U.S. Fire Administration/Technical Report Series

Fire Department Response 

to Biological Threat at 

B’nai B’rith Headquarters

Washington, DC

USFA-TR-114/April 1997

U.S. Fire Administration Fire Investigations Program

T

he U.S. Fire Administration develops reports on selected major fires throughout the country. 

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www.usfa.dhs.gov/

Fire Department Response to

Biological Threat at

B’nai B’rith Headquarters

Washington, DC

This is Report 114 of the Major Fires Investigation Project conducted 

by Varley-Campbell and Associates, Inc./TriData Corporation under 

contract EMW-94-C-4423 to the United States Fire Administration, 

Federal Emergency Management Agency.

Department of Homeland Security

United States Fire Administration

National Fire Data Center

U.S. Fire Administration

Mission Statement

As an entity of the Department of Homeland 

Security, the mission of the USFA is to reduce life and economic losses due to fire 

and related emergencies, through leadership, advocacy, coordination, and support. 

We serve the Nation independently, in coordination with other Federal agencies, 

and in partnership with fire protection and 

emergency service communities. With a 

commitment to excellence, we provide public education, training, technology, and data 

initiatives.

ACKNOWLEDGEMENTS

The United States Fire Administration Major Fire Investigation Team would like to thank the many members of the District of Columbia Fire and Emergency Medical Services (DCFEMS) Department who provided information for this report. We are grateful to the following persons for sharing their experience:

DCFEMS

Chief Donald Edwards

Assistant Chief Floyd Madison

Deputy Chief Joseph Herr, Training Division

Battalion Chief Thomas Johnson, Special Operations

Battalion Chief William Mould, Battalion 6

Hazmat Unit and Engine 12, including

Battalion Chief Tom Herlihy

Lieutenant Anthony Culver

Firefighters Shelley Nickelson, Jerry Barnes, Rob Small, Tim Clark

Lieutenant Keith Harter, Jr., Communications Division

DC Office of Emergency Preparedness

Dr. Michele Penick, Chief of Plans and Training Division

Washington Metro Council of Governments Metropolitan Medical StrikeTeam

Captain Mike Moultrie, Arlington County (VA) Fire Department

Federal Bureau of Investigation

Debbie Stafford, Unit Chief, FBI Headquarters

James Rice, Supervisory Special Agent, Washington Field Office/Joint Terrorism Task Force

Centers for Disease Control

Agency for Toxic Substances and Disease Registry

Dr. Richard Knudsen, Biosafety Branch

Department of Health and Human Services

Dr. Robert Knouss, M.D., USPHS, Director, Office of Emergency Preparedness

TABLE OF CONTENTS

OVERVIEW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Summary of Key Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DCFEMS PROFILE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

INCIDENT REVIEW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANALYSIS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DCF/EMS Preparedness and Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Hazmat Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Interagency Coordination and Command Post Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Public Information (PIO) Functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Metropolitan Strike Team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

LESSONS LEARNED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

INITIATIVES BY DCFEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Appendix A: District of Columbia Fire and EMS Department Incident Command System

and Checklist: Incident Command System forTerrorist Attacks. . . . . . . . . . . . . . . . . . . . . 15

Appendix B: B’nai B’rith Incident Pictures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Appendix C: Handbook on the Medical Aspects of NBC Defensive Operations

Part II – Biological, Annex B: Clinical Data Sheets for Selected Biological Agents. . . . . . . . 24

B.02 Anthrax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

B.09 Plague. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Appendix D: Incident Operations Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Appendix E: Model Action Plan Chart for Chemical/Biological Incidents

for First Responders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

1

Fire Department Response to Biological Threat at B’nai 

B’rith Headquarters

Washington, D.C.

April 24, 1997

Investigated by: Jeff Stern

Local Contacts: Fire Chief Donald Edwards

District of Columbia Fire and EMS Department

1923 Vermont Avenue, N.W.

Washington, D.C. 20001

Deputy Chief Joseph Herr, Training Officer

DCFEMS Training Division

4600 Shepherd Parkway, S.W.

Washington, D.C. 20032

Battalion Fire Chief William Mould

6th Battalion

1018 13th Street, N.W.

Washington, D.C. 20001

Battalion Fire Chief Thomas Johnson, Special Operations

DCFEMS Training Division

4600 Shepherd Parkway, S.W.

Washington, D.C. 20032

OVERVIEW

On April 24, 1997, the District of Columbia Fire/EMS Department (DCFEMS) responded to the 

Washington, D.C. offices of B’nai B’rith, an international Jewish organization, for a suspicious package. The package had been mailed to B’nai B’rith and contained a Petri dish labeled with wording 

which led local emergency responders to suspect the package might contain Anthrax and Yersinia, 

both disease-causing bacteria that have been used as biological weapons. Several occupants of the 

building complained of dizziness and headaches, additional factors that indicated the possible presence of a chemical agent as well.
2 U.S. Fire Administration/Technical Report Series

The DCFEMS established a perimeter around the site where the package was located, attempted to 

protect occupants of the B’nai B’rith building by isolating them in place, established a command 

post, and set up hazardous material decontamination procedures. After consultation with numerous 

national agencies, including the Centers for Disease Control (CDC) Biosafety Branch, responders 

engaged in Hazmat operations to secure the package and its contents, which were then sent to a 

Federal laboratory in Bethesda, Maryland. Laboratory tests revealed that the contents of the package 

were non-hazardous.

During the operation, DCFEMS decontaminated approximately 30 people for exposure, including 

civilians, police officers, and fire-rescue personnel. One security guard suffered chest pains during 

the incident and was transported to a local hospital for a heart attack following decontamination.

Though there have been several chemical and biological incidents over the past few years, this incident received National media exposure and was broadcast life on CNN and other news networks, 

generating discussions among emergency responders as to the actions that took place. Though the 

threat was a hoax, the incident revealed many lessons for the fire service to share in preparation for 

any future threats.

SUMMARy OF KEy ISSUES

Issue Comment

Incident command Although an incident command system (ICS) was established, weaknesses in 

operating a unified command post among all the responding agencies led to 

some uncoordinated actions. Some agencies, such as the health department, 

had not received prior ICS and emergency management training. The incident 

confirmed the advantages of conducting emergency management training 

among diverse city agencies.

Communications with victims It is essential to establish a single source of communications between victims of 

an incident and the emergency responders.

Training of first responders Police, Fire and EMS personnel should be trained to recognize and assess 

NBC hazards. Their initial actions will affect the course of the incident. Courses 

that cover recognition and response to these incidents should be provided to all 

potential first responders.

Biological agents differ from chemical agents Departments must develop protocols for handling each. Different action plans 

may be necessary depending upon both the type and the form of the hazard, 

biological or chemical, airborne, liquid or solid.

Resources Incidents involving potential chemical or biological agents will be resource intensive. They will require the assistance of multiple agencies, many personnel, and 

specialized equipment. Departments should know where these resources are 

how to get help quickly.

Access to emergency information Delays occurred as the department attempted to access information on the 

potential hazardous substances. Since this incident, the Federal government 

has established the National Response Center (1-800-424-8802) as a hotline 

number for incidents involving chemical, biological, or radiological agents.

Public information Strong public information and media relations is essential to get the corrected 

information disseminated to the public in a timely fashion. Regular briefings 

should be held, media access should ba appropriately limited to avoid interfering with operations, and an articulate technical advisor should be assigned to 

assist with media inquiries.
USFA-TR-114/April 1997 3

DCFEMS PROFILE

The District of Columbia Fire and Emergency Medical Services Department provides services to the 

600,000 citizens of Washington, D.C., including the government of the United States and millions of 

visitors annually. The DCFEMS service area includes numerous Federal facilities, including the White 

House, the Capitol, and the Supreme Court. Services are provided by over 1,400 personnel from 32 

fire stations covering 63 square miles. Mutual aid agreements exist with surrounding jurisdictions.

INCIDENT REVIEW

On April 24, 1997 at approximately 11:00 a.m. a person working for the Washington, D.C. office of 

B’nai B’rith discovered a suspicious looking package that was leaking a reddish fluid in the mailroom. 

The director of security for B’nai B’rith, a retired police officer, opened the package and found a Petri 

dish and a threatening note. He took the package and its contents outside the B’nai B’rith building 

and placed it on a small grass lawn. He then dialed 9-1-1 and requested police.

The DC Metropolitan Police Department (MPD) responded to the incident. Police officers and the 

MPD Bomb Squad were on the scene for about one hour. Assistance from the fire department was 

requested when the police determined that the package contained a Petri dish labeled Anthracis Yersinia,

a misspelled combination of the words Anthrax and Yersinia. Both are disease-causing bacteria that 

can be used in the production of biological weapons (see Appendix C).

At 12:20 p.m. the DCFEMS Communications Center dispatched Engine 16, Truck 9, the Hazmat Unit, 

and Battalion Fire Chief 6 on a local alarm for the report of an unknown package. The MPD personnel, including on member of the Joint Terrorism Task Force for the Washington area, reported to the 

fire department that the package might contain Anthrax. Battalion 6 instructed E-16 and T-9 to stage 

at 15th Street and Rhode Island Avenue while he and the Hazmat Unit responded to Scott Circle, about 

a block away from the location of the package in front of the B’nai B’rith Building. At 12:46 p.m., 

he requested the special response of the Hazmat team captain, who was serving as acting Battalion 

Chief 1 for the shift.

Some people in the building complained of headaches, dizziness, and other minor ailments. The 

rapid onset of these symptoms led responders to believe that the package might also contain some 

kind of chemical agent. An action plan was developed that treated the incident as a possible chemical 

hazard, as well as a biological one.

Initial efforts were made to contact Chemtrec (the Chemical Manufactures’ Association emergency 

information resource), the United States Army Medical Research Institute For Infectious Disease 

(USAMRIID) at Ft. Detrick in Maryland, and the Centers for Disease Control (CDC) in Atlanta, 

Georgia. Chemtrec had no information to pass on to the fire department, and the responders had to 

wait for return calls from USAMRIID and CDC. Battalion 6 requested a Hazmat Task Force, the full 

DCFEMS hazardous materials box assignment, bringing Engine 12, Truck 4, Rescue Squad 1, Medic 

17 and EMS 3 (an EMS supervisor) to the scene. A hot zone surrounding the area was established.

Once the Hazmat Task Force units were on the scene, E-16 and T-9 were returned to service. Other 

agencies responded, including the Federal Bureau of Investigation (FBI). Under Presidential Decision 

Directive 39 (PDD-39), which gives jurisdictional authority for “crisis management” to the FBI in 

terrorist incidents, the FBI assumed overall command of the incident.1 This was done in a quiet and 

1

 The Federal Emergency Management Agency (FEMA) is given jurisdiction over “consequence management” in the 

same directive.
4 U.S. Fire Administration/Technical Report Series

unassuming manner. The FBI Supervisory Special Agent in charge of the Joint Terrorism Task Force 

was present at the incident command post and offered assistance, as they simultaneously began a 

criminal investigation into the incident. Battalion 6 retained the key operational role in charge of 

mitigating the incident.

After some discussion over options, the fire department decided upon an action plan to shelter 

in place 109 civilians in the B’nai B’rith building. The fire department further isolated the scene, 

expanding the hot zone to include a one block area surrounding the B’nai B’rith building. Occupants 

of a hotel across the street from the B’nai B’rith building were also sheltered in place, and the HVAC 

systems for both buildings were shut down. At this time, approximately 1:05 p.m., the Metro/Safety 

Battalion Chief arrived on the scene, as did the DCFEMS Mass Casualty Unit. Additional responders 

included the deputy fire chief and the fire chief.

The CDC eventually provided information to the Hazmat team, advising them in protective measures 

and decontamination procedures. Based on the initial information, CDC surmised that the package 

might not pose a great threat because the form of the suspected contents (in a Petri dish) would not 

enable airborne pathogens to be transmitted immediately, if at all. However, since some occupants 

of the building exhibited various symptoms, Hazmat personnel decided to err on the side of caution, 

suspecting that a chemical agent might also be present.

The fire department Hazmat sector officer raised the protective level used by Hazmat personnel. 

Level A encapsulated entry suits were worn by entry personnel, and Level B suits were worn by the 

decontamination team. The CDC advised that decontamination with a 1.0% bleach solution would 

be effective.

The Hazmat Task Force was briefed and personnel were assigned to sectors. Battalion 1 adjusted 

the DCFEMS Hazmat procedures after conferring with the CDC. The lieutenant from Truck 4 was 

assigned to Safety Engine 12’s crew and was assigned to the Decon Sector, with the lieutenant from 

Rescue Squad 1 assigned as the Decon Officer. EMS 3 was assigned to handle the quarantine of civilians and police officers in the hot zone, and Medic 17’s paramedics were assigned to conduct post 

decontamination medical evaluations.

Additional resources arrived on the scene, including the DC Office of Emergency Preparedness 

(DCOEP), the DC Department of Health, and a liaison from the United States Secret Service Technical 

Security Division. Two Hazmat personnel were then dressed as an entry team, with two additional 

personnel dressed as a back-up team. The entry team, under directions from Federal experts on 

the scene, secured the package in double bagging and placed it in a five-gallon packing drum. The 

entry crew and the secured package were then decontaminated. The decontaminated package was 

turned over to the FBI, which transported it to the National Naval Medical Center in nearby Bethesda, 

Maryland, for laboratory analysis.

Personnel then waited for the results of the testing. During this time, a security guard in the quarantine 

area developed chest pains. He was carried on a chair through the decontamination corridor and then 

transported to a local hospital for treatment at 3:25 p.m. Also during this waiting period, several MPD 

officers became upset with instruction that they undergo decontamination. The officers had become 

aware that the media was broadcasting live pictures from cameras positioned on top of a nearby building. The officers refused to disrobe and undergo decontamination. One of the officers struck the EMS 

Lieutenant assigned to the quarantine area. High-ranking police officials were asked to help get the 

officers to comply with the procedures and, eventually, the officers were decontaminated. Firefighters 

were sent to check on the welfare of the civilians who had been sheltered in place.
USFA-TR-114/April 1997 5

The DCFEMS Rehab Unit was brought in to provide a waiting area for decontaminated civilians and 

police officers. Kosher food was ordered and delivered for the civilians still isolated in the B’nai 

B’rith building. At approximately 8:00 p.m., almost nine hours after the package was first discovered, results of the analysis of the package revealed that no chemical or biological threat was present. 

A final press conference was held, the civilians being protected in the building were released. The 

fire department terminated operations at 9:00 p.m.

Responders:

Agencies responding to or assisting at the B’nai B’rith incident included:

 Local:

 Fire/EMS Department

 Metropolitan Police Department

 Department of Consumer and Regulatory Affairs

 Department of Health

 Office of Emergency Preparedness

 Office of Communications

 Department of Public Works, Water and Sewer

 Office of the Mayor

 Federal:

 Federal Bureau of Investigation

 United States Secret Service

 Public Health Service Agency for Toxic Substances Disease Registry

 Centers for Disease Control Biosafety Branch

 National Naval Medical Center

 United States Park Police

Agencies which were notified or placed on standby:

 US Marine Corps Chemical/Biological Incident Response Force

 American Red Cross

 DC Housing Authority

 DC National Guard

 Metro Transit Authority (bus and rail)

 Metro Traffic Control

 DC Public Schools

 Military District of Washington

 Federal Emergency Management Agency

 Department of Human Services

 Users of Emergency Preparedness Network/NAWAS
6

ANALySIS

DCF/EMS	Preparedness	and	Response

Few fire departments are prepared to handle the scope of a potential terrorist chemical/biological 

attack. The DCFEMS was able to utilize existing response plans and adapt their own Hazmat policies 

and procedures to deal with the scope of this incident. The fire department incident commanders 

made appropriate decisions based upon their knowledge of the perceived threat, and consistent with 

their training and experience. First responding fire units were staged at appropriate distances while 

the battalion chief and the Hazmat Unit sized up the situation. A hot zone was established quickly. 

Unfortunately, these efforts were compromised by a few MPD officers on the scene who did not 

understand the serious nature of the potential chemical/biological threat and treated the incident 

more as a bomb scare. These officers initially crossed in and out of the hot zone, and could have 

contaminated themselves and other personnel had this been a real incident.

DCFEMS personnel performed admirably given the limited amount of information provided regarding what might be contained in the threat package. The Hazmat task force units provided trained 

hazardous materials technicians and specialists to conduct mitigation operations. Initial responding 

units (Engine 16 and Truck 9) that did not have trained Hazmat personnel were placed in service as 

quickly as possible to cover responses to other areas of the city.

The department was able to effectively utilize general guidelines it had established only a few months 

prior to this incident (Appendix A).

Hazmat	Operations

The Hazmat operations were conducted in accordance with Nationally acceptable practices (OSHA 

1910.120) for a fire department operating on the scene of an incident. It should be noted that, 

afterwards, some scientists and physicians expressed concerns as to how the department handled 

the contaminated package. These expressions ranged from comments that there was no real risk and 

the department’s actions were overkill, to complaints that the process was not thorough enough. 

The fact is that the fire service personnel acted conservatively, after receiving diverse and contradictory information from many different sources. Personnel were presented with a leaking package 

containing an unknown substance, civilians who claimed to be symptomatic, and a threatening 

letter from an unknown perpetrator. The department operated after consulting the CDC, and (due 

to the perceived threat of a possible chemical or biological agent) increased the level of protection used 

by personnel. Hot, warm, and cold zones were established, and a quarantine area was set up for 

contaminated civilians and first responders.

Limitations in equipment did hamper operations. The lack of tents for the discreet decontamination 

of civilians forced several people to disrobe in front of television cameras. However, decontamination procedures have traditionally been targeted for the decontamination of fire service personnel 

and victims under emergency conditions. The department should not be faulted for the live broadcasts by local and National media which were beyond the fire department’s ability to control. Many 

departments are, as a result, now taking the issue of the public’s modesty into consideration in 

developing action plans for decontamination operations.

There was also a problem with an inadequate number of Hazmat personnel. The limited number of 

trained Hazmat technicians forced many of the personnel tasked with decontamination and entry 

operations to remain suited up or to rotate through assignments over a long period of time.
USFA-TR-114/April 1997 7

Communications were also difficult on several levels. Hazmat entry teams were forced to use hand 

signals because their suit radios did not function effectively. The team did not have enough cell 

phones, fax machines, or a computer to access information in a rapid and systematic fashion. The 

DCFEMS has made several steps to address these shortfalls (see Initiatives, below).

Protect-in-place or evacuate to a safe haven? – The review of this incident revealed disagreements between 

fire service responders and health service professionals at both the local and National level as to 

whether the occupants of the B’nai B’rith building should have been sheltered in place. Traditional 

fire service and Hazmat actions often lead to the isolation of an incident, including the protection in 

place of civilians. The DCFEMS followed this long established procedure in developing their action 

plan. Both the civilians in B’nai B’rith and in the hotel across the street were isolated and the HVAC 

systems were shut down.

Some health service providers disagree with this tactic for a biological incident. The contention 

among some health service experts is that people must be evacuated from a possibly contaminated 

area (in this case, the B’nai B’rith building) and moved to a safe haven where they can either be 

quarantined or treated prophylactically with medications or antibiotics. By isolating people in an 

unventilated and possibly contaminated area, the victims are in effect exposed to any toxic biological 

pathogen for an extended duration. The perception is that the people isolated in place have been 

effectively written-off by emergency response personnel. Some respected experts have even suggested that, because there is no true decontamination process for exposure to a biological agent, possible victims should be simply treated, observed, or sent home. The view is that – unlike chemical 

agents – unless a biological agent is present in an aerosolized form, transmission of the agent from 

person to person is less likely.

Further discussion and research is required on this topic. Ultimately, such decisions will be at the 

discretion of the incident commander, after conducting a thorough risk assessment based the unique 

nature each incident, to develop and decide upon the best course of action.

EMS Operations

Initial reports indicated that several people were complaining of dizziness and headaches. Efforts 

were made to isolate and assess all people who might have been exposed. After the decon area was 

set up, these people were decontaminated and either held in a bus or in a quarantine area. The 

George Washington University Medical Center and the Washington Hospital Center were alerted of 

the situation and prepared to receive patients. Several personnel were evaluated and released from 

these hospitals; one patient was admitted to a hospital after suffering chest pains while waiting in 

the hot zone. More thorough interaction with the civilians protected-in-place in the B’nai B’rith 

building, (including possible prophylactic treatment with medications), might be a consideration in 

any future incident of a similar nature.

Police Operations

The MPD performed their police functions well, isolating the scene and limiting access. However, 

there were problems associated with underestimating the magnitude of the chemical/biological 

threat posed by the incident. The police bomb squad did not notify the fire department until over 

one hour into the incident. Some police personnel did not cooperate with the directives of the fire 

and EMS personnel on the scene, making isolation of the hot zone difficult in the early stages of the 

incident. The officers could have contaminated themselves, police, and EMS crews had the threat 

materialized. MPD personnel had received no training for Hazmat or chem/bio response.
8 U.S. Fire Administration/Technical Report Series

12

1. TOOL DROP

BUCKET

2. GROSS BLEACH

WASH

3. RINSE

4. SECONDARY

BLEACH WASH

5. RINSE

7. 55 GALLON DRUM

FOR CLOTHING DROP

Decontamination Procedures at B’nai B’rith

April 24, 1997

6. EMS EXAMINATION CHAIRS
USFA-TR-114/April 1997 9

Interagency	Coordination	and	Command	Post	Operations

Interagency coordination and unified command post operations were problematic during this incident. Key operational personnel (Fire/EMS, FBI, MPD, and Secret Service) had the benefit of previously working together during major events (such as the Presidential Inauguration), and were 

familiar with operating in an incident command system. Other agencies such as the DC Health 

Department, however, did not share that previous experience and did not have formal ICS training 

in unified command and emergency operations. The result was a fragmented operation in an overcrowded command post. While DCFEMS and FBI personnel were developing action plans, health 

department personnel were calling people in the B’nai B’rith building on their own, giving separate 

advice, and attempting to handle the situation as a public health operation. At on point, health officials told the people inside the building that they could leave, contrary to the instructions of the fire 

department incident managers. The local health officials, in turn, were operating under instructions 

they were receiving from their own National technical experts. The separate efforts led to different 

strategic decisions and action plans, and dramatically illustrates why it is critical for all responding 

agencies to operate under a unified approach during such incidents.

Public	Information	(PIO)	Functions

The fire and police department’s public information officers responded to handle the crush of media. 

An initial media area was established across the street from B’nai B’rith and later moved further away 

from the hot zone. Two media briefings were held during the event. More regular media updates, 

especially given the ongoing “live” broadcast of the incident, could have been helpful. Some people 

in B’nai B’rith were notified of the unfolding incident via associates who saw the incident coverage 

on television and called their colleagues in the building while the event was unfolding.

A close relationship with the media is helpful during almost any incident, but especially during 

chem/bio incidents. During this incident, the live broadcasts inhibited the ability of Hazmat crews 

to decontaminate people whose concerns about personal modesty appeared to outweigh their perception of life-threatening risk. In a real threat, the media can provide critical assistance by alerting 

civilians to necessary emergency actions. The department PIO can encourage media representatives 

to be sensitive to the victims’ privacy concerns, explain technical operations as they are occurring, 

and relay important information to the public through the media.

Metropolitan	Strike	Team

The Washington Metropolitan Area Council of Government’s Metropolitan Medical Strike Team was 

established in 1997 under a US Public Health Service grant to assist first responding agencies with 

the mass decontamination and treatment of victims of weapons of mass destruction. The Washington 

area MMST consists of police officers, fire department Hazmat personnel, and paramedics from the 

District of Columbia, Arlington County (VA), Fairfax County (VA), Alexandria (VA), Montgomery 

County (MD), and Prince George’s County (MD). While members of the MMST had received training at the time of the B’nai B’rith incident, the strike team was not yet operational. Thus, it was not 

a viable resource for DCFEMS, though some personnel and equipment could have been utilized had 

they been requested by the DC responders. The DCFEMS has incorporated plans for activating MMST 

resources into its plans, now the team is fully operational.

It is important to recognize that the function of MMST is as a back-up to the first responding agency. 

The local fire, EMS, and police will be the first on the scene, and their initial actions will affect the 

overall magnitude and scope of the incident.
10 U.S. Fire Administration/Technical Report Series

LESSONS LEARNED

Many valuable new lessons have been learned from this incident. Others have been documented 

before, but are worth reiterating.

1.	 Perhaps the most important lesson is that a true chemical/biological incident will quickly

overwhelm even the most prepared responders; it is essential to call early for additional

EMS and Hazmat resources, including mutual aid assets.

Had this incident been a true terrorist attack, producing a substantial number of victims, 

DC would have needed assistance from surrounding Hazmat teams and EMS systems available through existing mutual aid agreements. Quick response of a variety of technical Federal 

resources was available because the incident occurred in the Nation’s capital. Had the incident 

occurred elsewhere, it is likely that Federal resources would have taken much longer to arrive.

2.	 A supply of vaccines and antibiotics should be available in stockpiles for responders and

victims from a chemical or biological attack.

Stockpiles of nerve agent antidotes for chemical attacks, and medications for victims exposed to 

biological agents are only now being established. Vaccinations against some biological threats 

such as Anthrax are expensive and of yet unquantified value, though the military is inoculating 

many of its personnel. Treatment is available for many victims of bacteriological agents through 

prophylactic administration of antibiotics immediately after exposure. Limited treatments are 

available for those exposed to viral agents. Currently, it can take substantial time to collect and 

distribute the available medications and antidotes. Therefore, the identification of such resources 

should be an integral part of response plans.

3.	 Senior fire and EMS officers need real time information on evolving incidents which include

chemical and biological threats.

Fire department leaders are often kept “out of the loop” of intelligence reported to Federal law 

enforcement agencies or local police regarding valid threats of violence. In this incident, information gathered at the scene regarding the nature of the incident, the potential biological agent, 

and other police information was passed on to fire/EMS commanders in a timely fashion after 

the unified command was established. Prior to that, however, police units were on the scene for 

over one hour without informing the fire department of the incident.

4.	 This incident demonstrates the importance of multi-agency cooperation under the unified

command structure during major incidents.

At this incident, the agencies such as fire/EMS and FBI that had previously worked together in a 

command structure were able to operate in an efficient and unified means to achieve common 

goals. The agencies that had not previously worked with the fire department, such as the D.C. 

Health Department, had different information and approaches to the incident, and gave conflicting information to the people in the B’nai B’rith building. Unified command and exchange of 

key information and technical resources are critical factors for successful response.

5.	 All first responders, including police, should be trained to size-up a potential chemical/

biological incident and call for appropriate resources.

The lack of knowledge among MPD responders about the dangers posed by this threat could 

have led to unnecessary deaths had the threat been real. The delay in calling for fire department 
USFA-TR-114/April 1997 11

resources after the initial police response could have further endangered innocent civilians and 

severely inhibited the fire department’s ability to contain the incident. All police, fire and EMS 

personnel should receive first response training in recognition and assessment for these threats. 

In addition, it is important that responders be trained to recognize the different containment 

actions required for various chemical or biological threats. Airborne agents, for example, should 

be approached differently than other forms, such as solid agents. The training of responders in recognizing these differences is essential to accomplishing an appropriate and effective 

intervention. 

6.	 Security guards and civilians in high-risk buildings and areas should be trained in the

proper course of action for a suspicious package or device. The fire department or other

local emergency responders are the logical people to conduct this training.

B’nai B’rith is a clear target hazard for a terrorist incident (and actually was the site of a hostage incident in the 1970’s). If the security officer had known to leave the suspicious package 

in place in the mailroom, and then call 9-1-1, this incident may have been contained to an 

enclosed area, greatly facilitating exposure control, containment, and mitigation operations.

7.	 Biological agents present differently than chemical agents. Public health departments

response plans should include the capability to recognize the differences and address biological and chemical attacks.

While this incident was properly handled as a local chemical/Hazmat situation, a biological 

weapon release would likely sicken and kill victims over the course of several days. Anthrax, for 

example, mimics flu symptoms and has a 48-72 hour incubation period. A biological attack 

would reveal itself in the form of many people coming into emergency departments or being 

transported to hospitals with flu-like symptoms, or worse. A chemical agent will likely cause 

immediate and localized casualties. Mechanisms should be developed and put in place for public health departments and EMS services to identify when they are dealing with exposures that 

could be related to a biological attack, as opposed to a chemical attack.

8.	 While Federal resources may be necessary to mitigate a chemical/biological incident, local

public safety agencies will be the first on the scene. Advanced plans must be made for coordinated interagency and intergovernmental cooperation during response.

In this incident, civilian resources were effectively utilized to mitigate the incident. Military 

advisors were contacted for assistance, and military facilities were used to test the products. The 

FBI assumed its role without alienating fire/EMS personnel. The need for interagency coordination and cooperation is paramount, but it also must be remembered that the first responders will be uniformed civilian personnel: police, fire, and EMS. In most parts of the country, 

Federal resources will be deployed from distant locations requiring several hours to become 

operational.

9.	 Standard operating procedures are necessary for response to chemical and biological

terrorism.

The DCFEMS was able to successfully adapt its existing Hazmat SOPs and a terrorism check-list 

into a working action plan for this incident. All public safety departments need to develop SOPs 

or other operational guidelines for response to chemical and biological threats. These SOPs 

should identify key initial operations to maintain the safety of responders and minimize the 
12 U.S. Fire Administration/Technical Report Series

scope and impact of an incident, as well as list available local, State and Federal resources and 

contacts that may be useful during operations. A “response to terrorism” SOP should incorporate critical aspects of Hazmat, mass casualty, command, and emergency management operations. DCFEMS has included a check-list for response to terrorist incidents, including explosives 

and NBC weapons, into its incident command system. Fire commanders have trained for bomb 

and NBC response since 1996.

10.	 Hazmat teams need special equipment to respond to these types of incidents.

Due to budget constraints beyond the control of DCFEMS personnel, Hazmat crews were 

hampered by some equipment shortages, notably tents to protect the privacy of people being 

decontaminated. Additional trained personnel, protective equipment, supplied-air breathing 

apparatus, and communications gear would have aided Hazmat crews.

11.	 Good public information is key for helping to maintain public confidence in emergency

personnel and emergency organizations.

The terrorists’ goal is to make people feel unsafe and unprotected. Successful public information management utilizes the media to relay important information to the public as well as to 

help solidify the public’s confidence in the responding agencies. A technically competent person 

from the special operations groups involved should be assigned to explain technical operations 

in plain terms to the media.

The fire department PIO at such an incident needs to be supported with a technical expert to 

handle media inquiries in an appropriate fashion. Because of the lack of a technical spokesperson, the media turned to experts not directly involved for commentary. This practice encouraged people to speculate widely on what was occurring at this incident, and resulted in incorrect 

and conflicting information to be transmitted to the public.

12.	 Fire and EMS agencies should anticipate the requirements associated with quarantining a

sizeable portion of the exposed population after a biological incident.

A Biological weapon release may necessitate isolating any persons suspected of exposure for up 

to several days. The logistical and legal ramifications of such a task need to be reviewed. The 

DCFEMS isolated the small number of exposed persons at this incident. Departments should 

consider adding equipment such as large tents to their resource lists for temporary sheltering of 

victims.

13.	 A direct phone line should be established and kept open with those who are protected in

place. Information should be channeled through a single source from the incident management team.

The DCFEMS established communications with the people inside the B’nai B’rith building, but 

incident managers indicated that this line of communication was not kept open. This enabled 

conflicting information to be communicated to the people inside by other responding agencies. At any incident of this type, a single person or agency should be established as the contact 

for victims to ensure the delivery of consistent information and instructions from the incident 

managers.
USFA-TR-114/April 1997 13

14.	 Fire and EMS agencies should maintain an operational command post separate from the

unified command post.

DCFEMS commanders indicated that they would establish a separate operational command post 

away from the unified command post on future incidents to facilitate fire/EMS operations. The 

command post at this incident was crowded and made smooth organization of the actual fire 

service operations difficult. Fire departments should have plans for their own command post 

area so they can effectively coordinate the strategies that are developed in the unified command 

post. Additionally, access to the unified command post should be limited to key incident management team members and liaisons from responding agencies. Security is necessary at the fire 

and unified command posts to restrict access.

15.	 Thorough documentation and record keeping should take place concurrently and aftersuch

a incident.

Diverse information was collected for this report. Some information was contradictory or inaccurate. Other information, such as names of personnel, the decisions behind action plans and 

mitigation strategies, existed only in the memories of the responders. It is important and 

valuable for departments to develop a process to document all the decisions and actions made 

by personnel during such incidents. This documentation should preferably begin during the 

response to the incident, and continue after the incident as part of a comprehensive post-incident analysis. This would allow departments to develop plans for improving operations, provide 

a legal record of what occurred, and preserve as part of the institutional memory the lessons 

learned by the department, long after the current responders have left service.

The Federal Emergency Management Agency’s Urban Search and Rescue system has developed 

criteria for Technical Documentation personnel that could provide an excellent model for incorporating documentation of incidents into local department’s response plans.

16.	 First responders need affordable equipment to detect and characterize chemical and biological agents.

Devices and field test kits that are currently being developed for the military and Federal government should be made available to civilian first responders. Currently affordable technology is 

limited and some types are prone to false positive readings. More funding should be provided 

to develop promising technologies. The ability to detect the release of chemical and biological 

agents was recently identified as a priority in a survey of needs of State and local responders by 

the US Department of Justice.2

17.	 More research is necessary to determine the most appropriate strategies for protecting the

public during these incidents.

More research is needed to address the question of whether it is best to protect in-place or to 

evacuate to a safe haven, those civilians exposed to chem/bio agents.

2Inventory of State and Local Enforcement Technology Needs to Combat Terrorism, US Department of Justice, 1998.
14 U.S. Fire Administration/Technical Report Series

INITIATIVES By DCFEMS

The DCFEMS has taken several initiatives to improve response in the future to these incidents:

• Formed a Special Operations section and added a battalion chief for Special Operations to 

oversee technical rescue, Hazmat, and counter terrorism;

• Purchased additional level A encapsulated suits;

• Purchased chemical/biological filter masks;

• Trained all personnel in the First Battalion as Hazmat Technicians for suit operations;

• Added the Council of Government’s MMST to response plans;

• Purchased decontamination tents to protect the privacy of victims;

• Providing first response to terrorism training for commanders and firefighters;

• Purchasing new communications equipment for the Hazmat team;

• Reviewing and revising all incident command systems and SOPs, including the terrorism 

response checklist.
15

APPENDIx A

District	of	Columbia	Fire	and	EMS	Department		

Incident	Command	System	and	Checklist

INCIDENT COMMAND SySTEM FOR TERRORIST ATTACKS

Terrorism is a new challenge to the emergency services in this country that will tax every segment of 

the public safety community. The size of these incidents, the number of agencies involved, the need 

to preserve a very large crime scene, the number of casualties and entrapped victims, the possibility 

of contamination of the entire community, and injury to emergency personnel from contaminants 

or secondary explosions are problems unique to terrorist incidents. Pre-planning and cooperation 

between Federal, State, and local authorities will be essential to successfully mitigate this type emergency. The Federal Emergency Management Agency (FEMA) held a conference in November 1995 to 

address the Nation’s preparedness to deal with terrorist activity. At the conclusion of the conference, 

Strengthening the Fire and Emergency Response to Terrorism, it was resolved that Nationwide focus 

must be directed at the terrorist threat so communities will be properly prepared.

There was a broad scope of issues presented at the conference with presenters from France, 

Israel, Japan, Ireland, and England representing the international community. Federal 

agencies including the Federal Bureau of Investigation, State Department, Department of 

Defense, Department of Energy, U.S. Fire Administration, Nuclear Emergency Management 

Laboratories, U.S. Army, U.S. Marines, and the Office of Emergency Preparedness were 

represented. Chief officers from fire departments representing the entire Nation (including Oklahoma City and New York City which experienced terrorist attacks), professional 

associations such as the International Association of Fire Chiefs and the International 

Association of Chiefs of Police, and prominent figures from the media were part of the 

roster. Virtually all aspects of the terrorist issue were addressed from as many perspectives 

as possible. The consensus at the conference was that this was just the beginning of a 

Nationwide effort to prepare to meet the challenge.

There was one common chorus that sounded throughout the conference. A comprehensive, 

well organized, and efficiently implemented Incident Command System would be of paramount 

importance to successfully manage any large scale emergency incident, particularly one dealing 

with multiple agencies. It was also the consensus that the Fire Service had the most sophisticated 

Incident Command System and the most experience in applying it. For this reason fire departments across the Nation will be called upon to lead the way in mitigating incidents resulting from 

acts of terrorism. The check-off list below should be helpful in applying any Incident Command 

System to a terrorist attack.
16 U.S. Fire Administration/Technical Report Series

Some unique problems to be considered by the incident commander in applying the Incident 

Command System to a terrorist attack would include:

 1. Secondary explosions while rescuers are in the area

 2. The presence of biochemical contaminants

 3. The presence of radiological contaminants

 4. Preserving the scene for criminal investigation

 5. Coordination of multi agency response

 6. Resources for a long duration operation

 7. Controlling access to restricted areas

 8. Security of adjacent buildings and property

 9. Notification of relatives

10. Media briefings for a large scale media response

The check lists below are intended to remind the incident commander and sector leaders of some 

considerations that may be unique to a terrorist attack.

PROBLEM AREA SECTOR ASSIGNMENT CONSIDERATIONS

Limit Access Operations ____ Minimal Commitment Of Personnel

Secondary Explosion Operations ____ 1. Bomb Disposal Unit

____ 2. Building Search

____ 3. Snatch Rescue

____ 4. Specialized Unit

Contaminants Operations ____ 1. Hazmat

____ 2. Chemical

____ 3. Biological

____ 4. Radiological

Search & Rescue Operations ____ 1. Snatch Rescues

____ 2. Primary

____ 3. Secondary

EMS Medical ____ 1. Triage

____ 2. Treatment

____ 3. Overloading Facilities

____ 4. Transport

____ 5. Record Keeping
USFA-TR-114/April 1997 17

continued on next page

PROBLEM AREA SECTOR ASSIGNMENT CONSIDERATIONS

Evacuation Planning ____ 1. On-site Treatment

____ 2. Contamination of Facilities

____ 3. Safe Zones

____ 4. Child Care

____ 5. Mass Transit

____ 6. Record Keeping

Perimeters Planning ____ 1. Primary

____ 2. Secondary

____ 3. Large Enough for Specialty Equip.

Zones Planning ____ 1. Hot

____ 2. Warm

____ 3. Cold

____ 4. Notification of All Agencies

____ 5. Record Keeping

Other Agencies Planning ____ 1. Mutual Aid

____ 2. Federal

____ 3. State

____ 4. Military

____ 5. Statutory Auth.

Communication Communication ____ 1. Special Phones

____ 2. Compatibility

____ 3. Messenger

____ 4. Command Post Liaison

Foam & Other Agents Operation ____ 1. Type

____ 2. Compatibility

____ 3. Effectiveness

____ 4. Complications

Logistics Logistics ____ 1. Food On Site/Off Site

____ 2. Fuel

____ 3. Accountability

____ 4. Storage

____ 5. Santitation

____ 6. Water

____ 7. Waste
18 U.S. Fire Administration/Technical Report Series

PROBLEM AREA SECTOR ASSIGNMENT CONSIDERATIONS

Logistics (continued) Logistics ____ 8. Contamination

____ 9. Clothing

____ 10. Donations

____ 11. Purchases

____ 12. Loans

____ 13. Special Equip.

____ 14. Repair

____ 15. Parts

____ 16. Replacement

____ 17. Contracts

____ 18. Record Keeping

____ 19. Delivery Zone

Public Information P.I.O. ____ 1. Spokesperson

____ 2. Location

____ 3. Access

____ 4. Other Agencies

____ 5. Time

Special Teams Planning ____ 1. Specialty

____ 2. Command

____ 3. Equipment

____ 4. Response Time

____ 5. Communications

____ 6. Relief

Morgue Medical ____ 1. Criminal Invest.

____ 2. Record Keeping

____ 3. Restricted Access

____ 4. Temp/weather

Briefing P.I.O. ____ 1. Personnel

____ 2. Other Agencies

____ 3. Survivors

Relief Planning ____ 1. Short Term

____ 2. Long Term (8 Dys)

____ 3. Expertise
USFA-TR-114/April 1997 19

PROBLEM AREA SECTOR ASSIGNMENT CONSIDERATIONS

Family Assistance Liaison ____ 1. Survivors

____ 2. Relatives

____ 3. Briefing

____ 4. Debriefing

____ 5. Transportation

____ 6. Lodging

____ 7. Subsistence

Finance Finance ____ 1. Authority To Request

____ 2. Record Keeping

____ 3. Accountability

____ 4. Payment

____ 5. Cost

____ 6. Claims

____ 7. Analysis

____ 8. Other Agencies

Debriefing P.I.O. ____ 1. Right To Know

____ 2. Personnel

____ 3. Survivors

Physical Therapy Liaison ____ 1. Rescue Workers

____ 2. On Site

____ 3. Off Site

C.I.S.D. Liaison ____ 1. Critical Incident Stress Debriefing

____ 2. Additional Teams

____ 3. Follow Up

Counselling Liaison ____ 1. Personnel

____ 2. Relatives

____ 3. Survivors

____ 4. Next Of Kin

____ 5. Witnesses
20

APPENDIx B

B’nai	B’rith	Incident	Pictures

(Photos Courtesy DCFEMS)

Photo	1.	Firefighters	establish	a	decontamination	corridor

Photo	2.	Hazardous	materials	crews	prepare	decontamination	area.
USFA-TR-114/April 1997 21

Appendix B (continued)

Photo 3. Command post operations were crowded by

responders from multiple agencies.

Photo 4.The decon area is set up, consisting of a tool drop station, gross bleach

wash,rinse, and a second wash and rinse area.
22 U.S. Fire Administration/Technical Report Series

Appendix B (continued)

Photo 5. A civilian undergoes decontamination.
USFA-TR-114/April 1997 23

Appendix B (continued)

Photo 6. A patient is transported suffering from chest pains during the incident.

Photo 7. An overview of apparatus placement. The arrow points to the

B’nai B’rith Building.
24

APPENDIx C

HaNDBOOK	ON	THE	MEDICaL	aSPECTS	OF		

NBC	DEFENSIVE	OPERaTIONS	FM	8-9

PaRT	II	–	BIOLOGICaL	

aNNEx	B

CLINICaL	DaTa	SHEETS	FOR	SELECTED	BIOLOGICaL	

aGENTS

1	February	1996

B.02	anthrax

B.09	Plague
USFA-TR-114/April 1997 25

B.02 ANTHRAx

a. Clinical Syndrome.

(1) Characteristics. Anthrax is a zoonotic disease caused by Bacillus anthracis. Under natural 

conditions, humans become infected by contact with infected animals or contaminated 

animal products. Human anthrax is usually manifested by cutaneous lesions. A biological 

warfare attack with anthrax spores delivered by aerosol would cause inhalation anthrax, an 

extraordinary rare form of the naturally occurring disease.

(2) Clinical Features. The disease begins after an incubation period varying from 1-6 days, presumably dependent upon the dose of inhaled organisms. Onset is gradual and nonspecific, 

with fever, malaise, and fatigue, sometimes in association with a nonproductive cough 

and mild chest discomfort. In some cases, there may be a short period of improvement. 

The initial symptoms are followed by in 2-3 days by the abrupt development of severe 

respiratory distress with dyspnea, diaphoresis, stridor, and cyanosis. Physical findings may 

include evidence of pleural effusions, edema of the chest wall, and meningitis. Chest x-ray 

reveals a dramatically widened mediastinum, often with pleural effusions, but typically 

without infiltrates. Shock and death usually follow within 24-36 hours of respiratory distress onset.

b. Diagnosis

(1) Routine Laboratory Findings. Laboratory evaluation will reveal a neutrophilic leucocytosis. Pleural 

and cerebrospinal fluids may be hemorrhagic.

(2) Differential Diagnosis. An epidemic of inhalation anthrax in its early state with nonspecific 

symptoms could be confused with a wide variety of viral, bacterial, and fungal infections. 

Progression over 2-3 days with the sudden development of severe respiratory distress followed by shock and death in 24-36 hours is essentially all untreated cases eliminates diagnoses other than inhalation anthrax. The presence of a widened mediastinum on chest x-ray, 

in particular, should alert one to the diagnosis. Other suggestive findings include chest-wall 

edema, hemorrhagic pleural effusions, and hemorrhagic meningitis. Other diagnoses to 

consider include aerosol exposure to SEB; but in this case onset would be more rapid after 

exposure (if known), and no prodrome would be evident prior to onset of sever respiratory 

symptoms. Mediastinal widening on chest x-ray will also be absent. Patients with plague 

or tularemia pneumonia will have pulmonary infiltrates and clinical signs of pneumonia 

(usually absent in anthrax).

(3) Specific Laboratory Diagnosis. Bacillus anthracis will be readily detectable by blood culture with 

routine media. Smears and cultures of pleural fluid and abnormal cerebrospinal fluid may 

also be positive. Impression smears of mediastinal lymph nodes and spleen from fatal cases 

should be positive. Toxemia is sufficient to permit anthrax toxin detection in blood by 

immunoassays.

c. Therapy. Almost all cases of inhalation anthrax in which treatment was begun after patients were 

symptomatic have been fatal, regardless of treatment. Historically, penicillin has been regarded 

as the treatment of choice, with 2 million units given intravenously every 2 hours. Tetracyclines 

and erythromycin have been recommended in penicillin-sensitive patients. The vast majority 

of anthrax strains are sensitive in vitro to penicillin. However, penicillin-resistant strains exist 
26 U.S. Fire Administration/Technical Report Series

naturally, and one has been recovered from a fatal human case. Moreover, it is not difficult to 

induce resistance to penicillin, tetracyclines, erythromycin, and many other antibiotics through 

laboratory manipulation of organisms. All naturally occurring strains tested to date have been 

sensitive to erythromycin, chloramphenicol, gentamicin, and ciprofloxacin. In the absence of 

information concerning antibiotic sensitivity, treatment should be instituted at the earliest signs 

of disease with oral ciprofloxacin (1,000 mg initially, followed by 750 mg po (orally) bid 

(twice daily) or intravenous doxycycline (200 mg initially, followed by 100 mg q (every 12 

hrs.) Supportive therapy for shock, fluid volume deficit, and adequacy of airway may all be 

needed.

d. Prophylaxis

(1) Vaccine. A licensed, alum-precipitated preparation of purified B. anthracis protective antigen 

(PA) has been shown to be effective in preventing or significantly reducing the incidence 

of inhalation anthrax. Limited human data suggest that after completion of the first three 

doses of the recommended six-dose primary series (0, 2, 4, weeks, then 6, 12, 18 months), 

protection against both cutaneous and inhalation anthrax is afforded. Studies in rhesus 

monkeys indicate that good protection is afforded after two doses (10-16 days apart) for 

up to 2 years. It is likely that two doses in humans is protective as well, but there is too 

little information to draw firm conclusions. As will all vaccines, the degree of protection depends upon the magnitude of the challenge dose; vaccine-induced protection is 

undoubtedly overwhelmed by extremely high spore challenge. At least three doses of the 

vaccine (at 0, 2, and 4 weeks) are recommended for prophylaxis against inhalation anthrax. 

Contraindications for use are sensitivity to vaccine components (formalin, alum, benzethonium chloride) and/or history of clinical anthrax. Reactogenicity is mild to moderated: 

up to 6% of recipients will experience mild discomfort at the inoculation site for up to 72 

hours (tenderness, erythema, edeman, pruritus), while a smaller proportion (<1%) will 

experience more severe local reactions (potentially limiting use of the extremity for 1-2 

days); modest systemic reactions (anaphylaxis, which precludes additional vaccination) are 

rare. The vaccine should be stored at refrigerator temperature (not frozen).

(2) Antibiotics. Choice of antibiotics for prophylaxis is guided by the same principle as that 

for treatment; i.e., it is relatively easy to produce a penicillin-resistant organism in the 

laboratory, and possible, albeit somewhat more difficult, to induce tetracycline resistance. 

Therefore, if there is information indicating that a biological weapon attack is imminent, 

prophylaxis with ciprofloxacin (500 mg po bid), or doxycycline (100 mg po bid) is recommended. If unvaccinated, a single 0.5 ml dose of vaccine should also be given subcutaneously. Should the attack be confirmed as anthrax, antibiotics should be continued for 

at least 4 weeks in all exposed. In addition, two 0.5 ml doses of vaccine should be given 

2 weeks apart in the unvaccinated; those previously vaccinated with fewer than three doses 

should receive a single 0.5 ml booster, while vaccination probably is not necessary for those 

who have received the initial three doses within the previous 6 months (primary series). 

Upon discontinuation of antibiotics, patients should be closely observed; if clinical signs 

of anthrax occur, patients should be treated as indicated above. If vaccine is not available, 

antibiotics should be continued beyond 4 weeks until the patient can be closely observed 

upon discontinuation of therapy.
USFA-TR-114/April 1997 27

B.09 PLAGUE

a. Clinical Syndrome

(1) Characteristics. Plague is a zoonotic disease caused by Yersinia pestis. Under natural conditions, humans become infected as a result of contact with rodents, and their fleas. The 

transmission of the gram-negative coccobacillus is by the bite of the infected flea, Xenopsylla 

cheopis, the oriental rat flea, or Pulex irritans, the human flea. Under natural conditions, three 

syndromes are recognized: bubonic, primary septicemic, or pneumonic. In a biological 

warfare scenario, the plague bacillus could be delivered via contaminated vectors (fleas) 

causing the bubonic type or, more likely, via aerosol causing pneumonic type.

(2) Clinical Features. In bubonic plague, the incubation period ranges from 2 to 10 days. The 

onset is acute and often fulminant with malaise, high fever, and one or more tender lymph 

nodes. Inguinal lymphadenitis (bubo) predominates, but cervical and axillary lymph nodes 

can progress spontaneously to the septicemic form with organisms spread to the central 

nervous system, lungs (producing pneumonic disease), and elsewhere. The mortality is 50 

percent in untreated patients with the terminal event being circulatory collapse, hemorrhage, and peripheral thrombosis. In primary pneumonic plague, the incubation period 

is 2 to 3 days. The onset is acute and fulminant with malaise, high fever, chills, headache, 

myalgia, cough with production of bloody sputum, and toxemia. The pneumonia progresses rapidly, resulting in dyspnea, stridor, and cyanosis. In untreated patients, the mortality is 100 percent with the terminal event being respiratory failure, circulatory collapse, 

and a bleeding diathesis.

b. Diagnosis

(1) Presumptive. Presumptive diagnosis can be made by identification of the gram-negative coccobacillus with safety-pin bipolar staining organisms in Giemsa or Wayson’s stained slides 

from a lymph node needle aspirate, sputum, or cerebrospinal fluid (CSF) samples. When 

available, immunofluorescent staining is very useful. Elevated levels of antibody to Y. pestis

in a nonvaccinated patient may also be useful.

(2) Definitive. Yersina pestis can be readily cultured from blood, sputum, and bubo aspirates. 

Most naturally occurring strains of Y. pestis produce an “Fl” antigen in vivo which can be 

detected in serum samples by immunoassay. A fourfold rise of Y. pestis antibody levels in 

patient serum is also diagnostic.

(3) Differential. In cases where bubonic type is suspected, tularemia adentitis, staphylococcal or 

streptococcal adentitis, meningococcemai, enteric gram-negative sepsis, and rickettsiosis 

need to be ruled out. In pneumonic plague, tularemia, anthrax, and staphylococcal enterotoxin B (SEB) agents need to be considered. Continued deterioration without stabilization 

effectively rules out SEB. The presence of a widened meiastinum on chest x-ray should alert 

one to the diagnosis of anthrax.

c. Therapy. Plague may be spread from person to person by droplets. Strict isolation procedures 

for all cases are indicted. Streptomycin, tetracycline, and chloramphenicol are highly effective 

if begun early. Significant reduction in morbidity and mortality is possible if antibiotics are 

given within the first 24 hours after symptoms of pneumonic plague develop. Intravenous 

doxycycline (200 mg initially, followed by 100 mg every 12 hours), intramuscular streptomy-
28 U.S. Fire Administration/Technical Report Series

cin (1 g every 12 hours), or intravenous chloramphenicol (1 g every 6 hours) for 10-14 days 

are effective against naturally occurring strains. Supportive management of life-threatening 

complications from the infection, such as shock, hyperpyrexia, convulsions, and disseminated 

intravascular coagulation (DIC), need to be initiated as they develop.

d. Prophylaxis. A formalin-killed Y. pestis vaccine is produced in the United States and has been extensively used. Efficacy against flea-borne plague is inferred from population studies, but the utility 

of this vaccine against aerosol challenge is unknown. Reactogenicity is moderately high and a 

measurable immune response is usually attained after a 3-dose primary series: at 0, 1, and 4-7 

months. To maintain immunity, boosters every 1-2 years are required. Live-attenuated vaccines 

are available elsewhere but are highly reactogenic and without proven efficacy against aerosol 

challenge.
29

APPENDIx D

Incident	Operations	Chart

D - 2

B’nai B’rith Incident Operations Chart

Command Post

• DC Fire/EMS• DC Office of Emergency Services• FBI• DC Health Department• Metro Police Department• US Secret Service

Perimeter Control

BFC Herr, DCFEMS

MPD

Hazmat Operations

Capt. Johnson, DCFEMS

EMS Screening &

Quarantine

Lt. Lyles, DCFEMS

M-17

Safety

Lt. Faulkner

Research

Sgt. Nickelson

Entry Team

Hazmat Unit

Back-up Team

RS-1, T-4

Decon

E-12

Public Information

BFC Carter, DCFEMS

Sgt. Gentile, MPD

Fire/EMS Operations

BFC Mould, DCFEMS

Police Operations

FBI

MPD
30

APPENDIx E

Model	action	Plan	Chart	for		

Chemical/Biological	Incidents	for	First	Responders

E - 2

A Model Action Plan Chart for

Chemical/Biological Incidents for First Responders

Receive notification and

respond to incident

Isolate the area and attempt to

determine nature of the incident.

Is it a chemical or biological incident?

Could there be secondary devices?

Establish an incident management system and a

unified command post.

Call for and stage additional resources.

Police, Fire, EMS

Federal National Response Center

1-800-424-8802

for NBC incidents.

Attempt to isolate and triage number and type of casualties.

Establish single point of communications with victims.

If chemical, consider emergency

decontamination procedures.

Consider sheltering in place of

unexposed victims until they can be

removed to a safe area or until the

incident is stabilized.

Treat and transport victims.

Conduct post-incident medical screening

for responders.

Consider CISD for personnel and

families.

Conduct a critique and develop an

after-action report.

If biological, consider evacuation to safe

haven, quarantine, medical evaluation, and

prophylactic treatment with appropriate

medications.

(Ongoing)

Establish PIO

Victim assistance

liaison

Technical

documentation

What is the form of the substance (Solid, Liquid, Vapor)?

Are the victims symptomatic (symptoms indicate possible chemical)?

DEVELOP AN INCIDENT ACTION PLAN