Emergency Preparedness and Response to Chemical Terror Agents

Introduction

Since their conception as possible weapons of mass destruction, chemical agents have been associated with military use as chemical weapon inventory. However, the recent development of terror and the backing of terrorist activities by influential and financially stable elements, the use of chemical weapons against civilians is not farfetched. The resources by the United States to respond in cases of release of chemical terror agents are faced with unique challenges concerning agent detection, incident management, and the protection of emergency response personnel. The latter is because these resources are designed for industrial agent intervention and not outright public response. Whether they are released intentionally or unintentionally, chemical weapons have devastating effects on civilians as they are likely to overwhelm the current medical resources, response and emergency mechanisms set in place. Chemical terror agents (CTA's) pose a dangerous threat to the national security of the United States of America (Parker, 2006); therefore, the current capabilities must be developed by addressing the emergency public health and medical issues to effectively be prepared and respond in case of CTA release.

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Previous terror attacks were associated with readily available weapons such as hand grenades, explosives, and firearm (SIMUS, 2016). However, these groups have evolved over the centuries and are now in search of the sophisticated weapons that are hard to detect and can cause mass causalities. The US government through the US Army Medical Research Institute of Chemical Defense, Occupational Safety and Health Administration's Hazardous Waste Operations and Emergency Response (HAZWOPER), Department of Defense (DOD), FBI, DHS and many more agencies are tasked with the mandate of preparing and coping with possible incidence of CTA use against the public (Burke, 2017). These agencies have put measures that have minimized the possibility of CTA attack in the US. However, the low probability is no surety as states that refused to join the chemical weapon convention (CWC) harbor major terror groups with the capability of radicalizing local US citizens to carry out attacks on the home soil (Tucker, 2000). The recent technological advancement has also made it easy to access, reproduce, store and disseminate CTA's anywhere in the world. With the financial backing of the governments and political movements to the extremists, the political and technical constraints to the access and use of CTAs has reduced drastically. CTA containing munitions can also be dispersed through various means such as the atmosphere, product tampering or even contamination of food and water systems (Burke, 2017).

There is a need to learn from the events of the past for the US to be ready for any incidence of CTA attack. The Japanese subway in 1995 was considered to be among the safest transportation system in the world (Okumura, 1998). However, the Aum Shinrikyo sect managed to attack the civilian population by releasing lethal sarin vapor. The clinical and public health effects from the attack resulted in causalities in thousands with health practitioners and responders overwhelmed. Additionally, the world trade center attack was also accompanied by an attempt to use CTAs. The presiding judges stated that the explosives used during the attack had cyanide aimed at contaminating the structure. Providentially, the cyanide was destroyed by the blast (Singh and Singh, 2004). These past lessons plus imminent threats that have been made against civilians over the past in the US and other nations such as Germany points out the sophisticated nature that CTA can play in helping terror groups attain their objectives.

Properties of CTAs that makes them a significant threat

Most chemical agents such as cyanide, phosgene, and chlorine are used as weapons are used by industries. These chemical are volatile, persistence, latent and toxic; properties that make CTAs acutely life-threatening.

Persistence

CTAs are classified as either persistent, semi-persistent or non-persistent. Most CTAs that are industrial chemicals such as hydrochloric acid cannot be suspended for more extended periods in their therefore non-persistent. Sulfur mustard and VX, on the other hand, are persistent while Sarin is semi-persistent (Burke, 2017). By evaporating at a slower rate the persistent agents remain suspended and attached for long, thus longer contact with the skin. The prolonged contact with the skin increases the chances of causing clinical effects. This threat has a multiplier effect as the emergency responders are also likely to be subjected to the risk of contamination and secondary exposure both from the surrounding environment and the patients.

Volatility

The detonation of CTAs ammunition enhances the ability of the gases to be dispersed in liquid droplets in the atmosphere. The range of volatility of CTAs varies with cyanides and phosgene being the most volatile while VX and mustard being the least volatile (Burke, 2017). A volatile agent, however, is likely to have minimum persistence due to its ability to disappear easily.

Toxicity

CTAs pose the potential of causing injury an individual's biological organs (Burke, 2017). Different CTA's have a different median lethal dose and median effective dose which represents the percentage of the population likely to die or display clinical symptoms respectively. Another element influencing the concentration of CTAs is the concentration-time product (Ct) which takes into consideration the concentration levels one is exposed to in milligrams and the number of times the individuals have been exposed to the agent. CTAs have also incapacitating and lethality effects. Nerve agents and the cyanides are the most lethal of the CTAs with high concentrations resulting in death at 15 minutes and 5 minutes of exposure respectively (Worek, Wille, Koller and Thiemann, 2016). Vesicants also primarily incapacitate, however, they pose minimal risks of death. The incapacitation effect of CTAs is vital for terror groups as the gases used can result in multiple causalities increasing the potential of overwhelming the emergency medical responders.

Latency

CTAs have a different rate of absorption and onset of symptoms. Pulmonary agents and sulfur mustard are some of the CTAs with the longest latency. The nerve agents, cyanides and other vesicants have the shortest latency that lasts within minutes after exposure (Burke, 2017). These delays, however, do not reflect on the cellular and biological change most CTAs pose. Therefore, the lack of symptoms display does not mean that there is no risk of infection or secondary contamination. The latency period, therefore, depends on the CTA's properties, exposure concentration and period of exposure (Burke, 2017). Longest latency requires monitoring of individual's for extended periods of time, an aspect that can easily overwhelm any medical resources and response team.

Other properties of the CTAs entails flammability and reactivity which may also result in clinical illnesses (irritability, chocking, diseases and many more) or death (Burke, 2017).

Effective Emergency Preparedness and Response

The United States government has employed various education and training programs, specialized response teams, Disaster plans and exercises, public education and stockpiled antidotes as preparation strategies for emergency response mechanism. However, these efforts are needed to be supplemented by a multidisciplinary approach that entails merging the medical emergency and public health needs through coordinating efforts of various specialists involved.

Multidisciplinary Medical Emergency and Public Health Needs Response Strategies

Command and Control Capability

The incident Command system mandated to respond to domestic disasters in the US is likely to be faced with numerous challenges due to lack of coordination with other agencies such as the FBI. Command and control problems emanating from the lack of flexible coordination. Single agency mandated for overall coordination response, the actions of the control agency fall short as law enforcement primacies are likely to result in compromised public health care (Waeckerle, 1991). Coordination should be carried out in a smooth transition such that the crisis is contained, suffering is relieved, and the population is protected.

Preparedness of the emergency department

Emergency departments need to prepare to be able to recognize and manage causalities of CTAs. Therefore, there is a need to establish special hospital teams which are skilled in both the use of both decontamination procedures and PPEs. The ED should be able to alert the hospital and segregate chemical causalities from other patients in the hospital. Other measures such as crowd control and effective patient flow should be utilized to prevent secondary contamination (Burke, 2017). Wates such as the runoffs from shower use by contaminated patients should also be disposed using proper and treated discharge mechanisms. Preparing the department for possible CTAs threat will drastically reduce the damage extent of CTAs.

Levels of Response

When managing incidences of CTAs the local responders forms the first response team to the incidence. However, the resources and capabilities of these local teams are not sufficient in most regions, therefore creating a barrier to their activities. The primary goals of a preparedness program, therefore, should aim at increasing the capability of responders at a local level. Possibilities for mutual aid from neighboring municipalities should also be encouraged in incidences involving extensive CTAs use (Burke, 2017). Despite having a capable local and regional response team, federal resources should also be mobilized and mandated to implement both crisis and incidence management strategies after a suspected terror act that entails the use of CTAs.

Personal Protective Equipment

The response team should be protected against the hazardous nature of the CTAs by having protective equipment's. The United States government recognizes that the use of PPEs is an indispensable part of the emergency response. However, the availed PPEs are not universally grade A and may also fail to offer protection against certain industrial chemicals. The risk of contamination from secondary exposure drags any response mechanism. Thus, hazardous materials teams, EMS services, and hospitals should be trained and availed with the best and properly selected PPEs (Chalela and Burnett, 2012).

Agent Detection Mechanisms

The government as various early detection measures in place for the identification of possible chemical threats. Early detection and identification equate to early medical and public health interventions. Detectors such as the M8 Detection Paper have low specificity and may fail to detect military agents (Burke, 2017). Thus, there is a need to employ sophisticated detection mechanisms in all regions and equip the emergency responders with the knowledge to determine the possible CTA used through observation of its clinical signs and symptoms. Such response mechanisms should be integrated with most local disaster plans through both training and organized drills.

Medical treatment and antidotes

In most emergency incidences the identity of the threat is likely not to be instantaneously known. Therefore, patients should be managed using life decontamination, support measures, and supportive care. These services should be complemented by the treatment that is based on the clinical presentation to utilize the appropriate antidote immediately (Chalela and Burnett, 2012). Clinical evidence of cardiovascular and collapse Hyperpnea indicates possible exposure to cyanide...