Emergency Response

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Status Brief


Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:



Glass and Schoch-Spana (2002) propose a five point model for community participation in response bioterror attacks, especially epidemics: 1. “treat the public as a capable ally,” 2. “enlist civic organizations,” 3. “anticipate the need for home-based patient care and infection control,” 4. “invest in public outreach and communication strategies,” and 5. “ensure that planning reflects the values and priorities of affected populations.”


Winthrop, Jim, “The Oklahoma City Bombing: Immediate Response Authority and Other Military Assistance to Civil Authority (MACA),” Army Lawyer, July 1993.

  1. “Miliatry support to Civil Authority refers primarily to natural disaster relief…”
  2. Stafford Act, Federalism, police powers, FEMA, Posse Comitatus Act, DoD Directives 3025.15, 3025.1

Posse Comitatus Act, Emergency Response


Adamo, Beth, “Evacuating Your Home During a Terrorist Attack“, Safety. 2000. http://www.safety.com/articles/evacuating-your-home-during-terrorist-attack

  1. “If the order to evacuate is given, you should do so immediately and carefully follow the directions given by local authorities. If a local shelter has been established, go there.”
  2. “Wherever you’ve decided to go, the best way to get there is by car.”
  3. “Be prepared for any emergency by assembling an emergency supplies kit.”

Public Health, Emergency Response, Biosafety, Bioterrorism



  5. “Lab analysis, vaccines and drugs, “disease detectives,” and quarantine are all tools that can be directed toward a biological disaster by the CDC director without the involvement of any other federal agency, Lillibridge says. “We anticipate the rest of the government catching up with us.””



Maddox, P.J., “Bioterrorism: A Renewed Public Health Threat“. Dermatology Nursing. December 1, 2001

  1. “Even though national emergency preparations since the cold war have included consideration of biological weapons, the post mortem on emergency responses to the terrorist attacks on September 11, 2001, has brought renewed concerns about bioterrorism.” (Pg. 1)
  2. “Even a single exposure could result in local outbreaks of difficult-to-diagnose disease and fatal disease outbreaks.” (Pg. 1)
  3. “Unlike weapons that use explosives or chemicals, attacks using biological weapons may occur silently and covertly and, thus, be difficult and time consuming to detect. To complicate the matter, public symptoms of biological exposure may be delayed for days or weeks.” (Pg. 1)
  4. “Once detected, a massive public exposure could overwhelm local health systems that must treat victims of an outbreak, provide care for mass casualties, and prevent further disease.” (Pg. 1)
  5. “Department of Health and Human Services (DHHS) has special responsibilities, including detecting the disease, investigating the outbreak, and providing stockpiled drugs and emergency supplies in the large amounts needed.” (Pg. 1)
  6. “The MMRS emphasizes enhancement of local planning and response capability, including hospital capacity, to care for victims of a bioterrorist incident. MMRS systems provide designated communities with structured operations, specially trained responders, special Pharmaceuticals, detection and personal protection equipment, decontamination capabilities” (Pg. 2)
  7. “The role of the National Pharmaceutical Stockpile Program is to maintain a national repository of lifesaving pharmaceuticals and medical material that will be delivered to the site of a bioterrorism disaster in order to reduce morbidity and mortality in those affected” (Pg. 3)
  8. “Through the CDC, efforts will continue to ensure that all laboratories that ship or receive specially identified biological agents axe registered and in compliance with federal requirements.” (Pg. 3)

Bioterrorism, Public Health, CDC, Emergency Response


Miriani, Allison, “Hospitals pushed to plan for bioterrorist attacksCapital Service News. Feb. 22, 2004. http://cns.jrn.msu.edu/articles/2002_0222/biohazardplan.html

  1. “Most larger hospitals have a bioterrorism plan. The bill would make sure that all hospitals, including small outstate facilities, will comply, Scott said.”
  2. “Although there are 15 million doses of the vaccine for smallpox in the United States right now, Johnson said, many side effects could even result in death from the vaccine. That is why the Department of Community Health does not advocate a mass vaccination campaign, he said.”
  3. “”We need strict airport precautions, contact isolations. We have to notify public health authorities immediately at the local level and from there the state,” he said. “We need to identify those who have had contact with the person (who was exposed).””

Public Health, Smallpox, Bioterrorism, Emergency Response

Powers, Michael and Ban, Jonathan, “Bioterrorism: Threat and Preparedness“, National Academy of Engineering. Spring 2002

  1. Therefore, rather than planning for a narrow range of least-likely, high-consequence contingencies or focusing only on additional mailborne anthrax attacks, we must plan for a variety of future incidents–including incidents that cause mass casualties and mass disruption.”
  2.  “The incidents aroused significant fear and disruptions but not mass casualties. Based on these attacks, some analysts have suggested that terrorists would not be able to orchestrate mass-casualty attacks using biological weapons. Others have considered these attacks as demonstrations of terrorists’ ability to acquire high-quality anthrax”
  3.  “Rather than focusing on vulnerability to a particular organism or looking to history to determine what is to come, policy makers and scientists must recognize that the bioterrorist threat is not uni-dimensional. We must consider four key elements of the threat: the who (the actor), the what (the agent), the where (the target), and the how (the mode of attack).”
  4.  “We do not know how “massive” an attack would have to be to overwhelm the response system, instill fear and panic, or cause serious political or economic fallout.”
    “Every dollar spent preparing for a specific agent, such as building stocks of smallpox or anthrax vaccine or purchasing antidote for botulinum toxin, is a dollar that cannot be spent on preparedness for other organisms.
  5. Given the variety of combinations among actors, agents, targets, and dissemination techniques, a public health system must be capable of rapidly and accurately detecting and assessing a large number of bioterrorism scenarios and addressing most contingencies.”
  6.  “planning should be based on developing the capability of effectively and efficiently responding to a variety of bioterrorist contingencies”
  7.  “We must strike a better balance between hedging our defenses against high-end, mass-casualty events and building a “system of systems” capable of addressing both a wider range of bioterrorist contingencies and natural outbreaks of infectious disease.”
  8.  “In addition, accurate and timely information will be the backbone of the decision making process in times of crisis and will provide credible and consistent information to the general public to reduce panic.”
  9.  “A national surveillance system to provide an early warning of unusual outbreaks of disease, both natural and intentional, will be a critical component of our preparedness. This system will depend on an information infrastructure that includes electronic data networks connecting local public health departments and area health care providers and providing regular analyses of the data for the presence of unusual trends that could indicate a bioterrorist attack”

Public Health, Bioterrorism, WHO, Emergency Response, Smallpox, Anthrax


Editors, “Terrorism. Iodine pills, just in case.Harvard Medical School. July 2002.

  1. “People are also buying potassium iodide (KI) pills, which help protect the thyroid gland from radiation.” *“Health officials worry that people who take the potassium iodide will think they’re safe and ignore evacuation orders”





Bioterrorism, Public Health, Emergency Response, Quarantine, CDC


Hodge, James, “Bioterrorism Law and Policy: Critical Choices in Public HealthJournal of Law, Medicine & Ethics, 2002.

  1. “However, in many states, existing legal standards for response are absent, antiquated, or insufficient. Prior to September 11, many state health departments did not address bioterrorism in their emergency response plans. Recently, public health lawyers and scholars at the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities were asked by the Centers for Disease Control and Prevention and a series of national partners (i.e., the National Governors Association, the National Conference of State Legislatures, the Association of State and Territorial Health Officials, the National Association of City and County Health Officers, the National Association of Attorneys General, and the Turning Point Public Health Statute Modernization National Collaborative) to develop a model act for states to respond to public health emergencies.” (Pg. 1-2)
  2. “gives state and local public health authorities a modern series of powers to track, prevent, and disease threats resulting from bioterrorism or other public health emergencies. These powers include measures (e.g., isolation, quarantine, treatment, and vaccination requirements) that may temporarily compromise individual civil liberties (e.g., rights to due process, speech, assembly, travel, and privacy) to protect the public’s health. To date, thirty-two states have introduced legislative bills based on the Model Act.” (Pg. 2)
  3. “Bioterrorists may infect individuals through multiple routes: (1) intentional spread of contagious diseases through individual contact; (2) airborne dissemination of some infectious agents; or (3) contamination of water, food, controlled substances, or other widely distributed products. The equipment needed to manufacture biological weapons is easy to obtain and conceal.” (Pg. 3)
  4. “The Model Act broadly defines a “public health emergency” as: an occurrence or imminent threat of an illness or health condition that: (1) is believed to be caused by bioterrorism or the appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; and (2) poses a high probability of any of the following harms: (a) a large number of deaths in the affected population; (b) a large number of incidents of serious permanent or long term disability in the affected population; or (c) widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people in the affected population.” (Pg. 3-4)
  5. “First, the federal government has greater financial resources at its disposal to respond to a bioterrorism threat. Second, it may be in a better position to negotiate the price of needed vaccines, drugs, or supplies, or to suspend the patent rights of high-demand medications. These techniques were recently used by President George Bush and DHHS in negotiations with the German drug company Bayer, concerning the sale of Cipro, the antibiotic used to treat anthrax. Third, most significant bioterrorism threats will exceed the boundaries of any single state, thus requiring a national, coordinated response.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Model Act, CDC, Anthrax


Glass, Thomas A. and Monica Schoch-Spana, “Bioterrorism and the People: How To Vaccinate a City against Panic,Clinical Infectious Diseases, 34:217-23 (Jan 15, 2002)


Emergency Response, Public Health, Prophylaxis, Anthrax, Ethics


Bentham, Martin, “5,000 body bags ordered in case of terrorist chemical attack Government orders 120,000 decontamination suits to be ready for distribution ‘in minutes’“. SUNDAY TELEGRAPH, December 8, 2002.

  1. *“THE GOVERNMENT is buying more than 120,000 decontamination suits to protect people from a terrorist chemical or biological attack on potential targets across Britain such as Trafalgar Square.”
  2. “Thousands of decontamination showers, shelters, stretchers and other equipment are also being ordered – as well as 5,000 body bags. The equipment, which is intended to be available by the middle of next year at the latest, will be stored at 16 locations, ready to be distributed within minutes of a terrorist attack.”
  3. “Philip Ward, the managing director of Ferno UK, the country’s leading manufacturer of emergency and rescue equipment, said that his company was among those bidding for the contracts, which were for “huge” quantities that were “getting bigger by the day.”
  4. “One batch of contracts, which is about to be awarded, is for 120,000 pre-decontamination suits, to be used immediately after a chemical or biological attack. The contracts will also provide 100,000 post-decontamination suits to be worn by people after their initial treatment. Industry officials say the 20,000 difference reflects the number of deaths likely to occur.”
  5. “The treatment, said Mr Ward, would begin with each victim stripping and putting on a pre-decontamination suit. Their clothes would be placed in a separate bag for incineration. Swabs would then be provided for the victims to clean out orifices which could contain traces of the chemical, before each person passed through a shower – set up in shelters at the site of the attack – to wash off the substance. Finally, post-decontamination suits would be given to reclothe the victims.”
  6. “Other equipment required by the Government includes 50,000 decontamination shelters, 2,000 stretchers, 2,000 evacuation chairs and 5,000 body bags.He said, however, that pounds 56 million had been allocated this year to prepare for potentially catastrophic terrorist incidents. Some of the money would buy decontamination equipment, which would be held by the fire service.”

Decontamination, Public Health, Bioterrorism, Emergency Response


Barbaro, Michael, “A Worst-Case Enterprise; Md. Firm Busy Making Decontamination Shelters” The Washington Post. March 13, 2003.

  2. “TVI Corp. of Glenn Dale says it can’t keep up with back orders for its decontamination shelters, even after doubling its workforce to about 90 last year. Sales of its shelter, which sells for around $ 88,000, nearly tripled in 2002.”
  3. “But TVI’s flagship product is the High Throughput Mass Decontamination Shelter, a car-wash-like structure for humans that has at least 50 shower nozzles threaded into its vinyl interior, a hot water pump and soap dispensers. It is designed to be attached to a fire hose and has at least three shower lanes to separate men, women and the incapacitated after an attack.”
  4. “The product is designed for particular situations. If a “dirty” nuclear bomb is detonated or a biochemical agent is released, for example, people who flee the scene before being decontaminated would risk exposing others to the danger. The shelters would be used to rapidly contain the threat.”
  5. “The decontamination shelters operate on a simple principle.“You just cream people with water,” said Thomas D. Gibson, a lieutenant with the hazardous materials team at the National Institutes of Health campus in Bethesda.”
  6. “”Decontamination is the same whether you are talking about chemical, biological or radiological agents,” said Clendenin, the Massachusetts fire official. “Soap and water is never a bad thing.””

Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology


Goldstein, Avram, “Progress Cited on Health Threat; ‘We’re Worlds Better Prepared,’ City Official SaysThe Washington Post, April 17, 2003.

  1. “They are buying protective gear; expanding drug, food and water stockpiles; adding or enhancing decontamination facilities outside emergency rooms; and creating patient isolation rooms to help control a smallpox outbreak.”
  2. “The city has set up an elaborate incident command center that is so new it hasn’t been seen by Mayor Anthony A. Williams (D), said Feseha Woldu, acting administrator of the D.C. Emergency Health and Medical Services Administration.”
  3. “The District has expanded its epidemiology staff to eight and assigned nearly 60 city workers to bioterrorism preparedness. Meanwhile, hundreds of private doctors and nurses have volunteered to deliver health care services or to provide information to the public by phone or computer if called upon by the city.”
  4. “”We live in the No. 1 terrorist target in the world,” said Jeffrey A. Elting, medical director for bioterrorism response coordination at the D.C. Hospital Association. That stark reality has spurred much of the cooperation, he said.”
  5. “The best example is a radio system that enables all hospitals to communicate if telephone service is interrupted, allowing them to rapidly exchange information on their capacity to accept new patients and lend each other equipment and supplies. It also would let public health officials broadcast messages to hospitals regarding the dimensions and type of event. The system is tested a few times a day, when roll is called.”
  6. “The survey found that, on average, hospitals can generate their own electric power for 5.8 days. Without outside help, surveyed hospitals said, they had enough food to last 4.7 days, water for 2.5 days, and medical supplies for 7.1 days.”
  7. “At Providence Hospital, officials are buying 20 protective full-body suits, including respirators, so doctors and nurses can safely and rapidly care for people contaminated by dangerous chemicals or pathogens. They also are buying a mobile decontamination unit where patients exposed to hazardous substances can shower.”
  8. “If a smallpox outbreak occurred, Providence has 12 patient rooms and a 16-bed unit that can be isolated to keep a virus from spreading to unprotected patients and staff. The hospital also has eight portable HEPA (High Efficiency Particulate Air) filtration units that can convert a room or even a plastic tent to a temporary isolation unit.”
  9. “He said the hospital does not want to use the inflatable decontamination units they already have because they take too long to set up — 18 minutes.”
  10. “Wuerker said 12 people have been vaccinated for smallpox, including himself, and another 12 are scheduled. With that many first-line responders, he said, all 5,000 hospital workers could be vaccinated quickly to prepare for an outbreak.”
  11. “Exactly which surge facilities might be needed and when is unpredictable and depends on the exact location and nature of and attack, officials say. Instructions and guidance would be offered by public health officials through electronic and print media, they say.”

Vaccination, Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology


Editors, “Sentinel bioterrorism responders: Are hospital labs ready?”. MLO, August 2003.

  1. “Bioterrorism is the intentional application of microorganisms or their toxins for the purpose of causing death or disease in humans or in the animals or plants on which humans depend.”(Pg. 1)
  2. “Training is needed for laboratorians to know what specimens to collect and how to transport them.”(Pg. 1)
  3. “In May 2000, at the direction of the U.S. Congress, a mock bioterrorist event was held in Denver to test the nation’s systems. This $3-million exercise uncovered many deficiencies.” (Pg. 2)
  4. “Gradually, procedures for collection of specimens and detection of the agents in culture, when appropriate, are being posted on the ASM website at www.asm.org” (Pg. 2)
  5. “Generally, a leakproof package with a double liner and absorbent material to contain the specimen is sufficient. The package must be able to withstand the method of transport without damage.” (Pg. 3)
  6. “Staff can be trained specifically for the recognition of these agents. In addition, the laboratory will be able to identify other pathogens encountered on a daily basis more rapidly — but if the important tests for identification are not put into practice on a daily basis, rapid recognition will fail.” (Pg. 4)
  7. “The agents likely to be bioterrorist candidates, however, are all indolenegative.” (Pg. 4)
  8. “Do not wait for confirmatory tests to report to health department. Risk of human-to-human spread is significant.” (Pg. 5)

Bioterrorism, CDC, Emergency Response, Biosafety


Editors, “Hospitals are not prepared for terrorThe Toronto Star. January 31, 2003.

  1. “Decontamination of chemically or radiologically contaminated patients, ideally prior to entering the health-care facility, is a critical step in the delivery of care. Only 18 of 59 hospitals (30 per cent) had a decontamination area or a plan to establish one.”
  2. “The ideal system defines two areas: one where contaminated patients arrive for decontamination (the “hot” zone) and one where decontaminated patients receive care (the “cold” zone). Absence of this kind of system indicates a potentially ineffective plan. In our survey, only five emergency rooms (8 per cent) with a decontamination plan had a hot/cold system. This raises the concern that, even among hospitals with decontamination plans, the systems may not be sufficient.”
  3. “Emergency departments that have no decontamination plan must provide protective equipment so staff can function at relatively low risk. But only 41 per cent of the emergency department surveyed had protective coveralls and only 19 per cent had either gas masks”
  4. “Health regions often plan to store drugs in a central repository and deliver them when requested. This may not work in a true event”
  5. “Preparedness for chemical agents requires a readily available stock of antidotes. In this survey, we asked specifically about atropine, cyanide kits, and benzodiazepines and pralidoxime (for nerve agents). Most sites surveyed had inadequate supplies on hand. This is worrisome because, terrorism aside, these antidotes are also useful for patients with toxic ingestions”

Decontamination, Bioterrorism, Public Health, Emergency Response


Setlak, Paul, “Bioterrorism preparedness and response: Emerging role for health-system pharmacists”, American Journal of Health-System Pharmacy, 2004.

  1. “Furthermore, as pharmacists are becoming more integral in disaster relief and response, especially in the area of bioterrorism, they must be able to effectively and rapidly access the most current information about the biological agents they may encounter and the respective treatments.” (Pg. 1)
  2. “Once a pharmacist is accepted as a member of an NPRT, he or she must complete numerous Web-based training programs on emergency response, pharmaceutical caches, command operations, occupational health, and a host of other topics relating to bioterrorism and emergency response operations” (Pg. 3)
  3. “If called to serve in an emergency operation, each team will be deployed for approximately two weeks, during which time members will become temporary federal employees.” (Pg. 3)
  4. “The passage of USERRA by Congress in 1994 ensured that individuals serving in the uniformed services, including PHS and others designated by the president during war or an emergency, can return to their civilian job with the same seniority, pay, and status that they had before their service.” (Pg. 3)
  5. “The drill exposed pharmacists to the environment encountered during a pharmaceutical distribution campaign, taught them procedures for distributing mass quantities of medications, and allowed students to witness how pharmacists handle stressful situations.” (Pg. 4)
  6. “The SNS is an important deployable initial pharmaceutical stockpile for health care professionals at the state and local levels during the early stages of a bioterrorist attack.11 The Homeland Security Act of 2002 assigned responsibility for the deployment of the SNS to DHS.” (Pg. 4)
  7. “Avoiding unnecessary duplicated medications in stockpiles, repeated diagnostic steps, and similar patient paperwork can result in faster response and clinical decision-making and decrease patient fatalities.” (Pg. 7)
  8. “Treatment guidelines are available as downloadable charts for easy posting and presentation. In addition, links to federal and private sites that address bioterrorism are presented. All information is scrutinized by CDC, and great care is put into releasing correct and timely information that clinicians, especially health-system pharmacists, can use.” (Pg. 7)

Bioterrorism, Emergency Response, Pharma, CDC


Lecchire, Gary, and Michael A. Wermuth, et al., “Triage for Civil Support: Using Military Medical Assets to Respond to Terrorist Attacks“, TRIAGE, “Legal and Other Barriers to Military Support to Civil Authorities“, 2004.

  1. “State governments and their political subdivisions have primary responsibility for coping with emergencies, including terrorist events.”
  2. Military support for civil authorities, 4 categories allowed: ‘civil disturbance/insurrections, counterdrug operations, disaster relief, counterterrorism/weapons of mass destruction.’
  3. “Under the Stafford Act, a presidential declaration of a major disaster or an emergency triggers federal assistance. The type of federal assistance available depends on whether the situation is considered a disaster or an emergency.”
  4. “In the event of a catastrophic event, particularly when a deadly biological agent is implicated, officials, including military personnel, may need to restrict the civil liberties of Americans, especially freedom of movement, to prevent mass chaos and mitigate public health threats.”

Stafford Act, Public Health, Emergency Response, Posse Comitatus Act, Law Enforcement, Military


Hearne, Shelly, “Health departments remain ill-prepared to respond to public health emergenciesH&HN: Hospitals & Health Networks. February 2004.

  1. “The report, “Ready or Not? Protecting the Public’s Health in the Age of Bioterrorism,” examines 10 key indicators to assess areas of improvement and areas of ongoing vulnerability in the nation’s efforts to prepare against bioterrorism and other large scale health emergencies” (Pg. 1-2)
  2. “California, Florida, Maryland and Tennessee scored the highest, meeting seven of the 10 indicators.” (Pg. 2)
  3. “”Are we ready or not? The answer is not,” says Shelley A. Heame, executive director of TFAH.”Now is the time to get serious about developing an all-hazards approach to public health to ensure we are ready for the range of possible threats we face” (Pg. 2)
  4. “Among the major concerns raised in the report are: cuts to public health programs in nearly two-thirds of states; an impending shortage of trained professionals in the public health workforce; disagreements between state and local health agencies over resource” (Pg. 2)
  5. “The report also found that only Florida and Illinois are prepared to distribute and administer emergency vaccinations or antidotes from the national stockpile.” (Pg. 2)

Public Health, Bioterrorism, Emergency Response, Vaccination




Bioterrorism, Decontamination, Public Health, Quarantine, Emergency Response


Rose, Laura, “Chlorine Inactivation of Bacterial Bioterrorism AgentsApplied and Environmental Microbiology. Pg. 566-568, Vol. 71, No.1

  1. “Currently, chlorination is the most common method of disinfecting drinking water in the United States. (Pg. 1) *”The Bacillus anthracis spores were less susceptible to cholorine disinfection than the gram-negative organisms.” (Pg. 1)

Anthrax, Public Health, Emergency Response, Decontamination, Bioterrorism, Biosafety, Chemical


Shane, Scott, “At Hearings, State and National Guard Make Appeals for Aid“, NYT, Section A, Column 3, September 29, 2005.

  1. “National Guard has only a third of the equipment it needs to respond to domestic disasters and terrorist attacks ad will need $7 billion to acquire the radios, trucks, construction equipment and medical gear required.”
  2. National Guard: “using old radios were unable to talk to active duty troops with the latest communication systems as they patrolled New Orleans.”
  3. “The President seems to think we’ll use the Guard and Reserve in Iraq and the Army in Louisiana,’ Mr. [David] Obey [Democrat of Wisconsin] said, calling that approach ‘backward’.”

Military, Emergency Response


Rebmann, Terri, “Defining bioterrorism preparedness for nurses: concept analysisBlackwell Publishing Ltd. Novembver 30, 2005.

  1. “Bioterrorism poses a major threat to the health of citizens around the world [Centers for Disease Control and Prevention (CDC) 2000, Miller et al. 2001]. Infectious diseases can spread rapidly through a hospital, community or around the world, making a bioterrorism attack occurring anywhere a threat to all nations.” (Pg. 1)
  2. “Nurses are the largest group of healthcare providers and, as such, are a cornerstone in bioterrorism response. Because of this, bioterrorism preparedness has become a necessity for nurses, regardless of their education level, expertise area or practice setting (Malone 1999).” (Pg. 2)
  3. “Despite this, the US National Institute of Nursing Research has asserted that bioterrorism preparedness is a necessity across nursing specialties” (Pg. 2)
  4. “All-hazards preparedness efforts focus on biological as well as chemical, nuclear and radiological events. For example, planning is required for both all-hazards and bioterrorism response plans, but knowledge of patient chemical decontamination is only needed for all-hazards preparedness because patient decontamination will probably not be required after a bioterrorism attack” (Pg. 3)
  5. “In preliminary research, Shadel et al. (2001) describe differences in bioterrorism knowledge for various professions. For example, infection control practices, triage, health education and mental health were topics identified as critical for nurses, while pathogen epidemiology and clinical diagnosis were essential for physicians” (Pg. 3)
  6. “There are four attributes of nursing bioterrorism preparedness: (a) gaining bioterrorism management knowledge that is specific to the nursing profession; (b) planning response strategies; (c) practicing response behaviors; and (d) evaluating knowledge level and response plan content. These four attributes consist of protective actions undertaken to mitigate the potential outcomes of a bioterrorism attack” (Pg. 4)
  7. “gaining bioterrorism management knowledge that is specific to the nursing profession. Topics include identifying and reporting an attack, casualty triage and management, implementing control measures and management of victims’ families (Steed et al. 2004).” (Pg, 4)
  8. “Nurses, regardless of their level of education, area of expertise or practice setting should participate in at least one educational offering and one exercise each year to meet the minimum requirements of engaging in the bioterrorism preparedness process.” (Pg. 6)
  9. “Hosting bioterrorism exercises is time-consuming and expensive; for example, most facilities in the USA conduct only one or two exercises per year, which is the minimum required by the Joint Commission on Accreditation of Healthcare Organizations standards [Joint Accreditation Commission on Hospital Organization (JACHO) 2001].” (Pg. 6)
  10. “A group of school nurses believe that bioterrorism is a conceivable threat to themselves and their community, but feel that the risk of it occurring is low. Although they want to become better prepared for a bioterrorism attack and intend to do so at some point in the future, they currently have many other responsibilities that they believe are more pressing.” (Pg. 7)

Bioterrorism, Public Health, Emergency Response, CDC


Pine, Art. “Should Congress Scrap Posse Comitatus?” U.S. Naval Institute Proceedings. December 2005.  Last Checked. September 9, 2012

  1. ”Posse Comitatus is not the only governing statute on this issue, however. The 1974 Stafford Act broadly permits the president to use federal troops at home whenever he declares a disaster to be “an incident of national significance” — something Bush did the Saturday before Katrina struck.”
  2. “The 1956 Insurrection Act enables him to send U.S. forces to deal with civil disorders, even without a request from a state’s governor. And other titles permit the White House to send troops to deal with emergencies involving nuclear, chemical, or biological weapons. The Pentagon, too, has directives that authorize such action.”
  3. ”Eventually, the military response to Katrina included about 50,000 National Guard troops, 22,000 active-duty forces, about 350 military helicopters, and 20 ships. The flaw was in how long it took to get permission for them to deploy.”
  4. ”Some say the 1878 law is a relic of a different age that ties the hands of the military during natural disasters and should be repealed or revised. Others say that the statute still serves an important purpose. Meanwhile, paratroopers from the Army’s 82d Airborne Division (at left) were assisting civilian search-and-rescue personnel after Hurricane Katrina.”
  5. ”Few question that the military is best equipped to cope with major calamities such as Katrina when the impact spreads beyond what state and local agencies can handle. The armed forces already have a broad command structure and communications system in place, with an array of helicopters, trucks, and medical facilities, along with sufficient manpower to quell civil disorders.”
  6. ”Indeed, a recent study cited some 167 incidents over the past 200 years in which presidents have used federal troops to enforce the law, from suppressing insurrections and quelling race riots to breaking strikes and enforcing civil rights legislation.”

Posse Comitatus Act, Law Enforcement, Emergency Response


Olowokure, B. et al., “Global Surveillance for Chemical Incidents of International Public Health ConcernBulletin of the World Health Organization, 7 pages. December 2005.

  1. “This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003” – page 928
  2. “In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority” – page 928
  3. “The international community, through the World Health Assembly, has recognized the need to strengthen surveillance for chemical incidents. There are three main reasons for doing this.” – page 928
  4. “First, the continuing rapid growth and globalization of the chemicals industry means that chemical incidents will continue to be a problem.” – page 928
  5. “Second, chemical incidents may have an impact beyond their original location, in some cases crossing national borders.” – page 928
  6. “Third, there is concern regarding the deliberate use of chemicals for terrorist purposes, engendered by events such as the use of sarin on the Tokyo underground system and reports of the threatened use of ricin” – page 928
  7. “On a daily basis, information from a range of informal and formal sources was reviewed to identify acute chemical incidents and outbreaks of disease of unknown etiology that might be of chemical origin.” – page 929
  8. “The principal informal sources were the Global Public Health Intelligence Network (GPHIN), ProMED-Mail, and Hazard Intelligence (HInt)… all three had international scope” – page 929
  9. “Formal information sources included reports from national authorities, WHO offices, WHO Collaborating Centres and other United Nations agencies. ChemiNet and the communicable disease outbreak verification teams were additional sources, the latter particularly for diseases of unknown etiology that might be linked with chemicals.” – page 929
  10. “Each identified event was assessed against International Health Regulations (IHR) criteria … by the chemical alert and response team. If an event was deemed to be of potential international importance, WHO regional and country offices were contacted to obtain additional information, including official verification of the event…. Once verified, and depending on the nature of the event, a decision was taken about the need for a response.” – page 931
  11. “Such a response might include laboratory support (e.g. identification of a laboratory to carry out analyses, arranging supply of an analytical standard), on-site epidemiological assistance (e.g. assistance with investigation, control measures) or the provision of technical information.” – page 931
  12. “From 1 August 2002 to 31 December 2003, 779 chemical events were evaluated and 35 (4.5%) events of potential or actual international public health importance were identified in 26 countries” – page 931
  13. “…most chemical events tend to be localized, in contrast to communicable diseases, which are readily spread around the world by human or animal carriers.” – page 932

WHO, Chemical, Chemical Surveillance, Public Health, Emergency Response




Military, Emergency Response, Law Enforcement, Homeland Security




Military, Emergency Response, Homeland Security


Olmsted, Stuart, “Patient experience with, and use of, an electronic monitoring system to assess vaccination responses.Health Expectations. June 2006.

  1. “National Research Council (NRC) report, Networking Health: Prescriptions for the Internet, highlights the potential for information technology (IT) and the Internet to revolutionize health-care delivery in the near future” (Pg. 1)
  2. “When applied to populations, electronic monitoring of many individual patients with chronic or infectious diseases can improve surveillance and management of chronic diseases, as well as reducing health-resource utilization.” (Pg. 1-2)
  3. “In public health practice, a mass vaccination program, whether for pandemic influenza or smallpox, may be strengthened and easier to administer if an electronic system were used to monitor vaccine reactions and side effects.” (Pg. 2)
  4. “Such a system can reduce the need for clinical assessments of vaccine responses, cutting travel time, work absenteeism and clinician time to assess vaccine sites. In addition, a system such as this can act as an early warning device for adverse events.” (Pg. 2)
  5. “Users also reported that the picture on the web or pocket card closely matched the appearance of their vaccine site (143/169; 85%) and that they were confident that what they reported matched their true reaction to the vaccine (147/171; 86%).” (Pg. 3)
  6. “While survey responders in this study were comfortable with a physician tracking their vaccination status via their electronic reports, and many were comfortable with having their take check determined electronically, half of the respondents were not comfortable eliminating the follow-up visit with a health-care provider.” (Pg. 6)
  7. “a similar reporting system may prove useful in public health settings in which large numbers of people will need treatment and follow-up in a short period of time, such as a mass vaccination or prophylaxis during a bioterrorism event, an influenza pandemic or another public health emergency.” (Pg. 6)

Public Health, Bioterrorism, Biosurveillance, Biodetection, Emergency Response, Vaccination


Sabelnikov, A et. al, “Airborne exposure limits for chemical and biological warfare agents: Is everything set and clear?International Journal of Environmental Health Research, 16(4), 241-253. August, 2006.

  1. “In the case of a radiological terrorist event, emergency response guidelines (ERG) have been worked out.”
  2. “In the case of a terrorist event with the use of chemical warfare (CW) agents the situation is not that clear, though the new guidelines and clean-up values are being generated based on re-evaluation of toxicological and risk data.”
  3. “For biological warfare (BW) agents, such guidelines do not yet exist.”
  4. “In the case of a terrorist event with the use of chemical warfare (CW) agents, the situation is not that clear, because airborne exposure limits (AELs), obtained by extrapolation of toxicological data among animal species and from animals to humans has proven to be unreliable for many chemical agents (Johnson 2003).”
  5. “The Emergency Response Planning Guidelines (ERPG) developed by the American Industrial Hygienist Association (AIHA) (AIHA 2003) define three risk/exposure levels: level one is defined as ‘‘the maximum airborne concentration of toxic chemical below which, it is believed, nearly all the individuals could be exposed for up to 1 h without experiencing more than mild, transient adverse health effects or without perceiving a clearly defined objectionable odor.”
  6. “Research on man was not and is not possible, because of ethical reasons, and the most, if not all, the information on military tests and research in this area including animal models is classified (Johnson 2003 is one of the few exceptions).”
  7. “With regard to CW agents, it is suggested that in spite of the fact that the new, revised exposure limits were proposed or recommended by the Centers for Disease Control and Prevention, CDC, and the US Army, further research is still needed.”

Emergency Response, Anthrax, Biosafety, Classified, Scientist


Koplovitz I., et al., “Effect Of Atropine And Diazepam On The Efficacy Of Oxime Treatment Of Nerve Agent Intoxication“, 21 August 2007, J Med CBR Def. http://www.jmedcbr.org/issue_0501/Koplovitz/Koplovitz_05_07.html Last Checked 4 October 2011.

  1. “Saline or pyridostigmine was administered 30 minutes prior to nerve agent challenge; treatment was administered 1 minute after agent challenge and consisted of atropine (0.3, 3.0, or 16 mg/kg) plus the oxime, 2-PAM chloride (25 mg/kg) or MMB4 dimethanesulfonate (26 mg/kg). Approximately half of the animals were also treated with diazepam (1 mg/kg), injected immediately after atropine and oxime treatment. Survival was assessed at 24 hours.”
  2. “Categorical modeling analysis of the data indicated that, across all agents and treatments, there was no significant difference in the survival rate between saline-pretreated animals (337 of 474 survived [71%]) and PB-pretreated animals (370 of 486 survived [76%]); therefore, the saline and PB pretreatment data were combined when making further comparisons.”
  3. “In the absence of diazepam adjunctive therapy, all 3 doses of atropine in combination with either 2-PAM or MMB4 provided at least 70% survival of the guinea pigs against 2LD50s of GB. Against 2LD50s of GF, VR or GA, the 0.3 and 3.0 mg/kg doses of atropine in combination with 2-PAM provided no greater than 20% survival of the guinea pigs. The 0.3 mg/kg and 3.0 mg/kg doses of atropine in combination with MMB4 resulted in significantly greater survival of the guinea pigs than with 2-PAM against GF and VR but not against GA. The 16 mg/kg atropine dose in combination with either oxime was significantly more effective than either the 0.3 or 3.0 mg/kg dose of atropine.”
  4. “The addition of diazepam significantly improved survival rates for the 0.3 and 3.0 mg/kg doses of atropine in combination with either 2-PAM or MMB4. The beneficial effect of diazepam on survival rates was most evident in GF-, VR- and GA-intoxicated guinea pigs.”
  5. “The results of the present study support Ligtenstein’s view and suggest further that the amount of atropine needed to obtain significant survival rates is dependent on how effective the oxime is in reactivating the nerve agent-inhibited AChE in peripheral tissues.”
  6. “An important finding in this study was that in the absence of adequate doses of atropine and/or sufficient oxime reactivation of peripheral AChE, the presence of diazepam in the treatment regimen enhanced survival. This has important operational implications, which suggests that in the field where casualties are not going to be maximally atropinized, administration of diazepam with atropine and oxime therapy may be critical.”

Chemical, Emergency Response



  1. “During a bioterrorism incident, 68.9% of hospitals would contact EMS, 68.7% percent law enforcement, 61.6% fire departments, 58.1% HAZMAT, and 42.8% all four. About 74.2% had staged mass casualty drills with EMS, 70.4% with fire departments, 67.4% with law enforcement, 43.3% with HAZMAT, and 37.0% with all four.” (Pg. 1)
  2. “Federal funding through HRSA for hospital preparedness, including mass casualty drills, has fallen from a high of $514.9 million in fiscal year 2004, to $474.2 million in FY 2006.8 But the HRSA National Bioterrorism Hospital Preparedness Program continues to encourage integration of hospitals with public safety organizations, such as fire departments, EMS, and law enforcement” (Pg. 4)
  3. “Farmer and Carlton (2006) commented that a major factor working against developing a better interface between hospitals and communities in disaster planning was cultural differences between public and private entities, with 95% of police, fire, and EMS systems being public and 95% of the medical capability being private” (Pg. 5).
  4. “The majority of hospitals involve public safety organizations in their emergency plans and drills, but some types of hospitals are more likely to do so than others. Higher hospital bed capacity was the characteristic most predictive of drilling with these organizations.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Law Enforcement



  1. “The Spanish flu pandemic of 1918–1919 emerged killing an estimated 50 million people. Humans are still being assailed by infectious disease threats. In the past five years alone, several pathogens were seen in North America for the first time – West Nile virus, monkeypox virus, low pathogenic avian flu in commercial bird farms, mad cow disease and Severe Acute Respiratory Syndrome (SARS).” (Pg. 2)
  2. “several researchers have called for stricter controls over biotechnology experimentation that provide dual-use information and technologies, dissemination of bioinformatics data and regulation of researchers as a way to manage infectious disease risks” (Pg. 2)
  3. “Emerging diseases can be controlled but doing so requires significant funding and a coordinated effort. Implementation of strategies such as modern ‘ring containment’ where infectious disease was cordoned off by vaccinating individuals in a circle surrounding outbreak areas, and hospital quarantine under controlled conditions eradicated smallpox from the planet.” (Pg. 2)
  4. “Genetic engineering is defined as the process of manipulating the pattern of proteins in an organism by altering its existing genes. Since the genetic code is similar in all species, genes taken from one organism can function in another, allowing traits to be altered or introduced. Either new genes are added, or existing genes are changed so that they are produced by the recombinant.” (Pg. 3)
  5. “With 30,000 human gene targets, available biotechnologies, and scientific creativity just about any gene can be turned into a bioweapon target.16 The problem then becomes one of risk issue management as we try, as a society, to mitigate the risks of subverted uses of biotechnology.” (Pg. 3)
  6. “We have reached a point through science and communication technology where we can detect, track and contain most emerging diseases in real time, no longer passive victims from the assault of infectious diseases.” (Pg. 6)

Bioterrorism, Public Health, Emergency Response, Pandemic


Saulny, Susan, and Jim Rutenberg, “Kansas Tornado Reviews Debate On Guard At War: Slow Response to Storm, States Assert Deployments Stretch the Troops and Mate’riel Too Thin“, NYT, A1, May 9, 2007.

  1. “For months Governor Kathleen Sebelius of Kansas an other governors have warned that their state National Guards are ill-prepared for the next local disaster.”
  2. slow response, National Guard ill-equipped
  3. A report by the Government Accountability Office “concluded that the ongoing operations in Iraq and Afghanistan have ‘significantly decreased’ the amount of equipment available for National Guard units not deployed overseas, while the same units face an increasing number of threats at home.”

Military, Emergency Response, Iraq, Afghanistan


Vijayaraghavan R., et al., “Evaluation Of The Antidotal Efficacy Of Atropine Sulfate And Pralidoxime Chloride Given By Autoinjectors Against Nerve Agent (Sarin) Toxicity“, 18 June 2007, J Med CBR Def. http://www.jmedcbr.org/issue_0501/Vijay/Vijay_03_07.html#authorInfo Last Checked 4 October 2011.

  1. “The pupillary constriction was observed within two to three minutes of sarin instillation following 5, 10 or 20 µg/kg.”
  2. “Administration of either atropine sulfate or pralidoxime chloride alone through the autoinjectors marginally protected the animals, as noted by pupillary constriction, 30 minutes after the drug administration, but significantly protected affected pupillary constriction 120 minutes after the drug administration. The exception was for the 20 µg/kg dose group at 120 minutes, however by 24 hours, pupillary constriction was comparable with the lower dose groups.”
  3. “When atropine sulfate and pralidoxime chloride were administered together, they significantly protected pupillary constriction by 30 minutes after the combined drug administration.”
  4. “Administration of 5, 10 or 20 µg/kg of sarin produced a dose dependent decrease in the plasma cholinesterase level.”
  5. “Compared to the administration of atropine sulfate alone, pralidoxime chloride administration improved the cholinesterase level.”
  6. “Administration of atropine sulfate and pralidoxime chloride together significantly improved the level of plasma cholinesterase even after 30 minutes.”
  7. “The present study showed that administration of atropine sulfate or pralidoxime chloride individually did not give significant protection as measured by the pupillary constriction and plasma cholinesterase level, while both the autoinjectors together gave significant protection. Our study also showed that administration of atropine sulfate and pralidoxime chloride using the autoinjectors, one after the other but close in time, is an effective way of protecting against nerve agent toxicity.”

Chemical, Emergency Response


Good, Linda, “Addressing Hospital Nurses’ Fear of Abandonment in a Bioterrorism EmergencySlack Incorporated, December 2007.

  1. “A study of 212 Pentagon staff members indicated that respondents who were in or near the Pentagon during the September 11, 2001, attack were more likely to have posttraumatic stress disorder and major depression than coworkers who were at other locations” (Pg. 1)
  2. “Residual post-event effects included fear of returning to the site, sleep disorders, eating problems, grief response, and a new sense of vulnerability in their place of work and community” (Pg. 2)
  3. “Nurses on night shifts felt less prepared than nurses on day shifts because education and drills were usually scheduled at times they could not attend (O’Boyle et al., 2006). A day shift drill does not simulate after-hours resource issues, including concerns about access to supplies.” (Pg. 2)
  4. “The stocks of disposable respirators, isolation gowns, and gloves are finite and would deplete quickly. Traditional standard precautions, such as frequent disposal of PPE, may not be possible, yet facilities may lack a contingency plan.” (Pg. 2)
  5. “Biological attack adds elements of evil intention and activation of deeply rooted fears, resulting in the potential of strong psychological responses (Holloway, Norwood, Fullerton, Engel, & Ursano, 1997). Nurses have reported a lack of attention to their psychosocial needs in past domestic disaster events” (Pg. 3)
  6. “Nurses anticipate that in the event of a bioterrorism disaster, they would be functioning in a chaotic environment without the presence of hospital administration or a clear chain of command (O’Boyle et al., 2006). Nurses who have actually experienced the chaos of disaster response reinforce the need for the visible, reassuring presence of leadership.” (Pg. 4)
  7. “The focus group nurses anticipated that many coworkers would fail to report to work or even quit their jobs, rather than place themselves in harm’s way. Besides an unwillingness to report for duty, an inability logistically to get to work may exist in a disaster event (Qureshi, Gershon, Gebbie, Straub, & Moore, 2005). Consequently, the nurses in the study by O’Boyle et al. believed that resulting staff shortages would place even greater pressure on those remaining…… being free to attend to family safety. Qureshi et al. (2005) found this to be the most frequently cited reason for hospital employees being unwilling to report for duty in a disaster.”(Pg. 4)

Bioterrorism, Emergency Response, Biodefense, Public Health




Emergency Response, Homeland Security, Public Health






Young, Alison, “Georgia Lab Workers Exposed to Bioterror Agent,Atlanta Journal Constitution, January 30, 2008.

  1. “Hundreds of laboratory workers across the country -including 57 in Georgia- were potentially exposed to a weakened bioterrorism agent when samples were mishandled as part of a voluntary readiness test, state and federal health officials said.”
  2. “At 16 of Georgia’s 27 clinical labs participating in the test, workers failed to follow proper handling procedures and were potentially exposed to a vaccine strain of ”Brucella abortus RB51.””
  3. “So far, the CDC identified 916 workers in 254 clinical labs who were potentially exposed to Brucella during the nationwide Laboratory Preparedness Survey last fall.”
  4. “Twice a year, labs that voluntarily participate in the program are sent samples of various disease-causin organisms.  SInce 2006, the tests have included weakened bioterrorism organisms after the labs said they needed more realistic exercises of their preparedness, CDC officials said.”
  5. “The testing kits included written instructions stating the samples should be handled inside a special safety cabinet and within the protective barriers of a Biosafety Level 3 lab.  Despiet these instructions, some lab workers handled the samples in high risk ways, even sniffing open culture plates as they sought clues to what was growing on them, records show.  Certain odors are associated with some bacteria.”

Brucellosis, Lab Safety, CDC, BSL, Emergency Response


Roni Caryn Rabin, “Preparing for a Bioterror Attack, Assisted Suicide on TV and Bird Flu in Hong Kong,” December 10, 2008. NYT http://www.nytimes.com/2008/12/10/health/10rounds.html?_r=1&ref=health Last Checked, March 27, 2013.

  1. “States Cut Funding to Combat Disease Outbreaks The economy is jeopardizing the nation’s ability to handle public health emergencies and bioterror attacks, as both the federal government and states cut funding for programs to combat disease outbreaks and natural disasters, USA Today reports.”
  2. “Meanwhile Georgia, home to the Centers for Disease Control and Prevention, barely got a passing grade in a new report assessing its readiness to distribute stockpiled medicine and vaccines should a terror attack occur or pandemic break out, The Atlanta Journal Constitution reports. The stockpile is controlled by the C.D.C. and Georgia is one of 10 states that turned around a failing grade in the assessment last year.”
  3. “Hong Kong is reporting another outbreak of avian influenza, or bird flu, among chickens at one of the city’s largest poultry farms. Officials are concerned because the chickens were vaccinated against the virus. The city is culling birds and shutting down the local poultry industry for 21 days, Time Magazine reports.”

Emergency Response, Public Health, CDC



”’Sferopolous, Rodi”’, “A Review of Chemical Warfare Agent (CWA) Detector Technologies and Commercial-Off-the-Shelf Items.” Defense Science and Technology Organization. March 2009
* ”An ideal detector can be described as one that can detect both Chemical Warfare Agents (CWA) and Toxic Industrial Chemicals (TIC) selectively within an acceptable time; sensitive enough to detect agent concentrations at or below levels which post a health risk, and not be affected by other factors in the environment. As yet, the ‘ideal’ detector is not a commercial reality.” – Executive Summary
* ”Whilst Chemical Agents (CA) can cause serious injury or death, it is the method and accuracy of their delivery that determines the severity of the damage.” – page 2
* ”TICs are another class of CA that are less deadly than conventional CWAs, but pose a greater threat because they are more easily accessible in large quantities and are widely used in the manufacturing or primary material processing (mining and refining) industries.” – page 6
* ”Most detectors are designed to respond only when a threat is directly imminent and therefore tend to ‘detect to respond’ or ‘detect to react’ rather than ‘detect to warn.’” – page 10
* ”Individual Personal Equipment (IPE) is still utilized as the main form of protection against a chemical weapons attack as it has been proven to provide effective protection for an individual whilst the agent is neutralized or eliminated.” – page 10
* ”With increasing threats of terrorism, the roles of CA detectors are also increasing in civil emergency responses.” – page 10
* ”At present, the most challenging aspect for detection and identification of CAs is the differentiation of the agent of interest from another chemicals already present in the environment.” – page 11
* ”Environmental conditions, such as temperature, humidity, wind, dust and contamination concentration in the air, can affect the performance of a detector. It is crucial that during the selection process it is determined if a detector is able to operate effectively in the intended environment.” – page 14
* ”Ion Mobility Spectroscopy (IMS) based detectors are the most commonly deployed detectors for chemical monitoring by the military.” – page 16
* ”Existing IMS-based field detectors include Chemical Agent Monitor (CAM), Advanced Portable chemical Agent Detector (APD 2000), Multi-IMS, Rapid Alarm and Identification Device-Monitor (RAID-M), IMS-2000, GID-3 also known as Automatic Chemical Agent Detection Alarm (ACADA), SABRE 4000, and the Lightweight Chemical Detector (LCD).” – page 20
* ”Flame Photometry Detectors (FPD) are deployed in military forces and civil agencies worldwide, however they are more commonly found integrated with a gas chromatograph (GC) in the laboratory. To date, GC-FPD has been one of the most useful methods in determining the CWA concentrations in samples sent to a laboratory for confirmation analysis.” – page 32
* ”Existing FPD based field detectors include the French AP2C monitor, the updated AP4C version, and MINICAMS.” – page 34
* ”For field applications, Infra-Red (IR) Spectroscopy based detectors are used to determine whether a sample contains targeted chemicals rather than being used to identify them.” – page 38
* ”Existing IR based detectors include the M21 detector, Joint Service Lightweight Standoff Chemical Agent Detector (JSLSCAD), MIRAN SapphIRE Portable Ambient Air Analyzer, AN/KAS-1 and AN/KAS-1A Chemical Warfare Directional Detectors, TravelIR HCI, HazMat ID, and the IlluminatIR.” – page 43
* ”Raman Spectroscopy is a light scattering technique based upon the knowledge that when radiation passes through a transparent medium, any chemical species present will scatter a portion of the radiation bean in different directions.” – page 52
* ”Existing Raman spectroscopy based field detectors include the FirstDefender and the FirstDefender XL.” – page 54
* ”Surface Acoustic Waves (SAW) sensors operate by detecting changes in the properties of acoustic waves as they travel at ultrasonic frequencies in piezoelectric materials.” – page 57
* ”Existing SAW based field detectors include the HAZMATCAD, ChemSentry 150C, CW Sentry Plus, SAW MINICAD mk II, and the Joint Chemical Agent Detector (JCAD).” – page 59
* ”Colorimetric detection is a wet chemistry technique formulated to indicate the presence of a CA by a chemical reaction that causes a color change when agents come into contact with certain solutions or substrates.” – page 65
* ”Photo Ionization Detectors (PID) are typically used in first responder scenarios to give preliminary information about a variety of chemicals as they can detect vapors given off by certain inorganic compounds that other detectors may not. They only provide suggestive, not definitive, information about whether a site has been compromised.” – page 75
* ”Existing PID field detectors include MiniRAE 2000, MiniRAE 3000, ppbRAE, ppbRAE 3000, ppbRAE Plus, MultiRAE Plus, ToxiRAE Plus, and the TVA 1000B Toxic Vapor Analyzer.”- page 77
* ”Flame Ionization detectors are general-purpose and non-selective, therefore they respond to any molecule containing carbon-hydrogen bonds.” – page 86
* ”Existing FID field detectors include the Photovac MicroFID Handheld FID.” – page 87
* ”Current detection capability is somewhat limited, as such there is a need for further research into the development of technologies which are aimed at building improved detectors to accurately provide advanced warning of a CA release.” – page 89
* [[Chemical]], [[Military]], [[Chemical Surveillance]], [[Public Health]], [[Emergency Response]], [[WMD]]

”’Hartz, Marlena”’, “Scientists Develop CW Decontamination Wipe” NTI. March 11, 2009.
*“A Texas-based team has used federal funding to create a wipe that would neutralize chemical warfare materials released in a terrorist attack”
*“The thin sheet of carbon is included with a lotion-soaked sponge in a kit that could be distributed to U.S. military personnel and first responders. The items could be used to remove chemical agents from equipment, skin and even eyes and open wounds”
*[[Decontamination]], [[Bioterrorism]], [[Public Health]], [[Emergency Response]], [[Military]]
”’Shiga, David”’, “Report Examines Lifesaving Measures for Nuclear Strike”. NTI. July 13, 2009.
*“Since such an explosion would obliterate most structures and people within a roughly half-mile radius, the panel concentrated on measures that planners might employ to limit deaths outside the blast zone”
*“The most effective way for people to protect themselves from the deadly fallout, the panel found, was to stay indoors or underground rather than try to outrun the lethal gamma rays emitted by the explosion.”
*“Radiation exposure generally attacks the immune system and leaves victims extremely vulnerable to infections and uncontrollable blood loss. Recent pharmaceutical advances could mitigate these potentially deadly effects, though the need at any given hospital following an attack could easily outstrip the drug supply.”
*[[Nuclear]], [[Emergency Response]], [[Bioterrorism]], [[Public Health]]

”’Kuomikakis, Bill, Ho, Jim and Duncan, Scott”’, “Anthrax Letters: Personal Exposure, Building Contamination, and Effectiveness of Immediate Mitigation Measures,” Journal of Occupational and Environmental Hygiene, 7:2, 71-79. First Published on December 15, 2009.
*”This report is the first detailed and quantitative study of potential mitigation procedures intended to deal with anthrax letters using a simulated anthrax letter release within an actual office building.”
*”Several scenarios were devised to examine the effects of personnel movement on these characteristics as well as determining the effects of some potential mitigation techniques and published response guidelines for anthrax letters.”
*”Following each trial, all samplers as well as the table and chair at the release point were cleaned with 10% household bleach solution. At the completion of each scenario, extensive decontamination was performed.”
*”Opening a spore-containing letter at the release point resulted in a rapid increase in the spore aerosol concentration in less that 1 min after beginning to open the letter.”
*”The strategies tested in this study all proved to be ineffective, clearly demonstrating the extreme difficulties posed in attempting to respond to anthrax letter incidents.”
*”The rapid spread of spores outside the office where the letter was opened would make it difficult to devise a practical quick response protocol to prevent the spread.”
*”Based on this work we believe that existing response guidelines should be reassessed to provide a scientific basis on whether the procedures achieve the intended mitigation.”
*[[Anthrax]], [[Decontamination]], [[Emergency Response]], [[Biodefense]]

== 2010 ==
”’Nyamathi, Adeline”’, “Computerized Bioterrorism Education and Training for Nurses on Bioterrorism Attack Agents” SLACK Incorporated. 2010.
*“Compared with other potential biological agents, anthrax spores are stable in the environment and the aerosolized form has a high mortality rate.” (Pg. 1)
*“ Achieving the goal of bioterrorism preparedness is directly linked to comprehensive education and training that enables first-line responders, such as nurses, to diagnose infectious agents rapidly and assess and deal with risks appropriately to avoid widespread contamination, illness, and death. In the same way that the threat of biological attack is continuous and constantly evolving, bioterrorism education and training must take advantage of newer technologies and must be sustained and not limited to occasional seminars or a one-time symposium” (Pg. 2)
*“Fewer than 50% of the nurses were able to correctly differentiate anthrax from an upper respiratory infection or smallpox from chickenpox. Furthermore, nurses scored lower than physicians on all 12 of the knowledge-based questions. Of the respondents, only 20% reported having previous bioterrorism training and fewer than 15% believed that they could respond efficiently to a bioterrorism event.” (Pg. 2)
*“In a larger study of 651 physicians, an online program was used to train participants to diagnose and manage cases of smallpox, anthrax, botulism, and plague (Cosgrove, Perl, Song, & Sisson, 2005). Pretest/posttest scores for correct diagnosis increased from 47% to 79%, whereas scores for correct management increased from 25% to 79%. Thus, web-based, case-oriented programs were effective in educating physicians about agents of bioterrorism. (Pg. 2)
*“This didactic module, which was adapted for nurses, included a background on bioterrorism, encompassing a brief history of bioterrorism and the reasons why biological agents could be used as weapons and an overview of the category A bioterrorism agents, including the differential diagnosis, diagnostic methods, and treatment.” (Pg. 4)
*“Participants in the computerized bioterrorism education and training program were more likely to solve the cases critically without reliance on expert consultants. However, participants in the standard bioterrorism education and training program reduced the use of unnecessary diagnostic tests” (Pg. 10)
*[[Public Health]], [[Anthrax]], [[Smallpox]], [[Emergency Response]], [[Bioterrorism]], [[Biosecurity]]
”’Jacobson, Holly”’,“Training Needs of Nurses in Rural Texas”. Public Health Nursing, February 2010.
*“Federal funding for domestic biodefense increased from US$576 million in 2001 to an estimated US$5,415million in 2008, a 10-fold increase (Franco, 2008). This increase in funding has been instrumental in strengthening the preparedness infrastructure across a variety of federal, state, and local agencies.” (Pg. 1)
*“However, it still remains the responsibility of state and local health departments to create emergency plans that are specific to and reflect the unique characteristics of their communities” (Pg. 1)
*“Research suggests that nurses play an integral role in the early detection and timely management of biological agents” (Pg. 2)
*“response training is particularly notable in rural areas, which have unique organizational and geographic features demanding different approaches to bioterrorism preparedness training and response efforts.” (Pg. 2)
*“Also consistent with previous findings, nurses represented in this study have had very limited prior participation in emergency and bioterrorism preparedness and response. Considering the national interest in emergency preparedness, this result suggests that current training strategies may need to be revised.” (Pg. 5)
*[[Bioterrorism]], [[Emergency Response]], [[Biodefense]], [[CDC]]
”’Editors”’. “Swine Flu (H1N1 Virus)” New York Times. Jan. 4, 2010. Retrieved from NewYorkTime.com on March 23, 2011. [http://topics.nytimes.com/top/reference/timestopics/subjects/i/influenza/swine_influenza/index.html]
* “The outbreak highlighted many national weaknesses: old, slow vaccine technology; too much reliance on foreign vaccine factories; some major hospitals pushed to their limits by a relatively mild epidemic… Vaccine supply was a problem, but one small dose was enough.”
* “The origins of the flu are unclear; it seems to have first surfaced in Mexico or the southwestern United States. The outbreak was first identified in March 2009 in Mexico, where health authorities became alarmed over the deaths of several young and healthy adults.”
* “Pandemic flus — like the 1918 flu and outbreaks in 1957 and 1968 — often strike young, healthy people the hardest. This flu strain it appears to infect an unusually high percentage of young people. The median age of patients is 17.”
* “International health experts, who say the epidemic will spread regardless of attempts at containment, advised against closing borders. They encouraged governments to focus on mitigating the disease’s spread through public health measures…Many countries ignored the advice against containment efforts, leading to a welter of bans, advisories and alerts on certain pork products. In China, authorities quarantined Mexican travelers in hospitals and hotels — many of whom had shown no sign of illness. Mexico City, one of the world’s largest cities, temporarily closed schools, gyms, swimming pools, restaurants and movie theaters. Mexicans donned masks for protection outdoors.”
* “American health officials took a more cautious approach, which observers now credit with containing the pandemic with minimal disruption to the economy… In retrospect,the biggest mistake made by the government was its prediction in early summer that it would have 160 million vaccine doses by late October. It ended up with less than 30 million, leading to a public outcry and Congressional investigations.”
*[[Emergency Response]], [[Flu]], [[Pandemic]]
”’Neuman, William”’, “U.S.D.A. Plans to Drop Program to Trace Livestock,” NYT, B2, 2/5/2010.
*”Faced with stiff resistance from ranchers and farmers, the Obama administration has decided to to scrap a national program [the National Animal Identification System] intended to help authorities quickly identify and track livestock in the event of an animal disease outbreak.”
*”they  would start over in trying to devise a livestock tracing program that could win widespread support from the industry.  …it would be left to states many aspects of a new system, including requirements for indentifying livestock.”
*”New federal rules will be developed but … apply only to animals being moved in interstate commerce. …It could take two years or more to create new federal rules.”
*”The [present] system was created by teh Bush administration in late 2004 after the discovery in late 2003 of a cow infected with mad cow disease.”
*”[Some] believed the voluntary system would be become mandatory…”
*’The old system … gained the participation of only 40 percent of the nation’s livestock producers.”
*[[Food Supply]], [[U.S. Dept. of Agriculture]], [[Emergency Response]], [[Biosurveillance]]

”’Beam, Elizabeth”’. “The Nebraska Experience in Biocontainment Patient Care”. Public Health Nursing Vol. 27 No. 2, April 2010.
*“The Centers for Disease Control (CDC) set health protection goals and objectives that address preparation for these emerging health threats in the current era of international travel (2007)” (Pg. 1) .
*“Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. In some cases, caring for the index patient and their direct contacts in the diagnosing hospital is the most logical approach.” (Pg. 1)
*“Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or a public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak” (Pg. 1-2)
*“The collaboration of many organizations in Nebraska led to the development of a BPCU for the care of patients with potentially dangerous, highly infectious illnesses.” (Pg. 2)
*“Plans are most effective when routinely practiced. Under the direction of the lead registered nurse, NBU personnel drill on a quarterly basis to test the adequacy of policies and procedures, learn new equipment as it is introduced, and test various care processes.” (Pg. 2)
*“Community education is required for an isolation unit to be successful in achieving its public health mission. The NBU personnel provide education and training focused on communication and decision making in a situation requiring isolation of a potentially dangerous emerging infectious disease.” (Pg. 3)
*“Some examples of unique policies to the NBU include: Transporting a patient to the biocontainment unit from the emergency department; Transporting a patient to the biocontainment unit from another patient care area within the Nebraska Medical Center; Obtaining and processing laboratory specimens; Laundry and biohazard waste removal from the biocontainment unit; Contingency plan for hospital surge capacity; Removal of patient remains.” (Pg. 3)
*“Beyond moving a patient inside the hospital, vehicle transport for those who require intense isolation continues to be a concern among local, state, and federal organizations charged with this responsibility.” (Pg. 4)
*“The continued success of the NBU has been a function of several key factors. These factors include three major areas: strong leadership, an engaged professional team, and successful collaborations.” (Pg. 4)
*“The role of the lead registered Beam et al.: Nebraska Biocontainment Patient Care 143 nurse includes managing day-to-day operations and guiding routine monthly meetings and quarterly procedural drills.” (Pg. 4-5)
*“A BPCU would allow health care workers to maintain their personal safety while providing care to a patient with a hazardous infection. The personnel who work in this specialized care unit could also become a resource for a larger public health emergency.” (Pg. 5)
*[[Public Health]], [[Bioterrorism]], [[Emergency Response]], [[Biosafety]], [[CDC]], [[Quarantine]]
”’Bouri, Nidhi & Franco, Crystal”’, “Environmental Decontamination Following a Large-Scale Bioterrorism Attack: Federal Progress and Remaining Gaps,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Volume 8, Number 2, 2010. April 7, 2010.
*”The process of environmental decontamination is a key step in a successful response to a large-scale attack involving a biological agent. Costs for the decontamination response following the 2001 anthrax attacks were estimated in the hundreds of millions of dollars, and some facilities could not be reopened for more than 2 years.”
*”However, a large-scale biological attack would likely result in an even greater amount of contamination, more areas that need to be cleaned and made safe, and a much greater cost to the American public.”
*”The Select Biological Agents (biological organisms of particular concern) can be categorized along a continuum of decontamination difficulty, ranging from not problematic to very problematic, with a range of difficulty in between. Factors influencing the difficulty of decontamination for a particular agent following a biological attack would include both the natural stability of the agent in the environment and added man-made stability through weaponization.”
*”Bacillus anthracis, the causative agent of anthrax, is considered to be the most problematic agent of concern. Anthrax is both a threat to human health and extremely hardy in the environment. Thus, anthrax requires extensive environmental decontamination following a release.”
*”The main purpose of this analysis is to identify the gaps in decontamination policy and technical practice at the federal level, including safety standards, that must be addressed in order to facilitate a successful response to a large-scale attack involving a biological agent.”
*”The U.S. intelligence community, including the Central Intelligence Agency (CIA), the Defense Intelligence Agency (DIA), the Department of State, the National Intelligence Council, and the Defense Science Board, has assessed the threat of an attack on the U.S. using biological weapons, and they have determined that the threat of a biological attack on the U.S. is current and real.14 Yet, as noted by the Com- mission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism (the Commission) in their World at Risk report released in December 2008, the U.S. remains vulnerable and unprepared to deal with such an attack.”
*”Decontamination is the process of removing or inactivating a hazardous substance (in this case, a biological agent) from contaminated environments or surfaces, including skin, clothing, buildings, air, and water, in order to prevent adverse health events from occurring. Remediation fol- lowing an attack with a biological weapon will involve a number of different phases of response, including: Sampling, Testing, and Analysis; Containment and Mitigation; Decontamination, Confirmatory Sampling, and Testing”
*”Although efforts are underway and advancements have been made in the field of biological agent decontamination, there are a number of high-level policy and scientific questions that have not yet been resolved. These gaps will be major stumbling blocks to a successful decontamination response following a large bioterrorism attack. Gaps include challenges in leadership, research coordination, funding, and decontamination response.”
*”Numerous federal agencies have responsibility for portions of the decontamination response to a bioterrorism attack. Yet, federal plans do not sufficiently delineate decontamination leadership roles and responsibilities.”
*”Currently, the U.S. lacks a coordinated and sustained federal research program in biological decontamination.”
*”The federal government does not have the human resources to carry out a decontamination response on its own, even for a small biological event.”
*”The nation must be ready to effectively and efficiently respond to and recover from a large-scale bioterrorism attack, and the federal government must take steps now to ensure that the U.S. has the technical and operational capabilities necessary to re- cover after an attack.”
*“The DOD Chemical and Biological Defense Program (CBDP) strives to develop capabilities for decontamination research and response ‘‘that enable the quick restoration of combat power, maintain/recover essential functions that are free from the effects of CBRN hazards, and facilitate the return to pre-incident operational capability””(Pg. 3)
*“Investment now in biological decontamination research to improve technologies and methods has the potential to save the country tens of billions of dollars in clean-up costs for the next event” (Pg. 5)
*“The risks of secondary aerosolization are important to understand, because they will greatly affect decontamination methods and standards, as well as policy decisions surrounding evacuation, transportation, and population movement” (Pg. 6)
*“The federal government does not have the human resources to carry out a decontamination response on its own, even for a small biological event” (Pg. 7)
*[[Decontamination]], [[Anthrax]], [[Biodefense]], [[Biosafety]], [[Bioterrorism]], [[Emergency Response]], [[Public Health]], [[Biosecurity]], [[Quarantine]],

”’Editors”’, “Bioterrorism Decontamination Could Cost Trillions, Report Warns” NTI. April 13, 2010.
*“The United States might need to spend trillions of dollars to decontaminate the site of a major biological attack”
*“The federal government has not assigned clear-cut cleanup research and execution duties to the federal entities that would be most involved in dealing with the aftermath of a biological strike”
*“The paper urges the Homeland Security Department to designate clearer decontamination duties to each federal agency, and it presses lawmakers to increase spending on biological-weapon cleanup studies and personnel”
*[[Bioterrorism]], [[Public Health]], [[Decontamination]], [[Quarantine]], [[Emergency Response]]

”’Grossman, Elaine”’, “Pentagon Pulls $1B from WMD-Defense Efforts to Fund Flu Vaccine Initiative,” August 27, 2010, Global Security Newswire. [http://gsn.nti.org/siteservices/print_friendly.php?ID=nw_20100827_5297] Last checked September 2, 2010.
*”The U.S. Defense Department has shifted more than $1 billion out of its nuclear, biological and chemical defense programs to underwrite a new White House priority on vaccine development and production to combat disease pandemics, according to government and industry officials.”
*”The planned funding reduction ‘terminates essential CBRN [chemical, biological, radiological and nuclear] defense programs … required to meet high priority service needs, prevent casualties and protect against CBRN incidents,’ according to a Pentagon budget document drafted in early August.”
*”Amoretta Hoeber, a defense consultant and chair emeritus of the NBC Industry Group, said in an interview this week, ‘that if the funding reductions result in shutting down production lines for any highly specialized WMD defense items, it is unclear how quickly the industry could reconstitute its manufacturing capability in the event that a new threat emerged.’”
*”President Barack Obama noted the initiative in his Jan. 27 State of the Union address, saying it would ‘give us the capacity to respond faster and more effectively to bioterrorism or an infectious disease — a plan that will counter threats at home and strengthen public health abroad.’”
*”The new initiative includes both Health and Human Services (HHS) and Pentagon plans for constructing ‘Centers for Innovation in Advanced Development and Manufacturing,’ to help small biotechnology companies innovate new vaccines and field them more rapidly. The modern facilities would also be capable of large-scale production of vaccine stocks during a public health emergency involving ‘emerging infectious diseases or unknown threats, including pandemic influenza,’ the HHS report states.”
*”Meanwhile, the Pentagon is left with deep budget cuts in a number of its WMD-defense efforts, and it remains unclear whether funds to backfill those project accounts will be identified, even after the fiscal 2012 budget request is delivered to Congress.”
*[[Vaccination]], [[WMD]], [[Biodefense]], [[Bioterrorism]], [[Emergency Response]], [[Biotechnology]], [[Pandemic]]
”’Editors”’, ‘U.S. Awards Contract For Radiation Treatment Work’. GSN. Sept. 7, 2010.
*“Funding from the department’s Biomedical Advanced Research and Development Authority is to be used to develop a medical treatment which uses myeloid progenitor cells, which can develop into any type of blood cell. The medication, CLT-008, is intended to foster the growth of and assist the body’s progenitor cells, according to an agency release.”
*“The Biomedical Advanced Research and Development Authority also approved millions of dollars in new funding for additional work on a treatment for plague and tularemia — two disease agents classified as potential bioterrorism threats, according to a press release.”
*“The antibiotic could be used against tularemia and plague infections as well as more common illnesses such as pneumonia that are growing increasingly resistant to antibiotics.”
*“”This new antibiotic is part of our push against antibiotic resistance for certain bacterial infections, and at the same time could provide a new treatment for plague and tularemia biothreats””
*[[Bioterrorism]], [[Biosafety]], [[Public Health]], [[Emergency Response]], [[Pharma]], [[Drug Resistance]], [[Biodevelopment]], [[Biotechnology]], [[Quarantine]]

”’Julie Steenhuysen”’, “U.S. Invests in Drug to Protect Against Radiation” 17 September 2010, Reuters/Yahoo!News. [http://news.yahoo.com/s/nm/20100917/hl_nm/us_radiation_drug_clevelandbiolabs] Last checked 24 September 2010.
*“Tiny Biotech Cleveland BioLabs Inc has won a $45 million contract from the Department of Defense to conduct clinical trials of a drug to prevent cell damage in the event of a nuclear attack.”
*“The drug works by interfering with a process of programmed cell death called apoptosis — basically a form of cell suicide. ‘This helps the body rid itself of damaged cells’, Fonstein said, ‘interfering with this process appears to strengthen the body’s ability to recover from radiation exposure.’”
*“The compound is made from a salmonella protein that naturally makes cells resistant to cell suicide.”
*”’This is the first product that is close to completion of the scientific studies for protecting populations that might be exposed to (radiation fallout),’ Rear Admiral Craig Vanderwagen, a former official at the U.S. Department of Health and Human Services who has advised the company.”
*“The drug is intended to protect the public in the event of a dirty bomb or a Chernobyl-like accident.”
*“Fonstein said the drug, known as CBLB502, could be approved for use in humans by mid-2012.”
*[[Biotechnology]], [[Biodevelopment]], [[Nuclear]], [[Vaccination]], [[Emergency Response]]


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