Gradute Level Essay and Journal

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Course Learning Outcomes for Unit VI Upon completion of this unit, students should be able to:

3. Discuss the threat posed by radiological, chemical, and biological devices. 3.1 Explain the importance of tracking a bioterrorism attack on the population.

7. Evaluate medical response capabilities and strategies in relation to the use of chemical, biological,

radiological, nuclear, and explosive weapons by terrorist groups. 7.1 Explain the process of decontamination and how it impacts a bioterrorism event. 7.2 Contrast the two models of a public health response to a bioterrorism attack.

Course/Unit Learning Outcomes

Learning Activity

3.1 Lesson, Chapter 4.4, Essay

7.1 Lesson, Chapter 4.4, Essay

7.2 Lesson, Chapter 4.4, Essay

Reading Assignment Chapter 4.4: Unique Challenges of Responding to Bioterrorism Threats and Attacks, pp. 562-575, 579-593, 597-611

Unit Lesson The threat of a biological attack on the U.S. soil is a growing concern for the U.S. government. Adequate preparation, mitigation, response, and recovery measures are imperative to the success of saving thousands of lives in the event of an attack. The 2001 anthrax attack targeting the media and U.S. senators was considered the worst bioterrorism attack in U.S. history. The surprise attack one week after 9/11 left five dead and 20 more people with illnesses. Cleanup costs for the attack were in the hundreds of millions of dollars (Howard & Forest, 2013). Not only have terrorists been successful in introducing a chemical into the system, but they have created fear, panic, and financial strain, which are some of the goals of terrorism. Problems also occur after the attacks because the affected areas may be uninhabitable for months or perhaps years. Again, this shows the nature of the event and how terrorists feel they can accomplish their missions by causing physical and financial harm. The select biological agents (biological organisms of particular concern) can be categorized ranging from problematic to very problematic and includes the factors influencing how difficult it would be to perform decontamination. When a biological agent is referred to as weaponized, this means it is made for the purposes of being more virulent and moving easily and spreading quickly as an aerosol. Thus, the contamination levels are higher, which creates more concerns for responders and the population. Anthrax, for example, requires much preparation and extensive decontamination efforts for its release. Other agents, such as ricin, also pose significant challenges for decontamination and may be in the air for an extended period of time. The U.S. intelligence community, including the Central Intelligence Agency (CIA), the Defense Intelligence Agency (DIA), and a host of others has indicated the seriousness of possible attacks on the United States. In addition, it is indicated further that the likelihood of such an attack is a present danger, which requires preparation and development of policies. Recent documents that were released by the White

UNIT VI STUDY GUIDE

Environmental Decontamination Efforts

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House, the Department of Homeland Security (DHS), and the Environmental Protection Agency (EPA) have contributed to moving the policy process along for mitigation and decontamination of a bioterror attack.

What is decontamination? The process of decontamination involves the removal of the hazardous substance, chemical, or the inactivation of the agent that has been introduced into the environment. Remediation from such an attack will involve the sampling, testing, containment, mitigation, and decontamination confirmation testing and sampling as part of the cleanup criterion (Howard & Forest, 2013). The Department of Defense (DoD), EPA, DHS, and Center for Disease Control and Prevention (CDC) are some of the agencies working toward policies, procedures, and interagency planning regarding a response to a bioterrorist attack, but they also attempt to improve decontamination methods for the improved clean-up measures (Howard & Forest, 2013).

Having adequate funding is always an issue. The continual demand on government funding for a myriad of needs has an impact on the funding these agencies receive in an effort to prevent an attack. Additionally, the supplies that are needed for decontamination procedures are impacted. Other challenges that are presented include the lack of resources and methods for sampling, testing, and analysis, unresolved scientific and technical issues, defense against a secondary aerosolization taking place, and a lack of federal decisions on decontamination standards. If there is adequate funding for supplies, there might be a lack of trained personnel who will be able to use the supplies and decontamination equipment for a large bioterrorist event. Private decontamination contractors are available but may cost millions of dollars to contract and use for these large-scale events. Congress should continue to support such efforts regarding cleanup, testing, sampling, and decontamination. However, funding is the key issue that will remain a constant battle. Furthermore, consistent and universal guidance is needed for providing a framework for decontamination procedures. Biological weapons present a challenge for the people involved in the immediate areas of investigations. The inability to track the terrorists creates a dilemma for both containment and prosecution purposes. The emerging field of microbial forensics will play an integral role in determining such an attack and the type of agent being used. It can also assist in the process of attribution in an effort to pursue those who may have been responsible for the release of the agent. Nuclear forensics seeks to identify the source of a nuclear weapon attack and how it might be initiated. Progress is being made in these fields of detection, but there are many areas where terrorists are still able to elude authorities and produce these agents. The present state of microbial forensic analysis is improving; however, the knowledge base used draw inferences is limited regarding the processing of the agents. The North Atlantic Treaty Organization (NATO) has adopted a counter-proliferation strategy that requires the alliance members to continue developing a proven ability for detecting chemical, biological, or radiological attacks through forensic attribution methods and intelligence measures as a global effort. The process of biological attribution can be broken down into three sections:

1. identifying the infectious agent; 2. characterizing the release of the agent as intentional or natural in origin; and 3. determining the state, group, or agency that is responsible for the release, if the release was

intentional.

Hazardous materials response unit (Lynch, 2007)

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The concern arises when there is an intentional attack. Panic arises within the community; citizens are demanding answers, and sometimes the investigation and analysis requires several weeks before information can be presented. An effective means of holding those responsible for an attack is through the use of the attribution system. If the entity that carries out the attack cannot be located or identified, then the punishment or deterrent will not be operational and will cease to exist. If the guilty party cannot be determined, then the actions rendered by that party will not be punishable. The United States needs to promote international forensic technologies that will assist in the prosecution of those responsible for bioterrorist activities. Sharing this technological advancement with other nations will enhance the chances of minimizing an attack and bringing those to justice who have initiated the event. In the wake of a biological attack, the public health system will play an integral role in determining the type of agent that was used and what protective measures need to be taken in an effort to minimize health risks to the population. The public health response will likely be broken-down into two models: the coercive model and the cooperative model. The coercive model may have infringed upon personal rights that are typically taken very seriously. Those who are infected with the agent or possibly came in contact with it will be given a mandatory vaccination in the effort to contain the spreading of any infectious disease. Updating and modifying the strategies for the health departments is a good-faith effort to ensure proper procedures are followed during an event. The concern arises when individuals refuse to participate in the mandatory vaccinations and risk spreading infections further (Howard & Forest, 2013). The cooperative model allows for individuals to participate voluntarily in the mass vaccination procedures. The protection of individual rights is a main concern for this model form, and coercive measures are seen as counter-productive by those who are proponents of the cooperative model. The cooperative model also suggests working alongside the public and communities impacted by the event. This will increase the likelihood of compliance and willingness to be vaccinated and will allow health officials to utilize local knowledge for better health outcomes after such an event (Howard & Forest, 2013). There will be a continual debate over the proper response to a terrorist event. A focus on the cooperative model is suggested in an effort to maintain a progressive movement toward working with the community that has been affected by a bioterror event or community health-related issue. Coercive measures may lead to public backlash and the unwillingness to participate in vaccinations, which can minimize the effectiveness of treatments that may be given to those in need. The cooperative model suggests greater public cooperation and participation along with better outcomes because there is a willingness to help rather than use force. In the long run, the politics that are involved in an emergency are ever-present. Politically, the cooperative method will serve as a reflection of the government’s willingness to work with people and show a true concern for the event and its long-term impacts, along with minimizing the resistance that might be experienced from public groups that do not feel coercion is necessary in dealing with the event. The combination of progressive decision-making and leadership, willingness to work alongside others, and empowerment of citizens to take a more active role in health-related issues will create stronger working relationships and better responses regarding health standards.

References Howard, R. D., & Forest, J. (2013). Weapons of mass destruction and terrorism (2nd ed.). New York, NY:

McGraw-Hill. Lynch, P. (2007). Fireman in hazmat suite getting in truck in Wisconsin [Photograph]. Retrieved from

https://www.fema.gov/media-library/assets/images/51632

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Suggested Reading In order to access the following resources, click the links below.

The following Center for Disease Control and Prevention (CDC) document provides additional information on the CDC’s strategic plan and is useful in planning and developing emergency plans for bioterrorism events. Please review the document below to gain further insight. Khan, A. S., Levitt, A. M., & Sage, M.J. (2000, April 21). Biological and chemical terrorism: Strategic plan for

preparedness and response - Recommendations of the CDC strategic planning workgroup. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr4904a1.htm

The following CDC web page identifies emergency preparedness and response and lists preparedness and planning resources related specifically to bioterrorism. Centers for Disease Control and Prevention. (n.d.). Preparation and planning for bioterrorism emergencies.

Retrieved from www.emergency.cdc.gov/bioterrorism/prep.asp The following video produced by FEMA’s Center for Domestic Preparedness in Anniston, Alabama, is great viewing on how first responders receive the technical emergency response training for CBRNE (chemical, biological, radiological and nuclear) incidents. You are encouraged to view it. Arledge, S. (Producer). (2011). Center for Domestic Preparedness – Technical emergency response training

[Video file]. Retrieved from https://www.fema.gov/media-library/assets/videos/77573 Click here for the video transcript.

Learning Activities (Nongraded) Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit them. If you have questions, contact your instructor for further guidance and information. Access the Center for Disease Control and Prevention (CDC) website, www.cdc.gov, and search for the Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors. As an emergency manager or director, prepare a one- or two-page response for your local city government to assess the public health concerns that need addressing during the first 24 hours and then beyond after a bioterrorism incident. Use this guide and other resources to create a concise and brief report.