Biohazard Response Handbook from Schmeg.com

   

A First Responder's Guide to Biohazard Incident Response

Traditionally, in the fire service, biohazard incidents come under the general heading of HazMat incidents. This practice carries over in the planning and defense of weapons of mass destruction (WMD) incidents. Traditional response methods can under many circumstances provide adequate protection to the public and first responder. However, there are many incidents and situations where typical HazMat procedures will spread or worsen the biohazard incident. The recent small scale biological attack on America has shown the potential for spread, as well as the small quantities of materials needed to cause health problems and even death. We can already see that a disproportional amount of fear can be generated by a small number of casualties when a biological weapon is involved.

HazMat responders for the most part are trained to the technician level. The technician level of training often works well as long as degreed scientists and technical experts guide them. The main problem with this response lies in the fact that HazMat instructors treat biological hazards in only the most general of terms. The instructors themselves are often non-degreed, showing a very limited understanding of the basic principals of chemistry, biology, and physics. Of these three areas of HazMat response biological hazards are often the least explored and are usually lumped in as chemical incidents. For this reason, public health officials are often given the lead role in nuclear, chemical, and biological incidents. First responders need to rethink the approach to the biohazard situation. Biohazards are indeed HazMat incidents, but they are separate from chemical and nuclear problems and demand a different approach.

A typical response to a spill of a live biological agent will not show much at all on first inspection of the survey team. At best a small quantity of liquid may be present on the floor or the lab bench. The biggest problems associated with many biohazard incidents are: they are totally invisible, they have no odor, they are extremely hard to detect, and it takes a long time to confirm the presence of the agent.

This guide is not intended to take the place of HazMat technician training but instead is designed to supplement the training in the area of biohazard response. Some basic principals of biology and microbiology will help the responder understand the threat even when he or she cannot see or smell it. In addition, the differences that set biohazards apart from other HazMat incidents will be explored. Lastly, suggestions to mitigate biohazards will be provided to help guide the first responder in what to do to control the situation. A large section will be devoted to biological terrorism. Bioterrorist incidents are by far the most challenging threat to the first responder. The author believes all material to be factual and consistent with standard emergency procedures. It is offered only for academic consideration.

Biohazards Defined

A biohazard is a hazardous materials incident that arises from spill or release of a biological agent, toxin, or infected organism into the workplace or environment. The releases may be accidental, as in the escape of an infected animal from a laboratory or the spill of a disease-causing agent in a pharmaceutical facility. Or it may be intentional, as in a bioterrorist attack or military attack by a hostile nation using biological weapons. In the latter cases, it may be days or weeks before the first signs of a problem appear. Biohazards have the potential to kill or sicken large numbers of people, livestock, or crops. Many experts believe a well-planned biological weapons attack on a major city can cause more casualties than a nuclear attack. Biohazards can also arise from natural causes. Many diseases are highly contagious and can spread like wildfire through our modern urban societies.

In it's simplest terms biology is the study of life. With this in mind a biohazard is a dangerous condition that arises from a living organism. Scientist extends this definition to include toxins and venoms. Toxins are chemicals produced by living things that are poisonous. In many cases toxins are extremely lethal in very small quantities. As we well know, not all living things are dangerous. In fact many living things are helpful to humans. Living things that cause disease in humans are called pathogens. Pathogenic organisms fall into many categories of known life. Sometimes disease is spread from person-to-person or plant-to-plant by another animal. In this case, the animal that spreads it is called a vector. Vectors are animals that carry a disease. Some pathogens only affect plants. These are called plant pathogens. Even though they are harmless to humans they can destroy crops and cause widespread economic disaster.

Basic Microbiology

As the name implies microbiology is the study of microscopic living organisms. Microscopic living things are called microorganisms. The field of applied microbiology uses microorganisms to produce products useful to man. Many microorganisms produce foods and pharmaceuticals that we benefit from every day. Many laboratories work with pathogenic microorganisms in an attempt to develop cures and vaccines to protect the general public. Many types of living things fall under the general heading of microorganism.

The simplest of these are viruses. They are so small that they themselves are not alive but instead hijack living cells and make them make new viruses instead of carrying out there normal life functions. Viruses pose one of the most challenging of all biohazards due to their very small size. Normal respiratory protection may be of little help when working around a dangerous virus. In addition few viruses can be cured, instead supportive treatment is given to help a person fight them off. Disinfection of a virus can be difficult, requiring special effort and procedures. Many of the most horrible diseases facing mankind are caused by viruses including: AIDS, smallpox, ebola, west nile virus, and influenza.

Bacteria are true living organisms. They are all single-celled. What distinguishes then from most other forms of life is the lack of a true nucleus in their cells. Bacteria come in three major overall forms: bacilli, cocci, and spirella. The bacilli are rod or sausage shaped and contains many pathogens in the group. Anthrax and the plague are both caused by bacilli. Some bacilli have a way to protect themselves when the environment gets bad. They form a hard spore that is resistant to extreme environmental pressures. These types of bacteria are referred to as spore formers. These spores can become active many years later when conditions improve for the bacteria. The next type is called cocci. They have a shape of little round balls. Often they can be found in chains or clumps. A type of cocci bacterium causes strep throat. Spirella make up the third group and are little spiral bacteria. They cause many diseases such as Lyme disease.

Growing bacteria is called culturing and an active growing group of them is referred to as a culture. Sometimes they are grown on plates called petri dishes and each individual little group is called a colony. Each colony arises from an individual bacterium. The liquid or solid that bacteria are grown on or in is called media. The media contains nutrients needed for growth and provides a substrate for the bacteria to grow attached to. One way to distinguish between types of bacteria is called the Gram Test. It involves a process of staining bacteria then trying to wash the stain off. Gram positive or gram negative refers to how they respond to this test. Many, however, can become resistant to antibiotics over time. A resistant bacteria is one that is not very susceptible to common antibiotics. Some resistant bacteria occur naturally and others have been laboratory induced in the production of biological weapons.

Many organisms produce substances that are highly poisonous. We refer to these materials as toxins. All of us are familiar with some toxins such as those found in poisonous mushrooms and the venoms from dangerous snakes. Some plants also produce extremely deadly substances. A good example of a plant toxin comes from the castor bean. The toxin called ricin is one of the deadliest substances known. It has been used as a tool of assassination during the cloak and dagger days of the cold war. Many microorganisms produce toxins as well and they can be very deadly, as in botulism toxin (botox). In the times when the home canning of foods was popular this toxin claimed many lives each year. Toxins are classed as biological hazards because they arise from living things. They are however unable to reproduce and the effects from an accidental spill or intentional attack are much more similar to a chemical incident and can be treated as such.

Some diseases are transmitted to man by insects or other animals. Diseases that we get from animals are cooled zoonoses. The animal that carries the disease is called a vector. One of the best-known vectors is the mosquito. Yellow fever, malaria, and west Nile virus are all transmitted by mosquitoes. Some bioterrorism experts feel that a terrorist group may someday try to release infected vectors as a biological attack on the United States.

Infectious materials are another biohazard source. The blood, body fluids and tissues of infected person can transmit disease, as we all know. We will not spend much time on these types of biohazards, as they are well covered in all first responders' blood born pathogen training.

How do I handle a small biological spill?

A small biological spill might be the result of a medical or research laboratory accident. It could also be the result of blood and bandages from a trauma incident. A small spill would be less than a gallon of liquid or a pound of dry materials. Using proper gloves, eye protection, and respirator cover the spill with absorbent paper towels. Saturate the paper towels with the proper disinfectant and allow it to set for the proper amount of time for the selected disinfectant. Clean up the materials and bag in a biohazard bag. If anyone was contaminated in the spill, remove and bag their contaminated clothing and have them shower with warm soapy water. Have the exposed person evaluated by medical professionals to see if any additional treatment is needed.

How do I handle larger spills?

A large spill is likely to occur from a motor vehicle accident involving biohazard waste, or from any scene of trauma. For the most part many emergency responders dump bleach out of the bottle on it and have a fire engine wash it down. This old tried-and-true method leaves a lot to be desired. First, dumping bleach from the bottle causes a splash that can aerosolize infectious materials. In addition it causes an uneven saturation of bleach with some areas receiving large amounts of bleach and others not enough. Often the proper amount of contact time is not given before the wash-down starts. A better way would be to use pump sprayers or spray bottles to evenly saturate the spill. Allow fifteen to twenty minutes for the bleach to kill all pathogens. Then the material should be absorbed with kitty litter and bagged. The bags should be sealed, marked as biohazards, and disposed of in a proper way. Proper personal protection should be worn during the entire cleanup process.

Where are likely sources of a biohazard incident?

Biohazard spills may originate from many sources. Research laboratories often have many highly infectious organisms on the site. Infected animals may escape from these facilities and cause a biohazard in the surrounding area. Any type of medical facility such as a doctor's office or clinic may serve as a source of a spill. Hospitals generate large amounts of biohazard materials. Any incident-involving trauma will likely be contaminated with blood and other bodily fluids. Many private carting firms pick up and transport medical waste. An accident involving one of these vehicles can spread contamination to all responders at the scene. Domestic animals and livestock may serve as a source of a biohazard. One of the most likely biohazard sources is the result of improper handling and sanitation of food. Leaking septic systems may cause contamination of water. By far the most feared type of biohazard incident involves the intentional release of a biological weapon. The potential for casualties in a bioterrorism incident can even exceed those expected in a nuclear attack. Bioterrorism incidents will be the focus of much of the remaining material.

What are Biosafety Levels?

In the science of biosafety you will often hear reference to different levels of biohazard and protection. These are a little different than the levels of protection equipment referred to in HazMat response training. The levels of biohazard are rated as level I, II, III, and IV. Organisms are assigned a level based on their danger. Level I agents are those not known to cause disease in healthy humans, and normal laboratory clothing, lab coat and eye protection, are the only protective garments worn. Level II agents pose a moderate risk to people and the environment. Contaminated items are sterilized. Lab coats, two pairs of gloves, and a facemask are worn when working with these agents. Level III agents may cause illness or death by inhalation. They are considered dangerous. Gloves, gown, respirator, and goggles are worn. Work with these agents is restricted to a biosafety containment cabinet. Level IV agents are the most dangerous. They are a high risk for spreading. Fully contained and pressurized suits are worn with supplied air. All air is filtered and contained in the room where these agents are housed with the use of negative pressure to prevent air from escaping the room..

What is Bioterrorism?

The Federal Bureau of Investigation defines terrorism as: "the unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives." Bioterrorism is the use, or threatened use, of biological weapons in a terrorist attack. An example is the terror generated by anthrax mail attacks in 2001. It is the author's opinion that all the attention given to the letter attacks will make biological weapons even more desirable to terrorists in the future.

What are biological weapons?

Biological weapons are biological agents and toxins that have been engineered for military use. Many years of biological warfare research have produced a wide array of suitable biological agents and toxins that can be used to kill or incapacitate humans, animals, and crops. This research has also generated munitions and delivery mechanism for these agents. Biological warfare is not unknown in world history. In ancient times the decaying bodies of animals and people were thrown in wells to prevent the enemy from using water supplies. The bodies of plague victims were catapulted over the walls of fortresses under siege to infect the defenders. It is believed by many that smallpox-infected blankets were intentionally given to Native Americans during the French and Indian Wars. Many nations have had active military biological warfare programs including: the United States, Canada, the United Kingdom, and the former Soviet Union. Many rogue nations are believed to have active biological warfare programs such as: Iraq, Iran, Syria and North Korea.

What makes a biological attack so feared?

The thought of a disease running rampant through the population killing and incapacitating tens of thousands of people is a terrifying thought. All of us are aware of the great plagues that have ravaged history and the massive numbers of casualties that have resulted. Many citizens think this will be the outcome of any biological attack. Even though the possibility of a tremendous numbers of casualties is of course possible, it is in fact highly unlikely. Still the thought spurred by past history, recent science fiction books and movies, and the anthrax attacks have generated a great fear in the eyes of the general public. It must be expected that there will be great panic in the general population at the onset of any biological attack.

What are some of the signs that a biological attack is underway?

1. Explosive devices that do little damage.
2. Finding abandon spray and aerosol cans.
3. Crop-dusting aircraft operation over populated areas.
4. Trunks, vans, or other vehicles discharging mist or smoke as they travel.
5. Suspects carrying gas masks
6. Large numbers of sick people or animals.
7. Non-marked vehicles carrying biohazard marked containers.
8. Abandon vehicles with biohazard placards.
9. Home laboratories that have respiratory protective equipment.
10. Suspects with petri dishes or cultures flasks in their possession.
11. Unusual clouds or mists that don't arise from the weather.

Most of the equipment needed to make and deliver biological weapons has other legitimate uses. This adds to the difficulty of recognizing a biological attack. Law enforcement and intelligence tips from the public are of the greatest importance to recognize a biological terrorism incident.

What are the most likely agents to be used by terrorists?

There are many agents that are suitable for use as biological weapons. Very few have ever actually been used. Of all the possible agents a few are the most likely to be used. Three agents of special concern are anthrax, plague and smallpox. The following list contains agents deemed most likely to be employed in a biological attack.

• Anthrax
• Brucellosis (undulant fever)
• Cholera
• Plague
• Tularemia (rabbit fever)
• Typhoid Fever
• Smallpox
• Q Fever
• Ebola
• Dengue Fever
• Lassa Fever
• Typus
• Botulism Toxin
• Ricin Toxin
• Staphylococcus Enterotoxin B (SEB)

What is a Militarized Agent?

In nations with biological weapons programs, some biological agents have been tested to see if they can be used as weapons of war. Improvements have been made to agents to make them more infective or more resistant to antibiotics or vaccines. Spores of some agents can be milled to the proper size to penetrate deep into the lungs. Other chemicals have sometimes been added to the agents to make them aerosolize with ease and remain airborne longer. Genetic engineering can also be done to add dangerous traits to otherwise harmless microorganisms. A militarized agent has been modified in some way to make it a more effective weapon.

What is the Plague?

All of us have a natural fear of the plague. Millions of humans have died in the wake of its historical outbreaks. The plague is caused by the bacterium Yersinia pestis. The disease has two forms, bubonic and pneumonic. The plague is contagious and can be fatal. It can however be treated with antibiotics if caught in time. The flea is the vector involved in the spread of this disease. During World War II, the Japanese dropped infected flea bombs in Manchuria.

What is Smallpox?

Smallpox is a viral disease caused by the variola virus. It was once a scourge of mankind before being eliminated in its natural form by modern medicine. It is highly contagious and not treatable by antibiotics. Vaccination stopped after eradicating it in nature and has left the population helpless in the event of its use as a weapon. [Editor's note: the US and other countries have expanded vaccine stockpiles. Smallpox can be fatal, killing as many as 30% of those infected.

How can I protect myself during a biological attack?

As explained above, the chances are great you will not know a biological attack is underway. If you receive information an attack is underway or if you suspect an attack:

• Put on your SCBA or NBC gasmask immediately.
• Seek inside shelter. During an attack, inside is the safest area. This may not be the case after the attack has ceased.
• If in a vehicle, turn off the heat or air conditioning. Close the windows and stay in the vehicle until after the cloud has passed.
• Evacuate yourself and others from locations downwind of the attack area.
• Avoid plumes of mist or puddles of liquid that result from the attack.
• Report the direction of movement and speed of the cloud of mist.
• Button up shirts and coats to protect your skin.

How do I handle suspicious mail?

• Do not handle any mail you consider suspicious.
• Don't shake it, bump it, or smell it.
• Slowly, without much disturbance, cover the suspicious mail with paper, cloth, or a towel.
• Turn off fans, air conditioners or heaters.
• Wash hands thoroughly with soap and water and if possible shower.
• Call the police.

How do I decontaminate myself after an attack?

If possible, the very best thing you can do is take a long soapy shower in warm water. Before you enter any structure remove as much of your outer clothing as possible and your shoes. Shower in warm water using plenty of soap. Wash your hair with detergent shampoo and scrub head to toe, starting at your head and working to your feet. If a decontamination team is available they will decontaminate you on the scene.

If none of the above are available, remove as much outer clothing as possible and rinse with copious amounts of water. A decontamination solution can be made from common liquid bleach. Use one part of bleach out of the bottle to nine parts of water. This can be used on all parts of the body except your face. Keep bleach well away from your eyes. Remember never to mix with ammonia as a poisonous gas can result. Be sure to allow the bleach solution to remain in contact with your skin and clothes for fifteen minutes to allow time to kill any biological agents on you.

How do I decontaminate equipment?

To decontaminate equipment use full strength bleach. Bleach right out of the bottle should be 5% sodium hypochlorite in strength. Wipe or spray the solution over large equipment. Soak smaller equipment in a bucket filled with bleach. Allow at least a half hour of contact time before flushing with fresh water. With all decontamination of biological agents it is very important to allow proper contact time to kill the agent and its spores. If you use a solution other than bleach to decontaminate be sure to read the instructions for a proper contact time.

What is sterilization?

Sterilization is the complete removal of all living things from an object or area by use of physical or chemical means.

What is disinfection?

Disinfection is the removal of pathogenic organism by physical or chemical means.

In Conclusion

Responding to biohazards can present unique challenges to the first responder. The character of biological agents makes them different from other typical HazMat responses. As we continue our war on terror, new and once unbelievable horrors can be unleashed on our citizens. We must continue to expand our knowledge as first responders to better protect the public we serve.

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