protecting the population conspire to make management of casualties (including decontamination) or affected areas particularly difficult. The intrinsic fea- tures of biological agents that influence their potential use and establishment of management criteria include virulence, toxicity, pathogenicity, incubation period, transmissibility, lethality, and stability.

Early decontamination is critical for severe exposure to nerve agents.

Vesicant contamination may not be immediately noticed.

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If a dermal exposure is suspected, it should be managed by decontamination at the earliest opportu- nity. Exposed areas should be cleansed using the ap- propriately diluted sodium hypochlorite solution (0.5 percent) or copious quantities of plain soap and water. The victim’s clothing should also be removed as soon as possible.

Secondary contamination of medical personnel is a concern and is avoided by strict adherence to universal medical precautions. Biological agents, for the most part, are highly susceptible to environmental conditions, and all but a few present a persistent hazard.

Anthrax is a very stable agent; however, in a nonaero- solized state it presents only a dermal (requiring breaks or cuts in the skin) or ingestion hazard. The strategy rec- ommendations for potential exposure to anthrax are:

1. Gather personal information from the potentially exposed individual(s).

2. Explain the signs and symptoms of the disease. 3. Give victims a point of contact to call if they

show symptoms. 4. Send victims home with the following instruc-

tions: remove clothing and place it in a plastic bag, securing it with a tie or tape. Shower and wash with soap for 15 minutes.

5. Inform exposed individuals of the lab analysis results of the suspected agent as soon as possible. If results are positive, the correct medical protocol will be administered.

Effects of Weather on Decontamination Weather impacts the manner in which an agent will act in the environment and will have an impact on decon- tamination requirements. A release of chemical agents or toxic industrial materials always has the potential to cause injuries to unprotected people proximal to the point of release. Strong wind, heavy rain, or tempera- tures below freezing may reduce effects. Weather is of importance for the respiratory risks expected at different distances from the point of release. Weather conditions also influence the effect of ground contamination.

High wind velocity implies a short exposure time in a given area, reducing the number of casualties in an unprotected population. Low wind velocity increases the exposure time, increasing the number of casualties, and may cause effects at a greater distance.

To a high degree, the gas/aerosol concentration in the primary cloud depends on the air exchange or tur- bulence of the atmosphere. In clear weather, at night, the ground surface is cooled and inversion is formed (stable temperature stratification). Inversion leads to weak turbulence, resulting in the presence of a high concentration of material. Unstable temperature stratifi- cation occurs when the ground surface warms, resulting in increased turbulence. The effect is decreased con- centration, particularly at increased distances from the point of release.

The concentration in the primary cloud may also decrease in cold weather, particularly at temperatures below –20°C (–4°F), due to a smaller amount of agent(s) evaporating during dispersal. However, this will in- crease ground contamination at the point of release. Precipitation also reduces concentration but can increase ground contamination.

Low temperatures will increase the persistency of some agents. Some agents may cease to have an effect at very low temperatures due to their freezing point; how- ever, they present a problem when temperatures increase or if they are brought into a warm environment.

Biological agents are potential weapons of mass de- struction and generally have the following characteris- tics: they are odorless and tasteless, difficult to detect, and can be dispersed in an aerosol cloud over very large downwind areas. Ideal weather conditions for dispersal include an inversion layer in the atmosphere, high rela- tive humidity, and low wind speeds. Incubation periods can be as long as several days; therefore, wind speed and direction are a primary weather concern to determine the exposed population and predict the effects upon that population. Ultraviolet light has a detrimental effect on many biological agents, making periods of reduced natural sunlight the optimal time for release.

Most biological agents will not survive in extremely cold weather and it is difficult to aerosolize live biological agents in freezing temperatures. Toxins are less affected by cold weather; however, cold weather tends to provide a temperature inversion that prolongs the integrity of an aerosolized cloud.

Chapter Summary

A common-sense, well-informed approach to decon- tamination should be adopted. The following are ad- ditional considerations for decontamination operations in a mass casualty setting:

1. Establish a local protocol for decontamination and triage.

Weather is an important determination in the effec- tiveness of a chemical attack.

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180 Homeland Security: Principles and Practice of Terrorism Response

2. Decontaminate as soon as possible to stop the absorption process.

3. Establish multiple decontamination corridors including one for men, one for women, and one for families.

4. Establish security and control measures to con- tain contaminated casualties and prevent non- contaminated individuals/nonresponders from entering the affected area.

5. Decontaminate only when it is required. 6. Decontaminate as close to the point of contamina-

tion as possible (100 m or 328 ft outside, if the point of contamination was inside a building; 1 km (0.6 miles) for an outside release.

7. Involve the victim in the process, allowing as much self-decontamination as possible.

8. Use existing infrastructure as needed. 9. Continuously monitor the victims throughout the

process. 10. Provide privacy if possible with use of tents, avail-

able facilities, and/or removal of the media.

Organizations that have potential requirements to provide decontamination support for a mass casualty incident should focus on existing inherent capabilities. With modifications and enhanced training, a good, thorough decontamination system can be effectively implemented.

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Wrap Up Chapter Questions

1. List and discuss the three stages of decontami- nation.

2. Discuss at least five considerations for setting up a decontamination area.

3. Discuss lockdown procedures for controlling entry of contaminated victims at medical facili- ties.

4. Outline the 10 steps in mass casualty decon- tamination.

5. Outline triage procedures for mass casualty decontamination.

6. What factors determine the severity or effective- ness of a given biological agent?

7. How do the following weather elements influence the effects of a weapon of mass effect agent? • Wind direction and speed • Temperature • Atmospheric stability

Chapter Project

1. Develop a mass decontamination procedure for your community. Consider training, equipment, protocols, and triage procedures.

2. Develop a mass decontamination plan for a medi- cal facility. Consider security and lockdown, training, equipment, and control of contaminated vehicles.

Vital Vocabulary

Decontamination The process of removing or neutraizing a hazard from the environment, property, or life form.

Deliberate decontamination Type of decontamination that is required when individuals are exposed to gross levels of contamination or for individuals who were not dressed in personal protective clothing at the time of contamination. Emergency decontamination Actions taken by first responders to establish and perform decontamination operations for victims in a field setting. Gross decontamination The process of removing cloth- ing and flushing the affected area with water as quickly as possible to reduce contamination by a chemical or infectious agent. Hasty decontamination Type of decontamination that is primarily focused on the self-decontaminating indi- vidual using the M258A1 skin decontamination kit; this kit is designed for chemical decontamination and con- sists of wipes containing a solution that neutralizes most nerve and blister agents. Mass decontamination Type of decontamination for large numbers of victims exposed to unknown chemicals or infectious agents. Technical decontamination A process performed by haz- ardous materials teams to clean the members of the entry team once the members have entered a contaminated en- vironment. The process involves a thorough cleaning of personnel and equipment that often involves the use of brushes and chemical-specific cleaning solutions.

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Chapter 10
Chapter 11
Chapter 12

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