Health Update
UPDATE ON PUBLIC HEALTH PRECAUTIONS RELATED TO ORANGE THREAT LEVEL: PART 2 (PUBLIC HEALTH INFORMATION AND RESOURCES FOR A POSSIBLE CHEMICAL EMERGENCY)

In preparation for any possible public health emergency related to the current orange (high) threat level, the Centers for Disease Control and Prevention (CDC) is disseminating a series of notices on potential hazards. This is the second in a series of four updates. This message focuses on possible chemical threats.

During an orange (high) alert, public health agencies and clinicians should be prepared to respond to a terrorist event involving chemical agents. Local and state public health and environmental health officials would be the first called upon to respond to protect the public’s health.

Clinicians play a critical role in effective surveillance to determine possible chemical attacks. Clinicians who suspect cases of poisonings or chemical exposures are requested to immediately report such cases to their state or local health departments and local poison control centers. Case definitions and chemical syndromes for exposure to chemical agents can be found at:   http://www.bt.cdc.gov/agent/agentlistchem.asp. CDC requests that reports of suspected cases from state and local health departments be reported to the CDC Emergency Operations Center, telephone (770) 488-7100.

There are several possible scenarios for a chemical emergency. Toxic chemicals could be introduced into the water, food or medical supplies. An aircraft or conventional weapon could be used to disperse a toxic agent over a large area. A “silent source” could be used to expose people to a chemical (in a mall, subway or any place that people gather). Chemicals could be released during an explosion aimed at an industrial facility or transport vehicle.

An emergency involving toxic chemical agents would present special challenges for public health responders and clinicians. Treatment of casualties is more difficult because of the need to perform decontamination of exposed individuals to protect responders and clinicians. People who were not wounded in an immediate attack could still be harmed by environmental exposure to toxic agents. The affected area may be much larger than the immediate scene of the crime. Exposure to a toxic chemical, invisible and uncertain in terms of long-term health impacts, will cause considerable public fear and concern. The incident will be difficult to manage until appropriate monitoring equipment and well-trained technical individuals are available.

Public Health Roles and Responsibilities

In a chemical emergency, a broad public health response involving state, local and Federal public health agencies may be required. Public health activities that may be required include the following:

• Deploy the Strategic National Stockpile through the Department of Homeland Security
• Conduct field investigations and monitoring of people
• Conduct surveillance and epidemiological studies
• Establish an exposure registry and monitor long-term impacts
• Medical treatment and decontamination
• Criteria for entry and operations in the contaminated zone
• Medical interventions and recommendations
• Disease control and prevention measures
• Establish protective action guidelines
• Make evacuation and relocation decisions
• Evaluate health and medical impact on the public and emergency and medical personnel
• Communicate with the public, policy makers and the media. For CDC information for the public on chemical emergencies, see: http://www.bt.cdc.gov/agent/agentlistchem.asp

Public health agencies are encouraged to review plans for emergency response to chemical emergencies:

• The Federal Response Plan:   http://www.fema.gov/rrr/frp/
• The Federal National Oil and Hazardous Substances Pollution Contingency Plan. This plan provides information about how federal agencies will coordinate their support for local and state officials. http://www.access.gpo.gov/nara/cfr/cfrhtml_00/title_40/40cfr300_00.html   or http://www.epa.gov/oilspill/ncpover.htm

Information on management of a chemical emergency can be found at:

• Agency for Toxic Substances and Disease Registry : http://www.atsdr.cdc.gov/mhmi.html
• Safety Information for First Responders:   http://www.bt.cdc.gov/agent/agentlistchem.asp

Medical guidance related to chemical exposures can be found at:

• Centers for Disease Control and Prevention:  http://www.atsdr.cdc.gov/mhmi/mmg170.pdf
• Centers for Disease Control and Prevention:   http://www.bt.cdc.gov/agent/agentlistchem.asp
• U.S. Army’s Personal Protective Equipment Guide for Military Medical Treatment Facility Personnel Handling Casualties from Weapons of Mass Destruction and Terrorism Events:
  http://chppm-www.apgea.army.mil/documents/tg/techguid/tg275new.pdf Chapters 2, 3, 7 and 8

CDC information for personal protective steps and decontamination can be found at:

• http://www.bt.cdc.gov/planning/personalcleaningfacts.asp

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