White Powder Protocol

1. White Powder Protocol Suspicious Package Precautions for First Responders

2. Objectives • Identify situations in which the White Powder Protocol should be used • Describe the procedures for handling suspicious white powder • List the Agencies that must be contacted in a white powder incident • Identify the mission of law enforcement in a white powder incident

3. History of Bio-Terrorism 1495 600 BC 1000 BC 184 BC Lesson Learned: Even crude chemical and biological weapons create fear and panic.

4. US History before WWI • 1763, British officers distribute small-pox infected blankets to Native Americans at Fort Pitt, Pennsylvania. • Civil War: Luke Blackburn, MD sold Union troops clothing contaminated with smallpox and yellow fever. Lesson Learned: Not all biological terror comes from overseas.

5. During WWI • Unrestricted use of chemical agents caused 1 million casualties • 1914 – Germans created a cloud of poisonous gas by using cylinders filled with chlorine • 1915 – Allied troops came up with their own chlorine gas weapon which led the Germans to use more toxic chemicals. • Biological agents were mostly focused on infecting livestock with anthrax Lesson Learned: The horror of chemical weapons left the world reeling. The Geneva Convention made an attempt to limit their use in warfare

6. World War II • In 1935 Italy invaded Ethiopia and used chemical weapons despite the Geneva Protocol. • The Japanese invaded China using both chemical and biological agents. • Germany used a cyanide based gas to massacre Jewish civilians in concentration camps. Lesson Learned: It is impossible to get the genie back in the bottle. Countries with chemical and biological weapons will use them particularly against those who cannot or will not respond with weapons of mass destruction.

7. Cold War Lesson Learned:Chemical and biological weapons pose a danger to the health and environment of nations that possess them. Agreements banning their use are almost impossible to enforce. 50's 60's 70's 80's

8. Modern Terrorism 2001 - Anthrax Lesson Learned: Terror groups and individuals find chemical and biological weapons well suited to their purposes. Despite the relatively low number of actual casualties, biological and chemical weapons can clearly terrify large groups. 1994 1984

9. The Threat “If you are asking me what keeps me up at night or what I am most worried about…in the long run, in terms of something really earth-shattering the kinds of things I’m worried about are a nuclear dirty bomb attack or biological attack…the preparations that we need to deal with this threat are going to take a while to build. The greatest weapon they have is persistence and patience. One weakness we have is the tendency to lose patience and become complacent. It is important to stay focused…” Michael Chertoff

10. Worst Case? • Aerosolized Anthrax • Found in every continent except Anartica • Stable and easily reproduced in lab • Anti-biotics prior to symptoms/48 hours • Not technologically easy to aerosolize • Localized event most likely • Used for any mass prophylaxis event • Scale up and down as necessary

11. White Powder Protocol • Outlines procedures to be taken in a suspicious incident involving unknown substances • Protects 1st Responder (usually law enforcement) from unintentional exposure to biological agents • Must contact FBI’s Weapon’s of Mass Destruction Coordinator – (404)697-9000 • Always err on the side of caution! 11

12. Credible Threat A letter/package with material present Persons exposed to suspicious substance suddenly become ill A threat accompanies the letter or package A suspicious substance with threat The intended target is potentially vulnerable or is of strategic significance

13. Who You Call • District Public Health (Office of Emergency Preparedness • District then notifies State Public Health • Local EMA • Who then notifies GEMA • HazMat – if powder/substance is present • Georgia Poison Control Public Health Emergency Line: (404)230-8990 13

14. Credible Threat and Law Enforcement • Crime Scene • No field analysis for biological agent – get HazMat to bag powder ASAP • Transport to GA Public Health Lab • 1st call (404)327-7900 or 800-806-1376 • An FBI Case # is required for all specimens submitted to the GPHL DO NOT SMELL, TOUCH, TASTE, LOOK CLOSELY AT OR SHAKE THE SUBSTANCE!! 14

15. No FBI Credible Threat • Uncertain Risk: Clean and disinfect with bleach solution; place in plastic bag • Low Risk: Low profile, low-risk target with no threat • Whether or not the assessment should be conducted on scene is decided case by case at the discretion of law enforcement • Very Low Risk: Obvious explanation – assessment does not need to be conducted on scene • Extremely Low Risk: Known substance – clean like routine spill • Incorrect Appraisal: Information suggests FBI’s initial appraisal of No Threat is incorrect – IMMEDIATELY Begin steps as Credible Threat 15

16. Why Worry? • Inhaled Anthrax – untreated has a 90% mortality rate • Must treat prior to becoming symptomatic • Symptoms can occur between 48hrs and 45 days.

17. 1. 2. State Requests Federal Assistance Need for Drugs and Medical Supplies Exceeds Local & State Resources 3. Director of CDC Deploys SNS Assets 4. How SNS Assets are Deployed Augments Local/State Medical Materiel Resources Strategic National Stockpile (SNS) In Consultation with the Assistant Secretary for Health (ASH), Secretary HHS, HHS Office of Emergency Preparedness (OEP), FEMA and the FBI

18. Strategic National Stockpile • Requires the depletion of local resources prior to deploying • A “Push Pack” can take up to 12 hours to reach the state (once decision has been made to deploy) • Stockpile Managed Inventory (SMI) can take up to 36 hours to reach the State. • 48 hr window means NOTIFICATION MUST BE IMMEDIATE!

19. For More Information Consult Your Local Health Department