A homeland defense unit at the U.S. Army Soldier and Biological
Chemical Command is working with civilian first-responders to improve
the nation’s capabilities against chemical and biological
terrorist attacks.
Under a project called the Military Improved Response Program (MIRP),
SBCCOM partnered with and provided civilian first responders and
emergency managers practical solutions to improve their preparedness
in cases of biological and chemical terrorism. The program’s
successes underscore how Army scientists and engineers can partner
with federal agencies such as the FBI, Federal Emergency Management
Agency, Department of Health and Human Services, Environmental Protection
Agency and Department of Agriculture.
The MIRP was designed to leverage SBCCOM’s science and technology
efforts to help first-responders manage the consequences of a chemical
or biological event and improve the response capability of Defense
Department organizations that provide military support to civilian
authorities.
Four functional groups participate in the MIRP effort: health and
medical; fire and hazmat; law enforcement and fatality management.
The health and medical group is working to improve the response
capabilities against biological warfare by designing a set of alternative
medical facilities. These facilities comprise the Modular Emergency
Medical System (MEMS), a strategy for flexible expansion of a local
medical infrastructure to accommodate large numbers of patients.
The fire and hazmat group is developing recommendations for firefighters
and hazmat crews responding to chemical or biological terrorist
incidents. This group also performs equipment testing to support
fire and hazmat operations.
The law enforcement group is defining the role and conduct of criminal
investigations for biological and chemical terrorism. The fatality
management group is partnering with the civilian medical examiner
and public health communities to determine how military resources
can best support the management of mass fatalities resulting from
a biological or chemical incident. They are also working with military
mortuary affairs organizations to help develop a commander’s
guide for mass fatality management.
The MIRP’s origins date back to fiscal year 1997, when the
104th Congress passed Public Law 104-201. Title XIV—Defense
Against Weapons of Mass Destruction—provided for preparedness
training against weapons of mass destruction for civilian first
responders. Section 1415 of Title XIV stated, “The Secretary
of Defense shall develop and carry out a program for testing and
improving the responses of Federal, State and local agencies to
emergencies involving biological and chemical weapons and related
materials.”
As a result of this legislation and in support of the Defense Department,
SBCCOM established the improved response program (IRP). In October
2000, the civilian portion of the IRP was transitioned to the Department
of Justice’s Office of State and Local Domestic Preparedness
Support. SBCCOM continues to retain a military IRP (MIRP) as part
of its new homeland defense business unit.
Prior to the DOJ transition, the IRP conducted numerous analyses
designed to identify and demonstrate the best practical approaches
to improve the nation’s preparedness for biological and chemical
terrorism. The IRP was a multiyear analytical program designed to
enhance the preparedness of civilian emergency responders and managers.
As such, the IRP maintained a partnership between military experts
and civilian responders and emergency managers at the federal, state
and local levels. Civilian participants specialized in emergency
management, law enforcement, firefighting, emergency medical services,
hazardous materials and public health.
The IRP identified, prioritized and developed solutions to the
most pressing response issues associated with domestic chemical
and biological terrorism.
Medical Consequences
One of the most significant differences between chemical and biological
events is the way that medical consequences will unfold over time.
The Centers for Disease Control and Prevention’s (CDC) Strategic
Plan for Preparedness and Response to Biological and Chemical Terrorism
notes that the medical casualties of chemical terrorism will usually
be immediate and obvious. Alternatively, biological terrorism will
not have an immediate impact because of the delay between exposure
and onset of illness.
Because of these time differences in effects, chemical terrorism
will usually have an identifiable incident scene while biological
terrorism will not. The casualties of chemical terrorism will be
readily observable whereas the casualties of biological terrorism
may not even know that they are infected until many days after initial
exposure.
These significant differences between the consequences of chemical
and biological terrorism require that different disciplines of first-responders
be engaged in managing the consequences of each kind of incident.
Chemical terrorism will likely engage firefighters, law enforcement
personnel and emergency medical services converging at an incident
scene. Biological terrorism will likely engage public health officials,
nurses, physicians and other medical providers treating patients
at hospitals and clinics days after the initial event.
The primary consequence of a large-scale bioterrorist attack will
be a catastrophically large number of medical casualties. Response
systems must be capable of providing the appropriate types and amounts
of medical treatments and services. However, the full spectrum of
potential consequences is much broader than medical casualties.
A well-conducted bio-terrorist attack will strain the U.S. public
health medical surveillance systems. It will also require responders
to make quick, accurate medical diagnoses and disease identifications.
By definition, a bio-terrorist event is a criminal act that will
require a complex criminal investigation. Depending on the agent
used in an attack, such an incident could also result in residual
environmental hazards that would require mitigation. Considering
the potential magnitude of casualties, a significant portion of
a metropolitan area’s population may have to be medically
managed and physically controlled.
The medical treatment, criminal investigation, environmental hazard
mitigation, and population control activities will require a coordinated
command and control effort extending across federal, state and local
jurisdictions.
The biological weapons IRP team identified a myriad of emergency
functions necessary for bio-response. To be useful and understandable,
these multiple activities needed to be organized into a logical
and integrated response system. Thus, the IRP team formulated a
generic bioresponse template. The template organizes and integrates
the essential emergency response functions necessary for a city
to respond effectively to a bioterrorist incident. This generic
template serves as a useful starting point for cities and states
to prepare their own customized local emergency plans.
Medical surveillance, the first component of the template, should
operate continuously to improve the chances of quickly detecting
unusual medical events in the local population. Once an anomaly
is detected, medical diagnosis is necessary to identify and confirm
its cause. Rapid and accurate disease identification is essential
to initiate appropriate and timely medical treatments for many bio-warfare
agents. Once a disease is identified, the public health community
will likely begin an epidemiological investigation to determine
the distribution of cases and the sources of the disease outbreak.
This information is necessary to control disease propagation and
to identify and treat the population at risk.
Concurrent with these medical investigations, the law enforcement
community will begin a criminal investigation to assess the threat,
safeguard evidence, and identify and apprehend suspects. While the
criminal investigation is in process, and pending the specific disease
agent, local officials may begin a mass prophylaxis campaign to
prevent disease and death in exposed victims. Federal and state
assistance most likely would be needed to support local response
planning for mass prophylaxis.
Depending on the attack agent, residual hazard assessment and mitigation
may be necessary to assess and protect the population from further
exposure to potential environmental hazards. In the case of a contagious
disease, physical control of the affected population may be necessary
to control and minimize secondary infections. Quick dissemination
of accurate, authoritative medical information is essential to maintain
this kind of control.
The local medical infrastructure’s patient capacity will
have to be rapidly expanded to accommodate the high volume of patients.
Alternative health care centers will have to be established within
the affected area. Due to resource constraints, victims will likely
have to accept sub-traditional levels of care. Appropriate fatality
management strategies will have to be put into place to manage the
potentially large number of fatalities. The local community will
need to stand-up family support services to provide information,
non-medical assistance and crisis counseling to victims and their
families.
For an effective response to bio-terrorism, the described emergency
functions will need to happen at a rapid pace and in high volume,
all while insuring continuous operation of critical infrastructure
such as communications, power generation, water and sanitation services.
The local emergency operations center (EOC) and, likely, a joint
local/state/federal EOC will be necessary to lead and manage the
huge number of participants and resources involved.
The overall biological-warfare response template, along with implementation
guidelines, is described in detail in “Interim Planning Guide:
Improving Local and State Agency Response to Terrorist Incidents
Involving Biological Weapons,” which is available at SBCCOM’s
homeland defense Web site, http://www2.sbccom.army.mil/hld/bwirp/index.htm.
Response Template
The individual response components of the template warrant further
research. The IRP has done a series of follow-on analyses to build
on and refine the template. One involved defining the interface
between the criminal and epidemiological investigations after a
bio-terrorist incident. The law enforcement community will conduct
its criminal investigation. The medical and public health community
will perform an epidemiological investigation to identify and control
the disease outbreak.
Although each community conducts its respective investigation separately
and independently, information from each investigation could aid
and assist the other. For instance, identifying the source of the
outbreak or the time and place of agent release is relevant to and
could be a product of both investigations. Because neither community
is accustomed to working with the other, it is possible that information
that could benefit one or both investigations will not be exchanged.
In an effort to close this gap, the IRP team partnered with the
National Domestic Preparedness Office (NDPO) and sponsored an analytical
workshop in January 2000. The workshop’s goal was to identify
methods to establish information sharing relationships between the
law enforcement and the public health communities to ensure the
timely and appropriate exchange of information during investigations
involving bio-terrorism. Using a panel of law enforcement and public
health professionals and working through a structured, intensive
three-day workshop, the IRP identified what information is needed
for each investigation, who should get the information, how each
community could improve its information exchange with the other
and what critical decision points exist in each investigation. A
complete report of the findings is available at http://www2.sbccom.army.mil/hld/bwirp/index.htm.
The original template was derived through intensive analysis of
five credible biological threat scenarios. By design, these scenarios
were confined to infectious but non-contagious agents. Once a practical,
comprehensive strategy for response to a non-contagious agent was
developed, this strategy had to be modified to accommodate the more
complex case of a contagious agent. Response to a communicable disease
is substantially complicated by the possible diverse sources of
infection and reinfection.
To analyze and develop solutions to this problem, the IRP partnered
with the Centers for Disease Control and Prevention (CDC) to conduct
a workshop in April 2000. The goal was to refine the CDC smallpox
control plan and strategy by applying it against a credible contagious
bio-terrorist attack scenario. The workshop focused on the areas
of vaccination, quarantine/isolation and medical surveillance.
A panel of experts found that the response template, with certain
modifications, is a practical strategy for minimizing the consequences
of a bio-terrorist attack with a contagious agent. Some of these
modifications include: adding contact-tracing to the epidemiological
investigation, implementing protective measures for criminal investigators,
establishing community outreach teams to implement mass immunizations
at private homes rather than convene potentially contagious persons
at public facilities, limiting public gatherings and mass transportation
functions, implementing geographic isolation/quarantining, and establishing
more stringent handling, burial and disposition requirements for
fatalities.
Although the template was derived by a multi-disciplinary group
of responders from various jurisdictions around the nation, the
IRP wanted to validate and demonstrate its applicability to different
sized communities in various regions of the country. To do so, the
IRP team conducted workshops with local first responder and emergency
management teams in three communities: Wichita, Kan.; Pinellas County,
Fla., and Dover, Del. In each community, the template proved a valuable
starting point for development of customized emergency response
plans.
In addition to validating the template’s broad applicability,
these on-site community workshops brought out and identified the
key emergency management decisions inherent to biological emergency
response. The IRP team collated these decisions into two decision
trees, one for an announced biological attack, the other for an
unannounced attack. Both decision trees, with more detailed supporting
decision trees, are described in “Updated Biological Warfare
Response Decision Tree and Response Template,” can be accessed
at http://www2.sbccom.army.mil/hld/bwirp/index.htm.
Dr. Mohamed Athher Mughal holds a B.S. in chemical engineering,
an M.S. in engineering management and a Ph.D. in public policy.
He is also a branch-qualified Army chemical officer and an honor
graduate of the U.S. Army Chemical School.