Recovery Plan: Biological Attack in the U.S.

¶ … 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 their response is mainly determined by the ability of the incident commander to comprehend the crisis at hand and the state of the available resources" (2009, p. 6). The onsite incident commander would therefore communicate what was known to appropriate public information officers who would coordinate the information that would be communicated to the public concerning the event.

Description of the unique challenges first responders will face when responding to the attack.

The centralized location of the Rayburn House cafeteria makes the challenges facing first responders particularly pronounced because of the importance of the infrastructure to the functioning of the U.S. government. Moreover, the number of local, state, and federal agencies that would be involved makes the timely and effective coordination of all of the potential resources especially challenging, especially since the first responders might well vary depending on the unique circumstances of the event. There might well be contingents of various first responders already on site because of their assigned locations or the happenstance that they just might be dining there at the time in their various capacities as visitors or guests of congressmen. Whatever the particular mix of available resources, the main unique challenge in this type of event therefore relates to the need to establish a line of authority and a chain of command among responding agencies, and this would surely be affected by countless other variables (i.e., other terrorist attacks on the Pentagon or White House or simultaneous terrorist attacks elsewhere) that would affect the order in which first responders and the site commander would proceed with their intervention, but some general guidelines can be discerned from the literature concerning what should be done and then to do that to the maximum extent possible. This would, of course, include what types of turnout gear first responders should attempt to use when responding to botulinum toxin attacks and these issues are discussed further below.

Description of the proper Personnel Protective Equipment (PPE) that will be needed when responding to the attack.

The guidance provided by the State of Delaware Health and Social Services states that the following precautions should be taken when responding to incidents of botulinum toxin contamination:

1. Follow appropriate Body Substance Isolation (BSI) precautions, with use of Personal Protective Equipment (PPE).

2. Standard Precautions: Hand washing before and after all patient contacts and contact with patient care equipment.

3. Contact Precautions: Use of gloves, gown and eye protection.

4. Airborne Precautions: Initiate inhalation precautions including wearing masks (fit tested NIOSH approved N-95 respirator) in the event of suspected release.

5. Victims presenting immediately after aerosolized exposure require decontamination (Botulinum toxin, 2011, para. 2).

Evaluation of how first responders should establish a perimeter and how large the containment effort should be.

Given the potential for an aerosolized version of the botulinum toxin to affect nearby office complexes if it was included as part of the cafeteria attack, first responders to the event in question should establish a perimeter sufficiently large to evacuate and quarantine all neighboring buildings. In this regard, the close proximity of the Rayburn House Office Building to other major government buildings is shown in Figure 1 below which serve as the basis for such a perimeter.

Figure 1. Rayburn House Office Building and Adjacent Government Buildings

Source: http://www.aoc.gov/cc/images/ccm_map_2.jpg

Description of the decontamination procedures and equipment that will be necessary to treat victims.

According to the guidance provided by the State of Delaware Health and Social Services, decontamination procedures for exposure to the botulinum toxin are fairly straightforward but require careful application. In this regard, the guidance states, "Equipment can be decontaminated using soap, water and 0.5% hypochlorite solution PPE and equipment: (one part household bleach to 10 parts water) can be used as appropriate or if gear had any visible contamination" (Botulinum toxin, 2011, para. 3).