Why CBRNE? John Devlin, MD, FACEP. GA Poison Center / Emory University / Centers for Disease Control and Prevention

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1 Why CBRNE? John Devlin, MD, FACEP GA Poison Center / Emory University / Centers for Disease Control and Prevention

2 Why CBRNE? ptember_11_photo_montage.jpg sama_bin_laden_portrait.jpg

3 Why CBRNE? ma_bin_laden_portrait.jpg

4 Terrorist Motivations Further political or religious objectives Further individual agendas

5 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

6 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

7 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

8 15 National Planning Scenarios

9 Terrorism in Georgia?

10 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

11 Sources of Threat Risk from rogue nations Risk from non-state sponsored perpetrators International terrorist groups Domestic terrorist groups Cult groups Individuals

12 Who are the threats?

13 Who are the threats? ma_bin_laden_portrait.jpg

14 Militias in Georgia tes_m.asp m_risk_modeling.pdf

15 More homegrown terrorism

16 FBI s Southeastern Field Office

17 Is Georgia at Risk? arybases_pov.pdf

18 What s the most toxic city in the US?

19 Scenario 6 High production volume Single facility > 30 tons High toxicity NATO ITF-25 LCt 50 by inhalation > 100K mg/min/m 3 Appreciable vapor pressure at 20 o C Airborne hazards only HAZARD INDEX

20 Hincal et al., Pharm Sci, 2008

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22 National Occupational Mortality Surveillance (NIOSH) My job is killing me. 1. Ohio 2. Pennsylvania 3. N. Carolina 4. Georgia 5. New Jersey

23 Chemical Spill Sites in GA vigate.do Comprehensive Environmental Response, Compensation, and Liability Act of 1980

24 HAZMAT During Transit

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26 Waco Atlanta Athens Milledgeville Corridor 1 NW GA I % commercial vehicles Corridor 2 Cen GA I % commercial vehicles Macon Corridor 3 Cen GA I % commercial vehicles Savannah Corridor 4 So GA I % commercial vehicles Corridor 5 Coast GA I % commercial vehicles

27 Atlanta International Airport

28 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.

29 Waco Atlanta Athens Nuclear Power in GA How many plants do we have? Milledgeville Macon Alvin W. Vogtle Plant Savannah Edwin I. Hatch Plant US Navy SUBBASE King s Bay

30 Biggest Environmental Disaster in US History?

31 Biggest Environmental Disaster in US History? Vogtle Nuclear Plant Hatch Nuclear Plant ge.aspx?f=1&guid=cb26123a-5ce2-43a1- NPP.jpg 9c bffb087

32 Radiologics in Georgia

33 Explosives in Georgia 33

34 Injuries and Deaths ( ) 34

35 How real is the threat?

36 Waco Atlanta Athens Milledgeville Macon Savannah

37 Waco Atlanta Athens Milledgeville Macon Savannah

38 Waco Atlanta Athens Milledgeville Macon Savannah

39 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

40 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

41 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

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44 Georgia has a Meth Problem?

45 How prepared are we?

46 How prepared are we? - 10 incidents - 9 deaths - 4 law enforcement officers required medical care.

47 How prepared are we? gov.au/gallery.php?id=6 98&item=91

48 Managing HAZMAT Incidents

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50 How prepared are we?

51 Waco Atlanta Athens Milledgeville Macon Savannah

52 Toxic Plume