# INCIDENT Indications and First Responder Concerns

**NOTE:** Extensive additional information on weapons of mass
destruction (WMD) hazards and response, including information addressing
first responder concerns, is available from various commercial
publishers and at the on-line resources identified as part of this
"toolkit."

A. BIOLOGICAL

1\. **Indications.** Indicators that a WMD incident involving biological
agents has taken place may take days or weeks to manifest themselves,
depending on the biological toxin or pathogen involved. The Centers for
Disease Control and Prevention (CDC) recently developed the following
list of epidemiologic clues that may signal a bioterrorist event:

a\. Large number of ill persons with a similar disease or syndrome.

b\. Large numbers of unexplained disease, syndrome, or deaths.

c\. Unusual illness in a population.

d\. Higher morbidity and mortality than expected with a common disease
or syndrome.

e\. Failure of a common disease to respond to usual therapy.

f\. Single case of disease caused by an uncommon agent.

g\. Multiple unusual or unexplained disease entities coexisting in the
same patient without other explanation.

h\. Disease with an unusual geographic or seasonal distribution.

i\. Multiple atypical presentations of disease agents.

j\. Similar genetic type among agents isolated from temporally or
spatially distinct sources.

k\. Unusual, atypical, genetically engineered, or antiquated strain of
agent.

l\. Endemic disease with unexplained increase in incidence.

m\. Simultaneous clusters of similar illness in noncontiguous areas,
domestic or foreign.

n\. Atypical aerosol, food, or water transmission.

o\. Ill people presenting near the same time.

p\. Deaths or illness among animals that precedes or accompanies illness
or death in humans.

q\. No illness in people not exposed to common ventilation systems, but
illness among those people in proximity to the systems.

> 2\. **First Responder Concerns**

a\. The most practical method of initiating widespread infection using
biological agents is through aerosolization, where fine particles are
sprayed over or upwind of a target where the particles may be inhaled.
An aerosol may be effective for some time after delivery, since it will
be deposited on clothing, equipment, and soil. When the clothing is used
later, or dust is stirred up, responding personnel may be subject to
"secondary" contamination.

b\. Biological agents may be able to use portals of entry into the body
other than the respiratory tract. Individuals may be infected by
ingestion of contaminated food and water, or even by direct contact with
the skin or mucous membranes through abraded or broken skin. Use
protective clothing or commercially available Level C clothing. Protect
the respiratory tract through the use of a mask with biological
high-efficiency particulate air (HEPA) filters.

c.  Exposure to biological agents, as noted above, may not be
    immediately apparent. Casualties may occur minutes, hours, days, or
    weeks after an exposure has occurred. The time required before signs
    and symptoms are observed is dependent on the agent used. While
    symptoms will be evident, often the first confirmation will come
    from blood tests or by other diagnostic means used by medical
    personnel.

B. CHEMICAL

1\. **Indications.** The following may indicate a potential chemical WMD
has been released. There may be one or more of these indicators present.

a\. An unusually large or noticeable number of sick or dead wildlife.
These may range from pigeons in parks to rodents near trash containers.

b\. Lack of insect life. Shorelines, puddles, and any standing water
should be checked for the presence of dead insects.

c\. Considerable number of persons experiencing water-like blisters,
weals (like bee-stings), and/or rashes.

d.  Numbers of individuals exhibiting serious heath problems, ranging
    from nausea, excessive secretions (saliva, diarrhea, vomiting),
    disorientation, and difficulty breathing to convulsions and death.

e\. Discernable pattern to the casualties. This may be "aligned" with
the wind direction or related to where the weapon was released
(indoors/outdoors).

f\. Presence of unusual liquid droplets, e.g., surfaces exhibit oily
droplets or film or water surfaces have an oily film (with no recent
rain).

g\. Unscheduled spraying or unusual application of spray.

h\. Abandoned spray devices, such as chemical sprayers used by
landscaping crews.

i\. Presence of unexplained or unusual odors (where that particular
scent or smell is not normally noted).

j\. Presence of low-lying clouds or fog-like condition not compatible
with the weather.

k\. Presence of unusual metal debris---unexplained bomb/munitions
material, particularly if it contains a liquid.

> l\. Explosions that disperse or dispense liquids, mists, vapors, or
> gas.
>
> m\. Explosions that seem to destroy only a package or bomb device.
>
> n\. Civilian panic in potential high-profile target areas (e.g.,
> government buildings, mass transit systems, sports arenas, etc.).
>
> o\. Mass casualties without obvious trauma.

2\. **First Responder Concerns.** The first concern must be to recognize
a chemical event and protect the first responders. Unless first
responders recognize the danger, they will very possibly become
casualties in a chemical environment. It may not be possible to
determine from the symptoms experienced by affected personnel which
chemical agent has been used. Chemical agents may be combined and
therefore recognition of agents involved becomes more difficult.

C. Nuclear/Radiological

1\. **Indications.** Radiation is an invisible hazard. There are no
initial characteristics or properties of radiation itself that are
noticeable. Unless the nuclear/radiological material is marked to
identify it as such, it may be some time before the hazard has been
identified as radiological.

2\. **First Responder Concerns.** While there is no single piece of
equipment that is capable of detecting all forms of radiation, there are
several different detectors for each type of radiation. Availability of
this equipment, in addition to protective clothing and respiratory
equipment, is of great concern to first responders.