Additionally, the CDC has recently issued public health advisories to state health departments with the following information;

• Double bag letter using zip-lock clear, plastic bags
  
  
• Use latex gloves and particulate mask while bagging material
  
  
• Notify police and FBI
  
  
• Wash with soap and water
  
  
• Decontamination or prophylaxis is not warranted in most situations
  

But these guidelines may not be specific or informative enough for your locale. It may be prudent to issue additional information such as;

• Discouraging the public from opening envelopes and then blowing into them to gain access to a letter. This highly risky habit needs to be reconsidered.
  
  
• Some companies have been opening all letters and packages under fume hoods to better protect themselves. Smaller versions of fume hoods are readily available and reasonably priced.
  
  
• Impress upon the public that our changing times require that all people be alert for the potential of terrorist activity. This is not to evoke more hysteria but merely to be more cognizant of a problem.
  
  
• To assist in reducing hysteria it may be prudent to educate the public on the dangers of anthrax and that it is treatable with effective medications.
  

First Reponder General Guidelines
All first responders should remember that responses to unknown powder releases fall under hazardous material response guidelines. All previous training for hazmat response still applies. Most agencies use some type of plan or general guideline for hazmat response. If not, there are many such guidelines to adhere to such as;

• APIE by the International Association of Fire Fighters (IAFF)
  
• DECIDE by Ludwig Benner
  
• Eight Step Process by Michael Hildebrand and Gregory Noll
  
• GEDAPER by David Lesak
  

The point here is to find a process you feel comfortable with, train your personnel, and use it on all hazmat and unknown powder releases.

HazMat Response Team General Guidelines
Some general guidelines also exist for hazmat response teams for anthrax and other biological or unknown powder releases.

Remember, anthrax is a spore. It is not a true spore such as that of a puffball mushroom spore which is genetically designed for airborne dispersion. Anthrax is a bacterium, which develops a spore casing so it can survive in soil or water. While it is difficult for anthrax to become airborne if a sufficient amount of spores are in the air they present an inhalation (8,000 - 10,000 spores) or dermal exposure hazard, but this would usually require sufficient energy through some type of dissemination device to project a lethal concentration. If these conditions exist the following are some response considerations.

Site Control or Scene Management

Triage the Scene - Who was exposed? Patients who have product on them, touched the product or walked though a visible airborne concentration, are considered to be exposed. Other people who merely stepped into a room that contained a suspected contaminate, were in the room and did not have contact with the product, did not have contact with visible airborne concentrations, or significant contact (cross contamination) with other exposed people are at little risk and should be considered for release.

Isolate the Scene - Evacuate only what is necessary! A work area or a room is generally adequate, unless there has been a visible airborne release in which securing the ventilation system may be a consideration. Only in extraordinary cases should an entire occupancy be evacuated. Remember, Anthrax is not genetically engineered for airborne dispersion!

Establish Safe Refuge Areas - Establish a safe refuge area to keep exposed patients until they can be evaluated, decontaminated, and processed for medical transport. Preferably keep them indoors, but away from the exposure area. This will limit the possibility of cross contamination and it will also prevent environmental conditions such as wind, from sending particles airborne. An indoor safe refuge area will also significantly simplify modesty concerns associated with patient decontamination.

Decontamination


Take appropriate action with the following conditions. Remember that all personnel should be properly protected while conducting decontamination.

If no visible product is present- The only concern is patient(s) that have had direct contact with the suspected letter or package. Have patient(s) wash hands, face, and exposed skin with soapy water or anti-microbial solution. No transport or treatment advised. Obtain name, address, and phone for follow-up.

If there is a visible product but no airborne release- Have patient(s) wash hands, face, and exposed skin with soapy water or anti-microbial solution. Transport may be advised if dermal exposure to open wounds is suspected.

If there is a visible airborne release with dermal and inhalation exposures- Have patient(s) wash hands, face, and exposed skin with soapy water or anti-microbial solutions. As soon as possible, mist down the patient(s) with water in spray bottle to eliminate inhalation and cross contamination hazard. Have the patient(s) remove outer clothing and provide TyvekR coveralls or even hospital scrubs for re-dressing. Provide for modesty. Have hazmat personnel package contaminated personal effects such as wallets, purses, jewelry, etc in clear, zip-lock bags and give to the patient. In most instances, these items will not be contaminated and do not require packaging.

For gross product contamination- A shower may be indicated in extreme cases and a garden hose or fixed shower at the facility may be adequate. Time is not critical! Take your time and make good sound decisions.

Sample Responses
Another good idea to see if your response guidelines are prudent is to find out what other responders are doing in response to similar problems. A quick check with fire departments around the country found that responses to unknown powder releases vary greatly. For instance;

Akron is sending a hazmat battalion chief initially to these incidents to assess the situation and then make appropriate decisions as to what is needed for mitigation. If it is a mail problem the post office officials handle or remove the problem after the hazmat team stabilizes the situation. If it is a substantial threat or package with a threat the hazmat team works with local law enforcement and explosive ordinance disposal (EOD) teams, and the FBI to safely mitigate.

Boston is sending 5 man response teams to these types of incidents with 2 entry, 1 safety, 1 Team Leader, and 1 Communications person. The entry personnel are wearing Level C protection with TyvekR suits (double suiting with credible threats), TyvekR booties, double gloves, and air-purifying respirators (APR's). All material gets triple bagged and taken to the public health laboratory for analysis. Boston has also adapted the concept of large, clean plastic glove bags that are used for asbestos removal to drape over packages. This concept encapsulates the package and minimizes airborne releases when the package is opened.

Honolulu is sending both hazmat units separately to their unknown powder incidents. They are considering utilizing rapid action teams to initially assess the situation. These teams would consist of two technicians with Level B protection (TyvekR suits and self-contained breathing apparatus (SCBA)) and decontamination equipment. Health department and EOD would also respond as needed. Honolulu is also using glove bags for package opening but first the package is screened for radiation and x-rayed for explosives by the local Explosive Ordinance Disposal (EOD) team.

Miami-Dade has added an additional hazmat response unit just to deal with the increased call volume for these incidents. Their hazmat units are responding to over 100 calls per day at this time.

Milwaukee is responding to these incidents with TyvekR suits and cartridge respirators.

Phoenix is using Level B protection for anthrax/unknown powder releases.

It is dangerous if your own department has been all over the board regarding these unknown powder responses because there is no consistency. Inconsistent responses make for responder injuries and possible lawsuits. To correct these types of responses the following response guidelines may assist you. They have been developed with safety, efficiency, consistency, and reasonability in mind.

Response Considerations
Consider a terrorist event to be any event that was intended to do harm to life, the environment, or property. This includes both physical harm and disruption of normal activities.

At any intentional event, responders must be concerned about secondary devices, the risk of being assaulted by the perpetrator, or the possibility that the perpetrator will in some way interfere with efforts to aid the original target. In addition, responders must be more concerned with preserving evidence than they would be at an accidental event.

Accidental Event or Terrorist Attack?

Responders need to determine whether or not there is a credible threat present at every incident. The following are general indications that should raise suspicions of a possible terrorist event.

• Unexpected/Suspicious packages and letters
  
  
  • Excessive postage
  
  • Handwritten or poorly typed addresses
  
  • Incorrect titles
  
  • Title, but no name
  
  • Misspellings of common words
  
  • Oily stains, discolorations or odor
  
  • Obvious residue or powder leaking or on letter or package
  
  • No return address
  
  • Excessive weight
  
  • Lopsided or uneven envelope
  
  • Protruding wires or aluminum foil
  
  • Excessive security material such as masking tape, string, etc.
  
  • Visual distractions
  
  • Ticking sound
  
  • Marked with restrictive endorsements, such as "Personal" or "Confidential"
  
  • Shows a city or state in the postmark that does not match the return address
  
• Presence of hazardous materials not relevant to the occupancy
  
  
• Suspicious hazmat release (where equipment failure and human error have been ruled out)
  
  
• Advance warning
  
  
• Subsequent calls or letters from the people claiming responsibility
  
  
• Controversial or high risk target
  
  
• Timing of the event
  
  
• Recent terrorist activities
  
  
• Abandoned spray or dissemination devices
  
  
• Unscheduled or unusual dissemination of aerosol sprays
  
  
• Unexplained vapor clouds, mists, and plumes
  
  
• Unusual odors or tastes
  
  
• Unusual fire behavior
  
  
• Unexplained explosion, especially one that disperses a liquid, mist, or gas or one that seems to destroy only the package or the device itself (risk of secondary devices must be considered)
  
  
• Unexplained patterns of illness, injury, or death
  
  
• Mass casualties without obvious trauma
  
  
• Unusual security or the presence of booby traps
  

Respiratory Protection
The importance of safe and proper breathing protection cannot be over-stated in response to unknown powder incidents. Essentially, it is prudent to keep all contaminants out of our lungs. In order to do this we can filter breathable air before it gets to the lungs or we can supply clean air to breathe.

Filtering air can be as crude as simply using a handkerchief over the nose and mouth or as elaborate as using specialized chemical filters. With unknown powders and even biologicals we are dealing with particles. Physical filters will help reduce exposures to particles which all NIOSH (National Institute of Occupational Safety and Health) approved particulate respirators will do. However, there are no safe exposure levels for biological aerosols such as PEL's (Permissible Exposure Levels) or TLV's (Threshold Limit Values) and therefore while a respirator will reduce exposures there are no guarantees the protection will be adequate. This means that the risk of infection, illness, or disease cannot be eliminated.

Currently, published respirator guidelines for biologicals, including anthrax, do not exist and respirator manufacturers are reluctant to make recommendations. The final selection for proper respiratory protection rests with the user or the employer. This gray area can present moral and legal concerns.

Respirator Precautions
NIOSH does not currently certify respirators for use against anthrax or other biologicals. The use of any respirator will reduce an exposure but may not adequately protect the wearer. While particulate filters are certified for 95% to 99.97% efficient for particles as small as 0.3 microns, anthrax, with a particle size of 1 to 5 microns, has not been tested or certified by NIOSH.

Since there is no safe level of exposure to biologicals like anthrax there is no assurance that any respirator will adequately protect the wearer. In combination with the assigned protection factors (PF) for selected respirators it is questionable whether any particulate respirator be used for the breathing protection of biologicals. After all, the goal of using a respirator is to reduce the exposure to an acceptable level that will not adversely affect the wearer.

With no acceptable levels of exposure there appears to be too many unknowns in properly selecting a respirator. It is commonly accepted that it requires between 8,000 and 10,000 anthrax spores to cause an infection that may lead to death. How many spores is acceptable for an exposure that does not incur adverse health affects? Since this question is unanswerable the only option for the emergency responder in respect to respiratory protection is the self-contained breathing apparatus (SCBA).

The supplied, clean air that a SCBA affords (PF = 10,000) greatly increases a wearer's chance that they will not inhale any anthrax spores. This is on the contingency that the wearer has had adequate training, is properly fit tested, is clean-shaven, and is not over-breathing the regulator, among other things. SCBA should also be the choice in incidents where the atmosphere is not identified and/or quantified per OSHA's HAZWOPER regulation (29 CFR 1910.120)

Skin Protection
In addition to the inhalation hazards that biologicals present skin exposure also needs to be addressed. Cutaneous anthrax is a possibility through contact with the skin especially through cuts or abrasions. In fact, intact skin is a good barrier but to be careful responders would be prudent to wear impermeable clothing to protect the skin. A good choice for this protection because of cost concerns and wearer comfort is standard TyvekR by Du Pont Corporation. Information provided by the manufacturer states that TyvekR will hold out 99.9% of all dry particles down to 0.5 microns. Furthermore, TyvekR garments are designed for one time use after which they should be disposed after an exposure or potential exposure to anthrax spores or other biological and chemical agents. Consideration should also be made to polyethylene coated TyvekR, which is water and chemical resistant. Though this type of protection, also called TychemR, will be warmer for the wearer because it does not breathe it offers more capability for only a few more dollars per suit.

Structural Firefighting Protective Equipment (SFPC) should not be used for unknown powder responses. The porous nature of the materials used to manufacture SFPC prohibits its use. This recommendation is also consistent with manufacturer, CDC, and DOT recommendations.

Hand protection should also be considered to prevent exposure. Any material for gloves can be considered from latex, nitrile rubber, butyl rubber, neoprene, or vinyl with special attention given to durability and cut resistance.

Footwear should also be durable and porous materials should be covered with disposable layers. Disposable TyvekR or vinyl shoe covers would also suffice. Finally, duct tape, or a suitable substitute, should be used to seal seams and clothing interfaces.

Sampling Equipment
Responders should consider an adequate supply of sampling equipment to obtain product samples. When completed properly the gathering and containing of samples aids in the process of evidence collection and later in convictions. The following is a list of equipment that may be considered.

Primary containers composed of:

50 ml sterile screw-cap tubes

dry - for liquids or solids
wet - for swabbed samples (contains saline solution)

Absorbent pads - to wrap screw-cap tubes in
Whirl-pak - to enclose pad wrapped screw-cap tubes


Secondary containers composed of:


Bubble wrap- to wrap whirl-paks in
Gasket seal safety pack


Tertiary containers composed of:


Cardboard box with foam walls
Cold packs (2 per box)

Other equipment as needed:

Scoopers of various sizes
Large swabs (in pre-marked packages)
Bulb syringes
Plastic straight edge
Scissors
Sharpie permanent marker (for marking samples)
Transpore medical tape
Duct tape
Large zip-loc bags
Red biohazard bags
5 gal. Buckets with lids
Paper and pencil (for making site map)

Detection Equipment
Currently there are no established methods for measuring the concentration of B. anthracis spores in the air or other solid, particulate biological hazards. There are devices to determine the types and amounts of airborne chemical WMD agents such as nerve agents, blister agents, mace, and pepper spray. One such instrument is the APD 2000 which can be researched at www.envtech.com/Domestic.htm. The APD (Advanced Portable Detector) 2000 is designed to test for sarin, tabun, soman, VX, mustard gas, and lewisite all within 15 to 30 seconds sample time. Also, some home sampling kits for airborne anthrax have been advertised recently on Good Morning America and other television shows with questionable accuracy.

There are detection devices that responders can use to determine if dangerous spores or powders are present at incidents. Particularly, there are hand-held immunoassays for rapid detection of anthrax spores. Hand-held assays (sometimes referred to as "Smart Tickets") are sold commercially for the rapid detection of Bacillus anthracis. ("SMART" stands for Sensitive Membrane Antigen Rapid Test). These assays are intended only for the screening of environmental samples. First responder and law enforcement communities are using these as instant screening devices and should forward any positive samples to authorities for more sensitive and specialized confirmatory testing. The results of these assays should not be used to make decisions about patient management or prophylaxis. The utility and validity of these assays are unknown.

As a caution, CDC does not have enough scientific data at this time to recommend the use of these assays. The analytical sensitivity of these assays is limited by the technology, and data provided by manufacturers indicate that a minimum of 10,000 spores is required to generate a positive signal. This number of spores would suggest a heavy contamination of the area (sample). Therefore a negative result does not rule out a lower level of contamination. Data collected from field use also indicate specificity problems, or cross-sensitivity, with some of these assays. Some positive results have been obtained with spores of the non-anthrax Bacillus bacteria that may be found in the environment.

For these reasons, CDC has been asked to evaluate the sensitivity and specificity of the commercially available rapid, hand-held assays for B. anthracis. When this study is completed, results will be made available but conclusions from this study are not expected in the near future.

Another option exists with field test strips that have been designed for biological hazards such as anthrax, botulinum toxin, staphococcal enterotoxin B (SEB) and ricin. These hazards are sampled with results in 15 minutes or less through a wet chemical process. The strips are called "BTA Test Strips" and they can be reviewed at www.alexeter.com. With all of these field screening devices accuracy is important but all evidence should be tested by an accredited laboratory.

Decontamination

Personal
The CDC has recommended using soap and water for exposed people especially with their hands and face. Bleach (sodium hypochlorite) solutions are not recommended for use on people or exposed skin because it irritates the skin and can cause an increase in dermal absorption.

Equipment
A dilute bleach solution of 0.5% may be used on protective clothing. A bleach solution of 5% in water is recommended for other objects with a contact time of 10 to 20 minutes to kill biologicals. Commercial bleach is 5.25% sodium hypochlorite in water therefore it can be used without mixing.

Pertaining to anthrax, in the U.S. ARMY Medical Research Institute of Infectious Diseases handbook "Medical Management of Biological Casualties" it states under equipment decontamination procedures, "nylon and canvas equipment bags may be decontaminated by boiling them for one hour in water. The addition of soap will speed this process against nearly all agents. After removal from the boiling water, rinse, air-dry and return the items to service. Such equipment can also be decontaminated by using bleach slurry methods. Leather equipment, such as belts, quickly absorb liquid agents. Initial decontamination should be as rapid as possible. For a thorough decontamination, soak shoes, straps and other leather equipment in water heated to 122F to 131F for 4 to 6 hours and then air dry without excess heat."

Decon Foam
Federal authorities at Sandia National Laboratories in New Mexico have developed a decontamination foam that is effective on chemical and biological warfare agents. The formulation can be applied as a liquid spray, mist, fog, or foam and it neutralizes chemical and biological warfare agents in minutes. This technology, although designed for the military, has applications for civilian responses for several reasons;

1. A single decon solution can be used for both chemical and biological hazards.
2. It can be rapidly deployed.
3. It can be applied in several ways.
4. It exhibits minimal health and safety problems.
5. It has minimal runoff and environmental concerns.
6. It will kill 99.99999% of anthrax spores after a one-hour exposure to the foam.

Two vendors have been licensed by Sandia to commercially produce and sell the chem.-bio formulation (often referred to as a decon foam) and they are;

EnviroFoam Technologies, Hunstville, Alabama, www.easydecon.com
Modec, Inc., Denver, Colorado, www.deconsolutions.com

Technical data and testing information can be found at these websites.

Responder Actions
To offer guidance to first responders the CDC recently issued interim guidelines for unknown powder or anthrax related incidents. They are shared here in their complete form but they can also be downloaded at the CDC website.

Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents

The approach to any potentially hazardous atmosphere, including biological hazards, must be made with a plan that includes an assessment of hazard and exposure potential, respiratory protection needs, entry conditions, exit routes, and decontamination strategies. Any plan involving a biological hazard should be based on relevant infectious disease or biological safety recommendations by the Centers for Disease Control and Prevention (CDC) and other expert bodies including emergency first responders, law enforcement, and public health officials. The need for decontamination and for treatment of all first responders with antibiotics or other medications should be decided in consultation with local public health authorities.

This INTERIM STATEMENT is based on current understanding of the potential threats and existing recommendations issued for biological aerosols. CDC makes this judgment because:

1. Biological weapons may expose people to bacteria, viruses, or toxins as fine airborne particles. Biological agents are infectious through one or more of the following mechanisms of exposure, depending upon the particular type of agent: inhalation, with infection through respiratory mucosa or lung tissues; ingestion; contact with the mucous membranes of the eyes, or nasal tissues; or penetration of the skin through open cuts (even very small cuts and abrasions of which employees might be unaware). Organic airborne particles share the same physical characteristics in air or on surfaces as inorganic particles from hazardous dusts. This has been demonstrated in military research on biological weapons and in civilian research to control the spread of infection in hospitals.

2. Because biological weapons are particles, they will not penetrate the materials of properly assembled and fitted respirators or protective clothing.

3. Existing recommendations for protecting workers from biological hazards require the use of half-mask or full facepiece air-purifying respirators with particulate filter efficiencies ranging from N95 (for hazards such as pulmonary tuberculosis) to P100 (for hazards such as hantavirus) as a minimum level of protection.

4. Some devices used for intentional biological terrorism may have the capacity to disseminate large quantities of biological materials in aerosols.

5. Emergency first responders typically use self-contained breathing apparatus (SCBA) respirators with a full facepiece operated in the most protective, positive pressure (pressure demand) mode during emergency responses. This type of SCBA provides the highest level of protection against airborne hazards when properly fitted to the user's face and properly used. National Institute for Occupational Safety and Health (NIOSH) respirator policies state that, under those conditions, SCBA reduces the user's exposure to the hazard by a factor of at least 10,000. This reduction is true whether the hazard is from airborne particles, a chemical vapor, or a gas. SCBA respirators are used when hazards and airborne concentrations are either unknown or expected to be high. Respirators providing lower levels of protection are generally allowed once conditions are understood and exposures are determined to be at lower levels.

Interim Recommendations for the selection and use of protective clothing and respirators against biological agents.

When using respiratory protection, the type of respirator is selected on the basis of the hazard and its airborne concentration. For a biological agent, the air concentration of infectious particles will depend upon the method used to release the agent. Current data suggest that the self-contained breathing apparatus (SCBA) which first responders currently use for entry into potentially hazardous atmospheres will provide responders with respiratory protection against biological exposures associated with a suspected act of biological terrorism.

Protective clothing, including gloves and booties, also may be required for the response to a suspected act of biological terrorism. Protective clothing may be needed to prevent skin exposures and/or contamination of other clothing. The type of protective clothing needed will depend upon the type of agent, concentration, and route of exposure.

The interim recommendations for personal protective equipment, including respiratory protection and protective clothing, are based upon the anticipated level of exposure risk associated with different response situations, as follows:

1. Responders should use a NIOSH-approved, pressure-demand SCBA in conjunction with a Level A protective suit in responding to a suspected biological incident where any of the following information is unknown or the event is uncontrolled:
• the type(s) of airborne agent(s);
• the dissemination method;
• if dissemination via an aerosol-generating device is still occurring or it has stopped but there is no information on the duration of dissemination, or what the exposure concentration might be.

2. Responders may use a Level B protective suit with an exposed or enclosed NIOSH- approved pressure-demand SCBA if the situation can be defined in which:

• the suspected biological aerosol is no longer being generated;
• other conditions may present a splash hazard.

3. Responders may use a full facepiece respirator with a P100 filter or powered air-purifying respirator (PAPR) with high efficiency particulate air (HEPA) filters when it can be determined that:

• an aerosol-generating device was not used to create high airborne concentration,
• dissemination was by a letter or package that can be easily bagged.

These type of respirators reduce the user's exposure by a factor of 50 if the user has been properly fit tested.

Care should be taken when bagging letters and packages to minimize creating a puff of air that could spread pathogens. It is best to avoid large bags and to work very slowly and carefully when placing objects in bags. Disposable hooded coveralls, gloves, and foot coverings also should be used. NIOSH recommends against wearing standard firefighter turnout gear into potentially contaminated areas when responding to reports involving biological agents.

Decontamination of protective equipment and clothing is an important precaution to make sure that any particles that might have settled on the outside of protective equipment are removed before taking off gear. Decontamination sequences currently used for hazardous material emergencies should be used as appropriate for the level of protection employed. Equipment can be decontaminated using soap and water, and 0.5% hypochlorite solution (one part household bleach to 10 parts water) can be used as appropriate or if gear had any visible contamination. Note that bleach may damage some types of firefighter turnout gear (one reason why it should not be used for biological agent response actions). After taking off gear, response workers should shower using copious quantities of soap and water.

Additional Considerations
With all of the above in mind the following considerations should be given careful examination and then local guidelines should be issued to ensure a safe and consistent response by all personnel from a jurisdiction.

Gather Data
At a response to a possible terrorist event, the fire of hazmat officer needs to triage the scene by interviewing witnesses, complainants, police/security personnel, and anyone else that may be connected to the incident. Witnesses should be isolated until the officer determines a course of action. An assessment should be made of the credibility of any possible threat. If there is an overt threat connected with an anthrax event, local law enforcement should notify the FBI.

Devise an Action Plan
The officer on-scene needs to develop an action plan, which includes an inspection of the scene. Depending on the specific nature of the event, the inspection of the scene may be done in person or by using a properly dressed entry team (level of PPE to be determined by the fire or hazmat officer.)

Documentation
Consider the use of a video and/or a digital camera to record the scene for evidence. If, after gathering all available information regarding the event, the officer decides that a sample of a possible biologic hazard should to be taken, the procedure developed by the Wisconsin Regional Response Teams and the Wisconsin State Lab of Hygiene could be followed (the procedure is included in this column).

Decontamination
If decontamination of civilians and response personnel is required, guidelines in the CDC information should be adhered to when possible.

The Terrorist's Mind
Most of the "unknown powder" or possible anthrax incidents should be responded to in as quiet a manner as possible by as few response personnel as necessary. This response will be contrary to what the terrorist or hoax perpetrator desires. They ideally want to see disruption and chaos so if responders handle these incidents with resolve and reasonability many of the hoaxes will diminish. Terrorists may also be observing responder actions to discover any vulnerabilities. If they find their actions cause big disruptions and emergency units are dispatched to one side of a city it may present an opportunity for them to really cause a problem elsewhere.

The Tiered Response Concept
In some locales the police are the first line of defense as they may arrive at the location reporting a threat first. They interview people and make a determination on whether the fire department should be called. Police may even bag a suspicious letter or package if they decide the threat has low credibility. If the fire department is needed the first due unit would respond and consult with the police. If fire department personnel have TyvekR suits, gloves, and SCBAs available and have had proper training they may be able to bag suspicious packages and take samples of released material.

The first responders need to also make a determination as to their involvement or whether they should call a hazmat response team (if available) or even a licensed contractor. The hazmat team should be capable of more tasks and possess more specialized equipment. For instance, many teams have test intruments or strips to detect the presence of biologicals and make preliminary determinations at the scene as to the threat. The tiered response concept relies upon the training and knowledge of the personnel at each tier. It also increases efficiency as only the minimum number of personnel are required to mitigate each incident. The tiered response concept also frees up specialized equipment and personnel for the incidents that require their service.

Unknown powder collection procedures
To collect samples and preserve evidence the following is an accepted procedure by the State of Wisconsin Hygiene Laboratory and the regional hazmat response teams.

Collection Kit Materials
Kits should be constructed at the scene, based on evaluation of what is needed.

Primary containers composed of previously listed equipment should be considered.

Collection Procedures
Collection will be done by a two-person team dressed in level of protection deemed appropriate by the fire department personnel or the hazmat team having jurisdiction. One person will be designated the "Clean" person (C), and the second person will be designated the "Dirty" person (D).

Procedures will vary dependant on the physical state of the substance that is to be collected to include:

• Fine Solids (dust, light powder)
• Larger Solids (powders, granules)
• Small amounts of liquids
• Larger amounts of liquids
• Pre-contained items
• Larger items

Fine Solids

• C carries kit into hot zone, separates the caddies (one with supplies in it and one empty caddy) and sets them down in a relatively "clean" area.
• C hands one 50 ml "wet" screw-cap tube to D
• D opens tube, sets cap aside
• C cuts open swab package at pre-marked line
• D takes swab, dips in 50 ml "wet" tube
• D collects sample (rubs wet swab in the dust/powder). Two swabs could be used, one after the other, and stored in same 50 ml tube
• D places swab in 50 ml "wet' tube
• D recaps tube
• C hands absorbent pad to D
• D wraps tube in absorbent pad
• C opens whirl-pak
• D places wrapped 50 ml tube into whirl-pak
• C places this Primary container in the empty caddy for transport out of the hot zone

Large Particle Solids

• C carries kit into hot zone, separates the caddies (one with supplies in it and one empty caddy) and sets them down in a relatively "clean" area.
• C hands one 50 ml "dry" screw-cap tube to D
• D opens tube, sets cap aside
• C opens scoop package and hands the scoop and a plastic straight edge to D
• D scoops up sample
• D places sample in 50 ml "dry " tube
• D recaps tube
• C hands absorbent pad to D
• D wraps tube in absorbent pad
• C opens whirl-pak
• D places wrapped 50 ml tube into whirl-pak
• C places this Primary container in the empty caddy for transport out of the hot zone

Small Amounts of Liquids

• C carries kit into hot zone, separates the caddies (one with supplies in it and one empty caddy) and sets them down in a relatively "clean" area.
• C hands one 50 ml "wet" screw-cap tube to D
• D opens tube, sets cap aside
• C cuts open swab package
• D collects sample (no need to dip swab in saline prior to rubbing swab in the liquid sample). Two swabs could be used, one after the other, and stored in same 50 ml tube
• D places swab in 50 ml "wet' tube
• D recaps tube
• C hands absorbent pad to D
• D wraps tube in absorbent pad
• C opens whirl-pak
• D places wrapped 50 ml tube into whirl-pak
• C places this Primary container in the empty caddy for transport out of the hot zone

Larger Amounts of Liquids

• C carries kit into hot zone, separates the caddies (one with supplies in it and one empty caddy) and sets them down in a relatively "clean" area.
• C hands one 50 ml "dry" screw-cap tube to D
• D opens tube, sets cap aside
• C opens bulb syringe package, cuts a beveled angle at the tip of the syringe, and hands bulb syringe to D
• D uses bulb syringe to collect sample
• D squeezes sample into 50 ml "dry" tube ( D collects as much as possible - up to the 40 ml line)
• D recaps tube
• C hands absorbent pad to D
• D wraps tube in absorbent pad
• C opens whirl-pak
• D places wrapped 50 ml tube into whirl-pak
• C places this Primary container in the empty caddy for transport out of the hot zone

During the collection procedure, C will draw a site map of the hot zone or video the hot zone so that there will be a record of where the samples were found.

After the samples have been collected, C will carry the Primary containers to the edge of the warm zone and hand them to a decon person where they will then be packed into a Secondary container.

The Secondary container will then be packed into a Tertiary container and transported to a lab for analysis.

Pre-contained Items

If the substance is in a closed container, package that container using the previous procedures as guidelines If the substance is in an open container, then pour a sample of the substance into the appropriate screw-cap tube and package it accordingly If the substance is in a petri dish, tape a lid on it and package it accordingly

Large Items / Evidence Collection
Treat as if it is contaminated; use zip-loc bags and biohazard bags as necessary (triple bagging the item). May even place items in 5 gal buckets

Hopefully, these considerations, in concert with the CDC guidelines, provide concepts that can assist in the development of local guidelines in response to the unknown powder threat.

Conclusion
We can rise to the current challenge and conduct safe, efficient, and reasonable responses to unknown powder releases that may be biological, or even chemical, in nature. To do so will take planning, effective training, adequate equipment, and coordination with other agencies. We should be able to handle these calls and also retain the public's confidence. This will go a long way in quelling the current hysteria and enjoying hazmat's finest hour!

Resources:

• www.3M.com/occsafety
  
• www.cdc.gov
  
• www.bt.cdc.gov
  
• www.cdc.gov/mmwr
  
• www.cdc.gov/documents
  
• www.cdc.gov/niosh
  
• www.atsdr.gov
  
• www.osha.gov/nyc-disaster/wtc-additional.html
  
• www.labsafety.com
  
• www.iaff.org/safe/content/Anthrax
  
• http://dp.sbccom.army.mil
  
• State of Wisconsin Hygiene Laboratory
  
• Wisconsin Regional HazMat Response Teams
  
• Lieutenant Ron Schwenn, Madison, Wisconsin, Fire Department
  
• Captain Carter Davis, Honolulu, Hawaii, Fire Department
  

Related:

• Hazardous Materials Archives
  

About the Author - David F. Peterson, CHMM David is a 21-year veteran firefighter who is currently a lieutenant with the Madison, Wisconsin, Fire Department where previously he was the Hazmat Training Coordinator for the Level A Regional Response Team. He is a certified hazmat IAFF Master Trainer who has trained over 40 private and public hazmat response teams and several thousand first responders. He is a National Fire Academy instructor, an Emergency Management Institute presenter, and a FDIC presenter. He has authored numerous articles for fire service periodicals, newsletters, and websites and is the founder and past president of the Wisconsin Association of Hazardous Materials Responders, Inc. David can be contacted at hazmatpetie@aol.com