Terrorism and All-hazards Preparedness and Response: Basic Awareness

1. Terrorism and All-hazards Preparedness and Response: Basic Awareness Prepared by the faculty and staff at the Institute for Disaster and Emergency Preparedness (2011)

2. HISTORY OF BIOTERRORISM SPECIAL NEEDS POPULATIONS EMERGENCY STRUCTURE DISASTER ROLES EMERGENCY OPERATIONS BASIC AWARENESS HAZARD COMMUNICATIONS INFECTION CONTROL PUBLIC HEALTH DISASTER PERSONAL AND WORKPLACE EMERGENCY PLANS EMERGENCY RESPONSE Course Competencies

3. Agenda • Module 1: Overview of All-hazards Preparedness • What is a disaster • Overview of Terrorism • What is CBRNE • Module 2: Responding to an Emergency • Disaster Cycle • NIMS • State Emergency Management • Psychological Considerations • Module 3: Vulnerable and Hard to Reach Populations • Module 4: Personal and Workplace Emergency Preparedness and Response

4. Module 1: Introduction to All-hazards Preparedness

5. Objectives for Module 1 • Describe the basic concepts of all hazards emergency preparedness. • Identify various natural and man-made disasters, including examples of terrorism. • Identify and describe the acronym CBRNE. • Identify four types of natural disasters, differentiating between intentional and non-intentional man-made disasters. • Define terrorism and list the common elements of a terrorist act. • Define Pandemic Influenza and differentiate between annual influenza.

6. All –Hazards Defined…. • Homeland Security Presidential Directive • Defines all-hazards preparedness as “being ready for domestic terrorist attacks, major disasters, and other emergencies.” • Preparedness refers to existence of plans, procedures, policies, training and equipment • Development of personal preparedness plan

7. Module One: Bioterrorism and All-hazards Preparedness Why is planning and preparing important?

8. All-Hazards Preparedness - RAIN • RAIN • Recognize the hazard/threat (What do I see, hear, or smell?) • Avoid the hazard/contamination/injury (What do I stay away from?) • Isolate the hazard area (Whom do I protect?) • Notify the appropriate support (Whom do I call?)

9. Case Scenario: Hurricane Incident • How do you stay informed? • What is your family’s disaster plan? • What is the disaster plan at your workplace? • How is it activated? • What is your role?

10. All-hazards Preparedness Prevent Prepare Respond Mitigate Recovery

11. What Is a Disaster? Hurricane Rita Louisiana 2005 Mississippi Katrina 2005 Biloxi Hurricane Katrina 2005 Wildfire California

12. Disaster Natural Disaster Man-Made Disaster Intentional (Terrorism) Non- Intentional What is the difference between an intentional disaster and a non-intentional disaster? What are some examples of disaster ?

13. Examples of Natural Disasters • Earthquakes • Extreme Heat • Landslide and Debris Flow (or Mudslide) • Blizzards • Ice Storms • Hurricanes • Tsunamis • Fires • Floods

14. What Is a Man-made Disaster? • Elements of human intent • Morbidity, mortality, and economic damage • Preventable • Intentional and non-intentional

15. Non-intentional Disasters • Explosions • Spillage • Train derailments Source: CNN.com (http://www.cnn.com/2005/US/01/26/train.derailment/)

16. Intentional Disasters • Enemy attack • Sabotage • Civil unrest • Actions that impair the orderly administration of the government

17. Case Scenario: Tornado Incident • How do you stay informed? • What is your family’s disaster plan? • What is the disaster plan at your workplace? • How is it activated? • What is your role?

18. Summary • Disasters: • Typically unexpected • Unique • Contain common elements • Conducive to preparedness approach for planning and mitigation.

19. Terrorism TERRORISM IS THE UNLAWFUL USE OF FORCE AGAINST PERSON OR PROPERTY TO INTIMIDATE OR COERCE A GOVERNMENT, THE CIVILIAN POPULATION, OR ANY SEGMENT THEREOF, IN THE FURTHERANCE OF POLITICAL ORSOCIAL OBJECTIVES ~ Federal Bureau of Investigation

20. What is terrorism? Man-made intentional disasters – used to coerce • assassinations • bombings • cyber attacks • hijackings • kidnappings • CBRNE

21. Common elements of terrorism Difference between terrorism and other man-made disasters: • Acts of terrorism are intentional • Intent to coerce some population – often utilizing the element of fear • Targets are planned and specific

22. September 11, 2001 Attacks The September 11, 2001 attacks (often referred to as 9/11) were a series of coordinated terrorist attacks upon the United States of America carried out on Tuesday, September 11, 2001. Commercial airlines were used to crash into the World Trade Center in New York City and the Pentagon in Washington, D.C. Approximately 3,000 people died in these attacks. The explosion resulting from the crashing of United Airlines Flight 175 into the South Tower. A huge plume of smoke and fire can be seen emerging from the North Tower. Source: Public Domain

23. September 11, 2001 Attacks The Pentagon was severely damaged during the attack, and 125 lives were lost. Buildings surrounding the World Trade Center were heavily damaged by the debris and massive force of the falling twin towers.

24. Suicide Attacks A suicide attack is an attack in which the attacker or attackers intend and expect to die. Such attacks are often carried out with the help of vehicles or explosive materials such as a bomb (a suicide bombing), or both (i.e. a vehicle loaded with explosives). If everything goes to plan, the attacker is killed upon impact or detonation. Chechen suicide bombing at Rizhskaya station of the Moscow Metro on August 30, 2004 (above). An injured man stands in front a building destroyed by of two suicide car bombs targeting a hotel used by foreigners in Baghdad (left)Source: Guardian Unlimited, image.guardian.co.uk/.../2005/11/18/hamra372.jpg

25. London Subway Bombings The 7 July 2005 London bombings were a series of coordinated suicide bombings that struck London's public transport system during the morning rush hour. Fifty-six people were killed in the attacks, including the four bombers, and about 700 injured. A bomb damaged a subway train between Liverpool Street and Aldgate stations in London on July 7. Bombs also went off on two other subway trains and a bus. Police said the death toll was more than 50 from London's terrorist bombings. Sources: Ft. Wayne News Sentinel

26. Weapon of Mass Destruction (WMD) “Any weapon that can be used to kill or maim many persons at one time” (definition adapted from uslegal.com) • Weapons of mass destruction have been used throughout history • Expansion of the reach due to advanced technology

27. Bioterrorism Bioterrorism involves the deliberate release of viruses, bacteria, or toxins. Agents used are typically found in nature in order to cause illness or death.

28. Anthrax Attacks of 2001 In October 2001 anthrax attacks were conducted via five envelopes containing B. anthracis spores that were sent through the U.S. postal system. Twenty-two cases of anthrax resulted, and in all, five people died from inhalational anthrax. Image (top) of envelope in which the letter containing Anthrax was sent to Senator Tom Daschle during the 2001 anthrax attacks Source: Public Domain Workers handled a suspected letter containing anthrax (left) Source: Guardian Unlimitedhttp://image.guardian.co.uk/sys-images/Guardian/Pix/gallery/2001/12/19/anthrax.jpg

29. Bioterrorism Agents By Category

30. US policy on terrorism The old threat level awareness system with the five color-coded bars representing escalating threat levels has been replaced. The new system has only two levels: Imminent – for credible, specific and impending threats Elevated – for credible threats (with a Sunset Provision to expire if no new information becomes available) • Do you think this new system is better?

31. Case Scenario: Anthrax Incident

32. Summary • Disasters that can cause sudden mass casualties and poses a significant challenge to the health care system. • Examples are prevalent throughout history. • Heightened perception of terrorist attacks. • Understanding is the first step in preparedness

33. What is CBRNE?

34. CBRNE is a Classification System for Man-made Disasters

35. The accidental release of methyl isocyanate (MIC) in Bhopal, India on Dec 3rd, 1984, is an example of a non-intentional disaster involving a chemical agent. The deliberate release of Sarin nerve gas into the Tokyo, Japan subway system in 1995 was an intentional or terrorist disaster involving a chemical agent. Source: http://specials.rediff.com/news/2004/dec/01sld2.htm

36. Biological Agents The deliberate or unintentional release, or exposure to, certain biological agents. Difficult to diagnose a response to the release of a biological agent

37. The deliberate exposure of persons to anthrax in the U.S. in September and October of 2001 represents an example of intentional use of a biological agent to do harm As of now, the avian flu is not confirmed to be transmissible by human-to-human contact Source: http://www.chemrest.com/DomesticPrep2/Biological%20Agents%20Page.htmhttp://news.yahoo.com/photos/ss/events/sc/013105bir dflu/im:/060529/481/jak11005291251;_ylt=Av_aFX6371jlEF7jhUYtfp_lWMcF;_ylu=X3

38. Radiological and Nuclear Agents Intentional and non-intentional exposure to harmful radioactive materials The term ‘dirty bomb’ is most often used to refer to a Radiological Dispersal Device (RDD) with traditional explosives

39. The bombing of Hiroshima and Nagasaki during the closing days of World War II, was an intentional disaster. The accident, which occurred on April 26, 1986 at the Chernobyl nuclear power plant in Pripyat, Ukraine, is an example of a non-intentional, man-made radiological disaster. Source: http://news.bbc.co.uk/nol/shared/spl/hi/pop_ups/05/asia_pac_hiroshima_then_and_now/img/1.jpg www.niauk.org/images/education/chernobyl.jpg

40. Explosive Agents Any substance or article designed to detonate by the rapid release of heat or gas.

41. Madrid Train Station Bombing At least 190 people were killed and 1,240 wounded as 10 bombs rocked three Madrid train stations during the height of the morning rush hour. The intentional attack took place just three days before Spain's general elections in March, 2004. Bombing of the Atocha railway station, Madrid (above) Source:MSNBC, msnbcmedia.msn.com/j/msnbc/Components/Photos/.. Madrid: Aftermath of train station bombing (left) Source: www.vituperation.com/.../September/peace07.jpg

42. Case Scenario: Chlorine Spill

43. Source: http://www.historylink.org/essays/output.cfm?file_id=2090 • What is “pandemic influenza” and how do I prepare for it? • What are the phases that a pandemic may go through? • What is “avian influenza”?

44. Preparing for the Next Pandemic

45. What a Pandemic Flu Could Mean The normal winter flu season: • 36,000-40,000 deaths • 200,000 hospitalized • Global economic repercussion • No natural immunity • Stresses healthcare system • CDC Quarantine rooms in national airports

46. Infection Control in CHCs • Separate well and sick waiting rooms • Use of a facemask • Use of a respirator • Use of gowns and gloves • Use of eye protection or face shields • Dedicated equipment • Hand sanitation readily available • Home visits

47. Challenges • Staffing may be a problem • Communications • Hospitals are traditionally stand alone • Limited surge capabilities • Security • Appropriate staff training

48. Module 2: Understanding the System Response to a Disaster

49. Objectives for Module 2: • Describe the disaster cycle. • Describe a NIMS team approach. • Discuss the significance of incident and unified command planning in disaster management. • Define key agencies involved in state emergency operations. • Define psychological first aid and how mental health services can be integrated into disaster response.

50. The Disaster Cycle We Are Here