Recovery Plan: Biological Attack in the U.S. Congress
The havoc and deaths caused by the weaponized anthrax spores that were mailed to members of the U.S. Congress following the attacks of September 11, 2001 and the repeated attempted uses of botulinum toxin on U.S. Naval bases make it abundantly clear that governmental offices are vulnerable to biological pathogens. These agents have been and likely will be used by terrorists again to achieve their goals of bringing harm to the United States and it interests at home and abroad. The hypothetical comprehensive recovery plan developed in this project is in response to this type of food-borne pathogen attack and takes place in the cafeteria situated in the Rayburn House Office Building in the U.S. Congressional complex in Washington, D.C. which serves members of Congress, staff members and visitors. The scenario begins with the telephonic notification to the Capital Police that all of the food in the Rayburn House Office Building cafeteria has been infected with clostridia, a major source of botulinum toxin. Although the cafeteria was closed when this notification was received, there are several immediate steps that must be taken in response and these are described in the recovery plan below, followed by a summary of the research and important findings in the conclusion.
Review and Discussion
Description of the specific agent used in the attack and the effects of the agent on victims, and surrounding areas.
The clostridia group is a particularly virulent pathogen and can cause a number of adverse health outcomes, including death. According to Lathe (2006), the group of clostridia has been closely associated with a wide range of diseases, including gangrene, botulism, and tetanus, depending on the strain that is involved. Likewise, Rooney, Swezey, Friedman, Hecht and Maddox (2006) report that, "Clostridium perfringens is a spore-forming, gram-positive anaerobe that is found in soil and in the gastrointestinal tract of vertebrates. Pathogenic strains of C. perfringens cause a variety of human and animal diseases including food poisoning, antibiotic-associated diarrhea, gas gangrene, necrotic enteritis, necrotizing colitis, sudden death syndrome, and enterotoxemia" (p. 2081).
The clostridia group can induce disease in both non-food-borne and food-borne forms, and the food-borne form illness is the result of strains that carry a chromosomal enterotoxin gene with symptoms of the milder forms of the diseases typically persisting between 24 and 48 hours (Rooney et al., 2006). Farm-animal meat is a particularly suspect source of this pathogen (Rooney et al., 2006). If the clostridia strain involved in this event was botulinum toxin, though, the outcomes would be far more serious because this is among the most deadly substances known to humans (Dando, 2001). According to this authority:
When enough [botulinum] toxin is inhaled or ingested to produce clinical symptoms, there is a high fatality rate, death generally being rapid and medical treatment ineffective…. Specific anti-toxin is effective if administered before symptoms appear. An effective toxoid is available for immunization prior to exposure. The agent is not transmitted man to man. In short, this is a lethal agent that is not contagious and is fast acting in high doses. (Dando, 2001, p. 19)
Although botulism can be caused by improper food handling or preparation and cause serious illness or even death, a weaponized version of the pathogen would be much more lethal (Dando, 2001). As noted above, although the botulinum toxin is not contagious, it is possible to spread a purified, dried preparation of the pathogen via wind-borne routes (Dando, 2001). The potential for this eventuality must be considered in any such episode and would make evacuation and quarantine of surrounding buildings, such as the three Senate and three House office buildings an immediate requirement until the source of the contamination was confirmed with absolute certainty. In this regard, Hilborne and Golomh emphasize that, "Botulinum toxin can be delivered by the aerosol route; this method affords broader area spread, greater casualties, and less loss of the agent than introducing it into the food or water supplies. Because toxins are environmentally stable, this is the most probable route to deliver this agent as a biological weapon" (1998, p. 91). There are some typical symptoms that can be used to help first responders identify victims of such an attack, and these are discussed further below.
Symptoms victims will experience and display
Given its potential lethality and fast action, the symptoms that victims will tend to experience and display following infection by the botulinum toxin can be expected to be serious. This point is made by Dando who stresses, "The response of an affected victim is described as very severe" (2001, p. 20). Although potential paralysis is a common feature to all such infections, other symptoms include dry mouth, inability to focus (perceived as blurred vision), and diplopia in milder cases of infection, but severe cases of infection can cause dysphonia, dysarthria, dysphagia, peripheral muscle weakness, respiratory system failure and death (Hilborne & Golomh, 1998). According to the State of Delaware's Health and Social Services, infection is diagnosed according to "symmetric, descending flaccid paralysis with prominent bulbar palsies in an afebrile patient with a clear sensorium. Symptoms occur in 12-72 hours after inhalational exposure to an aerosol and are dose dependent. With food-borne botulism, symptoms begin within 6 hours -- 2 weeks, typically 18-36 hours" (Botulinum toxin, 2011, para. 1). The number of potential first responders and the countless local, state and federal agencies that would be involved in such an attack would vary from day-to-day, but some typical examples of which organizations would be immediately involved are provided below.
Government agencies (local, state, and federal) that will need to be involved in the response to the terrorist attack.
Assuming that the event in question was confirmed to be a terrorist attack rather than the result of improper food preparation or storage, Sobel, Khan and Swerdlow (2002) report that a wide range of governmental agencies would be required to respond to the type of botulinum toxin attack described above, including the following:
1. Local and state health epidemiology departments;
2. Public-health laboratories at the local and state level;
3. The Council of State and Territorial Epidemiologists;
4. The Association of Public Health Laboratories;
5. The Centers for Disease Control;
6. Neighboring state departments of agriculture or food-safety divisions; and,
7. The federal food-safety regulatory agencies, primarily the U.S. Food and Drugs Administration and the U.S. Department of Agriculture.
In addition, paramedics and other healthcare professionals would be required to provide immediate treatment for victims of the attack and to transport them to nearby tertiary healthcare facilities. Likewise, the Capital Police would be required to secure the perimeter and collaborate in the subsequent investigation based on their mandate to "protect life and property; prevent, detect, and investigate criminal acts; and enforce traffic regulations throughout a large complex of congressional buildings, parks, and thoroughfares" (U.S. Capital Police, 2011, para. 3). Everyone, clearly, would be very busy indeed.
Emergency first responders such as firefighters and law enforcements authorities would be responsible for the following:
1. Context Summary: information related to dynamic and static contextual parameters.
2. Casualty Summary: information related to the identified casualties.
3. Resources: information related to the material resources available at the incident location.
4. Surround Summary: information related to the surroundings of the incident location.
5. Weather: dynamic information related to weather in the vicinity of an incident.
6. Material Resource: dynamic and static information on physical resources belonging to fire and rescue services which are at the incident site or are expected to arrive shortly.
7. Human Resource: dynamic and static information relating to the allocation of fire officers either who are at the incident site or who are expected to arrive shortly.
8. Water Resource: information on available water resources belonging to fire and rescue services or others (Yang, Prasanna & King, 2009, p. 6).
Description of the appropriate role and responsibility for all agencies involved.
The state and federal agencies delineated above have been tasked with conducting investigations of food-borne pathogen terrorist attacks (Sobel et al., 2002). In addition, the bio-pharmaceutical sector would have an important consultation role to play in formulating appropriate responses. For instance, according to Kellman (2001), the bio-pharmaceutical sector would be required to advise first responders concerning the pathogenicity of the botulinum toxin and its treatment as well as providing guidance about the pathogen to local law enforcement authorities such as the Capital Police.
Communication methods between first responders and involved agencies; and identify necessary information that will need to be communicated to the public.
There have been a number of initiatives to improve the ability of first responders and concerned agencies to communicate following manmade and natural disasters that resulted from the fiasco experienced during the response to Hurricane Katrina that ensure compatible radio frequencies and other available communications modes are available, including handheld personal digital assistants (PDAs) (Yang et al., 2009). According to these authorities, "Emergency first responders are usually the main bodies which require assured control of the emergency response management. The efficacy of…