Emergency

Response to
Terrorism
Job Aid - Edition 2.0
 Emergency Response to Terrorism
Job Aid

This Emergency Response to Terrorism Job Aid

has been designed, produced and distributed
through a joint partnership of:

The Department of Homeland Security

Federal Emergency Management Agency
United States Fire Administration

The Department of Homeland Security

Office for Domestic Preparedness (ODP)

And

United States Department of Justice

Office of Justice Programs

February 2003

Edition 2.0
 Emergency Response to Terrorism
Job Aid
n I. INTRODUCTION
q Document Layout
q Instructions on the Use of Job Aid
q Development/Use Assumptions

Introduction
 Emergency Response to Terrorism
Job Aid

Section I: Introduction

Document Layout
This document is divided into five primary sections:

n I. INTRODUCTION
● Instructions for use of Job Aid.
● Development/use assumptions.

n II. OPERATIONAL CONSIDERATIONS

● Assess Security--response and initial approach.
● Indicators.
● If there is one indicator.
● If there are multiple indicators.
● Command considerations
● Onscene sizeup.
● Incident site management, safety, and security.
● Tactical considerations.
● Mass decontamination.
● Symptomatic patients.
● Asymptomatic patients (contaminated or
exposed).
● Remote site operations (i.e., hospital
emergency rooms).
● Evidence preservation.

Introduction I-1
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Section I: Introduction (cont.)

n III. INCIDENT-SPECIFIC ACTIONS (CBRNE)

● Chemical.
● General information.
● Chemical agent reference chart.
● Nerve agents.
● Blister agents/Vesicants.
● Blood agents.
● Choking agents.
● Riot control/Irritant agents.
● Response recommendations.
● Biological.
● General information.
● Response recommendations.
● Wet/Dry agent from point source.
● Threat of dry agent placed into Heating,
Ventilating, and Air Conditioning (HVAC)
system or package with no visible evidence.
● Confirmed agent placed into HVAC system
(visible fogger, sprayer, or aerosolizing device).
● Biological agent reference chart.
● Radiological/Nuclear.
● General information.
● Response recommendations.
● Explosives.
● General information.
● Response recommendations.
● Unexploded device/pre-blast operations.
● Exploded device/post-blast operations.

Introduction I-2
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Section I: Introduction (cont.)

n IV. AGENCY-RELATED ACTIONS

● Fire department.
● As the incident progresses, prepare to initiate
Unified Command System.
● Emergency Medical Services (EMS)
● If first on scene:
● If command has been established.
● Patient care mainstay worksheet.
● Law enforcement.
● If first on the scene.
● If Command has been established.
● Haz mat.
● Assisting agencies.

n V. GLOSSARY OF TERMS

Introduction I-3
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Section I: Introduction (cont.)

Instructions on the Use of This Job Aid

The Introduction provides basic directions, an overview of
the document, and explanation of how to use it. It also
includes a list of basic assumptions upon which the Job Aid
was developed and according to which it is intended to be
used.
Operational Considerations highlights specific strategic
and tactical issues that should be assessed. In many
instances, questions help direct responders to implement
appropriate options or actions.
Incident-Specific Actions (CBRNE) provides an overview
of considerations and issues that should be assessed with
respect to different types of potential terrorist incidents.
Agency-Related Actions provides an overview of
considerations and issues that should be assessed by
the four primary disciplines that would be immediately
involved in a potential terrorist incident.
The Glossary of Terms defines specific terms and concepts
used within the checklist. Throughout the document,
terms defined in the glossary appear with the symbol &.
The glossary also gives the full form of abbreviations used
in the document.

Introduction I-4
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Section I: Introduction (cont.)

Development/Use Assumptions
n The Job Aid is designed to assist the first responder
from the fire, EMS, Haz mat, and law enforcement
disciplines. This includes both tactical and strategic
issues that range from line personnel to unit officers
and up to and including the initial Incident Commander
(IC) (i.e., battalion chief, etc.).
n The document is not a training manual. It is expected
that personnel already have appropriate training and
experience to address the identified tactics. It should
serve as a reminder for those who already have
completed the appropriate level of tactical or strategic
training, such as the Emergency Response to Terrorism
courses developed for classroom and self-study.
n The document is designed to assist emergency
response personnel in identifying a possible terrorist/
Weapons of Mass Destruction (WMD) incident and
implementing initial actions.
n The document identifies both strategic and tactical
considerations that should be assessed within the first
hour of an incident. Appropriate tactics would then be
implemented as required.
n Every incident is different. It is not possible to develop
a document outlining a single chronology or sequence
of actions. The order of operations depicted in this
document may have to be altered to meet the situation.
In some cases, various issues may have to be
addressed simultaneously.

Introduction I-5
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Section I: Introduction (cont.)

n Terrorist/WMD incidents are complex by nature and

rarely handled by a single first-responding unit or
agency. The Job Aid is intended to be used by several
different agencies and the first responders at an
incident who will ultimately report their findings to the
IC. To accomplish that goal the responsibility for
different sections can be appropriately assigned to
different personnel from different agencies ifavailable.

Introduction I-6
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n II. OPERATIONAL CONSIDERATIONS
q Assess security - - response and initial approach.
q Indicators.
¦ If there is one indicator.
¦ If there are multiple indicators.
q Command considerations.
q Onscene sizeup.
q Incident site management, safety, and security.
q Mass decontamination.
¦ Symptomatic patients.
¦ Asymptomatic patients (contaminated or
exposed).
¦ Remote site operations (i.e., hospital
emergency rooms).
q Evidence preservation.

Operational Considerations
 Emergency Response to Terrorism
Job Aid

Section II-1: Assess Security-Response

and Initial Approach
Indicators
q Is the response to a target hazard or target event?
q Has there been a threat?
q Are there multiple (nontrauma related) victims?
q Are responders victims?
q Are hazardous substances involved?
q Has there been an explosion?
q Has there been a secondary attack/explosion?

If There Is One Indicator

q Respond with a heightened level of awareness.

If There Are Multiple Indicators

q You may be on the scene of a terrorist incident.
q Initiate response operations with extreme caution.
q Be alert for actions against responders.
q Evaluate and implement personal protective measures.
q Consider the need for maximum respiratory protection.
q Make immediate contact with law enforcement for
coordination.

Assess Security-Response and Initial Approach II-1-1

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Section II-1: Assess Security-Response

and Initial Approach (cont.)
q Response route considerations:
¦ Approach cautiously, from uphill/upwind if
possible.
¦ Consider law enforcement escort.
¦ Avoid choke points (i.e., congested areas). &
¦ Designate rally points (i.e., regrouping areas
(different from Staging Area) for responders). &
q Identify safe staging location(s) for incoming units.

Assess Security-Response and Initial Approach II-1-2

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Section II-2: Command Considerations

q Establish command.
q Isolate area/deny entry.
q Ensure scene security.
q Initiate onscene sizeup and hazard/risk assessment.
q Provide, identify, and designate safe staginglocation(s)
for incoming units.
q Ensure the use of personal protective measures and
shielding.
q Assess emergency egress routes: &
¦ Position apparatus to facilitate rapid evacuation.
¦ If you must use emergency egress, reassemble at
designated rally point(s). &
q Ensure personnel accountability.
q Designate incident safety officer.
q Assess command post security.
q Consider assignment of liaison and public information
positions.
q Assess decontamination requirements (gross, mass,
etc.). &
q Consider the need for additional/specialized resources.
¦ Fire.
¦ EMS.
¦ Haz mat.
¦ Law enforcement/explosive ordnance disposal
(bomb squad).

Command Considerations II-2-1

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Section II-2: Command Considerations (cont.)

¦ Emergency management.
¦ Public health.
¦ Public works.
¦ Environmental.
¦ Others.
q Consider as a potential crime scene:
¦ Consider everything at the site as potential
evidence.
¦ Ensure coordination with law enforcement.
q Make appropriate notifications:
¦ Dispatch center (update situation report).
¦ Hospitals.
¦ Utilities.
¦ Law enforcement.
¦ State point of contact as appropriate.
q Prepare for transition to Unified Command. &
q Ensure coordination of communications and identify
needs.
q Consider the need for advance/response of a regional,
State, or national Incident Management Team (IMT).

Command Considerations II-2-2

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Section II-3: Onscene Sizeup

q Review dispatch information.

q Look for physical indicators and other outward
warning signs (of biological, nuclear, incendiary,
chemical and explosive events, including armed
assault):
¦ Debris field.
¦ Mass casualty/fatality with minimal or no trauma.
¦ Responder casualties.
¦ Severe structural damage without an obvious
cause.
¦ Dead animals and vegetation.
¦ System(s) disruptions (utilities, transportation,
etc.).
¦ Unusual odors, color of smoke, vapor clouds.
q Victims’ signs and symptoms of hazardous substance
exposure:
¦ Are there unconscious victims with minimal or no
trauma?
¦ Are there victims exhibiting Salivation, Lacrimation,
Urination, Defecation, Gastrointestinal distress,
Emesis, and Miosis (SLUDGEM) signs/seizures?
&
¦ Is there blistering, reddening of skin, discoloration
or skin irritation?
¦ Are victims having difficulty breathing?
q Identify apparent sign/symptom commonality.

Onscene Sizeup II-3-1

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Section II-3: Onscene Sizeup (cont.)

q Interview victims and witnesses (if possible):

¦ Is everyone accounted for?
¦ What happened (information on delivery system)?
¦ When did it happen?
¦ Where did it happen?
¦ Who was involved?
¦ Did they smell, see, taste, hear, or feel anything
(out of the ordinary)?
q Identify type of event(s):
¦ Chemical.
¦ Biological.
¦ Radiological.
¦ Nuclear.
¦ Explosive.
¦ Armed assault.
q Weather report considerations:
¦ Downwind exposures.
¦ Monitor forecast.
q Determine life safety threats:
¦ Self.
¦ Responders.
¦ Victims.
¦ Public.
q Determine mechanism(s) of injury (TRACEM-P): &
¦ Thermal.
¦ Radiological.
¦ Asphyxiant.
¦ Chemical.
Onscene Sizeup II-3-2
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Section II-3: Onscene Size-up (cont.)

¦ Etiological.
¦ Mechanical.
¦ Psychological.
q Estimate number of victims:
¦ Ambulatory.
¦ Nonambulatory.
q Identify damaged/affected surroundings:
¦ Structural exposures.
¦ Downwind exposures.
¦ Environmental exposures.
¦ Below-grade occupancies.
¦ Below-grade utilities.
¦ Aviation/air space hazards.
q Consider potential for secondary attack:
¦ Chemical dispersal devices.
¦ Secondary explosive devices.
¦ Booby traps.
q Determine available and needed resources:
¦ Fire.
¦ EMS.
¦ Haz mat.
¦ Law enforcement/explosive ordnance disposal
(bomb squad).
¦ Emergency management.
¦ Public health.
¦ Public works.
¦ Environmental.
¦ Others.

Onscene Sizeup II-3-3

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Section II-4: Incident Site Management,

Safety, and Security
q Reassess initial isolation/standoff distances:
¦ Establish an outer perimeter. &
¦ Establish an inner perimeter. &
q Initiate public protection actions:
¦ Remove endangered victims from high-hazard
areas.
¦ Establish safe refuge area (contaminated versus
uncontaminated). &
¦ Evacuate.
¦ Protect in place.
q Identify appropriate personal protective equipment
(PPE) options prior to committing personnel.
q Dedicate EMS needed for responders.
q Prepare for gross decontamination operations for
responders. &
q Coordinate with law enforcement to provide security
and control of perimeters.
q Ensure force protection.
q Designate an emergency evacuation signal.

Incident Site Management, Safety, and Security II-4-1

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Section II-5: Tactical Considerations

q Life safety:
¦ Isolate/secure and deny entry.
¦ Public protection (evacuate/protect in place).
¦ Implementation of self-protection measures.
¦ Commit only essential personnel/minimize
exposure.
¦ Confine/contain all contaminated and exposed
victims.
¦ Establish gross decontamination capabilities. &
q Rescue considerations:
¦ Is the scene safe for operations?
¦ Can I make it safe to operate?
¦ Are victims viable?
¦ Are they ambulatory?
¦ Can they self-evacuate?
¦ Are they contaminated?
¦ Do they require extrication (bombing events)?
¦ Is a search safe and possible?
¦ Is specialized PPE required?
q Incident stabilization (consider defensive operations):
¦ Water supply.
¦ Exposure protection.
¦ Utility control.
¦ Fire suppression.
¦ Haz mat control.

Tactical Considerations II-5-1

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Section II-6: Mass Decontamination

q Separate the victims into groups of:

¦ Symptomatic and asymptomatic. &
¦ Ambulatory and nonambulatory.
q Properly protected medical personnel may access the
patients in the holding area to initiate triage, administer
antidotes, and provide basic care in accordance with
local protocols.
q The type of decontamination system is dependent on
the number of patients, the severity of their injuries,
and the resources available.
q Several patients may be handled with a single hose
line, while numerous patients will require the use of a
mass decontamination corridor. &
q Large numbers of patients may require engine
companies to use the “side-by-side” system as well as
numerous showers to move multiple lines of patients
through the process.

Symptomatic Patients
q Begin emergency gross decontamination &
immediately on victims who:
¦ Are symptomatic. &
¦ Have visible (liquid) product on their clothing.
¦ Were in close proximity to the discharge.
q In a mass casualty setting, life safety takes precedence
over containing runoff.

Mass Decontamination II-6-1

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Section II-6: Mass Decontamination (cont.)

q Set up decontamination in an area such that the

decontamination water will flow away from your
operation and into the grass or soil, if possible.
q Provide privacy only if it will not delay the
decontamination process.
q Remove all of the victims’ clothing down to their
underwear.
q Separate lines may be required to process
nonambulatory patients.
q As resources become available, separate
decontamination lines may be established for male and
female patients, as well as families.
q Provide emergency covering (i.e., emergency blankets
and sheets for the victims).
q Transfer patients to EMS for triage/treatment.

Asymptomatic Patients (Contaminated or Exposed)

q Process patients through the gross decontamination
& showers with their clothes on.
q Have them proceed to separate holding areas by
gender.
q Separate systems should be established for male and
female patients.
q Set up tents/shelters and provide showers or an
improvised wash system.
q Patients should be numbered and bags should beused
to store their personal effects.

Mass Decontamination II-6-2

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Section II-6: Mass Decontamination (cont.)

q Provide emergency covering/clothing.

q Transfer patients to a holding area for medical
evaluation.

Remote Site Operations (i.e., Hospital Emergency Room)

q Stand-alone decontamination systems may have to
be established outside of hospital emergency rooms for
patients who self-present at the location:
¦ Units with decontamination capabilities should be
dispatched to establish a system.
¦ Triage the patients and separate them into
symptomatic and asymptomatic groups. &
¦ Patients who are symptomatic or have visible
product on their clothes will be a priority. &
¦ Remove clothes and flush thoroughly.
¦ Liaison with the hospital staff to determine where
patients will be sent after decontamination.

Mass Decontamination II-6-3

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Section II-7: Evidence Preservation

q Recognize potential evidence.

¦ Unexploded device(s).
¦ Portions of device(s).
¦ Clothing of victims.
¦ Containers.
¦ Dissemination device(s).
¦ The victim(s).
q Note location of potential evidence.
q Report findings to appropriate authority.
q Move potential evidence only for life safety/incident
stabilization.
q Establish and maintain chain of custody for evidence
preservation.

Evidence Preservation II-7-1

 Emergency Response to Terrorism
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■ III. INCIDENT-SPECIFIC ACTIONS(CBRNE)
l Chemical
¦ General Information
¦ Chemical Agent Reference Charts
¦ Nerve Agents
¦ Blister Agents/Vesicants
¦ Blood Agents
¦ Choking Agents
¦ Riot Control/Irritant Agents
¦ Response Recommendations
l Biological
l Radiological/Nuclear
l Explosive

Incident - Specific Actions (CBRNE) Chemical

 Emergency Response to Terrorism
Job Aid

Section III-1: Chemical

General Information
q Victims’ signs and symptoms of hazardous substance
exposure:
¦ Are there unconscious victims with minimal or no
trauma?
¦ Are there victims exhibiting SLUDGEM &
signs/seizures?
¦ Is there blistering, reddening of skin, discoloration
or skin irritation?
¦ Are the victims having difficulty breathing?
q Look for physical indicators and other outward warning
signs:
¦ Medical mass casualty/fatality with minimal or no
trauma.
¦ Responder casualties.
¦ Dead animals and vegetation.
¦ Unusual odors, color of smoke, vapor clouds.
q Dispersal method(s):
¦ Air handling system.
¦ Misting or aerosolizing device.
¦ Sprayer.
¦ Gas cylinder.
¦ Dirty bomb.
q DOT-ERG’s provide additional information:
¦ Nerve agents (Guide #153).
¦ Blister agents (Guide #153).
¦ Blood agents (Guides #117, 119, 125).
¦ Choking agents (Guides #124, 125).
¦ Irritant agents (riot control) (Guides #153, 159).
Chemical III-1-1
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Section III-1: Chemical (cont.)

Chemical Agent Reference Charts

Nerve Agents
Common Name Tabu Sari Soma
(Military Symbol) n n n VX
(GA) (GB) (GD)
Volatility/
Persistenc Semi-persistent Persistent
y
Rate of Action Rapid Rapid

Route of Entry Respiratory and skin

Odor Fruity Camphor Sulfur

Headache, runny nose, salivation, pinpointing

Signs/Symptoms of pupils, difficulty in breathing, tight chest,
seizures/convulsions

Self-Protection Respiratory and skin

Remove from area, treat symptomatically

First Aid Atropine and 2–Pam chloride

Remove agent
Decontamination
Flush with warm water/soap

Non-persistent = minutes to hours

Semi-persistent = < 12 hours
Persistent = > 12 hours

Chemical III-1-2
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Section III-1: Chemical (cont.)

Chemical Agent Reference Charts

Blister Agents/Vesicants
Common Name Mustar Lewisit Phosgene Oxime
(Military Symbol) d (H) e (L) (CX)

Volatility/
Persistenc Persistent
y
Rate of Action Delayed Rapid

Route of Entry Skin, inhalation, eyes

Odor Garlic Geraniums Irritating

Red, burning skin, blisters, sore throat,

dry cough. Pulmonary edema,
Signs/Symptoms memory loss, coma/seizures.
Some symptoms may be delayed
from 2 to 24 hours.

Self-Protection Respiratory and skin

Decontaminate with copious amount of water,

First Aid remove clothing, support airway, treat
symptomatically

Remove from area, flush with

Decontamination warm water and soap

Non-persistent = minutes to hours

Semi-persistent = < 12 hours
Persistent = > 12 hours

Chemical III-1-3
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Section III-1: Chemical (cont.)

Chemical Agent Reference Charts

Blood Agents
Hydroge Cyanoge
Common Name n n Arsin
(Military Symbol) Cyanide Chloride e
(AC) (CK) (SA)
Volatility/
Persistenc Nonpersistent
y
Rate of Action Rapid

Route of Entry Inhalation, skin, and eyes

Odor Burnt almonds or peach pits Garlic

Cherry red skin/lips, rapid breathing, dizziness,

nausea, vomiting, convulsions, dilated pupils,
Signs/Symptoms
excessive salivation, gastrointestinal hemorrhage,
pulmonary edema, convulsions, respiratory arrest

Self-Protection Respiratory and skin

Remove from area, assist ventilations, treat

First Aid symptomatically, administer cyanide kit

Remove from area, remove wet clothing, flush

Decontamination with soap and water, aerate

Non-persistent = minutes to hours

Semi-persistent = < 12 hours
Persistent = > 12 hours

Chemical III-1-4
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Section III-1: Chemical (cont.)

Chemical Agent Reference Charts

Choking Agents

Common Name Chlorin Phosgen Diphosgen

(Military Symbol) e (CL) e (CG) e (DP)

Volatility/ Nonpersistent
Persistenc Vapors may hang in low areas
y
Rapid in high concentration, up to 3 hours
Rate of Action in low concentrations

Route of Entry Respiratory and skin

Newly Cut grass or

Odor Bleach mown hay green corn

Eye and airway irritation, dizziness,

Signs/Symptoms tightness in chest, pulmonary edema,
painful cough, nausea, headache

Self-Protection Respiratory and skin

Remove from area, remove contaminated

First Aid clothing, assist ventilations, rest

Wash with copious amounts of water,

Decontamination aerate
Non-persistent = minutes to hours
Semi-persistent = < 12 hours
Persistent = > 12 hours

Chemical III-1-5
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Section III-1: Chemical (cont.)

Chemical Agent Reference Charts

Riot Control/Irritant Agents

Common Name Tear Gas Mace Pepper Spray

(Military Symbol) (CS & CR) (CN) (OC)

Low–High Varies
Volatility/ depending upon
Persistenc > 60 days on Low
y porousmaterial surface
20 to 60
Rate of Action seconds Rapid

Route of Entry Respiration and skin

Apple Pepper or odor

Odor Hair spray blossoms of propellant

Tearing eyes, nose and throat irritation,

Signs/Symptoms coughing, shortness of breath, vomiting

Self-Protection Respiration and skin

Remove from area, support respirations, treat

First Aid
symptomatically, remove contaminatedclothing

Brush off material, use decon wipes, water,

Decontamination remove contaminated clothing

Non-persistent = minutes to hours

Semi-persistent = < 12 hours
Persistent = > 12 hours

Chemical III-1-6
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Section III-1: Chemical (cont.)

Response Recommendations
q Approach from uphill and upwind.
q Victims exposed to chemical agents require
immediate removal of clothing, gross &
decontamination and definitive medical care.
q Upon arrival, stage at a safe distance away from the
site.
q Secure and isolate the area/deny entry.
q Complete a hazard and risk assessment to determine if
it is acceptable to commit responders to the site.
q Be aware of larger secondary chemical devices.
q Personnel in structural PPE/SCBA should not enter
areas of high concentration, unventilated areas, or
below-grade areas for any reason.
q Personnel in structural PPE/SCBA may enter the hot
zone near the perimeter (outside of areas of high
concentration) to perform life-saving functions.
q Move ambulatory patients away from the area of
highest concentration or source.
q Confine all contaminated and exposed victims to a
restricted/isolated area at the outer edge of the hot
zone. &
q Symptomatic & patients should be segregated into
one area and asymptomatic patients should be placed
in another area.
q Law enforcement should establish an outer perimeter
& to completely secure the scene.
Chemical III-1-7
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Section III-1: Chemical (cont.)

Response Recommendations (cont.)

q If a particular agent is known or suspected, this
information should be forwarded to EMS personnel and
hospitals so sufficient quantities of antidotes can be
obtained.
q Hospitals should be notified immediately that
contaminated victims of the attack may arrive or
self-present at the hospital.
q Begin emergency gross decontamination &
procedures starting with the most severe symptomatic
& patients. Use soap-and-water decon.
q Decontamination capabilities should be provided at the
hospital to assist with emergency gross
decontamination & prior to victims’ entering the
facility.
q If available, haz mat personnel in chemical PPE may be
used for rescue, reconnaissance, and agent
identification.
q Asymptomatic & patients should be decontaminated
in a private area (tent or shelter) and then forwarded to
a holding area for medical evaluation.

Chemical III-1-8
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n III. INCIDENT-SPECIFIC ACTIONS(CBRNE)
l Chemical
l Biological
¦ General Information
¦ Response Recommendations
¦ Wet/Dry Agent from Point of Source
¦ Threat of Dry Agent Placed into HVACSystem
or Package with No Physical Evidence
(Visible Fogger, Sprayer, or Aerosolizing
Device)
¦ Biological Agent Reference Chart
l Radiological/Nuclear
l Explosive

Incident-Specific Actions (CBRNE) Biological

 Emergency Response to Terrorism
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Section III-2: Biological

General Information
q Biological agents may produce delayed reactions.
q Unlike exposure to chemical agents, exposure to
biological agents does not require immediate
removal of victims’ clothing or gross decontamination
in the street. &
q Inhalation is the primary route of entry.
q SCBA and structural firefighting clothing provides
adequate protection for first responders.
q DOT-ERG #158 provides additional information.

Response Recommendations
q Position uphill and upwind and away from building
exhaust systems.
q Isolate/secure the area. (DOT-ERG #158 recommends
initial isolation distance of 80 feet.)
q Do not allow unprotected individuals to enter area.
q Be alert for small explosive devices designed to
disseminate the agent.
q Gather information:
¦ Type and form of agent (liquid, powder, aerosol).
¦ Method of delivery.
¦ Location in structure.

Biological III-2-1
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Section III-2: Biological (cont.)

Operational procedures are provided on the

following pages for the following scenarios:
q Wet/dry agent from a point source.
q Threat of agent placed in HVAC system or package
(with no physical evidence).
q Confirmed agent placed into HVAC system
(visible fogger, sprayer, or aerosolizing device).

Wet/Dry Agent from Point Source

q Personnel entering area must wear full PPE, including
SCBA.
q Avoid contact with puddles, wet surfaces, powdery
substances, etc.
q Isolate area.
q Keep all potentially exposed individuals in close
proximity, but out of the high-hazard area.
q Shut down HVAC system that services the area.
q If victims have visible agent on them:
¦ Wash exposed skin with soap and water.
¦ If highly contaminated (i.e., splashed) and the
facility is equipped with showers, the victims may
take a shower and change clothes as a precaution.
¦ Haz mat team may be able to conduct a bioassay
field test (limited number of agents).

Biological III-2-2
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Section III-2: Biological (cont.)

q If possible, a sample of the material may be collected

for testing:
¦ If test results are positive, decontaminate in
shower facility with warm water/soap.
¦ Provide emergency covering/clothing and bag
personal effects.
¦ Refer to medical community for treatment.

Threat of Dry Agent Placed into HVAC System

or Package with No Physical Evidence
q Isolate the building:
¦ Keep all potentially exposed victims in the building.
¦ Shut down all HVAC systems for the building.
q Collect information regarding the threat, target, or any
previous activity to gauge the credibility of the threat.
q Initiate a search of the building.
q Personnel entering area must wear full PPE, including
SCBA.
q Avoid contact with puddles, wet surfaces, etc.
q Investigate all HVAC intakes, returns, etc., for evidence
of agent or dispersal equipment.
q If any evidence of an agent is found in/near the HVAC
system, remove occupants from the building and
isolate them in a secure and comfortable location.
q If a suspicious package is found, handle as a
point-source event.

Biological III-2-3
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Section III-2: Biological (cont.)

q Contaminated victims should shower and change. No

decontamination should take place unprotected and in
the open. Tents or other sites should be used.
q Exposed victims may shower and change at their
discretion.
q Refer to medical community for treatment.

Confirmed Agent Placed into HVAC System

(Visible Fogger, Sprayer, or Aerosolizing Device)
q Personnel entering must wear full PPE and SCBA.
q Avoid contact with puddles, wet surfaces, etc.
q Remove occupants from building/area, and isolate in a
secure and comfortable location.
q Shut down HVAC system(s).
q Haz mat team may be able to conduct a bioassay field
test (limited number of agents).
q If possible, a sample of the material may be collected
for testing.
q If test results are positive, contaminated victims should
shower and change. No decontamination should take
place unprotected and in the open. Tents or other sites
should be used.
q Gather all decontaminated victims in a specific holding
area for medical evaluation.

Biological III-2-4
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Section III-2: Biological (cont.)

Biological Agent Reference Chart

Transmissi
Agent Dissemination on (person Incubation Lethality
to person)
Spores in No (except
Anthrax aerosol cutaneous) 1 to 5 days High

Ingestion and 12 hours Low with

Cholera aerosol Rare treatment
to 6 days
High if
Plague Aerosol High 1 to 3 days untreated
Moderate
1 to 10 if
Tularemia Aerosol No days
untreated
Ingestion and 14 to 16
Q Fever aerosol Rare days Very low

10 to 12
Smallpox Aerosol High days Low

Aerosol and
VEE infected Low 1 to 6 days Low
vectors
Contact and 4 to 16 Moderate
Ebola aerosol Moderate days to high

Botulinum Ingestion and Hours to

Toxin aerosol No days High

T-2 Ingestion and 2 to 4

Mycotoxins aerosol No hours Moderate

Ingestion and Hours to

Ricin aerosol No days High

Staphylococal Ingestion and

Enterotoxin B aerosol No Hours < 1%

Biological III-2-5
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n III. INCIDENT SPECIFIC ACTIONS(CBRNE)
l Chemical
l Biological
l Radiological/Nuclear
¦ General Information
¦ Response Recommendations
l Explosive

Incident-Specific Actions (CBRNE) Radiological/Nuclear

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Section III-3: Radiological/Nuclear

General Information
q Radiological agents may produce delayed reactions.
q Unlike exposure to chemical agents, exposure to
radiological agents does not require immediate
removal of victims’ clothing or gross decontamination
in the street.
q Inhalation is the primary route of entry for particulate
radiation.
q In most cases, SCBA and structural firefightingclothing
provides adequate protection for first responders.
q Alternately, gamma sources require minimizing
exposure time and maintaining appropriate distance as
the only protection.
q Exposed/contaminated victims may not exhibit obvious
injuries.
q DOT-ERG’s #163 & 164 provide additional information.

Response Recommendations
q Position upwind of any suspected event.
q Isolate/secure the area. DOT-ERG #163 recommends
a minimum distance of 80 to 160 feet.
q Be alert for small explosive devices designed to
disseminate radioactive agent(s).
q Use time, distance, and shielding as protective
measures. &
q Use full PPE including SCBA.

Radiological/Nuclear III-3-1
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Section III-3: Radiological/Nuclear (cont.)

q Avoid contact with agent. Stay out of any visible smoke

or fumes.
q Establish background levels outside of suspected area.
q Monitor radiation levels.
q Remove victims from high-hazard area to a safe holding
area.
q Triage, treat, and decontaminate trauma victims as
appropriate.
q Detain or isolate uninjured persons or equipment.
Delay decontamination for such persons/equipment
until instructed by radiation authorities.
q Use radiation detection devices, if possible, to
determine if patients are contaminated with
radiological material.

Radiological/Nuclear III-3-2
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n III. INCIDENT-SPECIFIC ACTIONS(CBRNE)
l Chemical
l Biological
l Radiological/Nuclear
l Explosive
¦ General Information
¦ Response Recommendations
l Unexploded Device/Pre-Blast Operations
l Exploded Device/Post-Blast Operations

Incident-Specific Actions (CBRNE) Explosive

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Section III-4: Explosives

General Information
q Explosive devices may be designed to disseminate
chemical, biological, or radiological agents.
q Explosives may produce secondary hazards, such as
unstable structures, damaged utilities, hanging debris,
void spaces, and other physical hazards.
q Devices may contain antipersonnel features such as
nails, shrapnel, fragmentation design, or other
material.

WARNING: Always be alert for the possibility of

secondary devices

q Outward warning signs:

¦ Oral or written threats.
¦ Container/vehicle that appears out of place.
¦ Devices attached to compressed gas cylinders,
flammable liquid containers, bulk storage
containers, pipelines, and other chemical
containers (dirty bomb).
¦ Oversized packages with oily stains, chemical
odors, excessive postage, protruding wires,
excessive binding, no return address, etc.
q DOT-ERG’s #112 and 114 provide additional
information.

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Section III-4: Explosives (cont.)

Response Recommendations

Unexploded Device/Pre-Blast Operations

q Command Post should be located away from areas
where improvised secondary devices may be placed,
e.g., mailboxes, trash cans, etc.
q Stage incoming units:
¦ Away from line of sight of target area.
¦ Away from buildings with large amounts of glass.
¦ In such a way as to utilize distant structural and/or
natural barriers to assist with protection.
q Isolate/deny entry.
q Secure perimeter based on the size of the device.

WARNING: Coordinate activities with law

enforcement and be prepared for operations
if the device activates.

q Attempt to identify device characteristics:

¦ Type of threat.
¦ Location.
¦ Time.
¦ Package.
¦ Device.
¦ Associated history.

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Section III-4: Explosives (cont.)

q Standoff distance should be commensurate with the

size of the device:
¦ Car bomb = 1,500 ft. (increase distance for larger
vehicles).
¦ Package bomb (1 to 25 lbs.) = 1,000 ft.
¦ Pipe bomb = 500 ft.
q Use extreme caution if caller identifies a time for
detonation. It is very possible that the device will
activate prior to the announced time.
q Discontinue use of all radios, mobile data terminals
(MDT’s), and cell phones in accordance with local
protocols.
q Evaluate scene conditions:
¦ Potential number of affected people.
¦ Exposure problems.
¦ Potential hazards: utilities, structures, fires,
chemicals, etc.
¦ Water supply.
¦ Evaluate available resources (EMS, Haz mat,
technical rescue, etc.).
¦ Review preplans for affected buildings.
¦ Make appropriate notifications.
¦ Develop action plan that identifies incident
priorities, key strategies, tactical objectives,
potential tactical assignments, and key positions in
the Incident Command System (ICS) Unified
Command. &

Explosives III-4-3
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Section III-4: Explosives (cont.)

Exploded Device/Post-Blast Operations

q Command Post should be located away from areas
where improvised secondary devices may be placed,
e.g., mailboxes, trash cans, etc.
q Initial arriving unit(s):
¦ Stage a safe distance from reported incident (or
where you first encounter debris).
q Away from line of sight of target area.
q Away from buildings with large amounts of
glass.
¦ Utilize distant structural and/or natural barriers to
assist with protection.

WARNING: Be aware of the possibility of

secondary devices and their possible location.

q Stage incoming units at a greater distance. Consider

using multiple staging sites.
q Debris field may contain unexploded bomb material.
q Discontinue use of all radios, mobile data terminals
(MDT’s), and cell phones in accordance with local
protocols.
q Remove all citizens and ambulatory victims from the
affected area.

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Section III-4: Explosives (cont.)

q Determine onscene conditions and evaluate resource

requirements:
¦ Explosion.
¦ Fire.
¦ Structural collapse/unstable buildings.
¦ Search/rescue (nonambulatory/trapped victims).
¦ Exposures.
¦ Utilities.
¦ Number of patients and extent of injuries.
¦ Other hazards.
q Make notifications (law enforcement, hospitals,
emergency management) as appropriate:
¦ Local.
¦ State.
¦ Federal.
q Complete hazard and risk assessment.

WARNING: If it is determined that entry/intervention

must occur (life safety), the following procedures
should be implemented.

q Personnel should only be allowed to enter the blast

area for life safety purposes.
q Remove viable patients to safe refuge area.
q Direct ambulatory patients to care.

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Section III-4: Explosives (cont.)

q Limit number of personnel and minimize exposure

time. Personnel entering the blast area should:
¦ Wear full protective clothing, including SCBA.
¦ Monitor atmosphere:
l Radiation.
l Flammability.
l Toxicity.
l Chemical.
l pH.
q Establish emergency gross decontamination.

WARNING: Area should be evacuated of all

emergency responders if there is any indication
of a secondary device.

q Remove patients from the initial blast site to a safe

refuge area. &
q Triage/treatment area established at the casualty
collection point & (if established):
¦ Notify hospitals.
¦ Implement mass casualty plan.
q Do not allow rescuers to enter unsafe buildings or
highhazard areas.
q Control utilities and protect exposures from a defensive
position.
q Preserve and maintain evidence.

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n IV. AGENCY-RELATED ACTIONS
l Fire Department
¦ As the Incident Progresses, Prepare to Initiate
Unified Command System
l Emergency Medical Services
¦ If First on Scene
¦ If Command Has Been Established
¦ Patient Care Mainstay Worksheet
l Law Enforcement
¦ If First on Scene
¦ If Command Has Been Established
l Haz mat
l Assisting Agencies

Agency-Related Actions
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Section IV-1: Fire Department

q In a terrorist incident where fire is present any fire may

present intense conditions:
¦ Rapid spread.
¦ High heat.
¦ Multiple fires.
¦ Chemical accelerant.
q In a suspected terrorist incident, be aware that:
¦ Terrorists may sabotage fire protection devices.
¦ Be alert for booby traps.
¦ Be aware of the possibility of multiple devices.
q Isolate/secure the scene, deny entry, establish control
zones.
q Establish command.
q Evaluate scene safety/security.
q Stage incoming units.
q Gather information regarding the incident, number of
patients, etc.
q Assign ICS positions as needed.
q Initiate notifications (i.e., hospitals, law enforcement,
State/Federal agencies, etc.)
q Request additional resources.
q Use appropriate self-protective measures:
¦ Proper PPE.
¦ Time, distance, and shielding. &
¦ Minimize number of personnel exposed to danger.

Fire Department IV-1-1

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Section IV-1: Fire Department (cont.)

q Initiate public safety measures:

¦ Rescue.
¦ Evacuate.
¦ Protect in place.
q Establish water supply:
¦ Suppression activities.
¦ Decontamination.
q Control and isolate patients (away from the hazard, at
the edge of the hot/warm zone). &
q Coordinate activities with law enforcement.
q Begin and/or assist with triage, administering
antidotes, and treatment.
q Begin gross mass decontamination & operations.

As the incident progresses, prepare to initiate

Unified Command & system
q Establish Unified Command & post, including
representatives from the following organizations:
¦ Emergency Medical Services.
¦ Law enforcement.
¦ Hospitals/public health.
¦ Emergency management.
¦ Public works.
q Establish and maintain chain of custody for evidence
protection.

Fire Department IV-1-2

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Section IV-2: Emergency Medical Services

If First on Scene:
q Isolate/secure the scene, establish control zones.
q Establish command.
q Evaluate scene safety/security.
q Stage incoming units.

If Command Has Been Established:

q Report to and/or communicate with Command Post.
q Gather information regarding:
¦ Type of event.
¦ Number of patients.
¦ Severity of injuries.
¦ Signs and symptoms.
q Establish the EMS group within the ICS.
q Notify hospitals.
q Request additional resources as appropriate:
¦ Basic Life Support (BLS)/Advanced Life Support
(ALS).
¦ Medivac helicopter (trauma/burn only).
¦ Medical equipment and supply caches.
¦ Metropolitan Medical Response System (MMRS).
¦ National Medical Response Team (NMRT).
¦ Disaster Medical Assistance Team (DMAT).
¦ Disaster Mortuary Response Team (DMORT).

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Section IV-2: Emergency Medical Services (cont.)

q Use appropriate self-protective measures:

¦ Proper PPE.
¦ Time, distance, and shielding.
¦ Minimize number of personnel exposed to danger.
q Initiate mass casualty procedure.
q Evaluate the need for casualty collection point (CCP)
for ambulatory (walking wounded) patients & and a
patient treatment area.
q Control and isolate patients (away from the hazard, at
the edge of the hot/warm zone &).
q Ensure patients are decontaminated prior to being
forwarded to the cold zone &.
q Triage, administer antidotes, treat and transport
victims.
q Evidence preservation/collection:
¦ Recognize potential evidence.
¦ Report findings to appropriate authority.
¦ Consider embedded objects as possible evidence.
¦ Secure evidence found in ambulance or at
hospital.
q Establish and maintain chain of custody for evidence
preservation.
q Ensure participation in Unified Command & System
when implemented.

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Section IV-2: Emergency Medical Services (cont.)

PATIENT CARE MAINSTAYS WORKSHEET

APPROPRIATE PROTECTIVE MEASURES FOR EMS PERSONNEL
DURING DECONTAMINATION AFTER DECONTAMINATION

PATIENT EXPOSURECONSIDERATIONS

SUPPORTIVE CARE CONSIDERATIONS

DECONTAMINATION CONSIDERATIONS

PERSONAL PROTECTIONCONSIDERATIONS
(Potential infectious deceases or secondary contamination)

MEDICAL INTERVENTION
BLS TREATMENT ALS TREATMENT

PATIENT TRANSPORT AND TRANSFERCONSIDERATIONS

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Section IV-3: Law Enforcement

If First on Scene:
q Isolate/secure the scene, establish control zones.
q Establish command.
q Stage incoming units.

If Command Has Been Established:

q Report to command post.
q Evaluate scene safety/security:
¦ Ongoing criminal activity.
¦ Consider victims to be possible terrorists.
¦ Secondary devices.
¦ Additional threats.
q Gather witness statements/observations and
document.
q Initiate law enforcement notifications:
¦ Federal Bureau of Investigation (FBI).
¦ Bureau of Alcohol, Tobacco and Firearms (ATF).
¦ Explosive Ordnance Disposal (EOD)/bomb squad.
¦ State Police Agency.
¦ Private security forces.
q Request additional resources.
q Secure outer perimeter. &
q Traffic control considerations:
¦ Staging areas.
¦ Entry/egress.

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Section IV-4: Law Enforcement (cont.)

q Use appropriate self-protective measures:

¦ Time, distance, and shielding. &
¦ Minimize number of personnel exposed to danger.
¦ Proper PPE (if provided).
q Initiate public safety measures:
¦ Evacuate.
¦ Protect in place.
q Assist with control/isolation of patients.
q Coordinate activities with other response agencies.
q Evidence preservation:
¦ Diagram the area.
¦ Photograph the area.
¦ Prepare a narrative description.
¦ Maintain an evidence log.
q Participate in a Unified Command System & with:
¦ Fire/rescue services.
¦ EMS.
¦ Hospitals/public health.
¦ Emergency management.
¦ Public works.

Law Enforcement IV-3-2

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Section IV-4: Haz mat

q Establish the Haz mat group within the ICS.

q Provide technical information/assistance to:
¦ Command.
¦ EMS providers.
¦ Hospitals.
¦ Law enforcement.
q Detect/monitor to identify the agent, determine
concentrations, and ensure proper control zones.
q Continually reassess control zones.
q Enter the hot zone & (chemical PPE) to perform
rescue, product confirmation, and reconnaissance.
q Product control/mitigation may be implemented in
conjunction with expert technical guidance.
q Improve hazardous environments:
¦ Ventilation.
¦ Control HVAC.
¦ Control utilities.
q Implement a technical decontamination corridor for
Hazardous Materials Response Team (HMRT)
personnel.
q Coordinate and assist with mass decontamination.
q Provide specialized equipment as necessary, such as
tents for operations, shelter, etc.
q Assist law enforcement personnel with evidence
preservation/collection, decontamination, etc.

Haz mat IV-4-1

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Section IV-5: Assisting Agencies

q Federal Bureau of Investigation (FBI).

¦ WMD Coordinator.
¦ Haz mat Response Unit (HMRU).
q U.S. Army Medical Research Institute of Chemical
Defense (USAMRICD).
q U.S. Army Medical Research Institute of Infectious
Disease (USAMRIID).
q U.S. Army Medical Research Institute of Chemical
Causality Care Division (USAMRICD).
q U.S. Army Tech Escort Unit (TEU).
q Soldier and Biological Chemical Command (SBCCOM).
q Public works.
q Public health.
q Centers for Disease Control and Prevention (CDC).
q Agency for Toxic Substance Disease Registry (ATSDR).
q Federal Emergency Management Agency (FEMA).
q Disaster Medical Assistance Team (DMAT).
q Disaster Mortuary Response Team (DMORT).
q Chemical/Biological Incident Response Force (CBIRF).
q Bureau of Alcohol, Tobacco, and Firearms (ATF).
q Department of Energy (DOE).
q Nuclear Emergency Search Team (NEST).
q Local emergency managers.

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Section IV-5: Assisting Agencies (cont.)

q Assorted state agencies (Local Law Enforcement, State

Police, etc.)
This list is not all encompassing. Different types of
incidents will generate different responses by assisting
agencies. Supplement this list with local/state resources
as needed.

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Section IV-5: Assisting Agencies (cont.)

Local Law Enforcement:

FBI Area Office WMD Coordinator:

Local Emergency Management

Point of Contact:

Public Health/Medical Representative:

Public Works:

Utilities:
Gas:
Electric:
Water:
Sewer:
Telephone Service Provider:

National Response Center: 1-800-424-8800

Centers for Disease Control: 1-800-311-3435

Hospital Contacts:

Assisting Agencies IV-5-3

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n V. GLOSSARY OF TERMS

Glossary of Terms
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Section V-1: Glossary of Terms

Asymptomatic Exposed persons who are not exhibiting

signs/symptoms of exposure.
B-NICE Pertaining to biological, nuclear, incendiary,
chemical, or explosives.
CBRNE Pertaining to chemical, biological,
radiological, nuclear, and explosive.
Casualty Collection Point Predefined location at which patients are
(CCP) collected, triaged, and provided with initial
medical care.
Choke Point Natural or manmade area that maypresent
congestion hazard.
Cold (Support) Zone Clean area outside the inner perimeter
where Command and support functions
take place. Special protective clothing is
not required in this area.
CST National Guard WMD Civil Support Team.
DMAT Disaster Medical Assistance Team.
DMORT Disaster Mortuary Response Team.
DOT-ERG DOT Emergency Response Guide
Egress Designated exit area.
EOD Explosive Ordnance Disposal.
Gross Decontamination Initial decontamination to remove large
amounts of decontaminants.
HMRT Hazardous Materials Response Team
Hot (Exclusion) Zone Area immediately around the incident where
serious threat of harm exists. It should
extend far enough to prevent adverse
effects from CBRNE agents to personnel
outside the zone. Entry into the hot zone
requires appropriately trained personnel
and use of proper personal protective
equipment.
HVAC Heating, Ventilating, and Air Conditioning.
ICS Incident Command System.

Glossary of Terms V-1

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Section V-1: Glossary of Terms (cont.)

Inner Perimeter Secured inner area of operations.

Mass Decontamination Decontamination process used on large
number of contaminated victims.
MRS Metropolitan Response System.
MMRS Metropolitan Medical Response Team.
NMRT National Medical Response Team.
Outer Perimeter Outermost area from hazard that is secure.
Patient Staging Area Area where patients may receive continued
(PSA) medical treatment.
Persistent Agent An agent that upon release retains its
casualty-producing effects for an extended
period of time, usually anywhere from 30
minutes to several days. A persistent agent
usually has a low evaporation rate and its
vapor is heavier than air. Therefore, its
vapor cloud tends to hug the ground. It
is considered to be a long-term hazard.
Although inhalation hazards are still a
concern, take extreme caution to avoid skin
contact as well.
POC Point of Contact.
Point Source Letter, package, or dispersal area of agent.
PPE Personal Protective Equipment.
Protect- In- Place Method of protecting public by limiting
exposure.
Rally Point A predetermined location to which all
persons evacuate in an emergency. In
industry, facilities are evacuated and a rally
point is usually predetermined. It is at this
rally point that resources can regroup and a
revised plan can be established.

Glossary of Terms V-2

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Section V-1: Glossary of Terms (cont.)

Safe Refuge Area (SRA) An area within the contamination

reduction zone for assembling individuals
who are witnesses to the incident.
This assemblage will provide for the
separation of contaminated persons from
noncontaminated persons.
SCBA Self-Contained Breathing Apparatus.
SLUDGEM Acronym for salivation, lacrimation,
urination, defecation, gastric distress,
emesis and miosis.
Symptomatic Exhibiting signs/symptoms of exposure.
Time, Distance and Three types of protective measures
Shielding (TDS) commonly associated with hazardous
materials training.
TRACEM-P The acronym used to identify the six types
of harm one may encounter at a terrorist
incident: thermal, radioactive, asphyxiation,
chemical, etiological, mechanical and
psychological. Note: Some sources use the
acronym TEAM CPR, which stands
for thermal, etiological, asphyxiation,
mechanical, chemical, psychological, and
radioactive.
Unified Command In ICS, Unified Command is a unified
team effort which allows all agencies with
responsibility for the incident to establish
a common set of incident objectives and
strategies. This is accomplished without
losing or abdicating agency authority,
responsibility, or accountability.
VEE Venezuelan equine encephalitis.

Glossary of Terms V-3

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Section V-1: Glossary of Terms (cont.)

Weapon of Mass 1) Any explosive, incendiary, poison gas,

Destruction (WMD) bomb, grenade, or rocket having a
propellant charge of more than four
ounces, missile having an explosive or
incendiary charge of more than one-
quarter ounce, or mine or device similar
to the above.
2) Poison gas.
3) Any weapon involving a disease organism.
4) Any weapon designed to release
radiation at a level dangerous to human
life.

Glossary of Terms V-4