ALLOREN GRACE P.

BUNDALIAN BSN 4-1 THE MAN MADE DISASTERS Bioterrorism is terrorism involving the intentional release or dissemination of biological agents. These agents are bacteria, viruses, or toxins, and may be in a naturally occurring or a human-modified form. For the use of this method in warfare, see biological warfare. Bioterrorism is an attractive weapon because biological agents are relatively easy and inexpensive to obtain, can be easily disseminated, and can cause widespread fear and panic beyond the actual physical damage they can cause. Military leaders, however, have learned that, as a military asset, bioterrorism has some important limitations; it is difficult to employ a bioweapon in a way that only the enemy is affected and not friendly forces. A biological weapon is useful to terroristsmainly as a method of creating mass panic and disruption to a state or a country. However, technologists such as Bill

Joy have warned of the potential power which genetic engineering might place in the hands of future bio-terrorists. The use of agents that do not cause harm to humans but disrupt the economy have been discussed. A highly relevant pathogen in this context is the foot-and-mouth disease (FMD) virus, which is capable of causing widespread economic damage and public concern (as witnessed in the 2001 and 2007 FMD outbreaks in the UK), whilst having almost no capacity to infect humans. HISTORY 20th century By the time World War I began, attempts to use anthrax were directed at animal populations. This generally proved to be ineffective. Shortly after the start of World War I, Germany launched a biological sabotage campaign in the United States, Russia, Romania, and France. At that time, Anton Dilger lived in Germany, but in 1915

he was sent to the United States carrying cultures ofglanders, a virulent disease of horses and mules. Dilger set up a laboratory in his home in Chevy Chase, Maryland. He used stevedores working the docks in Baltimore to infect horses withglanders while they were waiting to be shipped to Britain. Dilger was under suspicion as being a German agent, but was never arrested. Dilger eventually fled to Madrid, Spain, where he died during the Influenza Pandemic of 1918. In 1916, the Russians arrested a German agent with similar intentions. Germany and its allies infected French cavalry horses and many of Russias mules and horses on the Eastern Front. These actions hindered artillery and troop movements, as well as supply convoys. In 1972 police in Chicago arrested two college students, Allen Schwander and Stephen Pera, who had planned to poison the city's water supply with typhoid and other bacteria. Schwander had founded a terrorist group, "R.I.S.E.", while Pera

collected and grew cultures from the hospital where he worked. The two men fled to Cuba after being released on bail. Schwander died of natural causes in 1974, while Pera returned to the U.S. in 1975 and was put on probation. 1984 Rajneeshee bioterror attack: In Oregon in 1984, followers of the Bhagwan Shree Rajneesh attempted to control a local election by incapacitating the local population. This was done by infecting salad bars in 11 restaurants, produce in grocery stores, doorknobs, and other public domains with Salmonella typhimurium bacteria in the city of The Dalles, Oregon. The attack infected 751 people with severe food poisoning. There were no fatalities. This incident was the first known bioterrorist attack in the United States in the 20th century. Aum Shinrikyo anthrax release in Kameido : In June 1993 the religious group Aum Shinrikyo released anthrax in Tokyo. Eyewitnesses reported a foul odor. The attack was a total failure, infecting not a single

person. The reason for this, ironically, is that the group used the vaccine strain of the bacterium. The spores recovered from the attack showed that they were identical to an anthrax vaccine strain given to animals at the time. These vaccine strains are missing the genes that cause a symptomatic response. 21st century 2001 - USA - Anthrax Attacks: In September and October 2001, several cases of anthrax broke out in the United States in the 2001 anthrax attacks, caused deliberately. Letters laced with infectious anthrax were delivered to news media offices and the U.S Congress. The letters killed 5. TYPES OF AGENT Under current United States law, bio-agents which have been declared by the U.S. Department of Health and Human Services or the U.S. Department of Agriculture to have the "potential to pose a severe threat to public health and safety" are officially defined as "select

agents". The CDC categorizes these agents (A, B or C) and administers the Select Agent Program, which regulates the laboratories which may possess, use, or transfer select agents within the United States. As with US attempts to categorize harmful recreational drugs, designer viruses are not yet categorized and avian H5N1 has been shown to achieve high mortality and humancommunication in a laboratory setting. Category A These high-priority agents pose a risk to national security, can be easily transmitted and disseminated, result in high mortality, have potential major public health impact, may cause public panic, or require special action for public health preparedness. Tularemia Tularemia, or rabbit fever, has a very low fatality rate if treated, but can severely incapacitate.

The disease is caused by the Francisella tularensis bacterium, and can be contracted through contact with the fur, inhalation, ingestion of contaminated water or insect bites. Francisella tularensis is very infectious. A small number (1050 or so organisms) can cause disease. If F. tularensis were used as a weapon, the bacteria would likely be made airborne for exposure by inhalation. People who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they are not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and

grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication. Anthrax Anthrax is a noncontagious disease caused by the spore-forming bacterium Bacillus anthracis. An anthrax vaccine does exist but requires many injections for stable use. When discovered early anthrax can be cured by administering antibiotics (s uch as ciprofloxacin). Its first modern incidence in biological warfare were when Scandinavian "freedom fighters" supplied by the German General Staff used anthrax with

unknown results against the Imperial Russian Army in Finland in 1916. In 1993, the Aum Shinrikyo used anthrax in an unsuccessful attempt in Tokyo with zero fatalities. Anthrax was used in a series of attacks on the offices of several United States Senators in late 2001. The anthrax was in a powder form and it was delivered by the mail. Anthrax is one of the few biological agents that federal employees have been vaccinated for. The strain used in the 2001 anthrax attack was identical to the strain used by theUSAMRIID. Smallpox Smallpox is a highly contagious virus. It is
[14]

transmitted easily through the atmosphere and has a high mortality rate (20 40%). Smallpox was eradicated in the world in the 1970s, thanks to a worldwide vaccination program. However, some virus samples are still available in Russian and American l aboratories. Some believe that after the collapse of the Soviet Union, cultures of smallpox have become available in other countries. Although people born pre-1970 will have been vaccinated for smallpox under the WHO program, the effectiveness of vaccination is limited since the vaccine provides high level of immunity for

only 3 to 5 years. Revaccination's protection lasts longer. As a biological weapon smallpox is dangerous because of the highly contagious nature of both the infected and their pox. Also, the infrequency with which vaccines are administered among the general population since the eradication of the disease would leave most people unprotected in the event of an outbreak. Smallpox occurs only in humans, and has no external hosts or vectors. Botulinum toxin Botulinum toxin is one of the deadliest toxins known, and is produced by the bacterium Clostridium

botulinum. Botulism causes death by respiratory failure and paralysis. Furthermore, the toxin is readily available worldwide due to its cosmetic applications in injections. Bubonic plague Plague is a disease caused by the Yersinia pestis bacterium. Rodents are the normal host of plague, and the disease is transmitted to humans by flea bites and occasionally by aerosol in the form of pneumonic plague.[21] The disease has a history of use in biological warfare dating back many centuries, and is considered a threat due

to its ease of culture and ability to remain in circulation among local rodents for a long period of time. The weaponized threat comes mainly in the form of pneumonic plague (infection by inhalation.) It was the disease that caused theBlack Death in Medieval Europe. Viral hemorrhagic fevers This includes hemorrhagic fevers caused by members of the family Filoviridae (Marburg virus and Ebola virus), and by the family Arenaviridae (for example Lassa virus and Machupo virus). Ebola virus disease has fatality rates ranging from 5090%. No cure currently

exists, although vaccines are in development. The Soviet Union investigated the use of filoviruses for biological warfare, and the Aum Shinrikyo group unsuccessfully attempted to obtain cultures of Ebola virus.[citation needed] Death from Ebola virus disease is commonly due to multiple organ failure andhypovolemic shock. Marburg virus was first discovered in Marburg, Germany. No treatments currently exist aside from supportive care. The arenaviruses have a somewhat reduced casefatality rate compared to disease caused by filoviruses, but are more widely distributed, chiefly

in central Africa and South America. Category B Category B agents are moderately easy to disseminate and have low mortality rates. Brucellosis (Brucella species) Epsilon toxin of Clostridium perfringens Food safety threats (for example, Salmonella species, E coli O157:H7, Shigella, Staphylococc us aureus) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudomallei) Psittacosis (Chlamydia psittaci) Q fever (Coxiella burnetii) Ricin toxin from Ricinus communis (castor beans)

Abrin toxin from Abrus

precatorius (Rosary peas) Staphylococcal enterotoxin B Typhus (Rickettsia

prowazekii) Viral encephalitis (alphavir uses, for example,: Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis) Water supply threats (for example,, Vibrio cholerae, Cryptosporidium parvum) Category C Category C agents are emerging pathogens that might be engineered for mass dissemination because of their availability, ease of production and dissemination, high mortality rate, or ability to cause a major health impact. Nipah virus Hantavirus SARS

H1N1 a strain

of influenza (flu) HIV/AIDS PLANNING AND RESPONSE Planning may involve the development of biological identification systems.Until recently in the United States, most biological defense strategies have been geared to protecting soldiers on the battlefield rather than ordinary people in cities. Financial cutbacks have limited the tracking of disease outbreaks. Some outbreaks, such as food poisoning due to E. coli or Salmonella, could be of either natural or deliberate origin. Preparedness Biological agents are relatively easy to obtain by terrorists and are becoming more threatening in the U.S., and laboratories are working on advanced detection systems to provide early warning, identify contaminated areas and populations at risk, and to facilitate prompt treatment. Methods for

predicting the use of biological agents in urban areas as well as assessing the area for the hazards associated with a biological attack are being established in major cities. In addition, forensic technologies are working on identifying biological agents, their geographical origins and/or their initial son. Efforts include decontamination technologies to restore facilities without causing additional environmental concerns. Early detection and rapid response to bioterrorism depend on close cooperation between public health authorities and law enforcement; however, such cooperation is currently lacking. National detection assets and vaccine stockpiles are not useful if local and state officials do not have access to them. Biosurveillance In 1999, the University of Pittsburgh's Center for Biomedical Informatics deployed the first automated bioterrorism detection system, called RODS

(Real-Time Outbreak Disease Surveillance). RODS is designed to draw collect data from many data sources and use them to perform signal detection, that is, to detect a possible bioterrorism event at the earliest possible moment. RODS, and other systems like it, collect data from sources including clinic data, laboratory data, and data from overthe-counter drug sales. In 2000, Michael Wagner, the codirector of the RODS laboratory, and Ron Aryel, a subcontractor, conceived the idea of obtaining live data feeds from "non-traditional" (non-health-care) data sources. The RODS laboratory's first efforts eventually led to the establishment of the National Retail Data Monitor, a system which collects data from 20,000 retail locations nation-wide. On February 5, 2002, George W. Bush visited the RODS laboratory and used it as a model for a $300 million spending proposal to equip all 50 states with biosurveillance systems. In a speech delivered at the nearby Masonic temple, Bush compared the RODS system to a

modern "DEW" line (referring to the Cold War ballistic missile early warning system). The principles and practices of biosurveillance, a new interdisciplinary science, were defined and described in the Handbook of Biosurveillance, edited by Michael Wagner, Andrew Moore and Ron Aryel, and published in 2006. Biosurveillance is the science of real-time disease outbreak detection. Its principles apply to both natural and man-made epidemics (bioterrorism). Data which potentially could assist in early detection of a bioterrorism event include many categories of information. Health-related data such as that from hospital computer systems, clinical laboratories, electronic health record systems, medical examiner record-keeping systems, 911 call center computers, and veterinary medical record systems could be of help; researchers are also considering the utility of data generated by ranching and feedlot operations, food processors, drinking

water systems, school attendance recording, and physiologic monitors, among others. Intuitively, one would expect systems which collect more than one type of data to be more useful than systems which collect only one type of information (such as single-purpose laboratory or 911 call-center based systems), and be less prone to false alarms, and this appears to be the case. In Europe, disease surveillance is beginning to be organized on the continent-wide scale needed to track a biological emergency. The system not only monitors infected persons, but attempts to discern the origin of the outbreak. Researchers are experimenting with devices to detect the existence of a threat: Tiny electronic chips that would contain living nerve cells to warn of the presence of bacterial toxins (identification of broad range toxins) Fiber-optic tubes lined with antibodies coupled to light-

emitting molecules (identification of specific pathogens, such as anthrax, botulinum, ricin) New research shows that ultraviolet avalanche photodiodes offer the high gain, reliability and robustness needed to detect anthrax and other bioterrorism agents in the air. The fabrication methods and device characteristics were described at the 50th Electronic Materials Conference in Santa Barbara on June 25, 2008. Details of the photodiodes were also published in the February 14, 2008 issue of the journal Electronics Letters and the November 2007 issue of the journal IEEE Photonics Technology Letters. The United States Department of Defense conducts global biosurveillance through several programs, including the Global Emerging Infections Surveillance and Response System. RESPONSE TO BIOTERRORISM INCIDENT

Government agencies which would be called on to respond to a bioterrorism incident would include law enforcement, hazardous materials/decontamination units and emergency medical units, if they exist. The US military has specialized units, which can respond to a bioterrorism event; among them are the United States Marine Corps' Chemical Biological Incident Response Force and the U.S. Army's 20th Support Command (CBRNE), which can detect, identify, and neutralize threats, and decontaminate victims exposed to bioterror agents. US response would include the Center for Disease Control. Historically, governments and authorities have relied on quarantines to protect their populations. International bodies such as the World Health Organization already devote some of their resources to monitoring epidemics and have served clearinghouse roles in historical epidemics.

BIOCHEMICAL TERRORISM Background It is important not to foster unnecessary public anxiety with regard to the risk of a biochemical terrorist incident, but the authorities need to consider their response strategy, particularly with regard to mental health issues. Aims To describe the likely effects of a terrorist incident involving biochemical agents and to identify important response issues. Method Literature survey. Results Observations following conventional terrorist incidents and other major trauma, including biochemical and nuclear accidents, suggest that a biochemical terrorist incident would have widespread public effects. The mental health services should play a major role in designing an effective multidisciplinary response, particularly with regard to the reduction of public anxiety, identifying at-risk individuals and collaborating with medical and emergency services, as well as providing care for those who develop post-traumatic psychopathology. Conclusions We should not feel helpless in the face of a biochemical threat; there is considerable knowledge and experience to be tapped. Awell-designed, wellcoordinated and rehearsed strategy

based on empirical evidence will do much to reduce public anxiety and increase professional confidence. Previous SectionNext Section Particularly since the tragedies of 11 September 2001, much has been said and written about the risk of a biochemical terrorist attack. If one pares away the hyperbole and unnecessary drama that this issue has attracted, the exposed conclusion is that the risk is genuine and the consequences would be serious. What used to be a theme of a genre of horror films and novels has been recast as a real phenomenon of the 21st century. This represents a major challenge with regard to designing an effective strategy for coping with the aftermath of such an attack. This paper will address some of the major issues in relation to a biochemical terrorist attack, including the aims of such terrorism, its likely psychological effects and the possible intervention strategies to mitigate such effects. Previous SectionNext Section BACK GROUND The US Department of Justice defines terrorism as

the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives (US Department of Justice, 1996). What we consider to be unjustifiable and repugnant acts of terrorists are viewed by the perpetrators as rational and may be allied to cherished martyrdom. Post (2002) has argued that an understanding of the motivations of terrorists can help their victims to make some sense of their suffering. The authorities are not able to calculate accurately the risk of such terrorist activity, but it is important that forewarning and preparation are not on such a scale that massive public anxiety is created, because this would serve well the aims of the terrorists by creating a nation of terro-phobes. To achieve a balanced approach, and to design an effective strategy for responding to biological or chemical terrorism, the mental health services have much to offer because, as will be argued below, biochemical terrorism is quintessentially psychological warfare (Wessely et al, 2001). Historically, terror has proved to be an effective instrument of coercion

and intimidation for state organisations such as the Tzarist Okrahana, the Nazi Geheime Staatspolizei (the Gestapo), and the East German Ministerium fur Staatssicherheit fr (the Stasi) and other groups with a specific agenda, such as the Mafia and the Ku Klux Klan. The political activities of the Baader-Meinhof Group, the Irish Republican Army, the Algerian Salafis, the Basque Homeland and Liberty Group (ETA) and the al Qa'ida have underscored just how effective the use of terror can be, at least in the short term. Most recently, suicide terrorism has caused profound fear and social disruption (Salib, 2003). However, we must maintain a realistic perspective; sometimes their efforts are not successful and may be counterproductive (Laqueur, 1999). Previous SectionNext Section AIMS The literature identifies the following aims: a. creating anxiety, panic; fear mass and

hopelessness demoralisation; c.

and

destroying our assumptions about personal security; disruption of the infrastructure of a society, culture or city; demonstrating the impotence of the authorities to protect the ordinary citizen and his/her environment.

d.

e.

The aims of terrorism do not require massive casualties for their fulfilment: death and physical damage is a means to an end, not an end in itself. Following the two attacks using the nerve gas sarin in the Japanese cities of Matsumoto (1994) and Tokyo (1995), carried out by the Aum Shinrikyo cult, only 19 deaths occurred but the psychological, social and economic effects of these incidents were enormous (Knudson, 2001). Previous SectionNext Section ATTRACTION

b.

creating helplessness,

Conventional terrorism made use of explosive and standard weaponry, but the authorities made access to such items more difficult and, as society adjusted to previous levels of violence and atrocity, terrorists have had to seek methods of achieving an even higher level of threat. Although there are impediments to their use, including storage and dispersal (Venkatesh & Memish, 2003), biological and chemical agents generally commend themselves to terrorists for at least six reasons: a. it is relatively easy to obtain information about them;

anthracis(anthrax) andYersinia pestis(plague) and highly toxic (Category B) chemicals such as ricin toxin, there is much to be learned about their effects and how to combat them (Arnon et al, 2001; Lane et al, 2001); d. the effects, particularly of biological agents, are commonly distant in time and place from the site of any initial incident; because viruses and microbes, and some toxic chemicals, cannot be detected through the senses they readily instill fear and trigger powerful vestigial fears of mysterious threatening forces; particularly with biological agents, there is no clearly defined low point from which survivors

and their care-givers can look forward to respite and improvement (Baum, 1986). Previous SectionNext Section

PHYSIOLOGICAL REACTIONS There is no absolute certainty as to how individuals and communities would react following such an incident in the UK. Thus, we need to cull from our knowledge relating to other major calamities (e.g. Piggin & Lee, 1992; van der Kolk et al, 1996; Joseph et al, 1997), conventional terrorist events (e.g. Simset al, 1979; Alexander, 2001; Schuster et al, 2001), nuclear accidents (Houts et al, 1988; Allen et al, 1996) and military campaigns in which toxic agents have been deployed (e.g. Fullerton & Ursano, 1990). Community reactions Tyhurst (1951) suggested that, following a major trauma, there is likely to be a triphasic response. In the initial impact, survivors will be preoccupied with their present situation and most will be stunned and numbed. Up to about 15% will still be able to retain their ability to

b. many agents are

relatively cheap and easy to produce, and can be delivered without high technology or much scientific knowledge (Smith, C. G., et al, 2000); although there have been considerable advances in the scientific understanding of the most lethal (Category A) biological agents such as Variola major (smallpox), Bacillus e.

c.

f.

think rationally, to evaluate the level of risk and to take appropriate action. During the recoil phase, survivors will want to talk to others and seek support. The reality of what has occurred becomes irresistibly obvious to survivors at the posttrauma phase. It is similar to the post-honeymoon phase described by Raphael (1986) that follows major trauma. During this phase survivors are likely to display a number of emotional reactions, including depression, anxiety and anger (particularly if they consider that their legitimate needs have not been met). Pennebaker & Harber (1993) describe a social stage model of collective coping: one that emphasises how the need of individuals to talk about their experiences varies over time. Immediately after such an event there is an enthusiasm for sharing views, but that stage is followed by an inhibition phase during which they are more likely to reflect on than talk about the incident. Panic describes a group response in which the impulsive flight reaction is acute and intense, for example when individuals feel completely trapped and lacking control of the situation (Pastel, 2001). It is contagious and results in individuals looking after their own safety and welfare. Panic should not be

confused with mass anxiety because the latter can lead to constructive action. To what extent mass panic is likely to occur after a major biochemical terrorist incident remains unconfirmed (Wessely, 2000). In relation to most major catastrophes this has not been shown to be a characteristic reaction (e.g.Quarantelli, 1960; Durodi & Wessely, 2002). Glass & SchochSpana (2002) also challenge the pessimistic view of community reactions. They argue that the general public are likely to display adaptive, collective action. They advocate that the community should be acknowledged as a key partner in the planning and execution of the medical and public health response to a terrorist incident. More specifically, they propose five guidelines regarding public involvement. These are: treat the public as a competent ally; involve community organisations in public health operations; anticipate the need for home-based patient care and control of infection; invest in public outreach programmes and communication strategies; and ensure that the response strategy reflects the values and attitudes of the communities affected by the incident. None the less, a biochemical terrorist incident would involve a number of

elements that could conduce to overwhelming anxiety and subsequent panic. Ramalingaswami (2001) reported that after the 1994 outbreak of suspected pneumonic plague in Surat, India, there was widespread panic such that overnight approximately 600 000 citizens (including medical staff) fled the region. The short-term effects of a biochemical incident require the authorities to plan for the provision of medical resources, including psychological services. In the longer term a terrorist incident is likely to have more chronic medical and psychiatric sequelae and substantial political and socio-economic effects. Terrorist action in New York and in Bali demonstrate how events on that scale can jeopardise the tourist trade, compromise financial markets and cause governments to review their political agenda. Several authorities have suggested that the longer-term consequences of a biochemical assault may be the more devastating and pernicious (e.g. Becker, 2001; Wessely et al, 2001). Individual reactions Observations following natural and human-induced major trauma describe a miscellany of individual reactions, although much would depend on the incubation period,

virulence and toxicity of the agents used (Holloway et al, 1997). However, these reactions are likely to include the following: a. stunned and numb: numbing shields us temporarily from overwhelming images, experiences and emotions; anxiety and fear: because of their unfamiliarity, biochemical agents would generate high levels of anxiety and fear and challenge our usual methods of coping; horror and disgust: biochemical incidents would expose the uninitiated to unfamiliar forms of suffering and injury; anger and scapegoating: the authorities and helpers may be blamed for a failure to protect and care for survivors;

e.

paranoia: terrorists are characteristically an unseen enemy and their unpredictable attacks are likely to generate a community sense in any community of being persecuted; there may also be xenophobia;

b.

f. loss of trust: as
Janoff-Bulman (1992) pointed out, traumatic events can shatter our core assumptions, including those relating to our safety and vulnerability; g. demoralisation, hopelessness and helplessness: a biochemical attack would challenge individuals' internal locus of control such that they would feel as though they were not in charge of their own destiny; guilt: survivor guilt will be experienced by some who survive a biochemical incident,

c.

d.

h.

and performance guilt is likely to be experienced by those who believe that they did not do enough to help others; false attributions: a lack of understanding about biochemical contamination may cause individuals to attribute falsely normal psychological stress reactions or other benign physical phenomena to the agents used by the terrorists; this has been observed in cases of mass psychogenic illness (Bartholomew & Wessely, 2002). Previous SectionNext Section MASS PSYCHOLOGENICILLNESS This term has been used to describe the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function whereby physical complaints that are exhibited i.

unconsciously have no corresponding organic aetiology (Bartholomew & Wessely, 2002). In an excellent review they emphasise the influence of sociocultural factors. Following the events of 11 September 2001, the threat of biochemical terrorism sired the anthrax scares and the World Trade Center syndrome (widespread reports of chest pain and respiratory problems). A concern is that the medical and welfare services would be overwhelmed in the wake of a major biochemical incident, primarily by many anxious individuals and not just those who had been exposed to contaminants (e.g.Tucker, 1997; Knudson, 2001), as occurred after the radiological contamination incident in Goiania, Brazil, in 1987 (Petterson, 1988). Of the first 60 000 screened, 5000 had not been contaminated but all had presented with symptoms of vomiting, diarrhoea and rashes, all of which are consistent with acute radiation sickness. Ultimately, 125 800 persons had to be screened but only 249 of them had been contaminated. Knudson (2001), with regard to the Aum Shinrikyo incident in 1995, reported that the ratio of those who sought medical help to those who

required immediate medical care was approximately 450:1. The concept of the worried well appears in the literature (Knudson, 2001) but this term is inaccurate and unhelpful (Pastel, 2001). Such individuals have cause to be anxious and, moreover, the level of anxiety may be such that they are not well, at least in psychological terms. Moreover, other authorities (e.g.Engel, 2001) have cautioned against dismissing such health concerns because this is likely to raise suspicions of a conspiracy or of an uncaring or incompetent authority. Hadler (1996) has also suggested that a dismissive approach could result in a contest in which survivors redouble their efforts to persuade doctors of the legitimacy of their symptoms. Engel (2002) refers to a similar dynamic in relation to medically unexplained physical symptoms whereby patients and medical staff can become locked in debate over contested causation. Engel (2001) has offered some guidelines as to how such individuals should be dealt with. These include the need to offer an empathic, nonjudgemental, collaborative approach to help these ailing individuals achieve a better level of adjustment. It is important to note the conclusion of Bartholomew & Wessely (2002) that none of us is immune from such

reactions because there are no clearly defined predispositions to mass psychogenic illness. Previous SectionNext Section PSYCHIATRICIPSYCHOLOGICAL SYMPTOMS There is a substantial body of epidemiological data that confirms that after major trauma significant levels of psychomorbidity can be expected (e.g.O'Brien, 1998; Harvey & Bryant, 1999; Fairbank et al, 2000; Alexander & Klein, 2003). Following terrorist incidents, the rates of psychiatric conditions tend to be quite high, particularly in terms of acute stress disorder, post-traumatic stress disorder, depression and pathological grief (Shalev, 1992; Koopman et al, 1995; Smith, D., et al, 1999). North et al(1999) reported that 34% of 182 survivors of the Oklahoma City bombing developed post-traumatic stress disorder and that a further 11% developed other psychiatric conditions, including depression and substance misuse. Schuster et al(2001) conducted a random-digitdialling telephone survey 35 days after the terrorist attacks of 11 September 2001. Of the 560 adults interviewed, 44% reported at least one substantial symptom of stress and 35% of the children had one or

more stress symptom. Even 12 months post-incident, increased rates of alcohol and tobacco consumption, stress and posttraumatic stress disorder were reported when compared with a control group comprising citizens of another city. Previous SectionNext Section THE MEDIA Following any major biochemical terrorist incident the media will be unavoidably but quickly involved, as has been confirmed by a number of specialists (e.g. Nocera, 2000). The subsequent level of uncertainty and anxiety (for reasons described above) would create a fertile soil in which rumour and ill-informed speculation would thrive, as was seen in the case of hyperbolic headlines about flesh-eating bugs and mad cow disease. The media can resonate with vestigial fears of microbial and viral agents, fears that have been recorded throughout history and particularly during the plague epidemics of the Middle Ages, leprosy and the polio epidemics of the 20th century. Children may be affected adversely by the media coverage of trauma, particularly if they themselves were bereaved as a result of the event (Pfefferbaum et al, 1999).

The media must be embraced by the authorities as allies because, particularly in the early stage after a terrorist incident, they can play a helpful role by broadcasting to an anxious population accurate information about, for example: a. b. c. what has happened; what sources of help are available; what are the signs suggesting that professional help might be required; what are reactions; normal

d. e.

what is the difference between contagion and other modes of infection; the resilience of individuals and communities.

f.

In addition, the authorities can, through the media, address important matters relating to, for example, decontamination and isolation procedures, restriction on travel and the disposal of dead bodies. In any multi-racial society the

last issue is likely to be a delicate one, particularly if cremation and a prohibition on access to the deceased is required, on health grounds, because this may transgress religious and cultural beliefs and values (Speck, 1978; Gibson, 1998). After so-called silent disasters involving radiation, there has been a temptation for the authorities to avoid releasing information (Green et al, 1994). It was not until 28 April 1986 that the Russian authorities admitted that there had been a nuclear accident at Chernobyl 2 days earlier. Similarly, they displayed a reluctance to give out accurate information after the sinking of their nuclear submarine, the Kursk, in 2001. The Japanese authorities behaved in a similar fashion after the accident at the nuclear fuel processing facility at Tokaimura (International Atomic Energy Agency, 1999). Denial and duplicity by the authorities are likely to carry penalties and a serious loss of confidence in them is the probable result (Tnnessen et al, 2002). Two further observations about communicating with the general public after a major incident are that statistics are less persuasive than are case studies, and that individuals are less influenced by statistical probabilities than they are by perceived outcomes (American

Psychological Association, 2001). Education a key element of any public campaign following a biochemical incident would have an impact on how a community viewed the impact of such an occurrence. Efforts should be made to develop non-adversarial and collaborative relationships with media personnel before a crisis. As Quigley (2001) has put it most graphically, if you don't engage and feed the beast, the beast will eat you. Previous SectionNext Section THE MENTAL HEALTH SERVICES Terrorism is psychological warfare. It is not anticipated that the mental health services would be among the ranks of frontline responders but they should play a signal role in developing major incident plans based on their extensive knowledge of reactions to trauma and of vulnerability and protective factors. An effective plan must be multidisciplinary and it must be rehearsed regularly under realistic conditions (Tucker, 1997). Also, they would be expected to treat acute and chronic psychiatric illness and to provide advice and supervision for other agencies. According to DiGiovanni (1999) there are a number of key roles that the

mental health professionals could be expected to fulfill: a. advising the authorities on how to manage anxious and distressed individuals; providing advice for surgical and medical staff about posttraumatic reactions; helping to determine whether symptoms such as tachycardia, tension, nausea and tremor are normal psychological reactions to stress or are the signs of biological or chemical contamination; assessing the mental status of those who have suffered physical contamination; conducting triage to identify those in need of more specialist psychiatric care.

b.

trauma to include the physical effects of likely toxic agents and their management, involving the use of decontamination procedures. Similarly, they need to know of the psychological effects of barrier environments and of the wearing of personal respirators and protective clothing. Previous SectionNext Section FORMAL METHODS The authorities cannot develop an effective intervention strategy if it is defined merely in terms of physical procedures and knowledge. The psychological dimension to a biochemical event and its effects is all-pervasive. More specifically, the physical interventions may themselves give rise to psychological needs and possible problems (Holloway et al, 1997). Barrier environments, quarantine, restricted travel, mass immunisation, decontamination and the destruction of personal clothing and property are experiences totally unfamiliar to most of us in the UK. After the second sarin attack in Tokyo much distress was occasioned by the apparent disregard for survivors' dignity and personal privacy (Holloway et al, 1997). Restrictions on travel, quarantine and isolation of

c.

contaminated individuals also have obvious adverse implications for family and social networks, which would represent the first line of support for those caught up in adversity. There is already evidence that those subject to such a regimen may react adversely even if that incident proves subsequently to be a hoax (Norwood, 2001), and Barbera et al (2001) explore in detail the implications of large-scale quarantine. Crisis intervention The general principles of crisis intervention provide an obvious foundation for an intervention strategy, and subsequent models of early intervention have embraced many of them while extending the intervention strategy. First used in relation to military combat, psychological first aid has been proposed by Raphael (1986) as an appropriate response in the first phase following major civilian trauma. It represents a coordinated strategy designed to reduce suffering and uncertainty and to harness the healing resources of the survivors without causing iatrogenic harm. Some of these key elements are:

a.

providing survivors with physical and psychological comfort; protecting them from further harm; providing accurate information; re-establishing a sense of order and control (e.g. by restoring the public utilities); involving survivors, where appropriate, in purposeful activities; developing or reestablishing, where appropriate, links with family, friends and other survivors; providing information about helping agencies;

b. c. d.

e.

f.

d.

g.

e.

h. conducting triage to
identify individuals at most risk of adverse psychological reactions (guidelines about risk factors

However, mental health personnel need to broaden their concept of

have been provided by a number of authorities Weisth, 1996; Yehuda, 1999; Klein et al, 2002). The implementation of psychological first aid will generally rest with the emergency services, the military and hospital personnel. Everly & Mitchell (2001) present a response strategy, following a terrorist incident, in the fashion of the Ten Commandments. These include: setting up walk-in centres and crisis hotlines; collaboration with the media; enlisting the support of key representatives of political, medical, religious, economic and educational domains; using symbols (e.g. flags and stickers) as a means of enhancing community cohesiveness; and initiating rituals to honour the dead, rescuers and helpers and the survivors. Their final commandment is a familiar one, namely, the Galenic principle of First, do no harm. An argument could be advanced for elevating this to the first principle, in deference to recent evidence and concerns about the psychonoxious potential of inappropriate early intervention (e.g. Wessely et al, 1999). Harm can innocently and inadvertently be caused by, for example, retraumatising individuals

by premature and/or insensitive reexposure to reminders of the trauma, by medicalising or pathologising what are normal acute stress responses and by compromising the natural healing potential of individuals, families and communities. With regard to an employer being concerned about liability for negligent intervention, a legal authority has emphasised particularly that the debriefer should be adequately trained and reputable and that those to be debriefed should be fully aware of the precise nature and purpose of the debrief (Wheat, 2002: p. 156). Critical incident stress debriefing was initially introduced as a group method of enabling emergency personnel to adjust to particularly disturbing events and to reduce their likelihood of developing posttraumatic stress disorder (Mitchell & Everly, 1996). Its popularity resulted in it being widely used for civilians as a single-session intervention following traumatic experiences, a development far removed from the original model. However, its therapeutic or prophylactic value has been questioned (e.g. Wessely et al, 1999; van Emmerick et al, 2002). Evaluative studies are limited in number and can be criticized on methodological grounds, as the review by the British Psychological

Society (2002) confirmed. None the less, certainly on the basis of these findings, mandatory debriefing cannot be justified. The debate must be pursued further because there are significant arguments both for and against this intervention (Wessely & Deahl, 2003) and there are many unanswered questions (Raphael & Wilson, 2000). There is also a need to evaluate other models of intervention. Blythe (2002) has produced a helpful manual to assist organisations prepare their staff for a major incident. This is a largely atheoretical practical approach, supplemented with a number of checklists covering a range of communication, health, safety, legal and humanitarian matters. Shielding also has been introduced as a practical public health intervention (Everly, 2002) offering a model for individuals, organisations and communities to minimise the impact of a biochemical terrorist incident, particularly through a self-imposed isolation. The concept of stepped care (Engel et al, 2003) is particularly attractive because it combines the benefits of population-based and individualbased levels of care. Simple community interventions are provided first and, for those individuals with particular medical and specific needs, specialist care is

made available later. In other words the psychiatric/psychological interventions are not offered indiscriminately. A peer support system, the Trauma Risk Management Programme, evolved from the Royal Marines' Stress Trauma Project; this is of particular relevance to hierarchical organisations. It is based on a system of self-help strategies, education, risk assessment and mentoring (C. March, personal communication, 2003). Previous SectionNext Section THE PREPARATION WELFARE AND

The threat of a biochemical incident raises questions about the training and preparation of front-line professional responders. As DiGiovanni (1999) has emphasised, there can be no reason to assume that such personnel would be immune from the deleterious psychological effects of a terrorist event of this kind; self-selection and a degree of natural personal resilience do not represent an impermeable barrier to the emotional impact of helping survivors of trauma (e.g. Duckworth, 1986; Figley, 1995; Paton, 1997; Alexander & Atcheson, 1998; Alexander & Klein, 2001; McFarlane & Bookless, 2001).

Thus, such personnel who are likely to be faced with the challenge of dealing with a biochemical terrorist incident are entitled to the best available training and preparation, in both physical and psychological terms. The psychoprophylactic value of good preparation and training has been shown already (e.g. Alexander, 1993; Deahl et al, 2000). Their training would need to include not only information about the normal and pathological reactions to extreme stressors but also experience in wearing protective clothing (i.e. moon suits) and personal respirators. Barrier clothing can compromise physical function and communication with colleagues and can cause overheating, hyperventilation, fatigue and panic (O'Brien & Payne, 1993; Krueger, 2001; Ritchie, 2001). The appearance of personnel in protective clothing can be disquieting to the onlooker. For this reason, following the pipe bomb explosion at the Centennial Olympic Park on 27 July 1996 it was agreed that it should not be worn by the FBI while conducting their investigations at the scene (Tucker, 1997). As was described above by Glass & Schoch-Spana (2002), the general public also must be considered as key partners in the overall response to a biochemical incident. Similarly,

Durodi & Wessely (2002) and Rowan (2002) advocate that governments should encourage the active cooperaton of the general public (including lay and voluntary bodies) in the preparation of emergency plans. Weaknesses in major incident plans for biochemical attacks have been revealed in field exercises in the USA and following hoaxes (Tucker, 1997). Ashraf (2002) highlighted the fact that, following the terrorist events of 11 September 2001, there were 7622 postal threats involving anthrax throughout Europe. Although anthrax was not used in any of these events, he claimed that they demonstrated that Europe was not fully prepared for widespread terrorist incidents. Previous SectionNext Section POSITIVE TRAUMA OUTCOMES AFTER

22 out of 36 survivors reported positive gains, including closer family relationships, a greater ability to be emotionally expressive and greater financial security after compensation claims were settled. There is the risk that we underestimate the resilience of individuals and communities through what Durodi & Wessely (2002) describe as the riskobsessed world-view that continuously seeks to catalogue peoples vulnerabilities'. Previous SectionNext Section CLINICAL IMPLICATIONS The threat of a biochemical terrorist incident is a real one, but overreaction by the authorities would be unhelpful and the natural resilience of individuals and communities must not be underestimated. A degree of preparedness is required, and this should be based upon the best empirical evidence from other trauma research.

The mental health services would have an important role to play in training, advising and assisting front-line responders as well as helping in the management of those with psychiatric and psychosocial problems.

LIMITATIONS The review had to be selective and there is a bias towards the English-language literature. In the absence of robust empirical evidence there had to be some reliance on judgement and informed speculation. This review does not specifically address many issues relating to the role of the emergency and hospital services or the military.

There can be positive gains following involvement in catastrophe, including: a more united community; individuals identifying new strengths; relationships becoming more closely bonded; and life priorities and values being constructively revised (e.g. Joseph et al, 1993; Calhoun & Tedeschi, 1998;Alexander, 2001). In a 10-year follow-up of the survivors of the Piper Alpha oil platform disaster, Hull et al(2002) found that

EXPLOSIONS

An explosion is a rapid increase in volume and release of energy in an extreme manner, usually with the generation of high temperatures and the release of gases. Supersonic explosions created by high explosives are known as detonations and travel via supersonic shock waves. Subsonicexplosions are created by low explosives through a slower burning process known as deflagration. Natural Explosions can occur in nature. Most natural explosions arise from volcanic processes of various sorts. Explosive volcanic eruptions occur whenmagma rising from below has much dissolved gas in it; the reduction of pressure as the magma rises causes the gas to bubble out of solution, resulting in a rapid increase in volume. Explosions also occur as a result of impact events and in phenomena such as hydrothermal explosions (also due to volcanic processes). Explosions can also occur outside of Earth in the

universe in events such as supernovae. Explosions frequently occur duringbushfires in eucalyptus forests where the volatile oils in the tree tops suddenly combust. Animal bodies can also be explosive, as some animals hold a large amount of flammable material such as animal fat. This, in rare cases, results in naturally exploding animals. Astronomical Among the largest known explosions in the universe are supernovae, which result when a star explodes from the sudden starting or stopping of nuclear fusion, andgamma ray bursts, whose nature is still in some dispute. Solar flares are an example of explosion common on the Sun, and presumably on most other stars as well. The energy source for solar flare activity comes from the tangling of magnetic field lines resulting from the rotation of the Sun's conductive plasma. Another type of large astronomical explosion occurs

when a very large meteoroid or an asteroid impacts the surface of another object, such as a planet. Chemical The most common artificial explosives are chemical expl osives, usually involving a rapid and violent oxidation reaction that produces large amounts of hot gas. Gunpowder was the first explosive to be discovered and put to use. Other notable early developments in chemical explosive technology were Frederick Augustus Abel's development of nitrocellulose in 1865 and Alfred Nobel's invention of dynamite in 1866. Chemical explosions (both intentional and accidental) are often initiated by an electric spark or flame. Accidental explosions may occur in fuel tanks, rocket engines, etc. Electrical and magnetic A high current electrical fault can create an electrical explosion by forming a high energy electrical arc which rapidly vaporizes metal

and insulation material. This arc flash hazard is a danger to persons working on energized switchgear. Also, excessive magnetic pressure within an ultrastrong electromagnet can cause a magnetic explosion. Mechanical and vapor Strictly a physical process, as opposed to chemical or nuclear, e.g., the bursting of a sealed or partially sealed container under internal pressure is often referred to as a 'mechanical explosion'. Examples include an overheated boiler or a simple tin can of beans tossed into a fire. Boiling liquid expanding vapor explosions are one type of mechanical explosion that can occur when a vessel containing a pressurized liquid is ruptured, causing a rapid increase in volume as the liquid evaporates. Note that the contents of the container may cause a subsequent chemical explosion, the effects of which can be dramatically more serious, such

as a propane tank in the midst of a fire. In such a case, to the effects of the mechanical explosion when the tank fails are added the effects from the explosion resulting from the released (initially liquid and then almost instantaneously gaseous) propane in the presence of an ignition source. For this reason, emergency workers often differentiate between the two events. Nuclear In addition to stellar nuclear explosions, a man-made nuclear weapon is a type of explosive weapon that derives its destructive force from nuclear fission or from a combination of fission and fusion. As a result, even a nuclear weapon with a small yield is significantly more powerful than the largest conventional explosives available, with a single weapon capable of completely destroying an entire city. PROPERTIES OF EXPLOTION Force Explosive force is released in a direction perpendicular to the surface

of the explosive. If the surface is cut or shaped, the explosive forces can be focused to produce a greater local effect; this is known as a shaped charge. Velocity The speed of the reaction is what distinguishes the explosive reaction from an ordinary combustion reaction . Unless the reaction occurs rapidly, the thermally expanded gases will be dissipated in the medium, and there will be no explosion. Again, consider a wood or coal fire. As the fire burns, there is the evolution of heat and the formation of gases, but neither is liberated rapidly enough to cause an explosion. This can be likened to the difference between the energy discharge of a battery, which is slow, and that of a flash capacitor like that in a camera flash, which releases its energy all at once. Evolution of heat The generation of heat in large quantities accompanies most explosive chemical reactions. The

exceptions are called entropic explosives and include organic peroxides such as acetone peroxide[2] It is the rapid liberation of heat that causes the gaseous products of most explosive reactions to expand and generate high pressures. This rapid generation of high pressures of the released gas constitutes the explosion. The liberation of heat with insufficient rapidity will not cause an explosion. For example, although a pound of coal yields five times as much heat as a pound of nitroglycerin, the coal cannot be used as an explosive because the rate at which it yields this heat is quite slow. In fact, a substance which burns less rapidly (i.e. slow combustion) may actually evolve more total heat than an explosive which detonates rapidly (i.e. fast combustion). In the former, slow combustion converts more of the internal energy (i.e. chemical potential) of the burning substance into heat released to the surroundings, while in the latter, fast combustion (i.e. detonation) instead

converts more internal energy into work on the surroundings (i.e. less internal energy converted into heat); c.f. heat and work (thermodynamics) are equivalent forms of energy. See Heat of Combustion for a more thorough treatment of this topic. When a chemical compound is formed from its constituents, heat may either be absorbed or released. The quantity of heat absorbed or given off during transformation is called the heat of formation. Heats of formations for solids and gases found in explosive reactions have been determined for a temperature of 15 C and atmospheric pressure, and are normally given in units of kilocalories per gram-molecule. A negative value indicates that heat is absorbed during the formation of the compound from its elements; such a reaction is called an endothermic reaction. In explosive technology only materials that are exothermic that have a net liberation of heat are of interest. Reaction heat is measured under conditions either of

constant pressure or constant volume. It is this heat of reaction that may be properly expressed as the "heat of explosion." Initiation of reaction A chemical explosive is a compound or mixture which, upon the application of heat or shock, decomposes or rearranges with extreme rapidity, yielding much gas and heat. Many substances not ordinarily classed as explosives may do one, or even two, of these things. A reaction must be capable of being initiated by the application of shock, heat, or a catalyst (in the case of some explosive chemical reactions) to a small portion of the mass of the explosive material. A material in which the first three factors exist cannot be accepted as an explosive unless the reaction can be made to occur when needed. Fragmentation Fragmentation is the accumulation and projection of particles as the result of a high explosives detonation. Fragments could be part

of a structure such as a magazine. High velocity, low angle fragments can travel hundreds or thousands of feet with enough energy to initiate other surrounding high explosive items, injure or kill personnel and damage vehicles or structures. Chemical explosions Nanaimo mine explosion 1887 Halifax Explosion 1917 Battle of Messines 1917 Oppau explosion, Ludwigshafen, Germany 1921 Bombay Explosion (1944) Port Chicago disaster 1944 RAF Fauld explosion 1944 Cdiz Explosion 1947 Texas City Disaster 1947 Nedelin catastrophe 1960 Soviet N1 rocket explosion 1969 Flixborough disaster 1974 PEPCON disaster, Henderson, Nevada 1988 AZF (factory), Toulouse, France 2001

Ryongchon disaster 2004 2005 Hertfordshire Oil Storage Terminal fire 2005 Albania explosion Gerdec 2008 Catao oil refinery fire 2009

Satchel charges and sapping Hand grenades

Volcanic eruptions Santorini Krakatoa Mount St. Helens Mount Tambora Mount Pinatubo Toba catastrophe theory Yellowstone Caldera

Nuclear testing Trinity test Castle Bravo Tsar Bomba

Use in war CHEMICAL SPILLS Artillery, mortars, and cannons Gunpowder and smokeles s powder as a propellant in firearms and artillery Bombs Missiles, rockets, and torpedoes Atomic bombings of Hiroshima and Nagasaki Land mines, naval mines, and IEDs Summary: While many chemical spills can be prevented, they still happen despite your best efforts to avoid them. It is important to know what to do in the event of a spill. In the event of a chemical spill, there are several options available: Call 911 from a campus phone. Your call will go to UCPD and you can report a chemical spill to the Operator at the Trouble Desk. If the phone you are calling from is a cell phone

or off-campus phone dial (310) 825-1491 for UCPD Dispatch. If the spill is not an emergency but requires assistance and is during normal business hours (8 a.m. - 5 p.m.) you can call Environment, Health and Safety (EH&S) at (310) 825-5689. Trained personnel are available for consultation and cleanup. EH&S maintains a welltrained Haz Mat Team who can handle spills of almost any size or complexity. Members of the team are available 24 hours a day, 7 days a week. After hours, Haz Mat Team activity is coordinated through the Trouble Desk and the UCPD. The UCLA Haz Mat Team will be alerted by the UCPD.

evaporated in fume hoods or disposed of in the normal trash. Contact EH&S for help in classifying waste as hazardous or nonhazardous. In case of a chemical spill, the procedures to follow are: Alert people in immediate area of the spill. Determine the chemical nature of the spill and check the Material Safety Data Sheet (MSDS). If the material is highly toxic or hazardous, call 911 from a campus phone or EH&S at (310) 8255689. If a volatile, toxic or flammable material is spilled, immediately warn everyone to evacuate the area, and turn off all electrical and spark producing equipment if possible. Use a fire extinguisher to extinguish any flames if applicable.

Determining if a waste is a "hazardous waste" can be difficult. The best policy is to assume all chemicals must be handled as hazardous waste and can only be disposed of through the EH&S Chemical Waste Program. Strict sewer, air emissions and landfill regulations require that hazardous waste is not drain disposed,

Small Spills (usually less than 1 liter of material)

If it is your laboratory policy and you have been trained in spill clean-up procedures, your laboratory can proceed to clean up the spill. The spill has to be in your lab or shop area for you to clean it up without the assistance of EH&S. If the spill occurs in a common area or corridor, you must contact the EH&S for assistance. Put up signs or barrier tape to prevent access to the area. Wear protective equipment, including respirator, safety goggles and gloves. Dike the spill by surrounding the area with absorbent materials such as paper towels, spill control pillows, vermiculite, sand or absorbent pads for organic liquids (where applicable). Proceed to clean up the spill using the same materials. Neutralize acids with sodium bicarbonate and bases with citric acid. After cleanup, all materials, including paper towels

used in the cleanup, must be disposed of as Hazardous Waste. Double bag the waste or more as needed. Label the waste bags using a Hazardous Waste Online Waste Tag. Wash the affected surface with soap and water and clean up by ordinary means. Bring the waste bag to the next regularly scheduled Hazardous Waste pickup, or call EH&S at (310) 2061887 to schedule a pickup.

Large Spills (usually more than 1 liter of material) Contact EH&S for clean-up

Mercury Spill Cleanup In the case of a small mercury spill in your laboratory, such as a broken thermometer, one option is to clean up the spill yourself. This option should only be exercised if it is your laboratory policy and you have been trained to do so. If your laboratory decides to clean up the mercury spill on their own, follow the clean-up procedure below. The other option is to contact EH&S to clean up the

mercury spill. They have a highly trained hazmat team with equipment to handle the clean-up of mercury. They also have sensitive mercury detection equipment to ensure that the mercury spill has been cleaned properly. Remember that mercury is a very toxic chemical. Prolonged exposure to mercury vapor will cause damage to the human nervous system. It is important to clean up all mercury spills completely. If the mercury spilled on a porous surface such as a rug or cloth chair, do not attempt to clean up and contact EH&S for assistance. For more information on chemical spills, see the Laboratory Chemical Spill Procedures. They can be found in your Laboratory Safety Manual. What NEVER to do in the Event of a Mercury Spill Never walk around an area that is contaminated with mercury. Mercury is easily spread and the spill area may not be easily identified. Contaminated clothing can also spread mercury around. Never use an ordinary vacuum cleaner to clean up mercury. The vacuum

will put mercury vapor into the air and increase exposure. The vacuum cleaner will be contaminated and will have to be disposed of as hazardous waste. Never use a broom to clean up mercury. It will break the mercury into smaller droplets and spread them. Never wash mercurycontaminated items in a washing machine. Mercury may contaminate the machine and/or pollute the water system.

2.

3.

What to do if a Mercury Thermometer Breaks in Your Laboratory: Initial Steps 1. Keep everyone away from incident room to prevent the spread of contamination. Before sending anyone out of incident room, check for mercury on clothing and the bottom of shoes. If mercury is visible on any article of clothing or shoes,

remove the articles from the person and keep the articles in the incident room. If the person has walked through the spill area and mercury is not visible, the individual must stay in the area until monitoring can be performed by EH&S personnel. Close any doors that may help to isolate the incident room as long as you can do so without walking through the spill. If you or any other person has come in contact with the mercury or suspect that you have been contaminated, do not leave the area so you dont spread the contamination. Call EH&S at x55689 or 911 from a campus phone for assistance in decontaminating the exposed individuals.

2. 3.

4. 5.

Clean-up Procedure: 1. If you have been trained and it is your laboratory policy to clean small mercury spills (usually the quantity found in a thermometer or less), you

6.

can proceed to clean up the spill. The spill has to be in your lab or shop area for you to clean it up on your own. You must contact the EH&S for assistance if the spill occurs in a common area, corridor, and/or if the amount of mercury spilled is larger than is typically found in a thermometer. Put on rubber, nitrile, or latex gloves. Put on disposable, nonporous shoe covers (plastic bags may work for this). Perform a visual inspection to determine the extent of the contamination. Use a flashlight to look for mercury beads. Shine the flashlight at many low, different angles on the spill area. The light will reflect off of the shiny mercury beads to make it easier to see them. Start at least one foot behind where you believe the contamination starts. If you cannot find the mercury, contact EH&S for assistance. Contain the mercury spill to as small of an area as possible. Prevent the mercury beads from

7.

8.

9.

spreading into drains, cracks or crevices, on to sloped or porous surfaces, or any other inaccessible areas. Work from the outside of the spill area to the center of the spill area. Push the mercury beads together with a 3 X 5 index card or stiff paper to form larger droplets. Mercury beads roll very quickly, so be careful! Push the mercury beads into a plastic dustpan or use a pipette to pick up the beads. You can also use tape to pick up the little beads of mercury, but be careful because they might not always stick. Collect all mercury into a sealable plastic bag. If the mercury spill involves glass pieces, such as from a glass thermometer, pick them up with care, as they may be sharp. Place all broken glass on a small paper towel. Fold up the paper towel and place it in the same sealable plastic bag as the mercury droplets. When you think youve picked up all of the

10.

11. 12. 13.

14. 15.

mercury, shine a flashlight (at many different, low angles) on the area to help find any remaining mercury beads or glass. The light will reflect off the shiny mercury beads and glass. Contact EH&S Hazmat Team at x55689 for mercury vapor monitoring to ensure that there is no further contamination. Remove shoe covers and gloves and place into waste bag. Seal the bag and place it into a second plastic bag. Seal the outer bag as well. Use the On-Line Tag Program (OTP) to create a hazardous waste tag. Affix the tag to the outer bag and bring it to the next hazardous waste pick-up for your building. Inspect your shoes and clothing for mercury before exiting the area. After you are completely finished with the mercury clean up, wash your hands. If other parts of your body may have come in contact with mercury, shower or bathe.

Mercury Spill Kit Recommendations 1. 4-5 ziplock-type bags (1gallon size) 2. 4-5 trash bags (30-gallon size) 3. At least 6 pairs of rubber, nitrile or latex gloves 4. Paper towels 5. 3 X 5 index card or stiff paper 6. Duct tape 7. Flashlight with spare batteries 8. Non-porous shoe covers 9. Plastic dust pan or plastic tray 10. Emergency contact information (EH&S Officex55689) REFERENCES MEDICAL SURGICAL NURSING BOOK www.wikipedia.com www.medsurg.com www.medline.com