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Foodborne Terrorism Tabletop Exercise October 21, 2005.

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Presentation on theme: "Foodborne Terrorism Tabletop Exercise October 21, 2005."— Presentation transcript:

1 Foodborne Terrorism Tabletop Exercise October 21, 2005

2 Schedule 8:00 – 8:30Mingling over Breakfast 8:30 – 9:00 Introduction 9:00 – 11:15Exercise, Phase 1 11:15 – 12:30Lunch 12:30 – 1:15Guest Presentation 1:15 – 2:15Exercise, Phase 2 2:15 – 3:00Media Segment 3:00 – 4:00Debriefing Breaks will occur both in the morning and afternoon at a time to be decided by the moderator.

3 Acknowledgements Sponsored by the TN Food Safety Taskforce Funding from The University of South Carolina Center for Public Health Preparedness Developed by TN Department of Health in conjunction with TN Dept. of Agriculture, Metro Public Health Department of Nashville/Davidson Co., and Center for Public Health Preparedness, University of South Carolina

4 Special Thank You to the Planning Committee Tim Jones Ryan Mason Karen Patton Brady John Sanford Jerry Rowland Jane Richter Erik Svendsen John Dunn

5 Schedule 8:00 – 8:30Mingling over Breakfast 8:30 – 9:00 Introduction 9:00 – 11:15Exercise, Phase 1 11:15 – 12:30Lunch 12:30 – 1:15Guest Presentation 1:15 – 2:15Exercise, Phase 2 2:15 – 3:00Media Segment 3:00 – 4:00Debriefing Breaks will occur both in the morning and afternoon at a time to be decided by the moderator.

6 Purpose This tabletop exercise will enable participants to demonstrate and evaluate the response capabilities, communication, resources, data, coordination, and organizational elements involved in a food security emergency response.

7 Purpose Participants will have an opportunity to assess their own preparedness for responding to such a scenario and identify individual needs for information and/or training.

8 Tabletop Exercise? Informal group discussion stimulated by a scripted disaster scenario Low stress, designed to promote free and open exchange of ideas Identify issues (e.g., data, coordination, communication, resources, and policy) Familiarize players with roles, functions, plans, and procedures

9 Objectives of the Exercise Identify the policy issues that would arise during a food-related terrorism event Identify and understand measures that can be performed at the local level Recognize the roles of various public officials Illustrate the need for intense teamwork and communication

10 Objectives of the Exercise Identify gaps in local preparedness plans, policies and/or procedures Build relationships with participants from other key agencies Identify additional training needs in your organization/agency

11 House Rules This is an exercise only. Please preface and end all phone calls pertaining to this exercise which extend outside of this facility with the statement this is an exercise. What happens in this room stays in this room with the exception of the lessons we learn and the relationships we develop. Please be sensitive to the noise level. Above all, courtesy and professionalism prevail. Name tags are required at all times. There will be no actual news media involved in this exercise.

12 Various Roles Moderator – Dr. Allen Craig Participants – You Facilitators – Planning Committee Members Evaluator – Dr. Erik Svendsen

13 Participants Roles Play your own role in your agency (if possible) Identify gaps and strengths of response plans Take note of perceived deficiencies to be discussed during The Debriefing

14 Instructions to Remember Respond as a group as the information emerges Maintain your agencys role throughout the exercise Not all will participate equally Lack of active participants does not mean lack of learning

15 Components of Exercise Phase 1 The Setting The Scenario Unfolds Various Agency Roles/Responses

16 Components of Exercise Phase 2 The Contamination Event Guest Presentation Media Segment Debriefing

17 THE SETTING (Metropolitan Davidson County)

18 The Setting Nashville / Davidson County, Tennessee 596,000 residents 946,000 people who commute to Nashville from neighboring counties

19 The Setting Approximately 30 medical centers, including 10 hospitals and specialty centers located throughout the county Numerous nursing homes and day care centers

20 The Setting Public water supply Public Health Department of Nashville/Davidson Co. is a local health department with approximately 500 employees/ State Health Dept.

21 The Setting Tourism and agriculture are major industries

22 Day 1 – Friday Afternoon Isnt it always?

23 Phone Call Mary, school nurse from Dan Mills Elementary School (Metro-Davidson Co.) calls the Metro Health Department concerned that 4 children, (ages 6-9), have reported to her clinic, ill, with vomiting and diarrhea, 1 of which is bloody diarrhea.

24 Parents have been called, and are on their way to pick up their children.

25 Same Day Health Department advises obtaining stool samples, which were collected and submitted to Vanderbilt ER (4 Total). Results are pending.


27 Question ? Which agencies do you think need to concern themselves with this information?

28 Question ? What would be their response?


30 Day 4Monday 11:00 am School nurses from Bellevue Middle and Crieve Hall Elementary report to Metro Health Dept. that 7 and 4 children, respectively, are exhibiting symptoms of vomiting and diarrhea with 3 children also experiencing bloody diarrhea.

31 Same Day The ages of the children ranged from 6-13. Several of the sick children apparently have not been in contact with any of the other children who exhibited similar symptoms. No Link has been established between the groups of ill children.


33 Question ? Which agencies need to concern themselves with this information?

34 Question ? What would be their response?


36 Day 6Wednesday 10:00 am Private practice physicians are reporting an unusual number of sick children (symptoms of nausea and vomiting) to the Metro Health Department. Concerned parents, hearing rumors of food poisoning are also calling schools and the Department of Education in an attempt to get more information.


38 Question ? Which agencies should be involved?

39 Question ? What needs to be done (and by whom) ?

40 Communication Who needs to be communicating with whom (and why) ?


42 Metro Health Dept. started interviews at 3 schools. Approximately 20% of students had some gastrointestinal symptoms.

43 Ongoing Epidemiological Investigation Reveals… No adult family members are presenting these symptoms. Most of the sick children ate at school cafeterias, but some brought lunch and only bought milk or juice at the cafeteria.

44 Metro environmental health specialists (health inspectors) report cafeteria inspection scores are 94 and 98 for Bellevue Middle and Crieve Hall Elementary Schools (no critical or serious violations were observed).

45 One inspector even remarked that Bellevue Middle Cafeteria was the cleanest one he had ever seen.

46 Approximately 40% of hospitalized children return to the hospital with similar symptoms after being discharged. None of these children have returned to school.

47 48 Students have been seen in area ERs. 2% of people who reported symptoms are teachers.

48 VARIOUS AGENCY ROLES/RESPONSES Refer to Handout # 1: Event Recap.

49 Question ? Who is in charge of the situation?

50 Question ? What would your agencys role be now?

51 Question ? With whom would your agency be communicating?


53 Day 6Wednesday 2:30 PM (Same Day) All stool cultures from ill people are negative. TN State Dept. of Education reports that absenteeism is up 18% in eleven counties in Middle TN.

54 Day 7Thursday, throughout day Epi-X (surveillance tracking software) reveals to state epidemiologists that Huntsville, AL; Rome, GA, Hopkinsville and Louisville, KY and their surrounding areas are all reporting similar activity.


56 Question ? Would your agency be impacted, if so, how?

57 Question ? What are your initial actions?

58 Question ? Within your own agency, with whom would you communicate first? Why? Others and why?

59 Question ? Due to the negative stool culture results and interstate involvement, which aspects of the investigation would change?

60 Question ? Who is in charge of the situation? Why?

61 Question ? What is your agencys involvement at this point?


63 Day 8Friday 9:00 AM Media picks up story about possible strain of stomach flu raging through the community and nearby areas of AL, KY, and GA.


65 Question Would your agency be talking to the media about this issue?

66 Question Who would be responding?

67 Question Outside your agency, with whom would you communicate first? Why? Others and why?


69 Day 11Monday Epi. Investigation Reveals… Another cluster of cases with similar symptoms was uncovered through an investigation of local hospital records. Several employees of Sunrise Dairy have been out of work sick for nearly 2 weeks, many have been hospitalized, and some keep returning to the hospital.

70 Same Day Vanderbilt Childrens Hospital notifies the Metro Nashville Health Department that two of the sick children from Crieve Hall Elementary School have died.

71 Epidemiological Investigation Reveals… Metro Health Dept. implicates milk as being associated with the unknown sickness (odds ratio of 8.3).


73 Question ? What are your agencys urgent priorities now?

74 Question ? Within your agency, with whom would you communicate first? Why? Others and why?

75 Question ? With whom would you be communicating outside your agency? Why?

76 Question ? Which aspects of the investigation/situation have changed?

77 Question ? Who is in charge of the situation? Why?

78 Question ? What are your resources?


80 Day 18 –Monday 4:00 pm Letter received at WSMV, a local news station, from a terrorist claiming responsibility for contamination of milk with a radioactive material.

81 Effects on your agency? Media onslaught ! Personal concerns and fears ! Community reaction ! Magnitude of public inquiry ! Financial implications !

82 Radiation Exposure CAUTION Crash Course

83 Radioactive Sources 157,000 licensed users in U.S. 2,000,000 devices containing radioactive sources Approximately 400 sources lost or stolen in U.S. every year

84 Sources used in mobile cesium irradiators in the former Soviet Union Recovered transport container Sources Around the World


86 Goiânia Morbidity 249 exposed; 54 hospitalized Eight with radiation sickness Four people died 112,000 people monitored (>10% of total population)

87 What Is Radiation? Nuclear Radio/TVSun Ligh t Heat Microwave

88 Radiation is NOT contagious!

89 Electromagnetic Spectrum Energy ElectricalPower Radio/TV Microwav e Light NON-IONIZING RADIATION X-ray Gamm a IONIZING RADIATION Frequency UV

90 Ionizing Radiation Ionizing radiation is radiation capable of imparting its energy to the body and causing chemical changes Ionizing radiation is emitted by - Radioactive material - Some devices such as x-ray machines

91 Types of Ionizing Radiation Alpha Particles Stopped by a sheet of paper Beta Particles Stopped by a layer of clothing or less than an inch of a substance (e.g. plastic) Gamma Rays Stopped by inches to feet of concrete or less than an inch of lead Radiation Source

92 Radiation Doses and Limits Flight from Los Angeles to London 5 mrem Annual public dose limit 100 mrem Annual natural background 300 mrem Fetal dose limit 500 mrem Barium enema 870 mrem Annual radiation worker dose limit5,000 mrem Heart catheterization (skin dose) 45,000 mrem Life saving actions guidance (NCRP-116) 50,000 mrem Mild acute radiation syndrome 200,000 mrem LD 50/60 for humans (bone marrow dose) 350,000 mrem Radiation therapy (localized & fractionated) 6,000,000 mrem

93 Physical Radionuclide Half-Life Activity Use Cesium-137 30 yrs 1.5x10 6 Ci Food Irradiator Cobalt-60 5 yrs 15,000 Ci Cancer Therapy Plutonium-23924,000 yrs 600 CiNuclear Weapon Iridium-192 74 days 100 Ci Industrial Radiography Hydrogen-3 12 yrs 12 Ci Exit Signs Strontium-9029 yrs 0.1 CiEye Therapy Device Iodine-131 8 days 0.015 Ci Nuclear Medicine Therapy Technetium-99m 6 hrs 0.025 Ci Diagnostic Imaging Americium-241 432 yrs 0.000005 Ci Smoke Detectors Radon-222 4 days 1 pCi/l Environmental Level Examples of Radioactive Materials

94 Causes of Radiation Exposure/Contamination Accidents –Nuclear reactor –Medical radiation therapy –Industrial irradiator –Lost/stolen radioactive sources –Transportation Terrorist Event –Radiological dispersal device (dirty bomb) –Attack on or sabotage of a nuclear facility –Low yield nuclear weapon

95 Time: Distance: Shielding: Increase distance between you and the source Decrease time spent near the radioactive source Increase the physical shielding between you and the source Reducing Radiation Exposure

96 Protective Action Guides Sheltering Evacuation Relocation Decontamination Worker PPE

97 Common Shelters StructureDose Reduction Factors Wood Frame (1 st floor)10% Wood Frame (Basement)40% Masonry40% Large building80%

98 Protective Actions If you are inside, shelter in place –Stay indoors –Turn off ventilation systems –Close and lock windows and doors If you are outside, –Cover your nose and mouth with a cloth –Leave the area and go inside

99 Protective Actions If you think you may be contaminated, –Remove outer layer of clothing and seal it in a plastic bag –Shower or wash your hands and face Listen for further instructions Seek medical attention only for severe injuries

100 IrradiationInternalContamination ExternalContamination Radiation Exposure Types * * * * * * * *

101 Basic Mechanism DNA is the primary target for biological effects

102 Health Effects of Radiation Exposure Lethal at high doses Mutagenic Carcinogenic Other biological effects, especially at high doses

103 Ingestion InhalationSurface LymphNodes LungSkin 1. Intact 2. Wounds Blood Kidney Deposition Sites Feces Urine 1. Whole Body 2. Bone 3. Liver 4. Thyroid Intake: Uptake: Excretion: GITract (Recycle) Lung Clearance Radionuclide Uptake

104 Patient Management - Triage Triage based on: Injuries Signs and symptoms - nausea, vomiting, fatigue, diarrhea History - Where were you when the bomb exploded? Contamination survey

105 Treatment for Unknown Radionuclide Unless treatment is instituted quickly, its effectiveness will be limited. Use of emetics, lavage, charcoal, and/or laxatives are common.

106 Radionuclide-specific Most effective when administered early May need to act on preliminary information Treatment of Internal Contamination RadionuclideTreatment Route Cesium-137Prussian blueOral Iodine-125/131Potassium iodideOral Strontium-90Aluminum phosphateOral Americium-241/Ca- and Zn-DTPAIV infusion, Plutonium-239/ nebulizer Cobalt-60

107 Surface Contamination…Injury First irrigate wounds, then follow the same clothing removal and washing routine. After decontamination, continue to treat wounds in the usual manner.

108 Key Points Medical stabilization is the highest priority Train/drill to ensure competence and confidence Pre-plan to ensure adequate supplies and survey instruments are available Universal precautions and decontaminating patients minimizes exposure and contamination risk Early symptoms and their intensity are an indication of the severity of the radiation injury The first 24 hours are the worst; then you will likely have many additional resources

109 All Emergencies Are Local Terrorist Attack Local Public Health Response Organizations State Public Health Response Organizations Federal Public Health Response Organizations

110 Local Government Responsibilities Local Chief Executive Officer (i.e., mayor, city or county manager) –Coordinates local resources –Suspends local laws or ordinances Communicates with the public

111 State and Local Public Health Response Monitor workers health and safety Assure safe shelters and healthy food and water supplies Coordinate sampling and laboratory analysis of samples

112 State and Local Public Health Response Field investigations and monitoring of people Criteria for entry and operations at the incident site Disease control and prevention measures

113 Medical Support Evaluate health and medical impacts on the public and emergency personnel Develop medical intervention recommendations Treat impacted citizens Request Strategic National Stockpile (formerly National Pharmaceutical Stockpile)


115 Facility Recovery Remove waste from the treatment area Survey facility for contamination Decontaminate as necessary –Normal cleaning routines (mop, strip waxed floors) typically very effective –Periodically reassess contamination levels –Replace furniture, floor tiles, etc. that cannot be adequately decontaminated Goal: Less than twice normal background… higher levels may be acceptable

116 Long-term Response Issues Application of EPA and FDA Protective Action Guides –Food and water –Non-food use of agricultural products –Recovery operations Develop plans for decontamination, re- entry, and recovery of affected areas

117 Long-term Response Issues Surveillance and epidemiological studies Establish exposure registry and monitor long-term impacts Provide information to public and responders on long-term health effects

118 Day 18 –Monday 4:00 pm Letter received at WSMV, a local news station, from a terrorist claiming responsibility for contamination of milk with a radioactive material.


120 Question ? How would this new information change the investigation/situation for your agency?

121 Question ? Who in your agency would be involved in the response?

122 Question ? Who is your agencys primary point of contact?

123 Question ? With which other agencies would you be communicating? With whom exactly?

124 Question ? What are the three most urgent priorities for your agency at this point?

125 Question ? What resources does your agency have for the response? Where are they located? How will you access and mobilize them?

126 Question ? Who is in charge of the situation? Why?



129 Various agencies deployed to the Sunrise Dairy production facility to confirm presence and extent of residual radiation. Geiger counters measure radiation, identifies one milk-storage silo.

130 Investigation Reveals…. Law enforcement personnel trace source back to 2 suspects, get confessions, and learn through interrogation that 2 other suspects have died, likely due to exposure. Law enforcement personnel learn that 64 grams of Cesium-137 were placed in milk tanker by 4 terrorists.


132 Debriefing Discuss the events of the exercise Identify gaps in plans, policies, and procedures Identify useful information (effective responses) Plan next steps Complete evaluation forms

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