Why CBRNE? John Devlin, MD, FACEP GA Poison Center / Emory University / Centers for Disease Control and Prevention Why CBRNE? http://en.wikipedia.org/wiki/File:Se ptember_11_Photo_Montage.jpg http://en.wikipedia.org/wiki/File:O sama_bin_Laden_portrait.jpg Why CBRNE? http://en.wikipedia.org/wiki/File:Osa ma_bin_Laden_portrait.jpg http://en.wikipedia.org/wiki/Anwar_al-Awlak Terrorist Motivations • Further political or religious objectives • Further individual agendas http://literacy.kent.edu/Oasis/PACT/marionette.html Impact of Terrorism • • • • • • • Produce mass casualties/fatalities Cause fear, panic, and confusion Overwhelm emergency response systems Disrupt normal city routine Shut down and contaminate facilities Create loss of faith in government Create loss of faith in emergency response National lessons learned ‐‐ Tokyo sarin incident • even a crude device can create chaos • chemical ID may take hours • providing treatment before chemical ID • 11 ED providers were affected by sarin carried into the ED by victims National lessons we’re learning ‐‐ United States, Fall 2001 • Anthrax as a weapon of terrorism – 4 deaths, <50 infected vs. traffic deaths, injuries • Publicity garnered even if no real infection • Ability to detect unusual diseases without specific warning a function of vigilance and surveillance 15 National Planning Scenarios Terrorism in Georgia? http://www.fbi.gov/statsservices/publications/terror_96.pdf The 1996 Centennial Olympic Games ‐ What We Learned • Increased risk for chemical release, accidental or intentional • Facilities and staff vary in interest and preparedness • Decontamination capability generally poor at hospital ED’s • Antidote availability often a problem Sources of Threat • Risk from rogue nations • Risk from non-state sponsored perpetrators – International terrorist groups – Domestic terrorist groups – Cult groups – Individuals Who are the threats? http://www.rms.com/Publications/9_11_Retrospective.pdf Who are the threats? http://en.wikipedia.org/wiki/File:Osa ma_bin_Laden_portrait.jpg http://en.wikipedia.org/wiki/Anwar_al-Awlak Militias in Georgia http://www.adl.org/extremism/Militia/sta tes_m.asp http://www.rms.com/publications/terroris m_risk_modeling.pdf More homegrown terrorism… http://www.fbi.gov/wanted/dt FBI’s Southeastern Field Office http://www.fbi.gov/stats-services/publications/terror_96.pdf Is Georgia at Risk? http://www.dca.state.ga.us/economic/DevelopmentTools/programs/downloads/gamilit http://www.sciencedaily.com/releases/2008/03/080304092842.htm arybases_pov.pdf What’s the most toxic city in the US? Scenario 6 NATO ITF-25 • High production volume – Single facility > 30 tons • High toxicity – LCt50 by inhalation > 100K mg/min/m3 • Appreciable vapor pressure at 20oC – Airborne hazards only HAZARD INDEX Hincal et al., Pharm Sci, 2008 http://www.forbes.com/2009/11/02/toxic-cities-pollution-lifestyle-real-estate-toxiccities-methodology.html National Occupational Mortality Surveillance (NIOSH) “My job is killing me.” 1. 2. 3. 4. 5. Ohio Pennsylvania N. Carolina Georgia New Jersey Chemical Spill Sites in GA Comprehensive Environmental Response, Compensation, and Liability Act of 1980 http://toxmap.nlm.nih.gov/toxmap/combo/na vigate.do HAZMAT During Transit http://www.nytimes.com/2007/11/03/nyregion/03crash.html Corridor 1 – NW GA I-75 11-33% commercial vehicles Atlanta Athens Corridor 2 – Cen GA I-20 6-31% commercial vehicles Waco Milledgeville Corridor 3 – Cen GA I-75 5-30% commercial vehicles Macon Savannah Corridor 4 – So GA I-75 11-38% commercial vehicles Corridor 5 – Coast GA I-95 11-29% commercial vehicles Atlanta International Airport http://global.metroatlantachamber.com/marketaccess.asp The Lugar Report How Likely is a Nuclear/Radiological Attack? “… the estimated combined risk of a WMD attack over five years is as high as 50%. Over ten years this risk expands to as much as 70%.” “The estimates of the risks of a biological or chemical attack during the same time periods were each judged to be comparable to or slightly higher than the risk of a nuclear attack.” “The median estimate of the probability of a radiological attack over ten years was twice as high as the estimate for a nuclear or biological attack during the same period.” Nuclear Power in GA Atlanta Athens How many plants do we have? Waco Milledgeville Macon Alvin W. Vogtle Plant Savannah Edwin I. Hatch Plant US Navy SUBBASE King’s Bay Biggest Environmental Disaster in US History? http://www.answers.com/topic/three-mileisland-large-image Biggest Environmental Disaster in US History? Vogtle Nuclear Plant Hatch Nuclear Plant http://www.answers.com/topic/three-milehttp://www.waymarking.com/gallery/ima http://en.wikipedia.org/wiki/File:Vogtle_ ge.aspx?f=1&guid=cb26123a-5ce2-43a1NPP.jpg island-large-image 9c30-25613bffb087 Radiologics in Georgia http://www.local-hospital.com/GEORGIA/Georgia.htm Explosives in Georgia 33 Injuries and Deaths (1988‐1997) 34 How real is the threat? Athens Atlanta Waco Milledgeville Macon Savannah Athens Atlanta Waco Milledgeville Macon Savannah Athens Atlanta Waco Milledgeville Macon Savannah Where? EVERYWHERE!!! • Chem – Atlanta, industrial centers, highways • Bio – facilities, universities, CDC • Rad – hospitals, industry • Nuc – nuclear power plants, military bases • Explosives – mining, demolition, military bases Emergency Responders Attitudes and Perceptions • A survey performed in Hawaii hospitals has shown that responders ranked radiation threats highest in terms of the fear generated when compared to chemical or biological terrorist attacks. Radiological Preparedness & Emergency Response Emergency Responders and Radiological Preparedness • Research has shown that US clinicians and Public Health workers felt unprepared to respond to radiological or nuclear incidents. • Canadian survey-based study: 31% of EMS providers reported receiving training in radiation detection. Radiological Preparedness & Emergency Response http://chronicle.augusta.com/latest-news/2010-12-01/ga-meth-seizure-near-us-record Georgia has a Meth Problem? http://www.justice.gov/dea/seizures/ How prepared are we? How prepared are we? - 10 incidents - 9 deaths - 4 law enforcement officers required medical care. How prepared are we? http://www.nswfb.nsw. gov.au/gallery.php?id=6 98&item=91 Managing HAZMAT Incidents http://www.croierg.com.au/newsarchive/copy4_of_front-page How prepared are we? Athens Atlanta Waco Milledgeville Macon Savannah Toxic Plume