Introduction to Leader's Guide

by Shirley Ayers

Terrorism knows no geographic boundaries. It is not limited to hot spots in Europe or the Middle East, nor is it limited to large urban centers. Terrorism threatens all communities, and emergency response and emergency management personnel have a responsibility to learn how to protect civilians within their jurisdiction and to prepare themselves to respond to terrorist incidents.

The U.S. Department of Justice defines terrorism as "A violent act or an act dangerous to human life, in violation of the criminal laws of the United States or any segment to coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives."

A terrorist act may be categorized by the weapon used. In general, terrorist weapons of mass destruction fall into four categories:

Explosives
Chemicals
Biological agents
Radioactive materials

This Leader's Guide accompanies "Terrorism: Biological Weapons," a training video that deals with terrorist incidents involving biological agents. For training on response to terrorism incidents involving explosives, Emergency Film Group has produced a video and Leader's Guide entitled "Terrorism: 1st Response." A third program in the terrorism response series, "Terrorism: Chemical Weapons," will be available at the end of 1999.

Bioterrorism is the release of infectious micro-organisms or toxins intended to kill or cause disease to an unsuspecting civilian population. Biological weapons may include naturally occurring viruses, bacteria or fungi as well as genetically engineered organisms previously unknown to man. These substances possess the common ability to kill or incapacitate large numbers of people. Hemorrhagic fever, cholera and plague are examples of diseases caused by biological agents.

Biological agents are infectious substances with characteristics unfamiliar to most emergency response personnel. These agents are difficult to recognize and identify. The sicknesses they cause are difficult to treat. These agents can be lethal in extraordinarily small concentrations and they can be disseminated by various surreptitious and relatively unsophisticated methods. Some experts believe the casualties produced by a successful full-scale biological weapon using anthrax or similarly lethal agent could cause up to 95,000 deaths and 125,000 incapacitated people.

Biological agents are particularly insidious as a terrorist weapon because they are silent and invisible. The onset of symptoms after exposure to a biological agent depends on the micro-organism and may vary from hours to days or weeks. Some will reproduce and spread once they are in the host. A person who is infected may be contagious and inadvertently may transmit the disease to others through contact with body fluids or aerosols produced by coughing and sneezing.

Dissemination
Compounding the danger of biological weapons is the relative ease with which agents can be disseminated. They may be pumped through ventilation systems, or delivered as aerosols, perhaps by industrial sprayers with nozzles modified to generate a smaller particle size. They could also be dispersed from airplanes, boats or helicopters traveling upwind of the intended target.

Other possible methods of exposure for biological agents include the intentional contamination of food and water, or skin puncture, perhaps by contaminated darts or even contaminated insects.

Victims and even medical personnel may be slow to recognize the attack because initial symptoms may be flu-like or common to other types of disease. An exposed contagious person could easily travel to other parts of the country, or world, spreading the disease even before symptoms appear. It should be stressed, however, that not all bioagents are contagious and even fewer are spread through coughing and sneezing.

The degree of mortality associated with infection by a biological agent is determined by many factors, including the agent, the health of the individual and how quickly treatment is begun. Treatment for some agents, such as anthrax, is most effective before symptoms even appear. Unfortunately, comprehensive quick detection and identification methods do not currently exist for biological agents.

Vaccinations and antitoxins do exist for some biological agents. According to the New York Times, the American military is vaccinating troops against anthrax and has begun a $322 million program to build stockpiles of 18 other vaccines, including one against smallpox. Congress recently approved $51 million to start building domestic stockpiles of medicines and antibiotics, especially for police, fire and health workers.

The case against biological agents
Contrary to public perception, terrorists face some major difficulties in employing biological agents as a weapon:

It is difficult to transform the agent into a form that is readily disbursed; In many cases it will be days or even weeks before any results appear; The terrorist stands a high risk of becoming contaminated; Some biological agents cannot survive in water, and some of those that do, such as cholera, will die if exposed to sunlight; Most agents deteriorate at unpredictable rates. From the terrorist's point of view, probably the greatest barriers to the use of biological warfare agents are the unpredictability of the effect and the lag time between dissemination and the appearance of any significant results.

There are other issues that may hinder the effectiveness or practicality of using biological agents for terrorism. The weather in the target area is very important in the use of aerosols, as higher wind speeds tend to break up the aerosol cloud. Stable wind direction is critical to a terrorist with a specific target in mind. Optimum conditions occur more often during nighttime and early morning hours.

To date, even sophisticated terrorists have had a hard time making good on the threat of biological terrorism. The Aum Shinrikyo cult in Japan had more than a billion dollars in assets and 50,000 members, several of whom were skilled biologists. But the cult was unable to mount a successful biological attack despite numerous attempts. Instead, it used a nerve gas, Sarin, to kill people in an attack on the Toyko subway.

Preplanning for an attack
Until recently, terrorists have been satisfied to commit symbolic acts of terror rather than kill large numbers of people. Unfortunately, emergency responders can no longer expect this to be the case and must prepare to be able to deal with massive numbers of casualties, including casualties of bioterrorism. A group of specialists commissioned by the Clinton Administration listed five agents in particular that present an immediate threat: anthrax, smallpox, plague, tularemia and botulinum toxin.

The greatest payoff in fighting biological terrorism lies not in trying to prevent incidents -- although preventive strategies are important -- but in improving emergency preparedness for such an unprecedented attack. Preparedness encompasses a long list of unaccustomed precautions, beginning with constant surveillance for unusual clusters of illnesses. Other elements include identifying areas within the jurisdiction that may be targeted by a terrorist; identifying state and federal resources available to provide assistance; stockpiling antibiotics and antitoxins; and planning how to manage mass decontamination, massive numbers of casualties and public hysteria.

Federal money is becoming available for terrorism response training at the local level The Comprehensive Antiterrorism Act of 1995 provides grant money through the Federal Emergency Management Agency (FEMA) for "the purposes of providing specialized training or equipment to enhance the capability of metropolitan fire and emergency service departments to respond to terrorist attacks." In addition, 10 states have been selected to have National Guard units specially trained to assist state and local authorities to manage the consequences of terrorist attacks.

Other support programs may be available as well. Information is available through state Emergency Management Agencies and local offices of the FBI.

Identifying and managing an outbreak
The key to dealing with a biological incident is to identify the event. Depending on the agent used, victims will first appear in hours or days with flu-like symptoms, then get progressively sicker. The sheer number of affected persons may be the first clue that a biological agent has been released, although it may be days before the specific agent is identified through laboratory analysis of tissue samples or other means.

Other clues that may be present that might indicate an incident involving biological agents include unusual numbers of sick or dying animals; unscheduled and unusual spray being disseminated; and abandoned spray devices, such as the type of chemical sprayers used by landscaping crews.

When a biological agent incident is suspected, all exposed persons should be considered contagious and treated as such until competent medical authority can evaluate the situation and circumstances and provide specific information and guidance.

When an event is identified as a biological incident, it is critical to take steps to limit the spread of the disease by controlling the movement of exposed persons. Strict site control and quarantine of suspected exposures is essential. Site control will limit the spread of the material and contamination. Quarantine of possible exposures will limit the spread of a disease that may be communicable.

Imposing quarantine requires action by a State Health Commissioner or designee. Quarantine must be imposed if the is communicable. Generally, transporting a few exposed persons away from the scene for treatment may be reasonable. The facility to which casualties are transported must be alerted and the facility should be capable of isolating contaminated patients when they arrive. When large numbers of exposures are involved, it may be necessary to impose quarantine at or near the incident site to begin treatment. All these issues should be addressed when setting up an emergency plan.

Decontamination as it applies to chemical exposures may not necessary or effective for biological agent casualties.

Emergency management personnel should keep in mind that not all incidents will be large scale. The small-scale incident, which is more likely to hit most jurisdictions, must be recognized and managed as well. An example of a small-scale incident is a documented food-poisoning case at several Oregon restaurants that caused 751 people to become ill. The case was solved when a cult member admitted the group deliberately spread salmonella bacteria on salad bars in the restaurants.

Of the 181 terrorist incidents recorded in the United States in 1998, 112 of them were biological. The majority of these incidents were anthrax hoaxes. Through the first third of 1999, 98 biological incidents were recorded, including 93 anthrax hoaxes.

Local officials may elect to keep response small scale to a potential or hoax incident. This low-key approach prevents unnecessary publicity and panic. Incidents of any size, including suspected hoax incidents, should be reported to the local FBI. Agents may be able to provide information over the telephone to help determine whether a threat is credible. The FBI investigates all incidents including hoax incidents.

Summary
As long as violence is viewed by some as a viable means to attain goals, terrorism will be used to create fear among the public, to try to convince citizens that government is powerless to prevent terrorism, and to get publicity for their causes. The first response to terrorism nearly always rests with local emergency responders. The decisions and actions that local emergency management personnel make in the first hours after a terrorist act will have a major impact on the response, and on the investigation as well.

The challenge of putting together a well-designed training program to respond to all categories of terrorism incidents must be addressed by emergency management agencies everywhere. Recognizing the threat, identifying possible targets, and coming up with a well thought out and well rehearsed response plan are the best steps you can take to protect your community against the unknown and to bring terrorists to justice.