**Response Protocol Toolbox:**

Planning for and Responding to

Drinking Water Contamination Threats and Incidents

**Module 5: Public Health Response Guide**

Interim Final -- April 2004

![](media/image1.wmf)

**OTHER RESPONSE PROTOCOL TOOLBOX MODULES**

> **Module 1: Water Utility Planning Guide** *(December 2003)*
>
> Module 1 provides a brief discussion of the nature of the
> contamination threat to the public water supply. The module also
> describes the planning activities that a utility may undertake to
> prepare for response to contamination threats and incidents.
>
> **Module 2: Contamination Threat Management Guide** *(December 2003)*
>
> Module 2 presents the overarching framework for management of
> contamination threats to the drinking water supply. The threat
> management process involves two parallel and interrelated
> activities: 1) evaluating the threat, and 2) making decisions
> regarding appropriate actions to take in response to the threat.
>
> **Module 3: Site Characterization and Sampling Guide** *(December
> 2003)*
>
> Module 3 describes the site characterization process in which
> information is gathered from the site of a suspected contamination
> incident at a drinking water system. Site characterization activities
> include the site investigation, field safety screening, rapid field
> testing of the water, and sample collection.
>
> **Module 4: Analytical Guide** *(December 2003)*
>
> Module 4 presents an approach to the analysis of samples collected
> from the site of a suspected contamination incident. The purpose of
> the Analytical Guide is **not** to provide a detailed protocol.
> Rather, it describes a framework for developing an approach for the
> analysis of water samples that may contain an unknown contaminant. The
> framework is flexible and will allow the approach to be crafted based
> on the requirements of the specific situation. The framework is also
> designed to promote the effective and defensible performance of
> laboratory analysis.
>
> **Module 5: Public Health Response Guide** *(April 2004)*
>
> Module 5 deals with the public health response measures that would
> potentially be used to minimize public exposure to potentially
> contaminated water. It discusses the important issue of who is
> responsible for making the decision to initiate public health response
> actions, and considers the role of the water utility in this decision
> process. Specifically, it examines the role of the utility during a
> public health response action, as well as the interaction among the
> utility, the drinking water primacy agency, the public health
> community, and other parties with a public health mission.
>
> **Module 6: Remediation and Recovery Guide** *(April 2004)*
>
> Module 6 describes the planning and implementation of remediation and
> recovery activities that would be necessary following a confirmed
> contamination incident. The remediation process involves a sequence of
> activities including: system characterization; selection of remedy
> options; provision of an alternate drinking water supply during
> remediation activities; and monitoring to demonstrate that the system
> has been remediated. Module 6 describes the types of organizations
> that would likely be involved in this stage of a response, and the
> utility's role during remediation and recovery.

**ACKNOWLEDGEMENTS**

This document was prepared by the United States Environmental Protection
Agency, Office of Ground Water and Drinking Water, Water Security
Division through a contract with SAIC. The EPA Work Assignment Manager
was Brain Frazer, and the SAIC Work Assignment Manager was Mary Wolfe.
The primary contributors to the document included:

-   Steven C. Allgeier (US EPA, OGWDW)

-   Mark J. Klingenstein (SAIC)

-   Jennifer L. Larkin (SAIC)

-   Carol A. Winston (SAIC)

Other contributors included Susan Dolgin, Grace Robiou, and Veronika
Pesinova of the US EPA, OGWDW.

Additional support for this work was provided by a panel of peer
reviewers, including: Cliff Bowen (California DHS), Keith Burkhart
(ATSDR), Lisa Christ (US EPA, OGWDW), Steve Clark (US EPA, OGWDW), Steve
Dennis (Alameda County Water District), Lauren DiSano (US EPA, ORD), Ron
Hunsinger (EBMUD), Kim Fox (US EPA, ORD), Audrey Galizia (USEPA, ORD),
David Hartman (Cincinnati Water Works), Vincent Hill (CDC), Craig D.
Jackson (NYSDOH Bureau of Water Supply Protection), Dennis Juranek
(CDC), Bart Koch (MWD So. Cal.), Janice Lee (Wisconsin DPH), Carrie
Lewis (Milwaukee Water Works), Matthew Magnuson (USEPA, ORD), Maureen
McClelland (US EPA, Region 1), Janet Pawlukiewicz (US EPA, OGWDW), Alan
Roberson (AWWA), Eletha Brady-Roberts (USEPA, ORD), Stanley States
(Pittsburgh Water and Sewer Authority), Gene Taylor (US EPA, Region 10),
Gregory Welter (O'Brien & Gere Engineers), James Wheeler (US EPA, OWM),
Caroline Wehling (US EPA, OGC), and Kelvin Yamada (California DHS).

**TABLE OF CONTENTS**

1 Introduction: Objectives and Organization of the Module
[14](#introduction-objectives-and-organization-of-the-module)

2 Overview of Public Health Response
[16](#overview-of-public-health-response)

2.1 Public Health Response Planning
[18](#public-health-response-planning)

2.1.1 Integrating Public Health Response Planning into ERPs
[18](#integrating-public-health-response-planning-into-erps)

2.1.2 Identification of Agencies Involved in Public Health Response
[20](#identification-of-agencies-involved-in-public-health-response)

2.1.2 Development of Communications Strategy
[23](#development-of-communications-strategy)

2.1.3 Development of Operational and Public Health Response Actions
[26](#development-of-operational-and-public-health-response-actions)

3 Public Health Consequences due to Water Contamination
[28](#public-health-consequences-due-to-water-contamination)

3.1 Contaminant Properties [28](#contaminant-properties)

3.2 Assessing the Spread of Contaminant in the System
[33](#assessing-the-spread-of-contaminant-in-the-system)

3.2.1 Manual Assessment Methods [33](#manual-assessment-methods)

3.2.2 Water Distribution Models [35](#water-distribution-models)

4 Operational Response Options [38](#operational-response-options)

4.1 Containment of Suspect/Contaminated Water
[38](#containment-of-suspectcontaminated-water)

4.2 Novel Operational Responses to Contamination
[42](#novel-operational-responses-to-contamination)

5 Public Notification Strategy [43](#public-notification-strategy)

5.1 How to Decide What Type of Public Notification is Appropriate
[43](#how-to-decide-what-type-of-public-notification-is-appropriate)

5.2 Target Audience [46](#target-audience)

5.3 Content and Format of the Public Notification
[46](#content-and-format-of-the-public-notification)

5.3.1 Content [47](#content)

5.3.2 Format [48](#format)

5.3.3 Notifications for Special Populations
[49](#notifications-for-special-populations)

5.3.4 Data Visualization and Interpretation Tools
[50](#data-visualization-and-interpretation-tools)

5.4 Methods to Deliver the Public Notification
[50](#methods-to-deliver-the-public-notification)

6 Short-term Alternate Domestic Water Supply
[53](#short-term-alternate-domestic-water-supply)

6.1 Alternate Supply for Consumer Use
[53](#alternate-supply-for-consumer-use)

6.1.1 Who Provides the Alternate Water
[54](#who-provides-the-alternate-water)

6.1.2 Potential Household Sources of Emergency Water Supply
[55](#potential-household-sources-of-emergency-water-supply)

6.2 Alternate Supply for Firefighting Needs
[57](#__RefHeading___Toc69959833)

7 Returning to Normal Operation and Use
[59](#returning-to-normal-operation-and-use)

8 References and Resources [60](#references-and-resources)

9 Appendices [62](#appendices)

9.1 Contaminant Characterization and Transport Worksheet
[62](#contaminant-characterization-and-transport-worksheet)

9.2 Public Health Response Action Worksheet
[68](#public-health-response-action-worksheet)

9.3 Example Notifications [72](#example-notifications)

9.3.1 Example Boil Water Notice [73](#example-boil-water-notice)

9.3.2 Example Do Not Drink Notice [74](#example-do-not-drink-notice)

9.3.3 Example Do Not Use Notice [75](#example-do-not-use-notice)

9.3.4 Example Notice for an Unknown Contaminant
[76](#example-notice-for-an-unknown-contaminant)

9.4 Description of the PipelineNet Distribution System Model
[77](#description-of-the-pipelinenet-distribution-system-model)

**LIST OF TABLES**

[Table 5-1. Public Health Response - Entities That Should Be Notified
25](#__RefHeading___Toc69960284)

[Table 5-2. Options for Short-term Alternate Supplies of Drinking Water
27](#__RefHeading___Toc69960285)

[Table 5-3. Properties Applicable to both Biological and Chemical
Contaminants 28](#__RefHeading___Toc69960286)

[Table 5-4. Properties Applicable to Chemical Contaminants
29](#__RefHeading___Toc69960287)

[Table 5-5. Properties Applicable to Biological Contaminants
31](#__RefHeading___Toc69960288)

[Table 5-6. Options for Short-term Alternate Supplies of Drinking Water
54](#__RefHeading___Toc69960289)

[Table 5-7. Alternate Water Sources in the Home
55](#__RefHeading___Toc69960290)

[Table 5-8. Public Guidance on Water Purification
56](#__RefHeading___Toc69960291)

**LIST OF FIGURES**

[Figure 5-1. Relationships among Components of PUBLIC Health Response
17](#__RefHeading___Toc69960619)

[Figure 5-2. Decision Process for Containment as a Public Health
Response 39](#__RefHeading___Toc69960620)

[Figure 5-3. Comparison of Contaminant Spread with and without Valve
Closure. 41](#__RefHeading___Toc69960621)

[Figure 5-4. Example Decision Process for Public Notification
44](#__RefHeading___Toc69960622)

[Figure 5-5. Output of Selection Process Showing Potential Monitoring
Locations. 79](#__RefHeading___Toc69960623)

[Figure 5-6. Water Quality Simulation. 81](#__RefHeading___Toc69960624)

[Figure 5-7. Consequence Assessment Tool.
82](#__RefHeading___Toc69960625)

[Figure 5-8. Isolation Tool Interface. 83](#__RefHeading___Toc69960626)

**DISCLAIMER**

The mention of trade names or commercial products does not constitute
endorsement or recommendation for use.

**DISCLAIMER**

This module summarizes and contains references to specific sections of
the Code of Federal Regulations (CFR) and to specific Statutes that
codify the Nation's environmental laws (e.g., the Public Notification
Rule). The summaries contained herein do not substitute for these
requirements. Interested persons should become familiar with the actual
federal regulations and

Statutes themselves, or the corresponding regulation adopted by the
primacy agency.

**ACRONYMS**

ATSDR Agency for Toxic Substances and Disease Registry

AWWA American Water Works Association

AWWARF American Water Works Association Research Foundation

CCR Consumer Confidence Report

CDC Centers for Disease Control and Prevention

CFR Code of Federal Regulations

DHHS Department of Health and Human Services

DHS Department of Homeland Security

EMPACT Environmental Monitoring for Public Access and Community Tracking

EMS Emergency medical services

EPS Extended period simulations

ERP Emergency response plan

ESF Emergency support function

ESRI Environmental Systems Research Institute

FBI Federal Bureau of Investigation

FEMA Federal Emergency Management Agency

GIS Geographic information system

HSPD Homeland Security Presidential Directive

ICS Incident Command System

JIC Joint information center

LRN Laboratory Response Network

NACCHO National Association of City and County Health Officials

NCP National Oil and Hazardous Substances Pollution Contingency Plan

NEDSS National Electronic Disease Surveillance System

NIOSH National Institute for Occupational Safety and Health

NRP National Response Plan

OSWER Office of Solid Waste and Emergency Response

PAO Public Affairs Officer

PN Public notification

PPE Personal protective equipment

RAIS Risk Assessment Information System

RR-MO FEMA's Response and Recovery Directorate\'s Mobile Operations
Division

RTECS Registry of Toxic Effects of Chemical Substances

SDWA Safe Drinking Water Act

UKWIR United Kingdom Water Industry Research

USACE United States Army Corps of Engineers

USAMRIID United States Army Medical Research Institute of Infectious
Diseases

US DOE United States Department of Energy

US EPA United States Environmental Protection Agency

UV Ultraviolet

WaterISAC Water Information Sharing and Analysis Center

WCIT Water contaminant information tool

WHO World Health Organization

WUERM Water Utility Emergency Response Managers

**GLOSSARY**

#  {#section .unnumbered}

Definitions in this glossary are specific to the Response Protocol
Toolbox but have been conformed to common usage as much as possible.

**Agency** -- a division of government with a specific function, or a
non-governmental organization (e.g., private contractor, business, etc.)
that offers a particular kind of assistance. In the Incident Command
System, agencies are defined as jurisdictional (having statutory
responsibility for incident mitigation) or assisting and/or cooperating
(providing resources and/or assistance).

**'Confirmatory' Stage** -- the third stage of the *threat management*
process from the point at which the threat is deemed 'credible', through
the determination that a contamination incident either has or has not
occurred.

**'Confirmed'** -- in the context of the *threat evaluation* process, a
water contamination incident is 'confirmed' if the information collected
during the threat evaluation process provides definitive evidence that
the water has been contaminated.

**Consequence** -- the adverse outcome resulting from a drinking water
contamination incident. In the context of the *threat management*
process, the consequence considers both the number of individuals
potentially affected as well as the severity of the health effect
experienced upon exposure.

**Consequence Management** -- DHS defines consequence management as
measures to protect public health and safety, restore essential
government services, and provide emergency relief to governments,
businesses, and individuals affected by the consequences of terrorism.

**Contaminant** -- any chemical, biological, or radiological substance
that has an adverse effect on public health or the environment.

**Contamination Site** -- the location where a contaminant is known or
suspected to have been introduced. For example, a distribution system
storage tank where a security breach has occurred may be designated as a
suspected contamination site. The contamination site will likely be
designated as an *investigation site* for the purpose of *site
characterization*.

**'Credible'** -- in the context of the *threat evaluation* process, a
water contamination threat is 'credible' if information collected during
the threat evaluation process corroborates information from the *threat
warning*.

**'Credible' Stage** -- the second stage of the *threat management*
process from the point at which the threat is deemed 'possible', through
the determination as to whether or not the threat is 'credible'.

**Drinking Water Primacy Agency** -- the *agency* that has primary
enforcement responsibility for national drinking water regulations,
namely the Safe Drinking Water Act as amended. Drinking water primacy
for a particular State or tribe may reside in one of a variety of
agencies, such as health departments, environmental quality departments,
etc. or may be US EPA. The drinking water primacy agency may also play
the role of *technical assistance provider* to drinking water utilities.

**Emergency Operations Center** -- a pre-designated facility established
by an *agency* or jurisdiction to coordinate the overall agency or
jurisdictional response to an emergency.

**Emergency Response Plan** -- a document that describes the actions
that a drinking water utility would take in response to various
emergencies, disasters, and other unexpected incidents.

**Field Safety Screening** -- screening performed to detect
environmental hazards (i.e., in the air and on surfaces) that might pose
a threat to the *site characterization* team. Monitoring for
radioactivity as the team approaches the site is an example of field
safety screening.

**Immediate Operational Response** -- an action taken in response to a
'possible' contamination threat in an attempt to minimize the potential
for exposure to the suspect water. Immediate operational response
actions will generally have a negligible impact on consumers.

**Impact** -- the consequence or effect on drinking water consumers, or
the utility itself, that results from the implementation of response
actions. An impact could also be considered as the cost of implementing
a response action.

**Incident** -- a confirmed occurrence that requires response actions to
prevent or minimize loss of life or damage to property and/or natural
resources. A drinking water contamination incident occurs when the
presence of a harmful contaminant has been confirmed.

**Incident Command System** -- a standardized on-scene emergency
management concept specifically designed to allow its user(s) to adopt
an integrated organizational structure equal to the complexity and
demands of single or multiple incidents, without being hindered by
jurisdictional boundaries.

**Incident Commander** -- the individual responsible for the management
of all incident operations.

**Information Officer** -- the individual responsible for interfacing
with the public and media or with other agencies requiring information
directly from the incident. Under the Incident Command System, there is
only **one** Information Officer per incident.

**Investigation Site** -- the location where site characterization
activities are performed. If a suspected *contamination site* has been
identified, it will likely be designated as a primary investigation
site. Additional or secondary investigation sites may also be identified
due to the potential spread of a contaminant.

**Joint Information Center** -- a center established to coordinate the
Federal public information activities on-scene. It is the central point
of contact for all news media at the scene of the incident. Public
information officials from all participating Federal agencies should
co-locate at the JIC. Public information officials from participating
State and local agencies also may co-locate at the JIC.

**Lead Agency** -- as defined in Homeland Security Presidential
Directive-7 (HSPD-7), the Federal department or agency assigned lead
responsibility to manage and coordinate a specific function --- either
crisis management or consequence management. Lead agencies are
designated on the basis that they have the most authorities, resources,
capabilities, or expertise relative to accomplishment of the specific
function.

**Mutual Aid Agreement** -- written agreement between agencies and/or
jurisdictions in which they agree to assist one another upon request by
furnishing personnel, equipment, or water.

**'Possible'** -- in the context of the *threat evaluation* process, a
water contamination threat is characterized as 'possible' if the
circumstances of the *threat warning* appear to have provided an
opportunity for contamination.

**'Possible' Stage** -- the first stage of the *threat management*
process from the point at which the *threat warning* is received through
the determination as to whether or not the threat is 'possible'.

**Public Health** -- the health and well being of an entire population
or community. Public health is not limited to the health of individuals.

**Public Health Response Plan** -- a document that describes public
health response actions taken in response to various emergencies,
disasters, and other unexpected incidents. The Public Health Response
Plan is typically developed by the State Health Department.

**Public Notification** -- under the Safe Drinking Water Act, public
water systems are required to notify their customers when they violate
US EPA or State drinking water standards (including monitoring
requirements) or otherwise provide drinking water that may pose a risk
to consumers\' health. 

**Rapid Field Testing** -- analysis of water during *site
characterization* using rapid field water testing technology in an
attempt to tentatively identify contaminants or unusual water quality.

**Response Decisions** -- part of the *threat management* process in
which decisions are made regarding appropriate response actions that
consider 1) the conclusions of the *threat evaluation*, 2) the
consequences of the suspected contamination incident, and 3) the impacts
of the response actions on drinking water customers and the utility.

**Response Guidelines** -- a manual designed to be used **during** the
response to a water contamination threat. Response Guidelines should be
easy to use and contain forms, flow charts, and simple instructions to
support staff in the field or decision officials in the *Emergency
Operations Center* during management of a crisis.

**"Reverse 911" Messaging** -- a communications product that establishes
a virtual calling network. This system enables public safety agencies to
telephone community residents with recorded messages informing them of
emergencies, hazards, major road closures, or other important matters
relevant to public health and public safety. The system is built on a
database of local resident and business phone numbers.

**Site Characterization** -- the process of collecting information from
an *investigation site* in order to support the evaluation of a drinking
water contamination threat. Site characterization activities include the
site investigation, *field safety screening*, *rapid field testing* of
the water, and sample collection. Site characterization is discussed in
Module 3.

**System Characterization** -- a detailed assessment of the nature and
extent of contamination in a drinking *water system* for the purpose of
planning remediation of the contaminated *water system*. The system
characterization process is modeled, in part, on the concept of a
*remedial investigation* under EPA's Superfund program and, similarly,
would be done with the *feasibility study*.

**Technical Assistance Provider** -- any organization or individual that
provides assistance to drinking water utilities in meeting their mission
to provide an adequate and safe supply of water to their customers. The
*drinking water primacy agency* may serve as a technical assistance
provider.

**Terrorist Incident** -- the FBI defines a terrorist incident as a
violent act, or an act dangerous to human life, in violation of the
criminal laws of the United States or of any State, to intimidate or
coerce a government, the civilian population, or any segment thereof in
furtherance of political or social objectives.

**Threat** -- an indication that a harmful *incident*, such as
contamination of the drinking water supply, may have occurred. The
threat may be direct, such as a verbal or written threat, or
circumstantial, such as a security breach or unusual water quality.

**Threat Evaluation** -- part of the *threat management* process in
which all available and relevant information about the threat is
evaluated to determine if the threat is 'possible' or 'credible', or if
a contamination *incident* has been 'confirmed'. This is an iterative
process in which the threat evaluation is revised as additional
information becomes available. The conclusions from the threat
evaluation are considered when making *response decisions*.

**Threat Management** -- the process of evaluating a contamination
threat and making decisions about appropriate response actions. The
threat management process includes the parallel activities of the
*threat evaluation* and making *response decisions*. The threat
management process is considered in three stages: 'possible',
'credible', and 'confirmatory'. The severity of the threat and the
magnitude of the response decisions escalate as a threat progresses
through these stages.

**Water Contamination Incident** -- a situation in which a contaminant
has been successfully introduced into the system. A water contamination
incident may or may not be preceded by a water contamination threat.

**Water Contamination Threat** -- a situation in which the introduction
of a contaminant into the water system is threatened, claimed, or
suggested by evidence. Compare *water contamination threat* with *water
contamination incident.* Note that threatening a water system may be a
crime under the Safe Drinking Water Act as amended by the Public Health
Security and Bioterrorism Preparedness and Response Act of 2002.

**Water Utility Emergency Response Manager (WUERM)** -- the
individual(s) within the drinking water utility management structure
that has the responsibility and authority for managing certain aspects
of the utility=s response to an emergency (e.g., a contamination threat)
particularly during the initial stages of the response. The
responsibilities and authority of the WUERM are defined by utility
management and will likely vary based on the circumstances of a specific
utility.

# Introduction: Objectives and Organization of the Module

The primary intended users of this module include water utility staff
and agencies, *drinking water primacy agencies*, and *technical
assistance providers* that will assist water utilities during the
response to a *water contamination threat* or *incident*. In addition,
public health *agencies* (e.g., US Environmental Protection Agency,
State and local health departments, Centers for Disease Control and
Prevention) are encouraged to read this module because they will
typically be involved in choosing and implementing the public health
response actions taken during a water contamination threat. The
objective of Module 5 is to help the user understand the issues and
activities involved in public health response to a contamination
incident or threat, including:

-   Identification of the organizations and officials responsible for
    making and implementing public health *response decisions* for
    drinking water.

-   Understanding the role of the drinking water utility during public
    health response to a water contamination threat.

-   Evaluation of the public health consequences due to water
    contamination, and identification of resources and techniques to aid
    in consequence evaluation.

-   Evaluation of response options to limit exposure to the public, by
    containing the suspect water and/or notifying the public to limit
    their use of the water.

-   Development of communication procedures and structures both within
    the responding organizations and also for communication with the
    public and the media.

-   Identification of potential short-term alternate water supplies.

This module is organized into eight sections as described below. Water
utility and public health officials are encouraged to review this module
in its entirety, as well as the other modules in the "Response Protocol
Toolbox," to obtain a comprehensive understanding of public health
response for water contamination threats and incidents.

Section 1: [Introduction]{.underline}: describes the overall
organization and objectives of this module.

Section 2: [Overview of Public Health Response]{.underline}: describes
the organizations that may be involved in public health response
decisions, response options, *impacts* of particular response actions,
and communications.

Section 3: [Public Health Consequences due to Water
Contamination]{.underline}: includes general procedures for evaluating
contaminant characteristics such as acute and chronic effects of
exposure, exposure routes, and stability of the contaminant in water,
and methods of estimating the spread of contaminated water.

Section 4: [Operational Response Options]{.underline}: describes
containment options and other novel operational responses.

Section 5: [Public Notification Strategy]{.underline}: discusses public
notification as a means of reducing or mitigating exposure and avoiding
panic.

Section 6: [Short-term Alternate Domestic Water Supply]{.underline}:
discusses issues to be considered in planning for an alternate water
supply to meet the needs of domestic consumption and sanitation,
firefighting activities, and customers with special requirements. (This
section will consider the need for an alternate water supply over a
short duration. Long-term alternate water supply needs will be addressed
in Module 6.)

Section 7: [Returning to Normal Operations and Use]{.underline}:
describes the actions to be taken and presents examples of returning to
normal operations.

Section 8: [References and Resources]{.underline}: includes literature
citations, sources of internet information, and other publications of
relevance to public health response.

Section 9: [Appendices]{.underline}: includes forms and tools that
support this module and that may aid in preparing for public health
response to a contamination threat.

# Overview of Public Health Response

In the context of this module, public health response can be defined as
the actions taken to mitigate consequences resulting from threats or
incidents involving biological, chemical, or radiological contaminants.
Public health response is one component of the *threat management*
process, which is described in detail in Module 2. Figure 5-1 provides
an overview of the public health response process, which is considered
in the following five major components:

1.  [Conduct planning]{.underline} -- During the planning phase, the
    roles and responsibilities of the agencies involved in public health
    response are identified; the communication strategy is developed;
    and the feasibility of potential operational response actions is
    evaluated. A water utility may choose to address its role during a
    public health response as part of the development or revision of its
    emergency response plan (ERP). As part of planning, identified gaps
    in operating procedures, technical capabilities, and communication
    should be addressed. As with all response plans, regular exercising
    of the plan is critical to effective implementation. The planning
    component is discussed in Section 2.1 of this module.

2.  [Determine public health consequences due to water
    contamination]{.underline} -- This is the process of assessing the
    properties and health effects of contaminants, as well as the
    potential spread of the contaminated water, which will support
    appropriate public health response decisions. However, the detailed
    information necessary to assess potential health consequences will
    be unknown or poorly characterized in the time frame in which public
    health decisions need to be made in many cases. The utility and
    public health agencies should be prepared to respond given these
    uncertainties, as discussed in Section 3 of this module.

3.  [Implement operational responses]{.underline} -- Certain operational
    responses identified during the planning process may be implemented
    in response to a *'possible'* or *'credible'* contamination threat
    if they are deemed feasible and effective. These operational
    response actions are generally limited to containment of suspect
    water in a distribution system, but other novel operational
    responses may be considered, as discussed in Section 4 of this
    module.

4.  [Implement public notification strategy]{.underline} -- The public
    notification strategy will aid in the development and distribution
    of appropriate notifications and instruction to the public. These
    notifications will be a key component of an effective response to a
    'credible' threat or *'confirmed'* incident. Section 5 provides
    guidance regarding the development of appropriate and effective
    public notification.

5.  [Implement alternate water supply]{.underline} - If restrictions are
    placed on water consumption or use due to a public health response
    action, it may be necessary to provide an alternate supply of
    domestic water. Section 6 discusses various options for short-term
    alternate drinking water supplies and their implementation by the
    appropriate organization.

![](media/image2.wmf)[]{#__RefHeading___Toc69960619 .anchor}**Figure
5-1. Relationships among Components of Public Health Response**

While Figure 5-1 is shown as a sequential process, the implementation
steps are not necessarily implemented sequentially, but rather may be
implemented individually or in combination at any point throughout the
threat management process. For example, it is highly possible that the
water utility could be evaluating the contaminant's properties,
implementing containment, and providing public notification
simultaneously during one or more stages of the threat management
process. The consideration of each public health response action at the
'possible', 'credible', and 'confirmatory' stages of the threat
management process is described in detail in Sections 3.1.8, 4.2.3, and
5.2 of Module 2, respectively.

## Public Health Response Planning

This section describes four key components of public health response
planning: integrating public health response planning into ERPs,
identifying agencies involved in public health response, developing a
communications strategy, and developing operational and public health
response actions. These components are described in Sections 2.1.1,
2.1.2, 2.1.3 and 2.1.4, respectively.

In addition to these four key components, training is critical to
ensuring smooth implementation of public health response. Training
should be conducted for all parties with responsibilities under the
Public Health Response Plan to ensure that all parties understand their
role and can implement the plan properly. The utility also should
conduct training on implementation of its ERP, including public
communication and short-term alternate water supplies. Additionally,
integrated public health response should be tested as part of a
table-top or actual field exercise involving all parties with a role,
such as public health agencies, the medical community, the utility,
laboratories, and others. The National Association of City and County
Health Officials (NACCHO) developed a table-top exercise template tool
that parties may use to exercise their plans.

### Integrating Public Health Response Planning into ERPs

Public health response planning should be integrated into planning at
both the State and local levels. Before initiating public health
response planning, a water utility should identify and evaluate any
existing emergency response or public health response plans at the State
or local level. Examples of such plans are described below.

**State ERPs** - States typically have ERPs that are wide-ranging and
designed to address the range of emergencies the State may face. Among
other objectives, these plans may address the protection of critical
infrastructure, such as water, approaches to public health protection
(described more fully in the State's Public Health Response Plan), and
communications strategies at the State level. The State drinking water
primacy agency may also have plans in place to address emergencies.

**State or Local Health Department Public Health Response Plans** - The
State or local health department typically develops a Public Health
Response Plan, which covers responses to a variety of public health
emergencies, potentially including *water contamination incidents*. Such
a plan may cover public health surveillance and epidemiological
investigations conducted by the medical community, laboratory diagnosis,
laboratory capacity planning, medical management, reconstruction of the
patients' recent whereabouts to determine potential sources of exposure,
and *consequence management*. To assist in the development of a Public
Health Response Plan, the Centers for Disease Control and Prevention
(CDC) published a planning guidance document entitled \"The Public
Health Response to Biological and Chemical Terrorism: Interim Planning
Guidance for State Public Health Officials\" (CDC, 2001a).

**City or Regional ERPs** - Cities or Regional governmental agencies
often develop ERPs that establish a plan of action and organizational
structure to efficiently respond to a variety of emergencies such as
fires, floods, tornadoes, terrorism, chemical and biological weapons
threats, workplace violence, major utility disruptions, etc. The plan
may delineate the roles and responsibilities of each agency involved
(municipal, State, Federal, and the private sector) in emergency
response; define what constitutes and who declares an emergency; provide
guidelines for implementation of the ERP components; and address
communication procedures (e.g., creating a list of key public- and
private-sector personnel who would respond to an emergency).

**Utility ERPs** - Finally, local drinking water utilities have ERPs
that consider vulnerabilities identified during a vulnerability
assessment and outline response plans for a variety of emergencies. The
utility's ERP should identify Federal, State, and local agencies that
need to be involved in response actions and address the roles and
responsibilities of the utility and these agencies during public health
response. These include a public notification strategy in the event of
loss of potable water due to any cause, including contamination, and a
plan for obtaining alternate water supplies should they be needed. The
ERP should include procedures for rapidly initiating strategies to
contain water suspected of being contaminated. To assist in the
development of utility ERPs, US EPA published the following two
documents: "Large Water System Emergency Response Plan Outline: Guidance
to Assist Community Water Systems in Complying with the Public Health
Security and Bioterrorism Preparedness and Response Act of 2002" (US
EPA, 2003) and "Small and Medium Water System Emergency Response Plan
Guidance to Assist Community Water Systems in Complying with the Public
Health Security and Bioterrorism Preparedness and Response Act of 2002"
(US EPA, 2004a).

Local and State health departments and utilities should work together to
fine-tune their public health response plans for water contamination
incidents. The utility should understand how the public health response
plans of local and State health departments would address a water
contamination incident and should integrate appropriate portions of
these plans into the utility ERP. In some cases, the local and State
health department's plan may need to be modified to address a water
contamination incident. The utilities and public health departments
should establish specific agreements on standardized communications
protocols, triggers for initiating notifications between the health
department and water utility, and analytical support from public health
labs.

In addition, there may be potential challenges in sharing data between
the public health agency and the utility (e.g., the public health agency
may not be able to share addresses based on patient privacy
constraints). The utility and public health agency should review any
requirements for special clearances necessary to share public health and
utility data as part of planning for a public health response.

The level at which public health response to a water contamination
threat or incident starts and which ERP takes precedence will depend on
the nature of the incident. Some of the factors that may determine which
ERP takes precedence include who discovers the incident, whether Federal
agencies are involved, and whether the public is already experiencing
illnesses. Furthermore, the lead agency and the role of supporting
agenicies may change during an incident, as discussed in Module 1. To
facilitate these transitions, utilities and other agencies should
incorporate the Incident Command System (ICS) in their ERPs, which is
discussed in Module 1, Section 4.4.

### Identification of Agencies Involved in Public Health Response

In preparing a Public Health Response Plan, the State health department
will most likely identify the agencies (at the Federal, State, and local
levels) to be involved in response during any type of public health
emergency, which would include water contamination incidents. Examples
include local (often county or city-level) public health agencies,
medical centers and hospitals, regional poison control centers, State
health departments and laboratories, and Federal agencies such as the
Department of Health and Human Services (DHHS) \[including CDC and the
Agency for Toxic Substances and Disease Registry (ATSDR)\] and the
United States Environmental Protection Agency (US EPA). The roles and
responsibilities of each of the identified agencies involved in public
health response should be defined in the Public Health Response Plan.

Significant roles and areas of responsibility for selected agencies and
groups in support of public health response are described below. In
addition, the roles and responsibilities of the water utility, which
plays an important role in public health response to water contamination
incidents, are described in detail at the end of this section. These
agencies and groups are subject to various regulatory requirements, so
their roles and responsibilities are subject to applicable regulations
and hence may be dependent on the nature of the contamination threat or
incident. The roles and responsibilities for other Federal agencies are
discussed throughout the remainder of this module where appropriate
(also in Module 1, Appendix 6.2 and Module 6, Section 2.2).

**Water Utility** -- The water utility will possess the most detailed
first-hand knowledge and technical expertise regarding the configuration
and operation of the water source, storage, treatment, and distribution
systems. Accordingly, water utility personnel will support immediate
operational responses (e.g., evaluation and implementation of
containment options). The water utility personnel will also be experts
in interpreting and explaining their operational and water quality data,
and can provide an historic perspective to the interpretation of this
data. In addition, the water utility will support, or potentially be the
lead agency for public notification, depending on arrangements made with
the State/local health department or drinking water primacy agency. The
water utility may also provide accurate and up-to-date information on
the water system to the designated information officer or media point of
contact. It is especially important that during public health response
planning, local health departments and utilities hold joint discussions
and develop an integrated response plan for water-related events that
clearly defines each organization's respective roles and
responsibilities to ensure that their plans are consistent with existing
State and local emergency response plans. The utility should participate
in drills designed to exercise communication networks, with the
understanding that the utility may not be the lead agency for public
notification when dealing with intentional contamination.

**Drinking water primacy agency --** The drinking water primacy agency
is the agency that has primary enforcement responsibility for national
drinking water regulations, namely, the Safe Drinking Water Act as
amended. The drinking water primacy agency is typically the State public
health department or the State environmental agency; however, US EPA is
the drinking water primacy agency for Wyoming, the District of Columbia,
and most of Indian country. The drinking water primacy agency will
provide guidance and oversight of public notifications. The drinking
water primacy agency should work with the State to ensure that the
State's ERP addresses water emergencies and with the water utility to
ensure that its ERP is consistent with the State's ERP. Additional roles
and responsibilities of the State public health department and US EPA in
support of public health response are described below.

**State public health department** -- The State public health department
is responsible for developing a Public Health Response Plan that
includes an effective communications strategy and identifies specific
actions to take in response to all types of public health emergencies,
including terrorist incidents. The health department may also coordinate
the investigation and control of disease, including coordinating the
allocation of medications essential to the public and implementing
appropriate public health response actions (e.g., issue health
advisories and protective action guides to the public). The State public
health department also typically has a clinical laboratory that is part
of the LRN and which may provide analytical support, particularly for
biological contaminants, in the case of a suspected contamination
incident. The State health department also provides support to local
emergency operations and serves as liaison to Federal and emergency
health and medical programs and services.

**Local public health department** -- The local public health
departments may assist in diagnosing and investigating disease outbreaks
and may have their own disease surveillance system in place. They may
coordinate the care to be provided by local health care entities and
provide mass prophylaxis to prevent epidemics. Local public health
departments may have authority and responsibility to issue public
notification to protect public health. In addition, the local public
health department may concur with the water utility regarding public
notification required under the Safe Drinking Water Act (SDWA).

**Hospital staff, clinics, physicians, and poison control centers** --
In accordance with individual State laws, health care personnel report
to the appropriate designated agency information on respiratory
infections, skin rashes, diarrhea, and other syndromes that may provide
an early warning of an outbreak of diseases such as anthrax, plague, and
smallpox, as well as the intentional release of more common infectious
agents. The ongoing reporting, compilation, and analysis of this data
can lead to the early detection of *terrorist incidents* as well as
other potential public health emergencies. Health care personnel are
also responsible for proper care and treatment of the impacted public
and containment of infectious diseases to the maximum degree possible.
Regional poison control centers have expertise in the diagnosis and
management of poisoning, including those involving hazardous substances.
In addition, they are actively involved in surveillance, including
collaboration with the CDC and ATSDR. The closest poison control center
can be reached by the national toll free number, 1-800-222-1222.

**State office of emergency services --** Most State offices of
emergency services coordinate overall State agency response to major
disasters in support of local government. The office is usually
responsible for assuring the State's readiness to respond to, and
recover from, natural, man-made, or war-caused emergencies and assisting
local governments with emergency response and recovery efforts. It is
important for water utilities and public health agencies to involve
their State office of emergency services in the planning process to
investigate the types of resources this office can provide in a crisis.

**Local office of emergency services --** Most city or county offices of
emergency services are mandated to coordinate disaster activities,
before, during, and following catastrophic emergencies impacting the
citizens of their particular jurisdiction. Local emergency service
offices usually provide planning, training, and coordination to county
or city departments and other agencies within their jurisdiction. In
most States, these local offices can provide a link to State and Federal
resources during a disaster.

**US Environmental Protection Agency (US EPA)** -- US EPA will typically
activate technical capabilities to support the Federal response to
terrorist incidents. US EPA may coordinate with individual agencies
identified in the National Oil and Hazardous Substances Pollution
Contingency Plan (NCP) to use the structure, relationships and
capabilities of the National Response System as described in the NCP
\[40 Code of Federal Regulations (CFR) Part 300 subpart B\] to support
the response operations. US EPA will also provide resources to help the
water utility assess the public health consequences due to a particular
water contaminant and the appropriate operational response actions to
take.

**Centers for Disease Control and Prevention (CDC)** -- An operating
division of DHHS, CDC develops resources to assist hospital staff,
clinics, and physicians in diagnosing diseases related to terrorism,
reporting incidences of disease, and controlling the spread of
infection. Working with States and other partners, CDC provides a system
of health surveillance to monitor disease and minimize the spread of
outbreaks, implement disease prevention strategies, and maintain
national health statistics. CDC provides expertise for investigating
unusual public health episodes, environmental contamination, and
unexplained illnesses. In 1999, CDC established the Laboratory Response
Network (LRN), which is a national network of approximately 120 clinical
laboratories that can respond to biological and chemical terrorism.
LRN's resources may be activated when the FBI designates that there is a
credible threat to water.

**Agency for Toxic Substances and Disease Registry (ATSDR) -** An
operating division of DHHS, ATSDR performs specific functions concerning
the public health effects of hazardous substances in the environment.
Some of these functions include health surveillance and registries,
response to emergency releases of hazardous substances, applied research
in support of public health assessments, and information development and
dissemination.

**Federal Emergency Management Agency (FEMA) --** FEMA, which is part of
the Department of Homeland Security (DHS), is the lead Federal agency
for supporting State and local response to the consequences of public
health emergencies, including natural disasters and terrorist attacks.
In response to requests from State or local agencies, FEMA provides
support through the Response and Recovery Directorate\'s Mobile
Operations Division, which can provide mobile telecommunications,
operational support, life support, and power generation (FEMA, 2003d).
FEMA may also train emergency personnel in preparation for emergency
situations (FEMA, 2003a).

**US Army Corps of Engineers (USACE)** -- Under National Response Plan
(NRP) Emergency Support Function (ESF) #3, Infrastructure Annex, USACE,
along with FEMA, serves as one of the primary agencies responsible, in
part, for emergency restoration of critical public facilities (e.g.,
temporary restoration of water supplies and emergency contracting to
support public health and safety).

Coordination among public health response agencies at all levels is
critical to the successful implementation of public health response
actions. The mechanisms for this coordination may be via phone, pagers,
or any other means of rapid and reliable communication. Another valuable
tool for rapid information exchange is the Water Information Sharing and
Analysis Center (WaterISAC). WaterISAC
([www.waterisac.org](http://www.waterisac.org/)) is a highly secure,
Web-based information service available only to subscribers. It provides
drinking water and wastewater utility managers with fast access to
sensitive information about physical, contamination, and cyber threats.
Established by the Association of Metropolitan Water Agencies, with
support from US EPA, WaterISAC gathers, analyzes, and disseminates
information on threats and incidents that is specific to the water
sector. It serves as an important link between the water sector and
Federal environmental, homeland security, law enforcement, intelligence,
and public health agencies. In addition to providing a forum for
sensitive water security discussions, WaterISAC provides information
resources for improvements to water system security and emergency
response plans.

### Development of Communications Strategy

Reliable and rapid communications are crucial to ensure a prompt and
coordinated public health response to a water contamination threat or
incident. The first step for a successful response is information
sharing and communication among water utilities, public health response
agencies, emergency response agencies , and any other agencies with
identified roles during a public health response. Ongoing communication
of accurate and up-to-date information can facilitate public health
response by the responsible agencies, help to minimize public health
consequences, and aid in calming public fears.

Especially important is communication with public health agencies.
Two-way communication between water utilities and public health agencies
is critical and should be routinely tested in advance of a water
contamination threat or incident. The *Incident Commander* (see Module
1, Section 4.4) of the investigation, who may or may not be from the
utility, should report a '*credible*' *contamination threat* to public
health agencies so physicians, hospital staff, and clinical laboratories
can be alerted regarding potential signs and symptoms that should be
reported to the public health department. In some cases, the
contamination threat may be identified by public health agencies, and
arrangements should be made for public health agencies to communicate
with water utilities regarding unusual symptoms that may have a
connection to drinking water.

The drinking water utility and public health officials should develop
criteria regarding when these notifications should occur and identify
the key contacts within each agency to ensure that effective
communications occur as a potential water-related public health incident
unfolds. Public health agencies should implement public health
surveillance procedures to determine if an increase in the occurrence of
unusual symptoms, or an increase in sales of over-the-counter
pharmaceutical products, warrants an investigation. The public health
agencies' notification procedures should include notification to the
drinking water utility if it is determined that the drinking water is a
potential cause of the increased death/disease. Coordination of
notification procedures between the Public Health Response Plan and the
utility's ERP will be critical to seamless notification protocols. Where
available, electronic means of information exchange/communication can
greatly enhance communications and the speed of response. One such
example is the National Electronic Disease Surveillance System (NEDSS)
being developed by CDC for automated, timely electronic capture of data
from the healthcare system.

Some critical features of effective communications are as follows:

-   A comprehensive communications and public notification strategy
    addresses the "why, who, when, what, and how" of relaying
    information to agencies involved in public health response, as well
    as to the media and public when necessary. It should identify the
    information to be communicated, target audience, potential
    dissemination vehicles, resources required, and feedback mechanisms.

```{=html}
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```
-   The strategy should include a list of entities to be contacted and a
    notification roster that contains the appropriate contact names,
    titles, addresses, and all applicable landline, cellular phone, and
    pager numbers. The list should also identify the secondary contact
    if the primary contact in an organization cannot be reached in a
    reasonable amount of time. This list should be maintained and
    updated on a periodic basis. In addition, the communications
    protocol should define the reasonable amount of time and effort that
    should be expended before emergency response actions are taken
    without consulting the organizations that could not be reached.
    Whenever practical, the communications list should be standardized
    in format among agencies to allow ease and consistency in updating.

-   In extreme emergencies (e.g., the terrorist incident involves more
    than contamination of the water system), it may not be possible to
    use normal channels of communication such as phones. Provisions
    should be made for an efficient and reliable form of backup
    communication to be available during emergency conditions when the
    use of normal facilities may be denied by the crisis. The utility,
    public health departments, and local or State emergency operations
    center may have already established backup forms of emergency
    communication.

-   Communications protocols should be endorsed by all involved
    agencies, tested prior to finalization, and exercised periodically.

As presented in Module 1, the Incident Commander will decide on the
appropriate communication to be implemented. The water utility should
have its own strategy in the event that (1) they are responsible for
incident command (potentially during the 'possible' and *'*credible'
stages of the threat management process) or (2) they are delegated
responsibility for communication by the Incident Commander.

Table 5-1 consists of a list of potential entities to be notified as
part of public health response, as well as the purpose of the
notification for each entity notified. Each utility should identify in
its ERP the appropriate entities to be notified. It is important to note
that under 40 CFR Part 141, Subpart Q \[the Federal Public Notification
(PN) Rule\], utilities must provide public notice to persons served by
the water system in situations with significant potential to have
serious adverse effects on human health as a result of short-term
exposure. Such a situation requires a Tier 1 notice under the Federal
Rule. Persons served by the water system include renters and transient
populations in addition to billed customers.

The utility must also provide a copy of the public notice to the primacy
agency. In addition, utilities that sell or otherwise provide drinking
water to other public systems (i.e., consecutive systems) are required
to give notice to the owner or operator of the system; the consecutive
system is responsible for providing notice to the persons it serves. The
PN Rule is described more fully in Section 5.

  ------------------------------------------------------------------------------------------
  []{#__RefHeading___Toc69960284                       
  .anchor}Table 5-1. Public Health                     
  Response - Entities That Should                      
  Be Notified                                          
  -------------------------------- ------------------- -------------------------------------
  **Entity**                                           **Purpose of the Notification**

  Public Health Agencies           State/local health  To work with these officials in
                                   and/or              making the decision on the
                                   environmental       distribution of "boil water," "do not
                                   department          drink," or "do not use" notices.
                                                       These officials may be involved with
                                                       public health decisions related to
                                                       the proper use of the water supply,
                                                       status of the water distribution
                                                       system, selection of a short-term
                                                       alternate water supply, and
                                                       communicating the necessary public
                                                       health information.

                                                       

                                   Other associated    
                                   system authorities  
                                   (wastewater, water) 

                                   Poison Control      
                                   Centers             

  Emergency Responders             Emergency Medical   To notify the organization of the
                                   Services (EMS)      need for assistance with the
                                                       distribution of an alternate water
                                                       supply (e.g., bottled water) and
                                                       whether or not the contamination
                                                       impacts the availability of water for
                                                       firefighting. Also, these agencies
                                                       should be provided with all
                                                       information related to public health
                                                       including: information on water
                                                       notices, alternate water supplies,
                                                       critical care facilities, and public
                                                       health notifications.

                                                       

                                   Fire Department     

                                   State and/or Local  
                                   Office of Emergency 
                                   Services            

  Law                              Federal, State, and Local law enforcement should be
                                   local law           notified immediately if a malevolent
                                   enforcement         act is suspected. Law enforcement
                                                       agencies should also be notified of
                                                       the need for assistance with getting
                                                       important information out to the
                                                       public and the distribution of water
                                                       from the short-term alternate water
                                                       supply (i.e., distribution of bottled
                                                       water, etc.). Law enforcement
                                                       agencies should also be contacted
                                                       because the public may be contacting
                                                       them through 911 regarding the
                                                       incident.

  Consecutive Systems (i.e.,                           To provide information related to
  public water systems that                            restrictions on the use of the
  receive water from the water                         drinking water supply, as well as
  utility where the water                              instructions on obtaining alternate
  contamination threat or incident                     sources of drinking water, through
  occurred)                                            the duration of the incident. Also,
                                                       information should be provided on the
                                                       status of the water supply, the
                                                       potential problem, and what is being
                                                       done to manage the incident.

  Customers/Public                                     To provide information related to
                                                       restrictions on the use of the
                                                       drinking water supply, as well as
                                                       instructions on obtaining alternate
                                                       sources of drinking water, through
                                                       the duration of the incident. Also,
                                                       information may be provided on the
                                                       status of the water supply, the
                                                       potential problem, and what is being
                                                       done to manage the incident. Section
                                                       5 provides more detailed guidance
                                                       regarding public notification.

  Customers with special needs     Critical care       These facilities should be some of
                                   facilities (e.g.,   the first to be notified. Information
                                   hospitals, clinics, should be provided regarding the
                                   nursing homes,      proper use of the water supply for
                                   dialysis centers)   public health purposes as well as the
                                                       identity of the contaminant so these
                                                       facilities can identify the symptoms
                                                       of exposure as well as potential
                                                       medical treatment. They may be given
                                                       information on how water will be
                                                       provided or how they need to obtain
                                                       short-term alternate water supplies.
                                                       Critical care facilities may also
                                                       need to be notified of any changes in
                                                       the type of chemical disinfection
                                                       being used or the concentration of
                                                       these chemicals in the water as this
                                                       may affect some of their medical
                                                       procedures.

                                   Schools             To provide information regarding
                                                       restrictions on water use, alternate
                                                       water supplies, and other public
                                                       health information.

                                   Day Care Facilities To provide information regarding
                                                       restrictions on water use, alternate
                                                       water supplies, and other public
                                                       health information.

                                   Businesses (e.g.,   To provide information regarding
                                   food and beverage   restrictions on water use, alternate
                                   manufacturers,      water supplies, and other public
                                   commercial ice      health information. These customers
                                   manufacturers,      may also need information regarding
                                   restaurants,        whether heating or superheating the
                                   agricultural        water may pose a hazard.
                                   operations, power   
                                   generation          
                                   facilities, any     
                                   other businesses    
                                   identified by the   
                                   utility)            

  Other                            Elected officials   To provide all information related to
                                                       public health, including: the status
                                                       of the *threat evaluation*,
                                                       information on "boil water," "do not
                                                       drink," or "do not use" notices,
                                                       alternate water supplies, customers
                                                       with special needs, and public health
                                                       notifications.
  ------------------------------------------------------------------------------------------

### 2.1.3 Development of Operational and Public Health Response Actions  {#development-of-operational-and-public-health-response-actions .unnumbered}

Module 2 presented a threat management process under which responses
occur during the 'possible', 'credible', and 'confirmatory' stages.
Public health response decisions, which may include containment of the
suspect water and/or public notification regarding restrictions on water
use, may need to be considered at each stage as a means of minimizing
and/or preventing exposure to the suspect water. However, it is also
necessary to consider the potential impacts of response actions on the
public (e.g., the lack of a supply of water for drinking and
sanitation). In many cases, the responsibility will fall on the water
utility to determine the proper approach and methods to address water
supply related impacts of various response actions.

Potential operational and public health response actions should be
defined during the planning process. The plan should identify the agency
or organization that is responsible for carrying out the action(s) as
well as the circumstances under which the actions are to be taken (the
"Threat Management Matrices" presented in Module 2 may be useful for
this purpose). Operational responses to a 'possible' water contamination
threat include isolating and containing the affected portion of the
system and other novel operational responses. A detailed discussion of
implementing operational responses can be found in Section 4 of this
module.

Potential restrictions on water use that might be achieved through
public notification include issuing a "boil water" notice, "do not
drink" notice (no consumption), and "do not use" notice. A detailed
discussion of implementing public notification can be found in Section 5
of this module.

An extremely important element of public health response is the
identification of options and plans for a short-term alternate supply of
drinking water if the public is notified not to drink or use the water.
These options should be identified in the drinking water utility's ERP.
Table 5-2 provides a list of potential options for short-term supplies.
A detailed discussion of potential alternate water supplies can be found
in Section 6 of this module.

+---------------------+------------------------------------------------+
| []{#__RefHe         |                                                |
| ading___Toc69960285 |                                                |
| .anchor}Table 5-2.  |                                                |
| Options for         |                                                |
| Short-term          |                                                |
| Alternate Supplies  |                                                |
| of Drinking Water   |                                                |
+---------------------+------------------------------------------------+
| > **Type**          | > **Source**                                   |
+---------------------+------------------------------------------------+
| > Bottled water     | > Local government agencies                    |
+---------------------+------------------------------------------------+
|                     | > Local retailers                              |
+---------------------+------------------------------------------------+
| > Bulk water        | > Certified water haulers                      |
+---------------------+------------------------------------------------+
|                     | > Military assets (i.e., National Guard)       |
+---------------------+------------------------------------------------+
|                     | > Neighboring water utilities                  |
+---------------------+------------------------------------------------+
| > Utility treated   | > Uncontaminated source water treated by the   |
|                     | > utility                                      |
+---------------------+------------------------------------------------+
|                     | > **Uncontaminated** water stored in the       |
|                     | > distribution system                          |
+---------------------+------------------------------------------------+

# Public Health Consequences due to Water Contamination

Potential consequences of a contamination threat or incident should be
considered to the extent possible when making public health response
decisions. Two factors that influence the potential consequences include
the contaminant properties and the spread of a contaminant through the
water system. Once the contaminant has been identified, the water
utility, working with other public health or law enforcement agencies,
as appropriate, may need to access information on the public health
consequences of that contaminant. The information, data, and methods
needed to assess public health consequences of contaminants are
presented in this section. In addition, this section examines various
methods to assess the spread of a contaminant.

## Contaminant Properties

Within this section, Tables 5-3, 5-4, and 5-5 contain an overview of
properties important in evaluating the threat that a contaminant poses
to public health, as well as a brief discussion of their relevancy in
determining public health consequences. These properties should be
considered collectively in determining the public health consequences of
a particular contaminant. Sources that provide this type of information
for specific contaminants are presented following these tables.

  ------------------------------------------------------------------------------------------
  []{#__RefHeading___Toc69960286   
  .anchor}Table 5-3. Properties    
  Applicable to both Biological    
  and Chemical Contaminants        
  -------------------------------- ---------------------------------------------------------
  **Property**                     **Discussion**

  Acute Health Effects             Acute health effects occur immediately (i.e., within
                                   minutes to days) following short-term exposure (i.e., up
                                   to 30 days) to certain contaminants such as pathogens or
                                   chemicals that may be in drinking water and depend on the
                                   route of exposure. For example, the acute health effects
                                   following ingestion of ethylene glycol can lead to
                                   myocardial failure, renal failure, metabolic acidosis,
                                   tachycardia, upper gastrointestinal bleeding, tremors,
                                   agitation, ataxia, stupor, seizure, loss of
                                   consciousness, coma, and death (CDC, 2004). Since the
                                   acute health effects of many biological contaminants are
                                   flu-like, many health care providers may not make the
                                   connection between increases in flu-like symptoms in the
                                   community and a potential water contamination incident.

  Chronic Health Effects           Chronic health effects can result from short-term
                                   exposure or prolonged exposure, presumably in low doses,
                                   to a contaminant. Contaminants causing long-term health
                                   effects are mostly chemical contaminants and include,
                                   among others, byproducts of solvents used by commercial
                                   and industrial facilities, disinfectants, pesticides, and
                                   metals such as lead and mercury. For example, chronic
                                   ingestion of small amounts of cyanide may lead to
                                   weakness of the fingers and toes, difficulty walking,
                                   dimness of vision, deafness, and decreased thyroid gland
                                   production (ATSDR, 1997a). Cyanide is regulated at 0.2
                                   mg/L on the basis of these chronic health effects.
                                   Although less common, chronic effects can also result
                                   from exposure to biological agents. For example, chronic
                                   arthritis can result from acute exposure to Salmonella
                                   bacteria if Reiter\'s syndrome develops. Chronic health
                                   effects from prolonged exposure may determine the
                                   remedial goal for a contaminated water system,
                                   particularly if the contaminant is persistent in the
                                   system. Drinking water regulations prescribe maximum
                                   concentrations of several contaminants on the basis of
                                   chronic effects.

  Taste/Odor/ Color                Although many contaminants will not be easily detectable
                                   via the five senses, those that produce a noticeable
                                   taste, odor, or color in water may pose less of a public
                                   health threat. These properties may alert consumers that
                                   the water may be unsafe, thus minimizing the use of
                                   contaminated water. For example, if a contaminant caused
                                   the water to have a strong, unpleasant odor (e.g., rotten
                                   eggs), it seems likely that many individuals would be
                                   deterred from consuming a sufficient quantity to cause
                                   serious health effects. However, these properties should
                                   not be relied on to eliminate exposure because some
                                   subpopulations (e.g., blind, elderly) may not be able to
                                   detect these changes. In addition, contaminants that
                                   adversely impact the aesthetic qualities of water, even
                                   if they have low health impacts, still present a problem
                                   because the public may refuse to use the water until the
                                   system is remediated.

  Aerosolization                   Aerosolization is the process of making particles of
                                   solid or liquid matter such that they can remain
                                   suspended in air for a few minutes to many months. The
                                   particle size and weight of contaminants will determine
                                   whether aerosolization is a concern and should be
                                   considered during the assessment of potential public
                                   health consequences. Specifically, chemical and
                                   biological contaminants likely to become suspended in air
                                   are more likely to pose a threat to public health through
                                   inhalation pathways (e.g., while showering).
  ------------------------------------------------------------------------------------------

  ------------------------------------------------------------------------------------------
  []{#__RefHeading___Toc69960287   
  .anchor}Table 5-4. Properties    
  Applicable to Chemical           
  Contaminants                     
  -------------------------------- ---------------------------------------------------------
  **Property**                     **Discussion**

  Toxicity Values (e.g., LD~50~,   Toxicity values can be used to estimate the contaminant
  LC~50~, TD~Lo~, TC~Lo~)          concentrations at which acute health effects will be
                                   realized in large portions of the population. Some
                                   examples of toxicity values include the lethal dose for
                                   50 percent of the population (LD~50~); lethal
                                   concentration for 50 percent of the population (LC~50~ );
                                   lowest dose at which toxic effects are observed in an
                                   individual (TD~Lo~); and lowest concentration at which
                                   toxic effects are observed in an individual (TC~Lo~).
                                   Typically, these doses are designated as being
                                   administered via the oral, inhalation, dermal, or ocular
                                   routes and are expressed as a mass of contaminant per
                                   mass of body weight. The toxicity of a chemical, as well
                                   as the resulting adverse health effects, depends on the
                                   route of exposure. The toxicity values may also be time
                                   dependent (i.e., the lethal dose or concentration will
                                   change depending on the time period over which exposure
                                   occurred). When human estimates for these parameters are
                                   available, they should be used, but in most cases it will
                                   be necessary to use data from animal studies. When data
                                   from animal studies are used, the type of animal used
                                   should be considered when estimating the concentrations
                                   that will cause health effects in humans. In addition,
                                   several methods are used to extrapolate the data to
                                   humans, including multiplying values by safety factors to
                                   account for genetic and physiological differences and
                                   susceptible populations. Furthermore, it is important to
                                   consider that sensitive populations may experience
                                   adverse health effects at levels significantly below the
                                   reported toxicity values.

  Hydrolysis                       Hydrolysis is the reaction that occurs between a chemical
                                   and the ions in water (H^+^ and OH^-^), which may produce
                                   byproducts that are less toxic than the parent chemical.
                                   However, it is important to consider the toxicity of the
                                   hydrolysis products, as some can be highly toxic
                                   themselves. The hydrolysis half-life of a chemical is the
                                   time required for the concentration to be reduced to ½
                                   the initial concentration as a result of hydrolysis
                                   reactions. Contaminants that are resistant to hydrolysis
                                   have longer half-lives in water, and thus may be of
                                   greater concern due to their persistence. For example, if
                                   a contaminant has a half-life in water of 8.5 hours, it
                                   would have less long-term contamination impact than a
                                   contaminant with a half-life of 8.5 weeks.

  Reactivity                       The reactivity of a contaminant is a function of how
                                   quickly it will undergo chemical change, in this case in
                                   an aqueous system. Reactive compounds will rapidly
                                   undergo reactions such as oxidation or hydrolysis.
                                   Reactivity will typically depend on environmental
                                   variables such as temperature, pH, type of disinfectant,
                                   and the presence of any materials that might catalyze
                                   (speed up) or inhibit the reaction. A less reactive
                                   compound would undergo oxidation or hydrolysis at a
                                   slower rate, or not at all. Thus, reactivity will
                                   determine how quickly contaminants in a water
                                   distribution system will break down.

  Solubility                       Solubility is the amount of material that will dissolve
                                   in water under specific conditions of pH, temperature,
                                   and dissolved solids concentration. Contaminants that are
                                   insoluble in water may be removed by conventional
                                   treatment processes if they are introduced upstream of
                                   the treatment plant. If introduced into the distribution
                                   system, insoluble chemicals may precipitate and settle
                                   out in the pipes and joints, potentially reducing the
                                   public health consequences due to the reduced
                                   concentration in water. However, compounds with limited
                                   solubility that deposit on pipe materials may present a
                                   greater remediation challenge (see Module 6).

  Implications of Oxidation        Oxidation is a chemical reaction process in which there
                                   is a loss of electrons from an atom or ion. Drinking
                                   water is often treated through the addition of an
                                   oxidizing agent (e.g., chlorine, chlorine dioxide, ozone,
                                   etc.) to accomplish disinfection. In this process,
                                   pathogens are inactivated through damage to the cell
                                   wall, and alteration and deactivation of the cell
                                   enzymes. Chemical compounds may also react with oxidizing
                                   agents. In some cases a sufficient oxidant concentration
                                   will fully break down chemical compounds to basic
                                   constituents such as carbon dioxide, water, or elemental
                                   nitrogen. In other cases such as phenol, low
                                   concentrations of oxidants such as chlorine will produce
                                   halogenated compounds, which may be more toxic than the
                                   original compound.

  Volatilization                   In an open system, such as a reservoir, the concentration
                                   of a volatile contaminant may be reduced as it evaporates
                                   into the atmosphere. However, while within the contained
                                   and pressurized portion of a water distribution system,
                                   volatilization is not expected to be a significant fate
                                   and transport process. Volatility is also a factor to
                                   consider during an assessment of potential public health
                                   consequences. Specifically, volatile chemicals are more
                                   likely to pose a threat to public health through
                                   inhalation and dermal pathways (e.g., while showering).
  ------------------------------------------------------------------------------------------

  ------------------------------------------------------------------------------------------
  []{#__RefHeading___Toc69960288   
  .anchor}Table 5-5. Properties    
  Applicable to Biological         
  Contaminants                     
  -------------------------------- ---------------------------------------------------------
  **Property**                     **Discussion**

  ID~50~ and Minimal Infective     The infectious dose for 50 percent of the population
  Dose (MID)                       (ID~50~) can be used to estimate the concentrations at
                                   which a significant portion of the exposed population
                                   (50% or greater) would develop disease. When human
                                   estimates for these parameters are available, they should
                                   be used, but in some cases it will be necessary to use
                                   data from animal studies. When data from animal studies
                                   are used, the type of animal used should be considered
                                   when estimating the number of pathogens necessary to
                                   cause disease in humans. Furthermore, it is important to
                                   consider that sensitive populations may develop the
                                   disease at exposures significantly below the ID~50~. The
                                   minimal infective dose (MID) is the minimum number of
                                   pathogens required to infect an individual, and may be
                                   significantly lower than the ID~50~ for susceptible
                                   individuals.

  Disease and Death Rates          The disease rate, or morbidity, is the rate of occurrence
                                   of a disease in individuals exposed to the pathogen. The
                                   death rate, or fatality, is the percentage of people
                                   infected who will likely die as a result of the disease.
                                   For example, plague is nearly always fatal unless treated
                                   within 12 to 24 hours, and thus has a fatality rate near
                                   100%. Estimates of these rates may be important in
                                   determining the impact of the contaminant on public
                                   health and the additional burden that critical care
                                   facilities may face as a result of the incident.

  Secondary Transmission           Some pathogens can be transmitted from person to person
                                   (i.e., a contagious disease), making direct exposure to
                                   the contaminated water unnecessary for infection. Thus, a
                                   terrorist attack with a non-contagious agent would be
                                   self-limiting, whereas an attack with a contagious agent
                                   could trigger an epidemic. Knowledge of this property
                                   will help determine whether public health responses
                                   beyond notification, such as patient quarantine, are
                                   necessary. For example, smallpox is a contagious disease
                                   with fairly high rates of secondary transmission, while
                                   anthrax is non-contagious.

  Survivability in Water           The length of time that pathogens can survive in water
                                   and/or their capability to reproduce in water can
                                   contribute to the severity of a water contamination
                                   event. For example, pathogens that can survive for months
                                   or longer in spore or cyst form will pose a greater
                                   public health and remediation challenge than those
                                   organisms that can survive for only hours or a few days
                                   in water. In addition, pathogens that are capable of
                                   reproducing in water may have a longer-term impact than
                                   those that need a host or other conditions to reproduce.

  Susceptibility to Disinfection   Generally, organisms that are susceptible to chemical
                                   disinfection pose less of a threat than those that are
                                   resistant to commonly used drinking water disinfectants.
                                   However, some disinfectants, such as ozone, UV, and
                                   chlorine dioxide, are only used in the plant and would
                                   not be effective against any contaminants introduced
                                   post-treatment. The maintenance of a chlorine residual in
                                   the distribution system provides some protection against
                                   contaminants that are susceptible to inactivation by low
                                   levels of chlorine. If biological contaminants that are
                                   more resistant to disinfection are detected, they may be
                                   inactivated by more aggressive disinfection practices as
                                   part of the remediation process (see Module 6).
  ------------------------------------------------------------------------------------------

Some of the information and data listed in Tables 5-3, 5-4, and 5-5 can
be found in the following sources; however information about all items
listed will likely not be available for each contaminant.

-   US EPA Water Contaminant Information Tool (WCIT), which is being
    developed specifically for the water sector and is described in
    Module 2, Appendix 8.9 (US EPA, in preparation)

-   US EPA's List of Drinking Water Contaminants & Maximum Contaminant
    Levels (MCLs): <http://www.epa.gov/safewater/mcl.html#mcls>.

-   Agency for Toxic Substances and Disease Registry (ATSDR):
    [www.atsdr.cdc.gov](http://www.atsdr.cdc.gov/).

-   CDC Emergency Preparedness and Response:
    [www.bt.cdc.gov](http://www.bt.cdc.gov/).

-   Recognizing Waterborne Disease and the Health Effects of Water
    Pollution: A Physician On-line Reference Guide:
    [www.waterhealthconnection.org](http://www.waterhealthconnection.org/).

-   Physician Preparedness for Acts of Water Terrorism:
    [www.waterhealthconnection.org/bt/index.asp](http://www.waterhealthconnection.org/bt/index.asp).

-   Registry of Toxic Effects of Chemical Substances (RTECS):
    [www.cdc.gov/niosh/rtecs.html](http://www.cdc.gov/niosh/rtecs.html).

-   Risk Assessment Information System (RAIS), which contains
    information taken from the US EPA Integrated Risk Information System
    ([IRIS](http://www.epa.gov/IRIS/)), the *Health Effects Assessment
    Summary Tables* ([HEAST-rad](http://www.epa.gov/radiation/heast/)
    [HEAST-nonrad](http://epa-heast.ornl.gov/heast/index.html)), US EPA
    Peer Reviewed Toxicity Values
    ([PRTV](http://epa-heast.ornl.gov/prtv/index.html)s) Database, and
    other information sources: <http://risk.lsd.ornl.gov/index.shtml>.

-   United States Army Medical Research Institute of Infectious Diseases
    (USAMRIID) Medical Management of Biological Casualties Handbook:
    <http://www.usamriid.army.mil/education/bluebook.html>.

-   WaterISAC, which contains information on contaminants including
    various contaminant fact sheets as well as the United Kingdom Water
    Industry Research (UKWIR) database:
    [www.waterisac.org](http://www.waterisac.org/).

-   World Health Organization (WHO):
    [www.who.int/search/en/](http://www.who.int/search/en/).

-   WHO's "Public health response to biological and chemical weapons"
    [www.who.int/csr/delibepidemics/biochemguide/en/index.html](http://www.who.int/csr/delibepidemics/biochemguide/en/index.html).

As a final note, the information described in the tables above can be
used not only to determine the level of threat that contaminants pose to
water users, but also to aid in determining the type of response actions
to take in the event of a contamination incident. Of particular
importance are fate and transport processes that impact the persistence
of a chemical contaminant in the water system. As shown in Table 5-4,
the rate of hydrolysis of a contaminant is a parameter that has a
significant impact on the amount of time that it will remain in the
water system at concentrations of concern and, therefore, might
influence the response decision. For example, if the identified
contaminant rapidly hydrolyzes under typical drinking water conditions
(i.e., has a relatively short half-life), the response action may be to
simply restrict water use for a sufficient time, monitor the system to
determine that the contaminant has fully degraded, and return the system
to normal operation once the monitoring has demonstrated that the
contaminant has degraded to acceptable levels.

## Assessing the Spread of Contaminant in the System

The ability of a water utility to assess the spread of a contaminant in
its water supply system depends largely on its understanding of the
system hydraulics and operation. The drinking water utility is in the
best position to characterize its system design and operation, flow and
pressure patterns, and containment options. It is recommended that every
utility perform a hydraulic assessment of its distribution system in
order to better understand the potential spread of a contaminant
**before** an actual water contamination threat or incident. This type
of analysis will facilitate an appropriate and timely response when a
threat or incident actually occurs.

Information from a hydraulic assessment conducted by the water utility
can:

-   Facilitate the identification of available containment options.

-   Assist in developing procedures for selecting and implementing the
    most appropriate containment option.

-   Provide information necessary to make decisions regarding public
    health response actions, specifically identifying the area of the
    distribution system that would be subject to water use restrictions.

-   Assist in identifying locations at which sampling and analysis may
    be most useful, thus reducing the amount of testing (and associated
    cost) that is required.

-   Target *"reverse 911"* messaging to a specific area (i.e., calls are
    made to businesses and residences in the defined risk area notifying
    recipients of the public health danger that is present and providing
    them instructions for protection).

-   Help in identifying feasible locations and methodologies for
    injection of disinfection to inactivate or reduce the threat posed
    by the contaminant.

-   Support the system characterization phase of the remedial process
    (see Module 6, Section 3.2).

Two types of methods (namely, manual assessment methods and modeling)
for assessing the spread of a contaminant in a distribution system are
described below. The methods selected for use by specific water
utilities will vary depending on their financial resources, size and
characteristics of the system (i.e., number of pipes and nodes), and
staff availability for training and utilization of the tools.

### Manual Assessment Methods

Manual methods for assessing the spread of a contaminant are based
primarily on the hydraulic operation of a system and use the utility's
knowledge of flow patterns and pressure zones in its system. The results
of this hydraulic analysis, when combined with maps or other
geographical and population information, can be used to estimate and
identify the population potentially affected by a suspected
contamination incident.

Much of the current literature regarding water distribution system
assessment focuses on the use of computerized models. Such models
certainly provide useful capabilities, especially for large and complex
water systems. However, manual assessment methodologies continue to have
advantages, particularly for small systems. These methods are often more
efficient and cost effective. In addition, such methods avoid several of
the potential drawbacks of more sophisticated computer-based methods.
First-time users of any software often become absorbed in learning to
successfully operate the software and, therefore, may not focus on the
technical substance underlying their efforts. Manual methodologies have
the potential benefit of allowing water system operators and engineers
to focus primarily on understanding their system's critical operating
characteristics. For many small systems, use of computerized modeling
may require outside assistance in the form of a consultant. Depending on
how involved the system's staff is in the ensuing evaluations, this may
result in the consultant acquiring a greater understanding of the system
than the operating staff. Unfortunately, the consultant's staff may not
be available when a contamination threat or incident arises.

In using manual methods, various types of scenarios should be created,
to assist the utility in better understanding the range of flow and
pressure patterns under various demand conditions that may be
encountered during a contamination threat or incident. Examples of
demand condition scenarios to be considered in the evaluation might
include:

-   Average day demand -- Use the ratio of unaccounted for or leaked
    water to raise all demands such that total demand equals total water
    pumped.

-   Peak demand -- Estimate the ratio of peak day to average day demand
    from pumping records.

-   Low-use day demand -- Estimate the ratio of winter/low day to
    average day demand from pumping records.

-   Variations in demand or flow patterns over the course of a 24-hour
    day (e.g., night versus day, morning and evening peaks versus
    average flow during the day) -- Consider variations within each of
    the three scenarios described above.

Factors that will impact system behavior under various scenarios will
include basic system configuration and hydraulic characteristics (pipe
sizes, use of booster pumping stations, etc.), physical ability to
isolate portions of the system using existing control structures, and
system topography. In particular, relative line elevations will control
the effects of any attempt to depressurize all or portions of the
system, by possibly creating various isolated zones once the system is
depressurized. Consideration of these characteristics under the various
types of scenarios described above may reveal possible containment
strategies that might be effective in response to various threat
scenarios.

In general, the utility should strive to identify demand scenarios that
will, to the extent possible, define the range of system behavior. For
example, in a particular system, if daily cycles in water usage patterns
result in reversal of flow in certain lines, response and recovery plans
for those portions of the system should include consideration of the
conditions that determine flow and include appropriate actions for both
conditions.

Utilities may find it useful to develop a list of typical travel times
from a reasonable number and spatial distribution of possible
contaminant introduction points to large population centers or critical
customers. Utilities may also apply basic hydraulic engineering methods,
such as simple network analyses, to understand how water moves through
their system during different circumstances. These simple analyses
(often carried out using simple spreadsheet software primarily for
convenience) allow the utility to estimate the likely spread of a
contaminant under the known conditions of a hypothetical contamination
incident. In situations where potential water contamination incidents
are reported from public health surveillance (i.e., emergency room
visits, hospital admissions, and disease reporting to public health
agencies), the water utility can compare case density and location to
distribution system maps. Large-scale maps can be created showing
locations at which exposure is suspected (e.g., points of ingestion or
other use) and likely introduction points of a contaminant. This
information can facilitate the identification of affected areas and be
used to guide initial public health response actions. As noted in
Section 2.1, difficulties in data sharing between the public health
agency and the utility should be resolved during public health response
planning. One example of how the public health agency and utility may
resolve these challenges is to have the public health agency lead the
assessment with input from the utility, thereby protecting patient
information.

### Water Distribution Models

In conjunction with the manual assessment methods, water distribution
models can be used to provide additional information to predict the
dispersion and dilution of a contaminant as it travels through the water
distribution system. As with the manual assessment methods, water
distribution system models may be run under various demand conditions to
simulate the expected range of flow and pressure patterns in a system.
Water distribution modeling should be performed as part of planning for
a response to a water contamination incident.

A variety of water distribution models with various features are
available. These are described below.

-   The simplest of these are steady-state models. These basic models
    only allow for the analysis of flow under steady-state conditions
    (i.e., all flow rates are constant). While such conditions never
    really occur in an actual system, the analyses carried out using
    such models can provide a basic understanding of distribution system
    hydraulics. This is particularly the case for smaller, less complex
    systems.

-   Dynamic models allow the more realistic simulation of changing flow
    conditions over time. As such, these more complicated models allow
    more realistic simulations of flow conditions in an actual system.
    The disadvantage of such models is their increased complexity and
    required level of expertise. They also require substantially more
    field data in order to be calibrated.

Both steady-state and dynamic models can be enhanced with the following
capabilities:

-   Water quality modeling capability allows a model to simulate
    dilution and production/decay of contaminants in the distribution
    system. This advanced feature should provide a better estimate of
    the contaminant concentration at any time or location in the system
    during an event. When using water quality modeling as a risk
    assessment tool, modelers should be very conservative in their use
    of inactivation/decay rates because the misuse of these rates can
    cause the model to significantly underestimate the contaminant
    concentration actually present in the water.

-   Linkage to GIS allows model input and output to be easily and
    quickly linked to actual geographical areas and specific customers.
    GIS can provide users with an immediate visual graphic to locate
    areas of high contamination or low flow. For example, an ArcView
    shape file (i.e., \*.shp) can be created with locations keyed to
    account numbers and nodes or model junctions from AutoCad.

These models allow a water utility to:

1.  More readily assess the consequences to the population and
    infrastructure within the area suspected of being contaminated.

2.  Examine the effects of isolating portions of the system by closing
    valves to prevent the spread of a contaminant.

3.  Identify existing isolation options and potential modifications to
    the system that may increase or enhance the existing options.

4.  Identify distribution options for providing an isolated area with
    water from adjacent areas or pressure zones.

Most distribution system models are used just for hydraulic assessments,
and only a limited number have a water quality component that could be
used to simulate a contamination incident. However, if the distribution
system model has the ability to consider contaminant properties that
impact fate and transport, water utility users can also simulate the
fate and transport of contaminants introduced into the distribution
system. Again, modelers should be conservative in their use of
inactivation/decay rates to avoid significantly underestimating the
concentration of contaminants.

For example, a pipe network hydraulic model, such as the industry
standard EPANET, can perform extended period simulations (EPS) of
hydraulic and water-quality behavior for water distribution systems. EPS
are not steady-state, but rather dynamic models that change over
extended periods. The program tracks the following for multiple time
steps:

-   The flow of water in each pipe.

-   The pressure at each node.

-   The water level in each tank.

-   The concentration of chemical species throughout the network.

EPS accomplish this by continuously utilizing information from a number
of time-variable factors, such as tank water levels, pump operation, and
demand fluctuations. EPS can only calculate the concentration of
chemical species if the decay parameters for the contaminant are known.
However, for most contaminants, the decay parameters are unknown, and it
is safer to assume no decay as a conservative approach.

EPS can be more accurate than steady-state models because typical system
velocities range from about 0.1 to 10 feet per second, so contaminants
can take hours or days to migrate through a distribution network.
Additionally, system demands vary throughout the day, which cannot be
accounted for in steady-state models.

EPANET is public domain software that may be freely copied and
distributed. Other similar models that could be used in this capacity
include, but are not limited to:

-   MWH Soft H~2~ONET
    ([www.mpact.com/page/p_product/net/net_overview.htm](http://www.mpact.com/page/p_product/net/net_overview.htm))

-   KYpipe PIPE2000 ([www.kypipe.com](http://www.kypipe.com/))

-   AdvanticaStoner SynerGEE Water
    ([www.advantica.biz/stoner_software/synergee_water/](http://www.advantica.biz/stoner_software/synergee_water/))

-   Haestad Methods WaterCAD
     ([www.haestad.com/water/default.asp]{.underline})

-   PipelineNet (<http://eh2o.saic.com/iwqss/>)

-   DH1 Software Mike Net (<http://www.dhisoftware.com/mikenet/>).

Note: The mention of these commercially available models is for
illustrative purposes and does not imply endorsement by the US
Government.

If calibrated and validated properly, the more sophisticated models can
enable water utilities to simulate contamination incidents more
accurately. Generally, these programs are able to import database files
from spreadsheets, database applications, and other models. The benefit
of these more sophisticated models is their ability to model contaminant
spread on a near real-time basis. As an example, Appendix 8.7 describes
the capabilities of PipelineNet, a complex model that was specifically
developed to estimate the consequences of a terrorist incident on a
city's drinking water infrastructure. This model incorporates census
population information to help assess total population at risk,
including sensitive populations at hospitals and schools.

Users should be able to use these more complex models to input points of
contaminant introduction and simulate downstream affected areas,
possible containment strategies, and potential points of disinfectant
injection. These models allow the user to simulate the spread of a
conservative tracer, like dye, through parts of the distribution system
under various conditions. In addition, the user can simulate disruptions
to critical system components and then evaluate different types of
operational response options to deal with the lose of the component.
Several models can also track the spread of multiple constituents
introduced at different points in the network.

Computerized models can provide powerful analytical tools, particularly
for large, complex water distribution systems. Nonetheless, like any
tool they are not needed by all systems, and in some cases their
drawbacks may outweigh their advantages. As noted above, for small
simple systems, manual evaluation methods may be more efficient.
Furthermore, model users may fail to adequately scrutinize model
results, due to the seemingly definitive and complex outputs of may
computer models.

In addition, to providing reliable results, models need to be
"calibrated" and "validated" using actual system flow and pressure data.
Failure to carry out adequate calibration and validation activities can
result in a model that is not representative of system operating
characteristics, which could lead to the development of ineffective
response strategies.

# Operational Response Options

As discussed in Module 2, the objective of *immediate operational
response* actions is to minimize the potential for exposure of the
public to the suspect water, as well as provide additional time to
evaluate whether or not the threat is 'credible'. Because these response
actions may limit public exposure, they may also be considered an
effective public health response. Operational response actions are
typically suitable for implementation early in the threat management
process, assuming that they will have minimal impact on the consumers.
In general, containment will be the most likely option for an
operational response, but other novel operational response options such
as elevation of the disinfectant levels in a targeted area of the
distribution system may be considered. Issues related to planning for,
and implementation of, operational responses are discussed in this
section. Note that distribution system flushing is not addressed in this
Module as a potential public health response due to the ramifications of
discharging potentially contaminated water. Module 6, Section 4.1.2
discusses distribution system flushing as a potential remedial action.

## Containment of Suspect/Contaminated Water

Containment of contaminated water may be an appropriate immediate
operational and public health response action, especially when at the
'possible' stage of the threat management process. The objectives of
containment are to 1) prevent the spread of the contaminant to as yet
uncontaminated sections of the system and 2) to the extent possible,
preclude system users from drawing the contaminated water from the
system. The decision to contain the water needs to be made quickly for
the measure to be effective and should involve the appropriate agencies
as identified during the planning process. The decision process for
implementing containment is shown in Figure 5-2 and also discussed in
Module 2. There are three key decision points in the process: 1) Can the
area potentially affected by the contaminant be estimated? 2) Is it
physically possible to contain the affected area? and 3) To what extent
will containment negatively impact consumers and/or fire protection? The
"Consequence Analysis," which deals with the number of individuals
affected, health effects on consumers, and impacts of response actions,
will influence the evaluation of potential containment options. It is
important to note that the fire department should always be contacted
prior to implementing containment if the act of containment would impact
firefighting capability in the area. Module 2, Section 2.3 describes a
general approach for consequence analysis, while Section 3 of this
module provides additional detail for assessing the public health
consequences associated with a particular contaminant.

When responding to a contamination threat at the 'possible' stage,
implementation of containment options may be limited by consideration of
the impacts of containment on consumers or firefighting (as shown in
Figure 5-2). If containment would have substantial, adverse impacts, it
may be prudent to accelerate the threat evaluation to establish whether
or not the threat is 'credible' such that a decision can be made
regarding the implementation of a containment strategy. On the other
hand, once a threat has been deemed 'credible', the most appropriate
option may be to implement the containment strategy and manage the
resulting impacts. In other words, the impacts of containment on
consumers and/or fire protection may not be as critical if the
contamination threat has been deemed 'credible'. In addition, if a
containment strategy was already implemented during the 'possible'
stage, expanded containment strategies might be considered at the
'credible' stage.

![](media/image3.wmf)

[]{#__RefHeading___Toc69960620 .anchor}**Figure 5-2. Decision Process
for Containment as a Public Health Response**

If there are consumers within the isolated area, it will likely be
necessary to notify them of any restrictions regarding use of the water
(i.e., public notification) and possibly provide them with an alternate
supply of drinking water. Public notification and provision of a
short-term alternate water supply are discussed in Sections 5 and 6,
respectively.

In preparing for the use of containment as an operational response,
water utilities can use either manual methods or computerized hydraulic
models coupled with GIS (discussed in Section 3.2) to estimate areas of
their systems that could be affected by contamination, detect
vulnerabilities in a water distribution network, and identify possible
containment strategies **prior to** the occurrence of a water
contamination threat. Using either manual methods or hydraulic models as
a means of understanding system hydraulics should generally be
considered a planning tool that will help the water utility understand
the implications of containing various areas of the system, allowing for
a prompt and informed response to contamination threats.

Containment or isolation is generally accomplished by closing specified
valves in the network to create a closed loop or to stop the flow from
one segment of the distribution network to another. However, utilities
should be cautious when isolating a portion of the system with valves
because the valves could leak making it unclear whether the contaminated
water has been effectively contained. Other containment options might
include hydraulically created reverse flow conditions or bypassing a
segment of the network. Familiarity with the system dynamics such as
knowing direction of flows (under specific circumstances) and various
loops and location of isolation valves will increase the likelihood of a
prompt and effective response.

Situations in which containment is likely to be feasible include those
in which a specific *contamination site* has been identified and can be
easily isolated without significant impact to normal operation of the
system. As an example, some distribution system storage tanks may be
isolated using valves with minimal impact on system pressure and
operation.

A more complicated situation arises when the suspected point of
contaminant introduction is directly into a main or service line. In
this situation, the utility may wish to physically prevent customers
from drawing water, which would entail dispatching crews to close
isolation valves or service line meter stops for each customer.

Figure 5-3 illustrates the potential effectiveness of isolation via a
valve closure. The two graphics compare the spread of the contaminant,
after 24 hours, through a portion of a hypothetical distribution system
with the indicated valve open in one case and closed in the other. The
pipe colors show contaminant concentration. In this case, closing the
valve successfully prevents the spread of the contamination to the
northern section of the distribution system. The hydraulic model output
provides both spatial and temporal information on the dispersion of the
contaminant.

For smaller systems there may be only a limited number of isolation
options. For such systems, evaluation of potential containment
strategies under a limited number of typical and critical conditions
will often be sufficient to assess the viability of a particular
isolation option. As with systems using computerized models to assess
response options, the important point is to identify viable actions and
to clearly define the conditions under which an action will be effective
and appropriate before an incident actually occurs.

![](media/image4.png){width="3.7992125984251968in"
height="3.5401574803149605in"}![](media/image5.png){width="1.589763779527559in"
height="0.7645669291338583in"}

[]{#__RefHeading___Toc69960621 .anchor}**Figure 5-3. Comparison of
Contaminant Spread With and Without Valve Closure.**

## Novel Operational Responses to Contamination

Intentional drinking water contamination incidents present the drinking
water industry with a series of challenges, and current capabilities and
practices may in some cases be insufficient. As a result, efforts to
develop effective response measures and tools may at times require the
development of new practices and equipment. The concepts discussed
briefly below are not specifically recommended for any particular
system. Instead, these as-yet untried measures are intended to
illustrate the potential for "thinking outside the box" in developing
approaches to responding to the new challenges posed by drinking water
contamination threats and incidents. It is critical that novel
approaches, such as those discussed below, only be considered if
approved by the drinking water primacy agency.

One possible immediate operational response is increasing the level of
disinfection at the treatment plant and/or injecting disinfectants in
close proximity to the contaminants. Neither method is likely to
adequately treat the water to allow the public to consume the
contaminated water within the distribution system, but the elevated
disinfection levels may aid in system remediation efforts, and may help
in limiting the volume of contaminated water to be handled during
remediation.

Manual or hydraulic assessment methods may provide a means of estimating
the efficiency of adding disinfectant at various locations in the
system. Utility operators can then compare scenario results and
implement the most effective treatment. Injection of a disinfectant as
an operational response at locations where disinfection currently does
not take place would require the development of mobile disinfection
capability. A mobile system would likely make use of an existing service
connection for most systems, and there would be a need to train staff in
its application. Most drinking water primacy agencies recommend or
require the use of chlorine for emergency disinfection of the public
water supply; thus some systems may already have some mobile
disinfection capability.

To address instances of contamination of storage tanks or reservoirs,
one challenge may be to rapidly and effectively disinfect the entire
tank volume. The development of equipment to allow the rapid addition
and mixing of disinfectant should be possible and may involve the use of
portable equipment involving multi-port diffusers and a mixing
capability.

In addition to chlorine, another potentially useful measure may be the
point injection of food-grade colorants or dyes into the distribution
system. The injection of the dye may discourage public consumption of
the potentially contaminated water and act as a second layer of
protection in addition to public notification. As with point injection
of a disinfectant, this approach would require a thorough understanding
of system hydraulics, such that the target areas are covered by the
response.

Another response may be to reduce the pressure in all, or at least a
portion of a system. This would reduce water availability to customers,
and potentially facilitate containment measures. Depressurization could
also have potentially serious hydraulic (possible damage to system
components due to water hammer and related effects) and public safety
(firefighting) consequences. Such consequences would need to be
carefully considered prior to implementation.

# Public Notification Strategy

The public notification strategy is a key component of public health
response. Once it has been decided to implement public notification, the
water utility and other appropriate agencies should be prepared to
quickly and effectively issue the appropriate public notices. This
section covers all of the essential components of a public notification
strategy including the process of deciding when to issue a public
notice; the type, format, and content of a public notice; the target
audience for the public notice; and methods for delivering the notice.

It is important to note that public notification in response to a water
contamination threat or incident may be required under the PN Rule (40
CFR Part 141, Subpart Q). Specifically, this rule may require public
notification in a "situation with significant potential to have serious
adverse effects on human health as a result of short-term exposure" as
determined by the primacy agency in its regulations or on a case-by-case
basis \[141.201(b)\]. In the PN Rule, this is called a Tier 1 public
notice. The Tier 1 public notice requirements address who must be
notified, when the notification must take place, and the required form
and manner of the public notice. In responding to a 'credible'
contamination threat, the utility needs to consult with the drinking
water primacy agency, and potentially the public health agency, to
determine whether or not the situation warrants public notification (in
compliance with the Tier 1 public notice requirements in the PN Rule).
If it is determined that the situation is subject to the PN Rule, then
the water utility is required to ensure that the public notification
complies with the requirements in the PN Rule. Throughout this section,
the specific Tier 1 public notice requirements are presented where
appropriate. Additional guidance regarding public notification and the
requirements of this rule can be found in the "Public Notification
Handbook" (US EPA, 2002a).

## How to Decide What Type of Public Notification is Appropriate

This section describes the decision process for implementing public
notifications in the overall context of threat management. Figure 5-4
illustrates an example decision process for public notification.

The decision process begins with an evaluation of threat credibility and
the potential consequences to public health to determine if public
notification is an appropriate response action. The first decision point
in Figure 5-4 considers the operational response actions taken at the
'possible' stage (described in Section 4 of this module) and evaluates
whether or not these actions are adequate to protect public health. If
they are, then it may not be necessary to consider public notification.
For example, if the suspect water has been confined to a tank, with some
degree of confidence that the water has not spread beyond the tank,
containment may provide adequate public health protection. However, if
the operational response actions are determined to be insufficient to
prevent or limit exposure, then public notification should be
considered. Any decisions to issue public notification should be made in
consultation with decision officials from the appropriate regulatory
agency, such as the drinking water primacy agency and/or health
department. (These agencies should have been identified in the Public
Health Response Plan as well as the water utility's ERP.)

**Arrangements need to be made with these organizations prior to an
incident in order to establish clear lines of communication, develop
templates for notification, and ensure access to decision officials on a
24/7 basis.**

#  {#section-1 .TEXT_BOLD}

[]{#__RefHeading___Toc69960622 .anchor}**Figure 5-4. Example Decision
Process for Public Notification**

For a Tier 1 notification under the PN Rule, which is required for
situations with significant potential to have serious adverse effects on
human health as a result of short-term exposure, the utility must:

1)  Provide a public notice as soon as practical, but no later than 24
    hours after the system learns of the violation (or credible
    contamination threat);

2)  Initiate consultation with the primacy agency as soon as practical,
    but no later than 24 hours after the public water system learns of
    the situation, to determine additional public notice requirements;
    and

3)  Comply with any additional public notification requirements
    (including any repeat notices or direction on the duration of the
    posted notices) that are established as a result of the consultation
    with the primacy agency. Such requirements may include the timing,
    form, manner, frequency, and content of repeat notices (if any) and
    other actions designed to reach all persons served.

Once a decision has been made to consider public notification as a means
of limiting exposure, it is necessary to evaluate the level of
notification appropriate for the incident (i.e., the level of
restrictions on water use that are necessary to protect the public). As
indicated at the second decision point in Figure 5-4, any available
information about the suspected contaminant will support the evaluation
of notification options. If the identity of the contaminant is unknown,
it may be necessary to adopt a conservative approach and issue a "do not
use" notice, which will limit the potential for exposure via any route
(but will also create the greatest burden on the community). If the
identity of the contaminant is known with a sufficient degree of
confidence as a result of the threat evaluation, then the public
notification may be crafted to deal with the specific risks to public
health posed by the contaminant (discussed in Section 3 of this module).
For example, if boiling will easily destroy the contaminant without
creating additional hazards through aerosolization, then issuance of a
"boil water" notice may be preferred. If boiling is not an option, but
the contaminant does not pose a risk through inhalation or dermal
exposure pathways, issuance of a "do not drink" notice may be
appropriate. A "do not drink" notice should restrict all use of the
water in which ingestion is possible (i.e., the water should not be
directly consumed or used in food preparation). Finally, if there is a
risk to public health through inhalation or dermal exposure, or if the
risk of exposure via these pathways is unknown, then a "do not use"
notice should be considered. By considering these notifications in a
progression from the least to greatest burden on a community, the impact
on the public should be minimized while still making public health
protection the priority consideration.

Figure 5-4 indicates that if the public is asked not to drink or use the
water, then the response should also consider provisions for an
alternate drinking water supply. If the restriction is only on
consumption, then the suspect water can still be used for all other
activities that do not involve ingestion of the water (e.g., flushing
toilets), and it will only be necessary to provide an alternate drinking
water supply for consumption and related activities such as food
preparation. A "do not use" notice is much more restrictive, and
decision-makers should consider how other needs of the community, such
as sanitation and firefighting, will be met. The planning and
preparation for short-term provision of water that may be necessary if
restrictions are placed on drinking water usage are described in Section
6 of this module.

## Target Audience

For notification under the PN Rule, the utility must provide public
notice to persons served by the water system and to the owner or
operator of any consecutive systems. Persons served by the water system
include renters and transient populations in addition to billed
customers. If the utility has a credible contamination threat or
incident in a portion of the distribution system that is physically or
hydraulically isolated from other parts of the distribution system, the
primacy agency may allow the system to limit distribution of the public
notice to only persons served by the portion of the system that is out
of compliance. Permission by the primacy agency for limiting
distribution of the notice must be granted in writing. The utility
should also consider notifying mobile users of the water supply, such as
airplanes or cruise ships that may have filled up with water from the
area during the contamination event and traveled away from the area
prior to notification.

In addition, when the water utility is identifying the list of entities
to be notified during a water contamination threat or incident,
customers with special needs should be considered. The water utility
should maintain a list of customers with special needs as part of its
ERP. Some of these users should be given priority notification due to
their public health mission and/or because they may serve customers
considered to be 'sensitive subpopulations' (e.g., children or the
elderly). Specific notification procedures should be developed for these
entities and those with special communication needs (see Section 5.3.3
of this Module for information regarding procedures for customers with
special communication needs). These lists and procedures should be
coordinated with the local public health department and the local health
officer. The following list includes some customers with special needs
served by the water system that may require immediate notification.
Using this list as a guide, each utility should develop, during
planning, its own list of specific customers with special needs:

-   Critical care facilities

    -   Hospitals

    -   Clinics

    -   Nursing homes

    -   Dialysis centers

-   Schools

-   Day care facilities

-   Businesses

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```
-   Food and beverage manufacturers

-   Commercial ice manufacturers

-   Restaurants

-   Agricultural operations

-   Power generation facilities

-   Any other businesses identified by the water utility.

## Content and Format of the Public Notification 

Once the decision has been made to issue public notification as a public
health response, the details of the instructions and information to be
provided to the public need to be crafted. The general content and
format for various public notices should be developed as part of
planning -- not during a crisis. These general templates can then be
quickly customized according to the details of a specific situation. The
water utility should work with appropriate public health officials to
determine the specific information and instructions to communicate in
the notice as well as the format and means of dissemination.

### Content

For notification required under the PN Rule, the utility must send a
copy of the notice to the primacy agency.

The PN Rule requires that the following elements be included in a public
notice:

-   A description of the incident, including a description of the
    contaminant(s) and information regarding how the contaminant(s)
    entered the water (if this information can be shared).

-   When the incident occurred.

-   Potential adverse health effects.

-   Population(s) at risk.

-   Whether alternate water supplies should be used. If alternate water
    supplies should be used, the utility should consider listing the
    locations at which these alternate supplies are being provided.

-   Actions consumers should take (e.g., do not use, do not drink,
    conserve water). **NOTE:** When issuing a boil water notice, the
    notice should include specific instructions for boiling the water
    (e.g., how long the water should be boiled) because of differences
    in the effect that boiling has on various potential contaminants as
    well as differences in recommended boiling times based on altitude.
    It is critical to confer with the drinking water primacy agency and
    health department prior to issuing a boil water notice to determine
    the appropriate instructions. Whenever possible, a standard (and
    conservative yet reasonable) boiling time should be adopted as a
    part of planning to reduce any confusion during an actual water
    contamination incident or threat.

-   When consumers should seek medical help, if known (e.g., "If you
    have been exposed and are experiencing severe flu-like symptoms,
    call 911; if symptoms are mild contact your physician for
    assistance.")

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-   Actions that are being taken to correct the situation. The utility
    should consider including information about how the utility, public
    health agencies, and law enforcement agencies are responding and if
    and why protection measures have a limited effectiveness.

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```
-   The expected duration of the emergency.

-   Name, business address, and phone number for additional information.

-   Standard language encouraging distribution to all persons served,
    where applicable.

-   Information in the appropriate language if there is a large
    proportion of non-English speaking persons.

Other information that may be beneficial to include in a public notice,
but is not required, includes:

-   Geographical extent of the affected area.

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-   Where the problem is.

-   Where the problem is NOT.

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-   Information regarding rehabilitation and recovery efforts.

-   Notice that the water utility will keep the public informed through
    selected mechanisms. (The means by which information will be
    delivered to consumers should be identified.)

In addition to the above items, public notifications should also
consider other potential consumer questions and concerns (e.g., can I
water my plants, fill the aquarium, give it to my pets, etc.). Rather
than on a printed notification, this information may be disseminated
through a consumer hotline set up to answer these types of questions.

For more information regarding risk communication, see US EPA's Risk
Communication in Action Case Studies from its Environmental Monitoring
for Public Access and Community Tracking (EMPACT) Program (US EPA,
2002b) and CDC's videotape titled "Risk Communication and Bioterrorism"
(CDC, 2001b).\]

### Format

The PN Rule under the SDWA requires that all public notices meet certain
standards. These requirements help prevent the notice from being buried
in a newspaper and help ensure that consumers can easily read and
understand the notice. For notification under the PN Rule, notices must:

-   Be displayed in a conspicuous way when printed or posted.

-   Not contain overly technical language or very small print.

-   Not be formatted in a way that defeats the purpose of the notice.

-   Not contain language that nullifies the purpose of the notice.

The drinking water primacy agency may have special formatting
requirements. Therefore, the water utility should check with the primacy
agency to ensure that all notification format requirements are met.

Suggestions for effective notifications are identified below:

-   Assume that consumers only read the top half of the notice (or what
    can be read in ten seconds). The most important information,
    especially instructions to protect consumers' health, should be
    placed on the top half of the notice in large print. Smaller type is
    appropriate for the less critical elements.

-   Try to limit the wordiness of the notice. A question and answer
    format is easy to read and guides readers to the information that is
    likely to concern them. Bullets and bold text are also effective.

-   Highlight the name of the water utility, especially where people in
    the area are served by more than one water system. The water utility
    may also want to prepare a map showing the area served, especially
    if it extends beyond city limits. The water utility may want to
    print the notices on its letterhead which, coupled with the title of
    the notice, will make people immediately recognize the importance of
    the notice.

Example "boil water," "do not drink," and "do not use" notices are
provided in Appendices 9.3.1, 9.3.2, and 9.3.3. An example notice for an
unknown contaminant is provided in Appendix 9.3.4. For more guidance on
the preparation of notices refer to the \"Public Notification Handbook\"
(US EPA, 2002a).

### Notifications for Special Populations

The notification procedures should address the needs of special
populations (within the water utility's service area) including but not
limited to people with disabilities (e.g., sight, hearing impairment,
etc.), non-English speaking residents, individuals who can't read or
with low levels of literacy, students, migrant workers, homeless
populations, and persons visiting public facilities (e.g., shelters,
train stations, playgrounds, parks, etc.). In developing the procedures,
the water utility should consider the means by which these population
groups and communities access information.

Water utilities should identify ways to target visually and hearing
impaired populations and meet their needs. Community centers or targeted
word-of-mouth may be useful. Other suggestions can be found in US EPA's
\"Public Notification Handbook\" (US EPA, 2002a).

For notification under the PN Rule, if a large proportion of the
population served by the water utility does not speak English, then the
water utility must provide at least partially multi-lingual notices. If
translations are needed, the water utility notification must, at a
minimum, contain information in the appropriate language(s) regarding
the importance of the notice, or it must provide a phone number or
address where a translated notice or assistance in the appropriate
language is available. The drinking water primacy agency for the water
utility may have established criteria for what constitutes a large
proportion of the people served. If the drinking water primacy agency,
or local government, does not determine what constitutes a large
proportion of non-English speaking consumers, it may be up to the water
utility to make this determination. The water utility should rely on its
knowledge of its consumer base or contacts with community
representatives. As a guideline in making this determination, some
States have used a threshold of ten percent of the population or 1,000
people, whichever is less, for providing multi-lingual information in
Consumer Confidence Reports (CCRs).

There are many ways to notify non-English speaking consumers; however,
the water utility should establish its own methods and keep them as
simple as possible. One way to reach non-English speaking consumers is
to establish contacts with local foreign newspapers, foreign television
and radio stations, and institutions and people who can translate
notices into other languages (e.g., community centers and universities).
Targeted word-of-mouth via religious organizations, community leaders,
and activist groups is also an effective way to get the notice to
non-English speaking consumers, especially if there are no television or
radio stations or newspapers in those languages. Posting notices in
grocery stores, laundromats, community centers, and other public
facilities is also an effective way to get the notice to both
non-English speaking populations and other special populations,
including migrant workers, homeless populations, and persons visiting
public facilities.

Water utilities should remember that some of their customers might have
a low reading ability. In this situation, it is important that notices
do not contain overly technical or confusing language. For example, a
brochure written at an elementary school reading level will need simple
explanations of technical information when addressing the general public
or a more targeted audience that may have little or no knowledge about
the subject matter. Water utility staff responsible for responding to
questions about the notice should keep in mind that it might be
necessary to read or explain the entire notice to a caller.

### Data Visualization and Interpretation Tools

It is possible to use data visualization tools such as icons, maps,
graphs, or other visual tools in place of language to convey risk
information in public notifications. These visual tools are useful
because they tend to transcend cultural boundaries and differing
educational levels more easily than language does. For example, a
running faucet with a large X over it conveys the message of do not use
the water. Thus, more people may understand your message through data
visualization than through text. However, use of these tools should be
carefully considered because some information may be too complex to
present without any language. It may be helpful to use an icon as a
background picture in a written notice.

## Methods to Deliver the Public Notification

For a Tier 1 notification under the PN Rule, the water utility must
provide notice within 24 hours in a form and manner reasonably
calculated to reach all persons served. The form and manner used by the
utility are to fit the specific situation, but must be designed to reach
residential, transient, and non-transient users of the water system. In
order to reach all persons served, water systems are to use, at a
minimum, one or more of the following forms of delivery: 1) Appropriate
broadcast media (such as radio and television); 2) Posting of the notice
in conspicuous locations throughout the area served by the water system;
3) Hand delivery of the notice to persons served by the water system; or
4) Another delivery method approved in writing by the primacy agency.
Preferably, the approval of any additional methods of delivery should be
done during public health response planning, so the utility is prepared
when an actual contamination threat or incident occurs. Examples of
other delivery methods include:

-   Government access channels

-   Web site (local government and others)

-   Listserve e-mail

-   Newspaper

-   Phone banks

-   Broadcast phone messages ("reverse 911" messaging)\*

-   Broadcast faxes

-   Mass distribution through community centers (e.g., religious
    centers, shopping malls, restaurants)

-   Door-to-door canvassing

-   Town hall meetings

-   Regular or special partner conference calls

-   Another method approved by the primacy agency in advance or during
    consultation.

*\* Note that "reverse 911" messaging may only be effective if the
accuracy of the phone numbers in the database are frequently verified.*

The water utility should be sure that all people associated with the
response and/or impacted by the event understand the importance of
notifying others who may travel through the contaminated area of the
distribution system. For instance, people who patronize restaurants or
work in office buildings in the distribution area but live elsewhere may
not be aware of the water contamination incident unless steps are taken
specifically to notify them. For notification under the PN Rule, the
utility must include the following language in its notice: "Please share
this information with all the other people who drink this water,
especially those who may not have received this notice directly (for
example, people in apartments, nursing homes, schools, and businesses).
You can do this by posting this notice in a public place or distributing
copies by hand or mail."

Issues to consider include the population served, population density
(i.e., whether the area is rural, urban, or suburban), available
assistance, and proximity to and relationship with radio and television
stations and newspapers. The methods chosen should reach all persons
served by the water system, including residents, employees, and
travelers. Also, during a water contamination incident, the area may
also experience loss of power, which may affect television
communications and potentially newspaper and telephone communications.
The water utility should plan alternate delivery methods for such
situations.

Any public notification issued should be coordinated with ICS and the
Joint Information Center. At the same time, emergency notification of
the public and affected businesses needs to be accomplished rapidly and
should involve all possible media to be sure of the widest possible
distribution. Local radio and television stations as well as web sites
should be given the first consideration because of the rapidity with
which news can be disseminated by these media. Local newspapers should
receive news releases at the same time they are provided to the radio
and television facilities; however, actual time of publication of the
items will depend on the newspaper's deadline. Notices posted on
bulletin boards and the use of sound trucks may provide information
quickly to those persons not immediately exposed to other media. Direct
notification to customers with special needs (e.g., schools, hospitals,
nursing homes, etc.) should be considered. (Customers with special needs
are discussed in Section 5.2 of this module.) Recordings describing much
of the available up-to-date information may be used on the water
utility's telephone system.

In communicating with the media, considerations should be given to
establishing protocols for both field and office staff to respectfully
defer questions to the personnel identified in the utility's ERP or
designated by the Incident Commander. It is essential that the water
utility identify **ONE** *information officer* to interface with the
media and disseminate public information. Once public health response
actions beyond containment are implemented, public health officials may
take responsibility for communication with the media. The severity of
the emergency may result in the Governor's office taking the lead for
communication. The decision on who to assign as spokespersons and
whether and when to change spokespersons will be up to the Incident
Commander in consultation with State and Federal representatives.
Regardless of the agency responsible for incident command, the drinking
water utility and public health officials will need to be involved to
ensure the accuracy of information being transmitted. Therefore, it is a
good idea for the water utility to have a plan in place because they may
be called upon to support the *lead agency* in crafting a message for
the public. The water utility should be prepared by organizing basic
facts about the crisis and its water system; developing key messages to
use with the media that are clear, brief, and accurate; and making sure
the messages are carefully planned and have been coordinated with local
and State officials. Specific details on communicating with the media
can be found in Chapter 4 of US EPA's \"Public Notification Handbook\"
(US EPA, 2002a).

Boiler plate news releases aimed at addressing various anticipated
events should be prepared in advance to ensure their rapid distribution
when a contamination threat or incident occurs. The list of persons
pre-authorized to prepare and release such news items should be layered
to ensure that at least one person will always be available and have the
authority to issue prompt publication. Preparation of typical press
releases as part of planning can save precious hours during an actual
emergency and possibly prevent serious health problems resulting from
exposure through use of contaminated water. The water utility should
explain to the newspaper or station what information it is trying to
communicate and why. When a water utility sends a notice to radio and
television stations and newspapers, they should write "PRESS RELEASE FOR
PUBLIC SAFETY" at the top of the notice to emphasize its importance.
Utilities can also have inactive web sites prepared with various
informational bulletins that can be quickly activated at the time of an
emergency.

The actual delivery of the public notification does not need to be the
sole responsibility of the water utility; it can be a coordinated effort
with the public health agency, law enforcement, and other agencies. The
responsibilities for the delivery of public notification should be
identified during public health response planning (discussed in Section
2.1.1 of this module).

# Short-term Alternate Domestic Water Supply

If the public is asked not to drink or use the water, then provisions
for an alternate drinking water supply should be considered. If the
water use restrictions are implemented in response to a 'credible'
contamination threat, the alternate water supply may be needed only on a
short-term basis while efforts are taken to 'confirm' whether or not an
incident has occurred. If the restriction is only on consumption (i.e.,
"do not drink"), then the suspect water can still be used for all other
activities that do not involve ingestion of the water. In this
situation, it will only be necessary to provide an alternate drinking
water supply for consumption and related activities such as food
preparation. A "do not use" notice is much more restrictive and may
adversely impact public sanitation. Because water use restrictions will
generally be of short duration while steps are taken to confirm the
incident and identify the contaminant, they should not significantly
impact firefighting. Strategies for short-term provision of an alternate
water supply are presented in this section. Such strategies may be
different from those used for a long-term alternate water supply that
may be necessary during remediation and recovery (see Module 6, Section
5).

## Alternate Supply for Consumer Use

The water utility will need to identify options for the provision of an
alternate water supply for consumer use during public health response
planning. To the greatest degree possible, plans for the provision of an
alternate water supply should not rely on Federal and/or State support.
During the planning stage, the utility and public health departments
should:

-   Identify agencies, companies, contractors, surrounding communities,
    and related utilities that could assist in providing alternate water
    supplies in the event of a water contamination incident.

-   Establish *mutual aid agreements* with companies, contractors,
    surrounding communities, and related utilities, as appropriate.

-   Maintain phone numbers for points of contact for entities that could
    assist in providing alternate water supplies.

-   Advise consumers to maintain an emergency supply of water such as
    bottled water.

-   Identify optimal locations for parking water tankers and
    distributing bottled water. Having a well-thought out plan regarding
    optimal locations for positioning these water supplies could greatly
    benefit the community.

-   Identify ways to use only uncontaminated water sources if multiple
    contributing water sources are available.

Possible alternate water supply options, as previously listed in Table
5-2, include (but are not limited to) the following:

+---------------------+------------------------------------------------+
| []{#__RefHe         |                                                |
| ading___Toc69960289 |                                                |
| .anchor}Table 5-6.  |                                                |
| Options for         |                                                |
| Short-term          |                                                |
| Alternate Supplies  |                                                |
| of Drinking Water   |                                                |
+---------------------+------------------------------------------------+
| > **Type**          | > **Source**                                   |
+---------------------+------------------------------------------------+
| > Bottled water     | > Local government agencies                    |
+---------------------+------------------------------------------------+
|                     | > Local retailers                              |
+---------------------+------------------------------------------------+
| > Bulk water        | > Certified water haulers                      |
+---------------------+------------------------------------------------+
|                     | > Military assets (i.e., National Guard)       |
+---------------------+------------------------------------------------+
|                     | > Neighboring water utilities                  |
+---------------------+------------------------------------------------+
| > Utility treated   | > Uncontaminated source water                  |
+---------------------+------------------------------------------------+
|                     | > **Uncontaminated** water stored in the       |
|                     | > distribution system                          |
+---------------------+------------------------------------------------+

The following is a list of entities that the utility and public health
departments should consider contacting to assist in providing alternate
water supplies in the event of a water contamination incident.

-   Local businesses such as dairies, well drillers, or distributors may
    have tank trucks that can be made suitable for carrying water.

-   Some companies may have equipment such as chlorinators or generators
    that can be used for emergency disinfection.

-   Irrigation supply companies may have pipe that can be used to extend
    water supply lines.

-   Other water utilities in the area may have spare parts (valves,
    pumps, pipe) available for use in an emergency and may be able to
    supply personnel to assist during emergencies.

-   Bottle manufacturers may be able to provide milk jugs, cubitainers,
    and other types of plastic bottles that can be used to transport the
    water to the affected community. Providing bottles would avoid the
    potential public health problems associated with the public using
    contaminated containers to collect and haul drinking water from
    distribution sites.

-   Hospitals and universities may maintain backup water supplies for
    consumption.

-   Farms may maintain water supplies for livestock and agriculture.

-   Local industries may maintain backup water supplies for industrial
    processes.

-   Some local citizens and businesses may have well water sources that
    can be utilized.

-   Local authorities may permit the utility to pump and treat an
    available surface water source.

Some of the sources listed above may not necessarily be connected to the
public water system or may not be connectable due to regulatory
restraints. The inclusion of a potential source of backup water in this
list should not be interpreted as permission to use them.

### Who Provides the Alternate Water

The water utility and local authorities may or may not have the
resources to provide an alternate short-term water supply. In the event
that resources are not adequate, the water utility may call upon State
and Federal authorities for assistance. The USACE is authorized to
provide clean drinking water to communities in cases where the existing
drinking water supply is compromised or otherwise unavailable. FEMA,
under the Disaster Relief Act Amendments of 1974, will provide various
services including relief efforts during an emergency. Other Federal
agencies such as US EPA may also provide assistance. Additional detail
regarding responsibility of Federal agencies for the distribution of
drinking water during an emergency is presented in Module 1, Appendix
6.2.

### Potential Household Sources of Emergency Water Supply

In conjunction with providing an alternate water supply, the water
utility should consider a public awareness program providing guidance to
consumers on finding alternate water supply sources around the home,
purifying water, and maintaining an emergency supply of water. This
information could be included in pamphlet form along with the utility
bill or with the CCR. Table 5-7, 5-8, and 5-9 contain information from
FEMA that could be provided to the public **after** the decision has
been made regarding the type of notice to post (FEMA, 2003c). This
information can be provided to aid the public in meeting the
restrictions of any "boil water," "do not drink," or "do not use"
notices. Any notice to the public should include only the options listed
in the following tables that are appropriate for the particular
situation. For example, most of the purification techniques are only
appropriate for biological contamination and would not be provided to
consumers in the case of chemical or radiological contamination.

+-----------------------------------------------------------------------+
| []{#__RefHeading___Toc69960290 .anchor}Table 5-7. Alternate Water     |
| Sources in the Home                                                   |
+=======================================================================+
| ***Any of the listed sources may contain contaminated water if filled |
| in the timeframe of the contamination incident.***                    |
|                                                                       |
| -   Ice cubes                                                         |
|                                                                       |
| -   Chilled water stored in the refrigerator                          |
|                                                                       |
| -   Hot water tank -- Turn off the power and let the tank cool. Place |
|     a container underneath and open the drain valve at the bottom of  |
|     the tank. Do not turn the tank on again until water services are  |
|     restored.                                                         |
|                                                                       |
| -   Toilet tank -- The water in the tank (**not the bowl**) is safe   |
|     to drink unless chemical treatments have been added to the tank   |
|     water, such as drop-in cleaners.                                  |
|                                                                       |
| -   Water pipes -- Release air pressure into the plumbing system by   |
|     turning on the highest faucet in the house; then drain the water  |
|     from the lowest faucet.                                           |
|                                                                       |
| -   Rain water, spring water, and water from streams, ponds, rivers,  |
|     lakes, and garden hoses -- ***Purify these water sources before   |
|     use.***                                                           |
|                                                                       |
| > ***Caution:*** Avoid water from waterbeds as a source for drinking  |
| > water. Pesticidal chemicals are in the plastic casing of the bed    |
| > and chemicals have probably been added to the water to prevent the  |
| > growth of algae, fungi, and bacteria. The water is safe only for    |
| > hand washing and laundering.                                        |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| []{#__RefHeading___Toc69960291 .anchor}Table 5-8. Public Guidance on  |
| Water Purification                                                    |
+-----------------------------------------------------------------------+
| -   ***Water that local officials report has been contaminated with   |
|     toxic chemicals or radioactive materials should not be purified   |
|     using home decontamination methods.*** Although some home         |
|     decontamination methods may be able to remove toxic chemicals or  |
|     radioactive material, they should not be relied upon as the sole  |
|     means of decontamination because it may not be possible to        |
|     determine the effectiveness of these devices (i.e., adsorptive    |
|     material that might remove chemicals could have been saturated    |
|     during previous use and may not remove the contaminant of         |
|     immediate concern).                                               |
|                                                                       |
| -   **Straining.** Water containing sediment or floating material     |
|     should be strained through a cloth or paper filter as the first   |
|     step in the purification process. Some cloth and paper filters    |
|     work better than others; practice is required to use this         |
|     technique to remove sediment and floating material.               |
|                                                                       |
| -   **Boiling.** (See Section 5.4.1).                                 |
|                                                                       |
| -   **Chemical sterilization (chlorine bleach).** In some situations, |
|     boiling may not be an option. The alternative is to treat the     |
|     water chemically. Plain household chlorine bleach may be used. Be |
|     sure the label states that hypochlorite is the only active        |
|     ingredient. Bleaches containing soap or fragrances are not        |
|     acceptable. With an eyedropper, add 8 drops of bleach per gallon  |
|     of water (16 drops if the water is cloudy), stir, and let stand.  |
|     After 30 minutes, the water should taste and smell of chlorine.   |
|     At this point, it can be used. If the taste and smell (and        |
|     appearance in the case of cloudy water) has not changed, add      |
|     another dose and let stand. If after one half hour the water does |
|     not have a chlorine smell, do not use it. Chlorine bleach has a   |
|     finite shelf life and tends to lose its effectiveness over time.  |
|     This may require that larger quantities be used than the ones     |
|     specified. It is advisable to check the expiration date and to    |
|     periodically refresh your supply.                                 |
|                                                                       |
| -   **Chemical sterilization (iodine).** Disinfection with iodine is  |
|     an alternative method of water treatment when it is not feasible  |
|     to boil water. Two well-tested methods for disinfection with      |
|     iodine are the use of tincture of iodine and tetraglycine         |
|     hydroperiodide tablets (e.g., Globaline, Potable-Aqua, or         |
|     Coghlan\'s). Tincture of iodine (2%) can commonly be found in     |
|     medicine chests or first-aid kits. The recommended doses are 5    |
|     drops for clear water or 10 drops for cloudy water. Water should  |
|     then stand for a minimum of 30 minutes before it is safe to use.  |
|     Very turbid or cold water can require prolonged contact time; if  |
|     possible, such water should be allowed to stand several hours     |
|     before use. To ensure that *Cryptosporidium* is killed, water     |
|     would need tp stand for 15 hours before drinking. The             |
|     tetraglycine hydroperiodide tablets are available from pharmacies |
|     and sporting goods stores. Users should follow the                |
|     manufacturers\' instructions. If water is cloudy, the number of   |
|     tablets used should be doubled; if water is extremely cold (\<5   |
|     °C; \<41 °F), an attempt should be made to warm the water, and    |
|     the recommended contact time should be increased to achieve       |
|     reliable disinfection.                                            |
|                                                                       |
| -   **Filtration devices**, such as those used for camping and        |
|     backpacking, may also be used to purify water from natural        |
|     sources (e.g., lakes and streams) provided that these devices are |
|     rated as "purification systems," which means they can remove      |
|     viruses.                                                          |
|                                                                       |
| > ***Caution:*** Any water that is obtained from sources outside the  |
| > home or water that does not appear clear should be sterilized.      |
| > Non-sterilized water may be contaminated with various harmful       |
| > microorganisms.                                                     |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Table 5-9. Public Guidance on Water Storage**                       |
+-----------------------------------------------------------------------+
| -   Store the water in a clean and sanitary glass or plastic          |
|     container. Opaque plastic containers are good because they are    |
|     lightweight, sturdy, and limit the entry of light, which can      |
|     shorten the shelf life of the water. Metal containers should be   |
|     considered as a last resort because they may corrode and give     |
|     water an unpleasant taste. ***Caution:*** Do not use pesticide    |
|     containers to store water.                                        |
|                                                                       |
| -   Store 1 to 2 gallons per person per day for drinking and 1 to 2   |
|     gallons per person per day for basic sanitation (e.g., brushing   |
|     teeth and washing hands). Consumers with infants and young        |
|     children, nursing mothers, and people who are ill will want to    |
|     store additional water.                                           |
|                                                                       |
| -   Store containers in a cool, dry place away from direct sunlight.  |
|                                                                       |
| -   Store plastic container away from heat and light to prevent       |
|     leakage.                                                          |
|                                                                       |
| -   Store water in plastic containers away from gasoline, kerosene,   |
|     pesticides or similar substances because vapors from these        |
|     products can penetrate plastic and contaminate the water.         |
|                                                                       |
| -   Make sure the shelf or storage area is strong enough to support   |
|     the weight of the water (over 8 pounds per gallon).               |
|                                                                       |
| -   Replace stored water every six months to maintain quality. For    |
|     commercially bottled distilled or drinking water, check the label |
|     for an expiration date. If none is given, the shelf life of       |
|     commercially bottled water is unknown and a conservative          |
|     six-month replacement practice should be followed.                |
|                                                                       |
| -   Water can also be stored in a freezer. In the case of a power     |
|     outage, the frozen water provides the added benefit of keeping    |
|     foods frozen until power is restored. Leave 2 to 3 inches of air  |
|     space in the top of containers before freezing to prevent the     |
|     container from bursting as water expands during freezing. Some    |
|     thin-walled glass containers may break regardless of the air      |
|     space provided. Water stored in the freezer should be replaced    |
|     periodically to avoid its accumulation of tastes and odors from   |
|     the food stored with the ice.                                     |
|                                                                       |
| -   If you are on a municipal water supply, the water you are         |
|     currently using for drinking and cooking should also be suitable  |
|     for storing for emergencies. While you can expect that water from |
|     a public water supply will be safe, remember that the container   |
|     used to collect and store the water should also be clean in order |
|     to maintain the quality of the stored water.                      |
+-----------------------------------------------------------------------+

## Alternate Supply for Firefighting Needs

A "do not use" notice will have implications with respect to water used
for firefighting. Because firefighting does not generally involve direct
contact with the water, it may be possible to use the contaminated water
for this purpose; however, certain contaminants may pose a hazard even
during firefighting activities. For instance, if a disinfection
resistant pathogen that poses a health risk via inhalation were
suspected as the contaminant, use of the water for firefighting could
expose firefighters and the public to aerosol release and possible
inhalation or dermal exposure to these harmful microorganisms. Thus, in
this case, it may be necessary to identify an alternate supply of water
for firefighting.

In deciding whether or not to permit use of the contaminated water for
the purpose of firefighting, the decision officials (i.e., public
health, utility, fire chief, local government, etc.) will need to
consider the following:

-   Whether the contaminant will be spread by use of the water during
    firefighting.

-   Whether the contaminant will pose a greater or more adverse/severe
    threat than the threat posed by lack of water for firefighting.

-   Whether the contaminant will pose a threat to firefighters.

-   Whether the contaminant will have an adverse environmental impact if
    used for firefighting.

If public health officials determine that the contaminant does not pose
an inhalation or dermal exposure threat, the Incident Commander, in
conjunction with local officials, may choose to permit use of the water
for fire protection. However, if a readily available alternate supply of
water for firefighting does exist, it may be preferable to use this
source in any case in order to eliminate any possibility of exposure via
firefighting as well as to allay public concern. Note that firefighters
may wear protective suits and/or respirators that may provide some level
of protection from some contaminants. In any event, the fire chief
should always be involved in deciding whether or not to use contaminated
water.

If the contaminant is determined to pose a significant risk during
firefighting, an alternate source of water for firefighting would need
to be secured. As part of public health response planning and emergency
response preparations, water utilities should make agreements with
surrounding communities to utilize their water sources for firefighting
purposes. During an emergency, pumper trucks could be filled at the
community water source and kept at the fire department for firefighting
purposes. State offices of emergency services may assist with the
acquisition of bulk water trucks from unaffected areas within the State
for firefighting purposes. Planning with these State offices is critical
to determine the types of resources available and the procedures to
acquire them. Federal agencies such as the USACE, FEMA, and the US
Forest Service may be able to provide firefighting equipment and water
for firefighting purposes. Under the NRP Emergency Support Function
(ESF) #4, Firefighting Annex, the US Forest Service serves as the
primary agency for firefighting support. Responsibilities under ESF #4
include detection and suppression of wildland, rural, and urban fires
resulting from, or occurring coincidentally with, a major disaster or
emergency requiring Federal response assistance. ESF #4 manages and
coordinates fire-fighting activities, including the detection and
suppression of fires on Federal lands, and provides personnel,
equipment, and supplies in support of State and local agencies involved
in rural and urban firefighting operations (FEMA, 2003b).

The reality is that it may take some time to mobilize alternate water
supplies for firefighting; therefore, in that short time period, the
contaminated water may need to be used for the purpose of firefighting.

# Returning to Normal Operation and Use

Following the issuance of a public notification in response to a
credible contamination threat or confirmed incident, it will be
necessary to notify the public once the situation has been resolved and
the appropriate officials have determined that it is safe to resume
normal use of the public drinking water supply. The same communication
methods discussed in Section 5.4 of this module (e.g., posting or
hand-delivery of public notices, broadcast media, web sites, etc.) for
notifying the public of use restrictions can be used to efficiently
inform the public that normal use of the water can be resumed. In
addition, it will be necessary to demobilize any alternate water
supplies that have been implemented. The following two examples
illustrate when this type of situation might occur:

Example #1: A "do not use" notice was issued in response to a 'credible'
contamination threat to the drinking water supply. The following day,
results from laboratory analysis of samples collected throughout the
distribution system became available. The Incident Commander, along with
officials from the utility, public health department, and drinking water
primacy agency reviewed this data, along with additional new
information, and concluded that the water had **not** been contaminated.
The public was notified, through a variety of vehicles such as broadcast
media, that it was safe to resume normal use of the water. A press
conference was held that evening to provide more detailed information
regarding the steps that were taken to ensure that the water was safe
and to explain the rational for issuing the "do not use" notice to begin
with.

Example #2: A "do not drink" notice was issued to consumers of the
entire distribution system in conjunction with implementation of a
containment strategy in response to a 'credible' contamination threat.
The distribution system was extensively sampled both within and outside
of the contained area. Twenty-four hours later, analytical results were
available that identified trace amounts of a contaminant within the
contained area of the system, while all results from the rest of the
system were below the detection limit for the same contaminant. Based on
this information, the Incident Commander, in conjunction with officials
from other organizations, determined that the containment strategy was
successful. The public was notified through the use of broadcast media
that they could resume normal use of the water outside of the contained
area. Since there were only a few dozen residents, and no businesses,
within the contained area, each resident was directly contacted and
instructed to continue use of only bottled water for drinking and
cooking. During a press conference that evening, officials provided more
detail regarding the contaminant, the steps taken to isolate the
contaminated water, and ongoing sampling throughout the system to verify
that the contaminant had not spread beyond the contained area.

Returning to normal operations after treatment and rehabilitation of a
contaminated water supply is addressed in Module 6, Sections 5.5 and
7.3.3.

#  References and Resources

References and information cited or used to develop this module are
listed below. The URLs of several sources are cited throughout the text.
These URLs were correct at the time of the preparation of this document.
If the document is no longer available at the URL provided, please
search the sponsoring organization's Web site or the World Wide Web for
alternate sources. A copy of referenced documents may also be provided
on the upcoming CD version of this module, although readers should
consult the referenced URL for the latest version.

AdvanticaStoner. 2003. "SynerGEE Water"
<http://www.advantica.biz/stoner_software/synergee_water/>

AWWA. 2002. Protecting Our Water: Drinking Water Security in America
After 9/11. Denver, CO.

ATSDR. 2004. "Home"
[http://www.atsdr.cdc.gov](http://www.atsdr.cdc.gov/)

ATSDR. 1997a. "ToxFAQs^TM^ for Cyanide"
<http://www.atsdr.cdc.gov/tfacts8.html>

ATSDR. 1997b. "Toxicological Profile for Ethylene Glycol and Propylene
Glycol" <http://www.atsdr.cdc.gov/toxprofiles/tp96.html>

CDC. 2004. "Emergency Preparedness and Response"
[http://www.bt.cdc.gov](http://www.bt.cdc.gov/)

CDC. 2001a. The Public Health Response to Biological and Chemical
Terrorism: Interim Planning Guidance for State Public Health Officials.
Atlanta, GA.
<http://www.bt.cdc.gov/Documents/Planning/PlanningGuidance.pdf>

CDC. 2001b. "Risk Communication and Bioterrorism"
<http://www.phppo.cdc.gov/PHTN/1206FactSheet.pdf>

CDC. 2001c. "Registry of Toxic Effects of Chemical Substances (RTECS)"
<http://www.cdc.gov/niosh/rtecs.html>

FEMA. 2003a. "Emergency Personnel"
[http://www.fema.gov/tabs_emergency.shtm]{.underline}

FEMA. 2003b. "Federal Response Plan" <http://www.fema.gov/rrr/frp>

FEMA. 2003c. "Locating Safe Drinking Water"
<http://www.fema.gov/rrr/waterf.shtm>

FEMA. 2003d. "Mobile Operations Capability Guide for Emergency Managers
and Planners" [http://www.fema.gov/rrr/mers01.shtm]{.underline}

Haestad Methods. 2004. "WaterCAD  "
<http://www.haestad.com/water/default.asp>

KYpipe. "PIPE2000" [http://www.kypipe.com](http://www.kypipe.com/)

Meinhardt, Patricia L. MD, MPH, MA. 2002. "Recognizing Waterborne
Disease and the Health Effects of Water Pollution: A Physician On-line
Reference Guide."
[http://www.waterhealthconnection.org](http://www.waterhealthconnection.org/)

Meinhardt, Patricia L. MD, MPH, MA. 2002. "Physician Preparedness for
Acts of Water Terrorism."
[http://www.waterhealthconnection.org/bt/index.asp](http://www.WaterHealthConnection.org/)

USAMRIID. 2001. "Medical Management of Biological Casualties Handbook
Fourth Edition" <http://www.usamriid.army.mil/education/bluebook.html>.

MWH Soft, Inc. 2004. "H~2~ONET"
<http://www.mpact.com/page/p_product/net/net_overview.htm>

Science Applications International Corporation. 2003. "PipelineNet"
<http://eh2o.saic.com/iwqss/>

US DHS. 2004. "National Response Plan, Draft #1"

US DOE. 2003. "Risk Assessment Information System"
<http://risk.lsd.ornl.gov/index.shtml>

US EPA. In prep. Water Contaminant Information Tool. Office of Water.

US EPA. 2004. "List of Drinking Water Contaminants & MCLs"
<http://www.epa.gov/safewater/mcl.html#mcls>

US EPA. 2004a. Small and Medium Water System Emergency Response Plan
Guidance to Assist Community Water Systems in Complying with the Public
Health Security and Bioterrorism Preparedness and Response Act of 2002.
EPA/816/R-04/002. Office of Water.

US EPA. 2003. Large Water System Emergency Response Plan Outline:
Guidance to Assist Community Water Systems in Complying with the Public
Health Security and Bioterrorism Preparedness and Response Act of 2002.
Office of Water.

US EPA. 2002a. Public Notification Handbook. EPA/816/R-00/010.
Washington DC. <http://www.epa.gov/safewater/pws/pn/handbook.pdf>

US EPA. 2002b. Risk Communication in Action: Environmental Case Studies.
EPA/625/R-02/011. Cincinnati, OH.
<http://www.epa.gov/ordntrnt/ORD/NRMRL/Pubs/625R02011/625R02011.html>

WHO. 2003a. "Search" <http://www.who.int/search/en/>.

WHO. 2003b. "Public health response to biological and chemical weapons:
WHO Guidance, 2nd edition (Draft, May 2003)"
<http://www.who.int/csr/delibepidemics/biochemguide/en/index.html>

# Appendices

## Contaminant Characterization and Transport Worksheet

Instructions

*The purpose of this worksheet is to help organize information that will
lead to the identification of the contaminant to facilitate decisions on
appropriate operational responses and provide more accurate information
for public communication/notification. Contaminant identification will
most likely first be a presumptive identification followed by more
lengthy procedures to verify the identity of the contaminant. While
validated analytical results are typically the most reliable means of
contaminant identification, other information collected during the
**threat evaluation** and **site characterization** may provide valuable
insight regarding the identity of the contaminant.*

**SITE CHARACTERIZATION/THREAT EVALUATION SUMMARY**

Describe the contaminant\'s odor, if applicable.

Describe the *reported* taste of the contaminant, if applicable.

***Caution: Do NOT taste the water.***

What was the physical form of the contaminant?

 Solid  Liquid  Gas

 Slurry  Powder  Granules

 Other

What color was the contaminant?

Summarize additional information obtained during site
characterization/threat warning that is relevant to contaminant
identification.

Summarize the on-line monitoring data, consumer complaints, or witness
accounts that are relevant to contaminant identification.

**Field Analysis Summary**

Summarize the results of the field analysis for the following
parameters:

Radiation

Chlorine residual

pH, conductivity

Cyanide

Volatile chemicals

Chemical weapons

Biotoxins

Pathogens

Other

**Public Health Information**

Have death or disease in the population been reported?  Yes  No 
Unknown

Type/symptoms

Is there information on unusual sales of pharmaceutical supplies (e.g.,
diarrhea medication)?

Number of people affected

Number of fatalities

Location/area affected

Was an epidemiological investigation conducted?  Yes  No  Unknown

Results

Was a clinical investigation conducted?  Yes  No  Unknown

Results

Is the contaminant acutely toxic and what are the acute effects?  Yes 
No  Unknown

Describe

**LABORATORY ANALYSIS SUMMARY**

Results of analysis

Reporting units

Analytical method

Minimum reporting level

Precision (relative standard deviation)

QA/QC (e.g., recovery of matrix spikes, standard checks, etc.)

Summarize additional information obtained during laboratory analysis
that is relevant to contaminant identification.

**CONTAMINANT CHARACTERISTICS**

What is the class of the contaminant?

 Biological  Chemical  Radiological

 Unknown

Can any conclusions regarding the contaminant properties be made? (Place
an 'X' in the appropriate column)

  ---------------------- --------- -------- ------------- -------------------------------
                         **Yes**   **No**   **Unknown**   **Comment/Additional
                                                          Information**

  Is the contaminant                                      
  susceptible to                                          
  disinfection or                                         
  chemical oxidation?                                     

  Does the contaminant                                    
  hydrolyze into less                                     
  toxic products?                                         

  Does the contaminant                                    
  hydrolyze into more                                     
  toxic products?                                         

  Does the contaminant                                    
  react at certain pHs?                                   

  Is the contaminant                                      
  water soluble?                                          

  Does the contaminant                                    
  have a discernable                                      
  taste, odor, or color?                                  

  Is the contaminant                                      
  volatile or                                             
  semi-volatile?                                          

  Does the contaminant                                    
  impact the pH?                                          

  Does the contaminant                                    
  impact conductivity?                                    

  Does the contaminant                                    
  impact other water                                      
  quality parameters?                                     

  Does the contaminant                                    
  react with certain                                      
  disinfectants (i.e.,                                    
  chlorine, chloramines,                                  
  etc.)?                                                  

  What is the                                             
  contaminant's half                                      
  life?                                                   
  ---------------------- --------- -------- ------------- -------------------------------

**Contaminant Public Health Effect Information**

What are the primary routes of exposure?

 Ingestion  Inhalation  Dermal Contact

 Unknown

What are the acute health effects for the exposure routes identified?

What is the contaminant's LD~50~/ID~50~?

What is the length of time to first onset of symptoms after exposure?

What are the chronic health effects associated with exposure to the
contaminant?

Does the contaminant have a method of secondary transmission?

 Yes  No  Unknown

Describe

Is an approach available to prevent undesirable health effects from the
contaminant?

 Yes  No  Unknown

Describe

Are there treatments available for individuals exposed to the
contaminant?

 Yes  No  Unknown

Describe

Are health standards for the contaminant available?

 Yes  No  Unknown

Describe

By which exposure route(s)?

 Ingestion  Inhalation

 Dermal  Ocular

List the levels for each exposure route.

**Contaminant Treatment Information**

  ----------------- ---------------- ------------------- --------------------
  **Treatment       **Could be used  **Degradation       **Rating of
  Types**           to treat the     products formed as  effectiveness (poor,
                    contaminant?**   a consequence of    fair, good) of
                                     treatment**         percent
                                                         effectiveness**

  Lime softening    Yes No                               

  Reverse osmosis   Yes No                               

  Standard          Yes No                               
  chlorination                                           

  Enhanced          Yes No                               
  chlorination                                           

  Standard          Yes No                               
  filtration                                             

  Enhanced          Yes No                               
  filtration                                             

  Membrane          Yes No                               
  filtration                                             

  Nanofiltration    Yes No                               

  Electrodialysis   Yes No                               

  Cation exchange   Yes No                               
  resin                                                  

  Anion exchange    Yes No                               
  resin                                                  

  Activated alumina Yes No                               

  Chloramine        Yes No                               

  Chlorine dioxide  Yes No                               

  Standard UV       Yes No                               

  Enhanced UV       Yes No                               

  Standard ozone    Yes No                               

  Enhanced ozone    Yes No                               

  Standard GAC      Yes No                               

  Enhanced GAC      Yes No                               

  Standard air      Yes No                               
  stripping                                              

  Enhanced air      Yes No                               
  stripping                                              

  Other Methods     Yes No                               
  ----------------- ---------------- ------------------- --------------------

Access to contaminant information (effects and properties)

*In-house information*

Contact/phone no.

Internal database

*Public Health officials*

Contact/phone no.

Web site/database

*US EPA Water Contaminant Information Tool*

Web site/access code

*Resources*

-   US EPA water contaminant information tool (WCIT), which is being
    developed specifically for the water sector and is described in
    Appendix 8.9 of Module 2.

-   US EPA's List of Drinking Water Contaminants & MCLs:
    <http://www.epa.gov/safewater/mcl.html#mcls>.

-   Agency for Toxic Substances and Disease Registry (ATSDR):
    [www.atsdr.cdc.gov](http://www.atsdr.cdc.gov/).

-   CDC Emergency Preparedness and Response:
    [www.bt.cdc.gov](http://www.bt.cdc.gov/).

-   Recognizing Waterborne Disease and the Health Effects of Water
    Pollution: A Physician On-line Reference Guide:
    [www.WaterHealthConnection.org](http://www.WaterHealthConnection.org/).

-   Physician Preparedness for Acts of Water Terrorism:
    [www.waterhealthconnection.org/bt/index.asp](http://www.waterhealthconnection.org/bt/index.asp).

-   Registry of Toxic Effects of Chemical Substances (RTECS):
    [www.cdc.gov/niosh/rtecs.html](http://www.cdc.gov/niosh/rtecs.html).

-   Risk Assessment Information System (RAIS), which contains
    information taken from US EPA\'s Integrated Risk Information System
    ([IRIS](http://www.epa.gov/IRIS/)), the *Health Effects Assessment
    Summary Tables* ([HEAST-rad](http://www.epa.gov/radiation/heast/)
    [HEAST-nonrad](http://epa-heast.ornl.gov/heast/index.html)), US EPA
    Peer Reviewed Toxicity Values
    ([PRTV](http://epa-heast.ornl.gov/prtv/index.html)s) Database, and
    other information sources: <http://risk.lsd.ornl.gov/index.shtml>.

-   United States Army Medical Research Institute of Infectious Diseases
    (USAMRIID) Medical Management of Biological Casualties Handbook:
    <http://www.usamriid.army.mil/education/bluebook.html>.

-   WHO: [www.who.int/search/en/](http://www.who.int/search/en/).

-   WHO's "Public health response to biological and chemical weapons:"
    [www.who.int/csr/delibepidemics/biochemguide/en/index.html](http://www.who.int/csr/delibepidemics/biochemguide/en/index.html).

**CONTAMINANT TRANSPORT**

Summarize what is known regarding the location of contaminant
introduction.

How much material was used [(]{.underline}lbs., tons, gal, etc.)

How was it added?  Single dose  Over time  Unknown

Time period of suspected contaminant introduction.

Elapsed time.

Method of estimating the spread.

 Manual calculations  Hydraulic model  Water flow analysis

 GIS  Field analysis  Areas of customer complaints

 Areas of people with health-related symptoms

 Other

Estimate the contaminated area.

Estimate the population affected.

Identify any customers with special needs that are within the affected
area.

 [Critical Care Facilities]{.underline}

 Hospitals  Clinics

 Nursing Homes  Dialysis Centers

 Other

 [Schools]{.underline}

 [Day Care Facilities]{.underline}

 [Businesses]{.underline}

 Food and Beverage Manufacturers  Commercial Ice Manufacturers

 Restaurants  Agricultural Operations

 Power Generation Facilities

 Other

**SIGNOFF**

Name of person completing form

Print name

Signature Date/Time:

## Public Health Response Action Worksheet

INSTRUCTIONS

*The purpose of this form is to help organize information to aid in the
evaluation of containment and public notification options. The
objectives of public health response actions (operational and public
notification) are to prevent or limit public exposure to potentially
contaminated water by either restricting further propagation of the
contaminant through the distribution system or restricting use of the
water through public notification. This worksheet assumes that the
"Contaminant Characterization and Propagation Worksheet" in Appendix 9.1
has been completed to the extent possible.*

ASSESSMENT OF PUBLIC HEALTH IMPACT

**Identity of the contaminant**  Suspected  Known  Unknown

Describe

Contaminant properties (if known):

> Toxic or infectious dose (LD~50~/ID~50~):

Route of exposure:

 Ingestion  Inhalation  Dermal Contact

 Other

> Symptoms of exposure to high dose:
>
> Symptoms of exposure to low dose:
>
> Other:

**EVALUATION OF CONTAINMENT OPTIONS**

Describe the location and extent of the contaminated area.

**Containment options**

 Valve closures  Reverse flow conditions  By-pass

 Isolate zone(s)

 Other

Critical equipment within contaminated area

 System equipment  Zones  Pump stations

 Hydrants

 Other

Customers with special needs within contaminated area

 [Critical Care Facilities]{.underline}

 Hospitals  Clinics

 Nursing Homes  Dialysis Centers

 Other

 [Schools]{.underline}

 [Day Care Facilities]{.underline}

 [Businesses]{.underline}

 Food and Beverage Manufacturers  Commercial Ice Manufacturers 
Restaurants  Agricultural Operations

 Power Generation Facilities

 Other

Effectiveness of containment options

 Complete contaminant isolation  Reduction in spread of contaminant

 Unknown

 Other

Is containment expected to provide adequate public health protection?

 Yes  No  Unknown

Timeline for implementation of containment options

Containment procedures to begin:

Containment procedures to end:

EVALUATION OF PUBLIC NOTIFICATION OPTIONS

Is public notification necessary?  Yes  No

Collaboration Agencies (identified in Public Health Response Plan and
Utility's ERP)

 Public health agencies  Police departments  Fire departments

 Hospitals/clinics  Laboratories  Drinking water primacy agency

 Regional Poison Control Center

 Other

**Type of notification (Follow steps shown)**

Is the contaminant known?  Yes  No

***If no, issue a " Do Not Use" notice.***

\- If yes, is boiling effective and advisable?  Yes  No  Unknown

***If yes, issue a "Boil Water" notice.***

\- If no, is there a risk of dermal or inhalation exposure?  Yes  No 
Unknown

***If no, issue a "Do Not Drink" notice.***

***If yes/unknown, issue a " Do Not Use"***

***notice.***

Content of public notification

 Has the contamination incident been confirmed?  Yes  No

 Is the contaminant known?  Yes  No

 If yes, identity of the contaminant

 Characteristics of the contaminant

 Restrictions on use

 Ingestion exposure  Inhalation exposure  Dermal exposure

 Exposure symptoms

 Medical treatments

 Transmission mode (if biological)

 Duration of restriction

 Alternate water supply

 Additional instructions to consumers

 Other information about the incident

 Other

Notification to customers with special needs

 [Critical Care Facilities]{.underline}

 Hospitals  Clinics

 Nursing Homes  Dialysis Centers

 Other

 [Schools]{.underline}

 [Day Care Facilities]{.underline}

 [Businesses]{.underline}

 Food and Beverage Manufacturers  Commercial Ice Manufacturers

 Restaurants  Agricultural Operations

 Power Generation Facilities

 Other

Are there subpopulations that will be affected at a greater rate than
general population?

 Yes  No  Unknown

Describe

Notification to consecutive system.

 Yes  No  Not Applicable

Method of dissemination (check all that apply)

 Broadcast media (radio and television)  Government access channels

 Web site  Listserve email

 Newspaper  Letters by mail

 Newsletters (water utility/partner organizations)  Phone banks

 Broadcast phone messages  Broadcast faxes

 Posting in conspicuous locations  Mass distribution through partners

 Hand delivery  Door-to-door canvassing

 Town hall meetings  Conference calls

 Other

Notification/restriction timeline

Notification/restriction to begin:

Notification/restriction to end:

**ALTERNATE WATER SUPPLY NEEDS**

Is an alternate water supply needed?

 Drinking water  Firefighting

 Other

Where can customers obtain the alternate water supply?

 Bottled water provided by local government agencies

 Bottled water provided by local retailers

 Bulk water provided by certified water haulers

 Bulk water transported or provided by military assets

 Bulk water providing by neighboring water utilities

 Water treated at plant and hauled to distribution centers (i.e., in
the case of distribution system contamination)

 Other

What customers with special needs should be notified of the alternate
water supply availability?

 [Critical Care Facilities]{.underline}

 Hospitals  Clinics

 Nursing Homes  Dialysis Centers

 Other

 [Schools]{.underline}

 [Day Care Facilities]{.underline}

 [Businesses]{.underline}

 Food and Beverage Manufacturers  Commercial Ice Manufacturers

 Restaurants  Agricultural Operations

 Power Generation Facilities

 Other

**SIGNOFF**

Name of person completing form

Print name

Signature Date/Time:

## Example Notifications

The subsections that follow contain examples of notices, as listed
below.

9.3.1 Example Boil Water Notice

9.3.2 Example Do Not Drink Notice

9.3.3 Example Do Not Use Notice

8.3.4 Example Notice for an Unknown Contaminant

The contaminant (E. coli) used in the example in Appendix 9.3.1 has
mandatory language on health effects, which must be included exactly as
written according to 40 CFR 141.205(d). This mandatory language is
presented in *italics*.

All notices must also contain the following italicized language, where
applicable \[40 CFR 141.205(d)\].

> *Please share this information with all the other people who drink
> this water, especially those who may not have received this notice
> directly (for example, people in apartments, nursing homes, schools,
> and businesses). You can do this by posting this notice in a public
> place or distributing copies by hand or mail.*

Information in brackets in each example is to be filled in with specific
details relevant to the situation.

### Example Boil Water Notice

**WARNING**

**BOIL YOUR WATER BEFORE USING**

**\[The Holly County Water System\] water is contaminated with \[fecal
coliform/E. coli\]**

\[Fecal coliform or E. coli\] bacteria were found in the water supply on
\[November 5th\]. These bacteria can make you sick and are of particular
concern for people with weakened immune systems.

**What are Fecal Coliforms and E. Coli?**

-   *Fecal coliform and E. coli are bacteria whose presence indicates
    that the water may be contaminated with human or animal wastes.*

**What should I do?**

-   DO NOT DRINK THE WATER WITHOUT BOILING IT FIRST OR USE BOTTLED
    WATER. Bring all water to a boil, let it boil for \[three minutes\],
    and let it cool before using. Boiled or bottled water should be used
    for drinking, making ice, brushing teeth, washing dishes, and
    preparing food until further notice. Boiling kills bacteria and
    other organisms in the water.

**What are the symptoms of illness caused by these organisms?**

-   *Microbes in these wastes can cause diarrhea, cramps, nausea,
    headaches, or other symptoms. They may pose a special health risk
    for infants, young children, some of the elderly, and people with
    severely compromised immune systems.\
    *

-   The symptoms above are not caused only by organisms in drinking
    water. If you experience any of these symptoms and they persist, you
    may want to seek medical advice. People at increased risk should
    seek advice about drinking water from their health care providers.

What happened? What is being done?

The water distribution system was contaminated with fecal coliform. We
are working with law enforcement and the public health department to
investigate/resolve this issue. We are currently increasing the
chlorination levels at the treatment plant as well as at other locations
throughout the system. Therefore, your water may have a stronger
chlorine smell than usual. In addition, we are evaluating all available
information and conducting tests to confirm the extent of the
contamination of the system. We will inform you when tests show no
bacteria and you no longer need to boil your water. We anticipate
resolving the problem within the next 48 hours.

Who do I contact for more information?

For more information, please contact \[Joseph Smith\] at
\[555-555-6789\]. General guidelines on ways to lessen the risk of
infection by microbes are available from the US EPA Safe Drinking Water
Hotline at

1-800-426-4794, Poison Control at 1-800-222-1222, and \[the Public
Health Department Hotline at 1-800-123-4567\].

> Please share this information with all the other people who drink this
> water, especially those who may not have received this notice directly
> (for example, people in apartments, nursing homes, schools, and
> businesses). You can do this by posting this notice in a public place
> or distributing copies by hand.

This notice is being sent to you by \[Holly County Water System\]. State
Water System ID# \[10001\]. Date distributed: \[November 6, 2003\]

### Example Do Not Drink Notice

**WARNING**

#  {#section-2 .TEXT_BOLD}

**DO NOT DRINK THE WATER**

\[Paraquat\] found in the \[City of Rolling Brook\] water supply on
\[October 10th\]

**Bottled water can be obtained at \[Islington Station High School and**

**Penn Road High School 24 hours per day\].**

**What is Paraquat?**

Paraquat is a chemical usually used to kill weeds. This chemical can
make you sick and may result in death.

**What should I do?**

-   Do NOT drink the water. Do ***not*** use the water for drinking,
    making ice, brushing teeth, washing dishes, or preparing food until
    further notice.

**What are the symptoms of illnesses associated with paraquat
poisoning?**

-   Symptoms associated with exposure to paraquat include Number range
    CHAPTERabdominal pain, nausea, vomiting, hematemesis, diarrhea,
    Number range CHAPTERconvulsions, lethargy to coma, and death.

-   If you or someone you know exhibits any of these symptoms,
    immediately contact your health care provider. In addition, please
    notify \[the public health department at 1-800-123-4567\].

**What happened? What is being done?**

On October 10th, the water distribution system was contaminated with
paraquat. We are working with law enforcement and the public health
department to investigate/resolve this issue. We have tested the water
in various parts of the distribution system to verify the extent of the
paraquat contamination. Based on these tests, we have isolated the
portion of the system located north of Aspen Street and east of River
Road. Everyone in this portion of the system **should not drink the
water**. We have implemented additional security procedures to protect
the system against further contamination. Additional information will be
provided 24 hours/day on Channel 57- the local government television
channel.

**Who do I contact for more information?**

For more information, please contact \[Joseph Smith\] at
\[555-555-6789\]. Additional information is available from the US EPA
Safe Drinking Water Hotline at 1-800-426-4794, Poison Control at
1-800-222-1222, and \[the Public Health Department Hotline at
1-800-123-4567\].

> Please share this information with all the other people who drink this
> water, especially those who may not have received this notice directly
> (for example, people in apartments, nursing homes, schools, and
> businesses). You can do this by posting this notice in a public place
> or distributing copies by hand.

This notice is being sent to you by \[City of Rolling Brook Water
System\]. State Water System ID#\[50005\]. Date distributed: \[October
10, 2003\]

### Example Do Not Use Notice

**WARNING**

**DO NOT USE THE WATER**

**\[Parathion\] found in the \[Lyonelle Water System\] water supply on**

**\[November 14th\]**

Bottled water can be obtained at \[Murray High School and

Central High School 24 hours per day\].

**What is Parathion?**

Parathion is a chemical usually used to kill insects. This chemical can
make you sick and may result in death.

What should I do?

-   DO NOT USE THE WATER. Do ***not*** use the water for drinking,
    making ice, brushing teeth, washing dishes, washing clothes,
    bathing/showering, food preparation, or toilet flushing. Bottled
    water should be used for all of the above necessities until further
    notice.

What are the symptoms associated with the exposure to parathion?

-   It can cause constriction of the pupils, blurred vision, muscle and
    abdominal cramps, excessive salivation, sweating, nausea, vomiting,
    dizziness, headaches, convulsions, diarrhea, weakness, labored
    breathing, wheezing, and unconsciousness. Exposure can even lead to
    death.

-   If you or someone you know exhibits any of these symptoms,
    immediately contact your health care provider. In addition, please
    notify \[the public health department at 1-800-123-4567\].

What happened? What is being done?

The water distribution system was contaminated with parathion. We are
working with law enforcement and the public health department to
investigate/resolve this issue. We have tested the water in various
parts of the distribution system to verify the extent of the parathion
contamination. Based on these tests, we have isolated the portion of the
system located north of Lincoln Avenue and east of Maple Road. Everyone
in this portion of the system should not use the water. We have
implemented additional security procedures to protect the system against
further contamination. Additional information will be provided 24
hours/day on Channel 57 - the local government television channel.

Who do I contact for more information?

For more information, please contact \[Joseph Smith\] at
\[555-555-6789\]. Additional information is available from the US EPA
Safe Drinking Water Hotline at 1-800-426-4794, Poison Control at
1-800-222-1222, and \[the Public Health Department Hotline at
1-800-321-4567\].

> Please share this information with all the other people who drink this
> water, especially those who may not have received this notice directly
> (for example, people in apartments, nursing homes, schools, and
> businesses). You can do this by posting this notice in a public place
> or distributing copies by hand.

This notice is being sent to you by \[Lyonelle Water System\]. State
Water System ID# \[90008\]. Date distributed: \[November 14, 2003\]

### Example Notice for an Unknown Contaminant

**WARNING**

**DO NOT USE THE WATER**

**\[Contamination Event\] of the \[Masterson Water System\] water supply
on \[November 14th\]**

Bottled water can be obtained at \[Fairmont High School and

North High School 24 hours per day\].

Local authorities have found evidence of contamination of the Masterson
Water System.

What should I do?

-   DO NOT USE THE WATER. You should ***not*** use the water for
    drinking, making ice, brushing teeth, washing dishes, washing
    clothes, bathing/showering, food preparation, or toilet flushing.
    Bottled water should be used for all of the above necessities until
    further notice.

What happened? What is being done?

The water distribution system was contaminated with an unknown
contaminant. We are working with law enforcement and the public health
department to investigate/resolve this issue. We are conducting tests in
attempts to identify the contaminant and verify the extent of the
contamination. We have implemented additional security procedures to
protect the system against further contamination. Additional information
will be provided 24 hours/day on Channel 57- the local government
television channel.

Who do I contact for more information?

For more information, please contact \[Joseph Smith\] at
\[555-555-6789\]. Additional information is available from the US EPA
Safe Drinking Water Hotline at 1-800-426-4794, Poison Control at
1-800-222-1222, and \[the Public Health Department Hotline at
1-800-321-4567\].

> Please share this information with all the other people who drink this
> water, especially those who may not have received this notice directly
> (for example, people in apartments, nursing homes, schools, and
> businesses). You can do this by posting this notice in a public place
> or distributing copies by hand.

This notice is being sent to you by \[Masterson Water System\]. State
Water System ID# \[90018\]. Date distributed: \[November 14, 2003\]

## Description of the PipelineNet Distribution System Model

PipelineNet was developed by US EPA to simulate the fate and transport
of contaminants in water distribution systems, particularly as related
to use and application in an emergency response situation. The
PipelineNet model allows a user to model the flow and concentration of a
biological or chemical contaminant within a water system, thus giving
*Water Utility Emergency Response Managers* (WUERMs) real-time
information for estimating the risks to public water supplies. This
model assesses the effects of water treatment on the contaminant, models
the flow and concentration of the contaminant through the water
distribution system within a municipality, and estimates the population
and infrastructure (e.g., hospitals, schools) at risk. PipelineNet works
by integrating the two following computer programs: EPANET and ArcView.

-   EPANET performs extended period simulations of hydraulic and water
    quality behavior within pressurized pipe networks. A network can
    consist of pipes, nodes (pipe junctions), pumps, valves and storage
    tanks or reservoirs. EPANET tracks the flow of water in each pipe,
    the pressure at each node, the height of water in each tank, and the
    concentration of a chemical species throughout the network during a
    simulation period comprised of multiple time steps. In addition to
    chemical species, water age and source tracing can also be
    simulated.

-   ArcView is a GIS-based desktop mapping software package created by
    Environmental Systems Research Institute (ESRI) that provides data
    visualization, query, analysis, and integration capabilities along
    with the ability to create and edit geographic data. GIS systems use
    hardware, software, and geographic data to manage geographically
    referenced information.

This integration gives PipelineNet all the computational (hydraulics and
water quality) capabilities of EPANET and all the functionality of
ArcView. The integrated system calculates, locates, and maps the
population at risk from the introduction of contaminants to the public
water supply.  The model performs the following functions:

-   Simulates the flow and concentration of biological or chemical
    contaminants in a city or municipality\'s water distribution system
    from single and multiple sources if single contaminant.

-   Simulates water quality (fate and transport), water tracing, and
    water aging

-   Assesses the effects of water treatment on the contaminant.

**Capabilities**

Based on an ArcView platform, PipelineNet provides user interfaces to
assist with a range of real-time responses and planning scenarios.
Although no formal GIS training is required to run PipelineNet, some
understanding of these systems will help the user. PipelineNet key
capabilities are highlighted below.

**Ranking/Prioritization Methodology for Determining Contamination
Threat Monitoring Locations.** The key questions in the design of a
monitoring protocol for a contamination threat is how many samples and
where should the samples be collected. Typical sampling and monitoring
locations in distribution systems may include points close to water
treatment systems, core business locations, secondary water storage
reservoirs, re-pumping or re-treatment facilities and change in water
quality. Selection of appropriate monitoring locations should reflect a
mix of utility concerns and priorities including:

-   Protecting customers with special needs (e.g., hospitals).

-   Tracking water quality at or near locations vulnerable to
    contamination.

-   Facilitating suitable response actions to contamination incidents
    (e.g., ability to isolate the system, or boost chlorine residuals).

US EPA's PipelineNet can be used for determining optimal placement of
sampling equipment in the system, to help develop monitoring programs
for routine screening of distribution system water quality, and to
predict/track the fate and transport of contaminants in a system to
effectively respond to a contamination incident. These sampling
locations would be tapped for monitoring during a contamination threat.

Figure 5-5 provides a conceptual view of how US EPA's PipelineNet can be
used to determine the location of potential monitoring sites for a
contamination event.

![](media/image7.png){width="6.7034722222222225in" height="5.65in"}

[]{#__RefHeading___Toc69960623 .anchor}**Figure 5-5. Output of Selection
Process Showing Potential Monitoring Locations**.

**Water Quality Simulation.** A water quality simulation is initiated
through PipelineNet's point and click interface. The user points to a
node to introduce a contaminant. An instantaneous or continuous release
may be simulated. Additional inputs include mass or concentration,
half-life or decay coefficient, length of simulation, and time step.
Note that these input parameters are unknown for most contaminants.
Therefore, the ability of the model to predict contaminant
concentrations that result from decay is limited. Any existing EPANET
Pipeline concentration result may be displayed to simulate the
contaminant\'s hourly flow through a pipeline network at anytime (see
Figure 5-6).  All pipeline concentration results are placed directly in
PipelineNet's GIS table of contents. 

**Water Tracing.** Source tracing tracks over time what percent of the
water reaching any node in the network had its origin at a particular
node. The source node can be any node in the network, including storage
nodes. Source tracing is a useful tool for analyzing distribution
systems that draw water from two or more different raw water supplies.
It can show to what degree water from a given source blends with water
from other sources, and how the spatial pattern of this blending
changes.

**Water Aging.** Water age is the time spent by a parcel of water in the
network. It provides a simple, non-specific measure of the overall
quality of delivered drinking water. New water entering the network from
reservoirs or source nodes enters with an age of zero. As this water
moves through the pipe network, it splits apart and blends together with
parcels of varying age at pipe junctions and storage facilities. EPANET
internally treats age as a reactive constituent whose growth follows
zero-order kinetics with a rate constant equal to one (i.e., each second
the water becomes a second older).

**Consequence Assessment Tool.** The PipelineNet Consequence Assessment
Tool (see Figure 5-7) allows the user to select an area of interest
(i.e., region of contaminated pipes) by drawing a rectangle with the
help of the cursor on the map in the view. This tool performs the
following calculations within the selected area:

-   Total population.

-   Number of taps.

-   Miles of pipe.

-   Total number of hospitals and beds for each hospital.

-   Total number of schools and enrollment of students.

**Isolation Tool.** The PipelineNet Isolation Tool (see Figure 5-8) is a
post-processing tool that allows the user to change the status (open or
closed) of a pipe in the EPANET input file. The model can then be re-run
to determine what will happen to the flow by changing the status of the
pipe. This tool can be used for public health response planning to
determine how best to isolate a portion of the system once it has been
contaminated.

![](media/image8.png){width="8.381944444444445in"
height="5.514583333333333in"}

[]{#__RefHeading___Toc69960624 .anchor}**Figure 5-6. Water Quality
Simulation.**

![](media/image9.png){width="8.120833333333334in"
height="5.152777777777778in"}

[]{#__RefHeading___Toc69960625 .anchor}**Figure 5-7. Consequence
Assessment Tool.**

![](media/image10.png){width="6.748611111111111in"
height="5.232638888888889in"}

[]{#__RefHeading___Toc69960626 .anchor}**Figure 5-8. Isolation Tool
Interface.**

##  {#section-3 .unnumbered}