Recovery Plan Scenario: Chemical Attack on the Super Bowl - Term Paper Example

 Recovery Plan Scenario: Chemical Attack on the Super Bowl Introduction During the Super Bowl, the Louisiana Superdome has become the target of a bioterrorism attack involving the release of hydrogen cyanide into the stadium, with the attackers utilizing the ventilation system to carry out the violence. Football fans who have been exposed to higher concentrations of the substance in the bathrooms are showing the most severe symptoms, however all stadium participants, including team members and fans, are showing evidence of cyanide poisoning. Hydrogen cyanide is a deadly chemical substance which has historically been utilized as a method of carrying out criminal executions, hence the risk of humans becoming deceased as a result of exposure is significantly high. The lethality implication for this particular chemical substance makes this specific bioterrorism attack of significant urgency to act quickly in order to protect human lives. Defining the Chemical Agent and its Effects Hydrogen cyanide (HCN) is a highly poisonous chemical substance which boils at a very low temperature, 78.1 degrees F, hence making the substance easily transformed into a vapor. Hydrogen cyanide is lethal to human beings with an atmospheric concentration of only 300 milligrams per cubic meter, fatal to those poisoned between 10 and 60 minutes (ICMI, n.d.). Higher concentrations are lethal to those exposed in just one minute. What makes hydrogen cyanide such a significant concern is that it is highly explosive in small atmospheric concentrations of only 5.6 percent (Vernot, MacEwen, Haun & Kinkead, 1977). Hence, there is not only a danger of lethality for those exposed, but a risk to the stadium in terms of potential combustion which poses even further risk to health and human safety. Those who have been exposed to higher concentrations of hydrogen cyanide will quickly begin to exhibit symptoms of respiratory failure as HCN inhibits breathing as a result of the chemical’s introduction into human mitochondria. Even low levels of exposure can cause neurological problems and impact cardiovascular functioning (Blanc, Hogan, Mallin, Hryhorczuk, Hessl & Bernard, 1985). A recent case study involving a two year old girl who had ingested cyanide had become unconscious only 20 minutes after consuming the compound, illustrating a gasping respiratory function of only eight breaths per minute (Iqbal & Maqbool, 2009). The child’s blood pressure, upon being admitted to a hospital emergency room, was completely non-recordable. A 1975 study involving a small sample of electroplating workers that had been exposed to cyanide used in manufacturing processes identified common symptoms including nausea, headache and stomach pain (El Ghawabi, Gaafar, El-Saharti, Ahmed, Malash & Fares, 1975). It is also known that cyanide inhalation can lead to coma and cardiac arrest. Those who have been exposed to the chemical can also have chronic problems with weakness and the ability to absorb Vitamin B12, an important vitamin necessary to sustain human health and vigor. Therefore, outside of the potential lethality of low-level exposure to hydrogen cyanide, there are long-term implications on human health that must be addressed in the event of exposure to this dangerous chemical. Agencies Critical to Participation and Role in Recovery Efforts Responders will need to make immediate contact with the Centers for Disease Control and Prevention to gain professional insight into the potential lethality of the chemical. The CDC is a relevant authority in a bioterrorism attack, an agency which maintains the capacity to perform rapid lab work and maintains advanced knowledge of the impact of dangerous chemical compounds on human health. New Orleans, where the Superdome is located, has been cited as being substantially unprepared for disaster response which was exposed after Hurricane Katrina ravaged the region (Government of Louisiana, 2007). The CDC must, therefore, provide necessary guidance in order to contain the threat and provide relevant treatment to those exposed to this dangerous compound. The CDC, further, is authorized to provide immediate pharmaceutical supplies that are available in the National Pharmaceutical Stockpile that can be immediately disseminated through state-level requests from relevant Louisiana government authorities. There is going to be local citizenry panic when news of the attack is broadcast, leading to many instances of acute anxiety. There will be a need for additional pharmaceutical supplies of such drugs as diazepam which serves as a sedation mechanism for citizens that are illustrating very severe symptoms of anxiety. Since New Orleans is unlikely to maintain such anxiolytics as diazepam, the CDC must be actively involved in guidance, control measure determinations, atmospheric recovery and proper treatment methodologies to secure the health of poisoned fans and players. The mayor of New Orleans as well as the Governor of Louisiana must be actively involved in the disaster response, both as authorities to inform the public and to coordinate hierarchical management structures of the recovery effort. These authorities have statutory authority to coordinate the efforts of disparate disaster response team members. These government representatives will also conduct relevant planning and consultation with Federal authorities, such as the Department of Homeland Security that maintains legal authority to seek prosecution of suspects. Immediate contact must be made with local hospital staff members and administrative bodies to improve hospital capacity in preparation for the flood of fans and players that will require treatment. It will be necessary to consider disinfection of equipment utilized in treatment to ensure that no other victims within the hospital network are contaminated, as hydrogen cyanide remains on clothing and skin. The pathology departments of these hospital networks must also be consulted of the dangers of hydrogen cyanide to human health as there will likely be a need for post-mortem activities for victims who have been exposed to lethal doses of the chemical. The Environmental Protection Agency and FEMA will also be required as consultants and recovery experts in this bioterrorism attack. These relevant agencies with advanced knowledge in the lethality and general danger of hydrogen cyanide can be active in enacting the Emergency Broadcast System for federal representation to inform the public of the disaster event. These agencies also maintain funding for reparation in the environmental clean-up effort after making first response efforts to treat victims of the cyanide poisoning. These agencies have relevant authority to coordinate reimbursement to the city of New Orleans by coercing Federal authorities to declare the region a disaster area which will assist in long-term recovery in the high risk area impacted by the bioterrorism incident. The New Orleans Policing Agencies in conjunction with assistance from the United States Military will be required to participate in order to maintain social order and prevent criminal activity. In the event of a disaster, as a result of human behavioral characteristics, it is common for such activities as looting to occur which poses a risk to non-exposed citizens throughout the city of New Orleans. These two agencies will patrol the city as a deterrent for recurring criminal activity and ensure appropriate blockades are established which prevent non-exposed citizens from entering the high risk region. Inter-Agency Communication Methodology and Public Information Dissemination Because immediate response is necessary to prevent fatalities due to exposure to the gaseous chemical, the ability to coordinate efforts rapidly is absolutely critical to sustaining human health. SMS messaging, the utilization of two way radios, and general cellular technology will be critical in ensuring a rapid response. First responders will need the ability to conduct consultation with relevant authorities (such as the CDC) to advise on first response treatment while in the field conducting response operations. Relevant experts in toxicology and health administration services must also be able to coordinate efforts in real-time as many first responders will be unfamiliar with medical treatment methodologies and require conference to ensure that treatment procedures are aligned with established best practices. The non-exposed public will require regular reporting of activities which will require coordination with relevant local media agencies servicing the New Orleans area. Local and state-level authorities will need to be integral in ensuring that accurate risk reports are disseminated via television and radio broadcasts both as a method of reducing public panic and ensuring that no other citizens become exposed to the deadly hydrogen cyanide. Dissemination of knowledge regarding the potential short and long-term contact risks needs to be coordinated with these agencies to ensure further public health. Regular television broadcasting interruptions via the Emergency Broadcast System will also be a relevant medium for ensuring that citizens understand the risks of the chemical and understand what specific efforts are being undertaken in the response and recovery efforts. Relevant Challenges to First Responders Fans and players that have been exposed to hydrogen cyanide will be disoriented and, in some instances, incoherent to describe their symptoms. This will make it difficult to determine which of the exposed are the most critical, hence causing challenges in determining who requires more advanced treatment and who can wait to receive important medical-related care. Isolating which individuals are at higher risk of death will be significantly difficult, especially when having to respond to the health needs of over 70,000 individuals with varying levels of exposure to the chemical. Hence, first responders must be inclusive of relevant personnel from the medical industry that have experience identifying the intensity of symptoms being illustrated by the exposed groups. First responders will also have the challenge of working with youths who have attended the Super Bowl who are cognitively unable to express their symptoms and concerns effectively. As it is likely that the parents and guardians of these children will be incoherent or otherwise disoriented as a result of exposure, first responders must understand methodologies of communicating intentions for treatment in order to gain youth cooperation and reduce their anxieties that can conflict effective medical treatment methodology. It may be necessary to coordinate a handful of experts in child psychology and child counseling to ensure that youths are accommodating and that they understand their predicament utilizing appropriate age-relevant terminologies. Responders from agencies such as the American Red Cross have ample experience in working with affected youths in a variety of disaster scenarios and will be a valuable resource for enhancing response with affected children. As it is likely that there will be immediate fatalities as a result of exposure, removal of bodies will be a priority to reduce panic from the exposed who are witness to these deaths. The United States military, which maintains ample experience in this type of recovery effort in wartime environments, can reduce the potential disquiet caused by exposed onlookers who continue to view fatalities. As the majority of treatments must occur in the exposed area due to the rapidity required to secure the health of those poisoned, cadaver removal will be critical in ensuring that the exposed groups are not substantially terrified and cooperate with response efforts. PPE Requirements in the Response Effort OSHA indicates the appropriate PPE requirements when dealing with hydrogen cyanide. Responders will require protection with gloves made of Neoprene (NJ Department of Health, 2011). First responders will require clothing that is constructed with the material Tychem to avoid exposing responders to the chemical, which is produced by the DuPont Company. This fabric is considered a “vapor protective Level A suit”, constructed with a lime-colored fabric that makes responders visible even in dim light environments (DuPont, 2006). This lightweight product makes it easy for responders to maintain dexterity and sustain effective anatomical movements during response efforts. Additionally, approved respirators and relevant eye protection will be required for responders that may not have access to the Tychem clothing. In this scenario where exposure levels are higher than 4.7 ppm, it will be necessary to procure many different NIOSH approved air respirators equipped with a facepiece and, in some instances in high risk areas, a self-contained breathing apparatus. Because even small concentrations of hydrogen cyanide create a combustion risk, responders should NOT be equipped with any source of ignition. Perimeter Establishment and Containment Area Determinations The first best practice in treatment is to remove the exposed individual from the contaminated area. Hence, all 72,000 individuals must be escorted (or carried via appropriate gurneys and transport materials) from the stadium. The majority of treatment, due to the rapidity necessary for effective treatment, will be conducted outside of the affected stadium. In the troposphere, the lowest portion of the atmosphere, HCN is quickly dispersed (Cicerone & Zellner, 1983). Hence, perimeter establishment will not extend far beyond the stadium-exterior treatment region occurring with the use of mobile tents on adjacent streets. The containment area will be limited to a half-mile radius of the affected stadium as there is limited risk of exposure to citizens outside of this perimeter. Relevant police and military forces will establish perimeters and mark containment areas utilizing appropriate blockage mechanisms and caution tapes. Decontamination Procedures and Treatment Methodologies A simple solution consisting of water and detergent with a pH value between 8 and 10.5 must be made available for decontamination effectiveness. Use of soft brushes to decontaminate clothing and PPE is effective in removing risks to skin and internal organs. Responders should utilize the brushes and detergent mixtures using a head-to-toe motion and victim clothing as well as contaminated PPE should be disposed of using 6-mil polyethylene bags. Victims of the attack should have all of their clothing removed and their skin brushed with the detergent mixture. Responders must be careful not to break the skin and ensure covering of all open wounds that might have been caused by the HCN exposure. Victims should be covered to avoid shock and subsequently moved to an area where effective medical treatment can be administered post-decontamination procedures. Upon decontamination, victims should be injected with Hydroxcobalamin, a type of Vitamin B12 vitamer that is effective for cyanide poisoning. Intravenous introduction of this treatment is required at a dose of 5g over a 15 minute period. Those with severe exposure levels should be injected with a dosage of an additional 5g. Hydroxcobalamin binds cyanide molecules to form cyanocobalamin that is easily disseminated from the body through urination. Responders should also have access to Sodium Thiosulfate and be administered to those with severe symptoms of nausea, vomiting, heart palpitations, and respiratory dysfunction. These treatments should be conducted over a 10 minute period at a dosage of .75ml per pound for child victims and 50ml per pound for adults. For those victims that have already entered comatose states, a solution of sodium nitrite should be injected into the victims at a rate of .15ml per pound for children and 1.65ml per kilogram for adults (CDC, n.d.). First Responder Evidence Hydrogen cyanide has a bitter almond-like odor. Hence, responders should be considerate of this odor to initially determine the potential contamination risks in different regions within the stadium and the surrounding region. Consultation with victims about their potential level of awareness of this almond-like odor will assist in determining which region of the stadium is most affected. High-level exposure can lead to seizures, loss of consciousness and pupil reactivity. Responder should be determining which fans or players require the most rapid treatment response conducting simple examination of the eyes to determine pupillary responsiveness. Additionally, responders should coordinate with the stadium administration to review any potential video security footage that occurred during and prior to the Super Bowl. These videos could be crucial in identifying the perpetrators of this chemical bioterrorism attack. Homeland Security and other first responders can coordinate examination of video evidence that will assist in prosecution and/or identification of the criminals involved in the scenario. Effects of the Attack on the Area In the stratosphere, hydrogen cyanide maintains a residency period of approximately 2.5 years and is not as easily dissipated as in the troposphere. In the troposphere, the region of the atmosphere that would potentially put human health at risk in the event of lingering HCN, introduction of a hydroxide (OH) can assist in dissipating hydrogen cyanide. OH is an anion consisting of a single oxygen atom and a hydrogen atom that is cohesive with a covalent bond and sustains a strong negative charge. Common substances such as sodium hydroxide can assist in long-term decontamination in the event that HCN remains potent in the stadium environment. This particular hydroxide has a boiling point of 2,530 degrees F which would allow the compound to be introduced into the stadium atmosphere in gaseous form to eliminate the threat of continued HCN contamination. Sodium hydroxide, however, is highly detrimental to human tissue and has been utilized as a means of digesting tissues of human and animal carcasses. Hence, upon potential introduction of sodium hydroxide as a decontamination procedure, appropriate PPE must be utilized to prevent the risk of a breakdown of chemical bonds that maintain flesh integrity. However, sodium hydroxide is very inexpensive and is the most viable method of ensuring that there are no long-term contamination problems in the stadium. Conclusion As iterated, the lethality of hydrogen cyanide is substantial and requires immediate response and treatment to prevent a high volume of human deaths. Since studies have shown that long-term exposure to HCN leads to chronic health problems, the importance of responding within 60 minutes of low-level and high-level exposure is crucial. This illustrates the urgency of coordinating efforts with local-level, state-level and federal-level agencies and authorities to ensure that proper treatment is administered and that decontamination activity begin immediately in order to preserve human well-being. By stockpiling important technologies for communication, developing a plan of action for consultation with relevant media sources, and ensuring appropriate and rapid triage services for high-exposure victims, New Orleans can quickly respond to this particular bioterrorism attack and reduce human fatalities in the process. This response and recovery plan identified the potential symptoms of hydrogen cyanide exposure, how to effectively assist victims, and how to productively coordinate response and recovery efforts. It is a comprehensive plan that identified hierarchical concerns and responsibilities of various response agencies that will participate in the effort. By following this plan, the lives and health longevity of impacted victims can be better serviced and the risks to non-exposed populations significantly reduced. References Blanc, P., Hogan, M., Mallin, K., Hryhorczuk, D., Hessl, S. & Bernard, B. (1985). Cyanide Intoxication among Silver-Reclaiming Workers, Journal of the American Medical Association, 253, pp.367-371. CDC. (n.d.). Sodium Cyanide: Systemic Agent, Centers for Disease Control and Prevention. Retrieved May 20, 2014 from http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750036.html Cicerone, R.J. & Zellner, R. (1983). The Atmospheric Chemistry of Hydrogen Cyanide (HCN), Journal of Geophysical Research, 88(C15), pp.10689-10696. DuPont. (2006). DuPont Tychem TK – Chemical Protective Clothing: Our Highest Level of Protection. Retrieved May 19, 2014 from http://www2.dupont.com/Personal_Protection/en_US/assets/downloads/tychem/h90532ty chemtktechdata.pdf El Ghawabi, S.H., Gaafar, M.A., El-Saharti, A.A., Ahmed, S.H., Malash, K.K. & Fares, R. (1975). Chronic Cyanide Exposure: A Clinical, Radioisotope and Laboratory Study, British Journal of Industrial Medicine, 32, pp.21-219. Government of Louisiana. (2007). Section VI: Emergency Preparedness and Disaster Planning. Retrieved May 19, 2014 from http://lra.louisiana.gov/assets/docs/searchable/reports/EmerPreparedness_1.pdf ICMI. (n.d.). Environmental and Health Effects, International Cyanide Management Code. Retrieved May 18, 2014 from http://www.cyanidecode.org/cyanide-facts/environmental- health-effects Iqbal, I. & Maqbool, B. (2009). Case Report: Acute Cyanide Poisoning, Nishtar Medical Journal, 1(2), pp.26-28. NJ Department of Health. (2011). Hazardous Substance Fact Sheet. Retrieved May 19, 2014 from http://nj.gov/health/eoh/rtkweb/documents/fs/1013.pdf Vernot, E.H., MacEwen, J.D., Haun, C.C. & Kinkead, E.R. (1977). Acute Toxicity and Skin Corrosion Data for some Organic and Inorganic Compounds and Aqueous Solutions, Toxicology and Applied Pharmacology, 42, pp.417-423. Read More