Bioterrorism Fundamentals Awareness Training
Trainer Instructions
Attention-getter:
Use the following information to get the attention of attendees: In recent history, biological weapons have become more accessible to terrorist and rogue nations. We experienced a very small bioterrorism attack with mailed anthrax in 2001. However, the outcome of a bioterrorism incident can have a far greater impact and is becoming more likely as biotechnology and information become more widely available.
Qualifications for Training/Comfort Level:
The trainer should complete a “trainer” in-service on how to use the equipment, complete forms and conduct training prior to conducting this course. This course focusesonlyon the fundamentals of biological agents and the threat of bioterrorism.
Equipment Needed:
●PowerPoint projector or
●An overhead projector or
●Video tape or
●DVD player
Applicable Departments to Train:
This training provides basic awareness to any employees who may be involved in an incident involving biological materials or a surge of infectious patients due to natural or intentional outbreaks. Your facility should have completed an assessment to determine which specific departments and individuals might be in that category.
Main departments where training is required include the following:
●Maintenance
●Housekeeping
●Security
●Other Ancillary and non-clinical staff
Time Requirement:
Will take approximately 30 minutes to train.
Explanation of Handouts:
You are provided with handouts to give each employee. The page titled “Goals & Objectives” begins the handout pages to be copied and given to attendees. Use the power point slides or the VHS/DVD material to aid in your training.
Frequency:
This course should be taught initially, prior to any decontamination drills or incidents, and annually (as a minimum) thereafter, unless the employee is assigned to a job, which does not require them to participate in biological emergency efforts.
Class Size:
There is no size limit for this course.
Student Evaluation:
There will be a multiple-choice test following the completion of all units.
Certification:
Fill out certificates for attendees and hand out at the end of the course.
Personalization:
For this training you should become familiar with your facility’s bioterrorism preparedness and infection control policies in order to incorporate any facility specific information into your training.
Trainer Feedback for Improvement:
Please encourage your students to provide you with feedback on the course and its content. Was there too much information, not enough, too many visual aids, not enough, did the class take longer than expected, less time than planned, etc.
Goals & Objectives
Title:Bioterrorism Agent Training Module
Awareness Level
References:
●Presidential Directive 5
●29 CFR 1910.120 Hazwoper
●29 CFR 1910.1200 Hazard Communication
Terminal Objectives
Students should be able to do the following after completion of this training:
●Identify the six bioterrorism-related diseases that pose the greatest threat to the U.S.
●Identify that advantages and disadvantages to using biological weapons
●Identify the delivery methods that may be used for biological agents
●Identify suspicious labeling, containers, and agent names that may be associated with a possible bioterrorist weapon
●Understand how the roles of employees may drastically change during a major bioterrorism attack
●State that knowledge and adherence to their facility emergency plan is the most important first step in preparedness
Enabling Objectives
Students should be able to do the following after completion of this training:
●Explain why bioterrorism is becoming a more likely threat.
●State advantages of employing biological weapons in a terrorist attack
●State disadvantages of employing biological weapons in a terrorist attack
●Describe some of the common characteristics of biological agents
●Identify a biohazard label
●Identify suspicious containers used to transport biological agents
●Recognize the names of critical biological agents of concern
●State one or more environmental factor that affects the use of biological weapons
●State the ways that terrorists might deliver biological weapons
●State three things everyone must do to prepare for a bioterrorism attack
●State additional training will be needed for certain skills and jobs
Proposed script for video segment
Slides have been provided to show material that will be utilized in video production
Slide 1:This unit is going to deal with the possible terrorist use of biological agents as a weapon. Again, this course provides an awareness level of training or at a very basic knowledge on the threats posed by these types of weapons against health care facilities.
Slide 2:Instructor Introduction; Tell them who you are and a little about your background; Set Ground rules for the class.
Slide 3:Have the students state their names, their department or organizations, and any radiological training or work experiences they have had.
Slide 4:Fictional Scenario:
Several busy days of EMS activity and hospital admissions seem to signal the start of an unusually early and severe influenza season. The patients are younger and otherwise healthier than patients normally seen during typical flu seasons. There is initially little notice taken of these differences. The diversity of the organizations and settings of care providing treatment to the ill make recognition of unusual trends difficult. The traditional processes of physician case reporting and public health department collection and analysis of epidemiological information are underway. These processes take time and delay the recognition of epidemiological trends that indicate this outbreak is not a natural event. A physician noticing the unusually young ages of his severely ill “flu patients” orders additional lab tests. These initial results raise suspicions. Subsequent chest x-rays on several patients with worsening conditions show mediastinal widening, a hallmark of advanced inhalational anthrax disease. Confirmatory lab tests verify cases of anthrax. The Federal Bureau of Investigation initiates a criminal investigation as public health officials initiate an epidemiological investigation to identify additional cases and characterize the exposures. Federal and state officials are anxiously waiting to see if the dosages of antibiotics, numbering in the thousands, are adequate therapeutic supplies for the potentially large number of individuals at risk. Local officials are hopeful that the mass care plans they have developed are effective. The public is waiting for answers and demanding action.
Slide 5:An anthrax release was carried out covertly at a college basketball game. Public healthauthorities quickly pin-point the common source of exposure as the basketball game but now need to quickly identify everyone at risk and treat them before they get ill. Healthcare workers begin to triage individuals seeking antibiotics to prevent progression of anthrax disease but are quickly becoming overwhelmed and running short on resources. Many people not even in attendance at the game feel like they still may be at risk and are demanding treatment even though their risk is low.
Slide 6:At the end of this course you will be able to:
●DEFINE the the fundamentals of bioterrorism and biological agents of concern.
●DESCRIBE the dispersion methods, characteristics and advantages / disadvantages of using biological agents as weapons.
●LIST the primary responsibilities of clinical and non-clinical staff in bioterrorism preparedness
Slide 7:RECOGNIZE the presence of biological materials from biohazard postings (colors and symbols), container shapes/types, or unusual signs that may indicate the threat of a biological incident, and appropriately COMMUNICATE the need for additional resources during a bioterrorism incident.
Slide 8:Lecture: Here is a quote from our former CIA Director, James Woolsey. From the insight that he has into the intelligence gathered throughout recent decades, he concludes that the use of biological weapons pose the greatest threat to our national security in coming years.
Transition: There is some confusion over what is really meant by the term bioterrorism, so let’s define it more specifically.
Slide 9:Lecture: Bioterrorism is the unlawful use or threatened use (It is important to note that in order to be legally accused of an act of bioterrorism, you do not need to have the substance. The threat alone is grounds for jail time.) of microorganisms or their byproducts to produce death or disease in humans, animals, or plants. Here is another key point. Bioterrorism is not only an attack on humans. An act of bioterrorism may be an attack on animal or even plant populations. The intent of these acts is the same as any other act of terrorism. The intent is to create fear and intimidate societies in pursuit of goals that conflict with them.
Transition: The pursuits of these weapons have been limited to nations or state-sponsored programs throughout most of the 20th century. However, there are reasons why it is becoming more possible for small groups or individuals to build their own program.
Slide 10:Lecture: We have seen a boom in biotechnology over recent years. The availability and volume of potentially dangerous bio-information is staggering. In addition, much of that information is now available to anyone over the Internet. There is also more expertise available. In the early 1990s, many of the Soviet scientists employed in the BW Program lost their jobs when the Iron Curtain fell and the Soviet Union was dissolved. Some of these scientists have been recruited by rogue nations to build their programs. There is also tremendous proliferation of dual use equipment. For example, microbreweries have become very popular in recent years. The same tanks used to ferment beer can be used to ferment biological agents such as anthrax.
Transition: There is one other necessary component to start a program. That is the seed cultures.
Slide 11:Lecture: There are many legitimate sources for dangerous pathogen seed cultures. They are necessary to carry out a variety of medical and pharmaceutical research. Does anyone have any questions? Hundreds of repositories in over 60 nations serve as the source for these cultures. Less than a decade ago, anyone could order these cultures, including anthrax and plague, and have them shipped to their home. New laws have been put in place to restrict the availability of these pathogens in the U.S. but not all nations have the same strict standards in place. It is still possible, but illegal to order from overseas vendors. If these nations can be convinced to put the same strict laws in place, there is still the possibility of black market acquisitions from companies and researchers that have access. An additional factor that increases our vulnerability is the fact that most clinicians have never seen cases of these diseases. Even though many of these illnesses have a window of opportunity where aggressive treatment is effective, that opportunity may be lost on initial cases since providers are not familiar with them and will likely experience delays in diagnosis.
Slide 12:Lecture: There are many advantages to selecting these agents. One of the most important is cost. A study carried out by NATO in 1970 determined the raw material cost of generating 50% casualties in 1 square kilometer of a city. They found that using conventional weapons such as bombs and bullets would cost about $2,000; a nuclear weapons, although it would affect a vast area, would cost about $800 in the raw materials expended in 1 square kilometer; chemicals would cost about $600 and anthrax would only be about $1. This low cost makes these weapons very attractive to rogue nations and terrorist organizations.
Transition: Although the low cost is an important advantage, there are many more.
Slide 13:Lecture: There seems to be such a deep- seated fear in most people of diseases they don’t understand. As a result, even a threat with one of these unusual agents is often enough to create panic. That is why the threat alone of using a biological weapon is considered to be an act of terrorism under U.S. law. In addition, if an actual agent is dispersed, it can cover an enormous geographical area. Examples will be provided later in this presentation. Unlike many chemical agents that have a rapid, apparent effect, biological agents may not be detected. They cannot be sensed by human senses and so the first sign of an attack may be human illness. This is very concerning since some of these diseases are also contagious. If someone remains undiagnosed until they have symptoms, they may infect others and spread the disease. Another attractive feature of these weapons is that perpetrators may treat themselves, preventing infection so they can safely handle the organisms, infecting others without becoming ill.
Transition: Although there seem to be many advantages for a terrorist or rogue nation to use these weapons, there are also some distinct disadvantages.
Slide 14:Lecture: Many biological weapons are very difficult to control. Attacking a population with biological weapons carries the risk that the illness inflicted may migrate back to the source. In other words, if a nation used smallpox against an enemy, it is very likely to come back to their doorstep. It is also difficult to disperse these agents. Some are very sensitive to the elements and cannot survive if released in extreme heat and cold or even in sunlight. These weapons carry a risk to those developing and delivering the agents. Those involved may become infected and become severely ill before they can carry out their attack. There is also may be a significant disadvantage to carrying out a very effective attack. The retaliation by the affected nation may be tremendous.
Slide 15:Lecture: In spite of the tremendous diversity of biological agents that carry the risk of weaponization, they share many common characteristics. Most can be delivered as either a liquid or as a powder. However, they must be the right size in order to be effective. The ideal size of an agent is 1 to 5 microns. Particles that size are typically able to travel deep enough into the lung to begin the disease process. Particles much larger than 5 microns have a difficult time making the turns in the respiratory tract, are caught in the mucous, and may be expelled through coughing. Releases can either be from a single location or point. That is referred to as a point source release. If a release is carried out in motion, it is called a line source release. A line source release can create an enormous affected area or “footprint”. Weather plays a big part in the success of an attack. In particular, if there is a thermal inversion, it will hold contaminants close to the ground and dramatically increase the likely number of fatalities.
Transition: However, the most significant variable influencing the impact of an attack is the method of delivery.
Slide 16:Lecture: Biological agents may be delivered in many ways. The most common methods include contaminating food and water sources or aerosolizing agents with spray devices. It is also possible to use human or animal disease carrying hosts to deliver an attack. We learned through the anthrax attacks of 2001 that other, less frequently considered, delivery methods such as the mail might be employed.
Transition: However, the worst-case delivery scenario is a large-scale aerosol release during a thermal inversion.
Slide 17:Lecture: Two photos are shown here of the St. Louis, Missouri skyline. The first photo shows normal weather conditions. As warm air rises from the city streets and buildings, pollutants are lifted and dispersed as cleaner, cooler air moves downward. Occasionally, a weather condition occurs where warm air is trapped between layers of cooler air preventing normal circulation. Looking at a smokestack or chimney can help to quickly identify this condition. During a thermal inversion, smoke will rise out of a stack and move sideways as if there is a glass ceiling above it as displayed in the second photo. If an aerosol attack is carried out during these conditions, it can hold the pathogens close to the ground in the breathing zone of the target population and greatly increase exposures.
Slide 18:Lecture: In order to understand the potential impact of an aerosolized release over a populated area, it is important to consider modeling estimates such as the one displayed here. Using the weather parameters displayed on the right, a 5-gram anthrax release from the top of a St. Louis high-rise building was modeled. Under these conditions, a plume would result carrying a lethal concentration in approximately 2% of the population (LCt2 = yellow plume). Using census data of those residing under the plume, over 3,000 people could receive a lethal dose.
Slide 19:Lecture: Using the same parameters, we modeled a 5-pound release and it resulted in a lethal concentration for over 62,000 people. We repeated this release changing the weather parameters to thermal inversion conditions. The results were a shocking jump from 62,000 to over 360,000 receiving a lethal dose.
Transition: We have seen many examples of anthrax used as a bio- weapon, including the anthrax attack of 2001. However, anthrax is only one of the agents we must concern ourselves with.