bucci_liu_thesis

Running head. FIRST RESPONDERS IN A BIOTHREAT ENVIRONMENT 1

HOMELAND SECURITY MANAGEMENT INSTITUTE LONG ISLAND UNIVERSITY - RIVERHEAD

THESIS PROPOSAL

03 February 2015 From: Philip S. Bucci To: Director, Homeland Security Management Institute Via: (1) Dr. Vincent E. Henry, Thesis Advisor (2) Dr. Steven Bucci, Second Reader (3) Prof. Neal Anderson, Third Reader SUBJECT: THESIS FOR THE DEGREE OF MASTER OF SCIENCE IN HOMELAND SECURITY MANAGEMENT Please find the attached thesis proposal, entitled “First Responders in a Biothreat Environment”. My anticipated graduation date is January 2015. For your information and appropriate attention. ______________________________ Philip S. Bucci

FIRST RESPONDERS IN A BIOTHREAT ENVIRONMENT 2

Table of Contents

Table of Contents 2

Abstract 3

Introduction: First Responders in a Biothreat Environment 4

Significance of Research 6

Literature Review 14

Methodology 18

Types of Biological Warfare Agents 20

Biological Warfare Agent Production by Agent 32

Biological Warfare Agent Production Equipment 35

Policy Options and Recommendations 45

Conclusion 54


Abstract

The threat of extremists attacking major American population centers with weapons of

mass destruction has increased since the September 11th Terror attacks. Consequently, the need

for the Nation’s First Responders, police, fire, and Emergency Medical Service (EMS)

personnel, to be trained to recognize and respond to this unconventional threat has grown as

well. While many technologies exist to detect chemical or biological threats, along with nuclear

and radiological, the primary method of detection is Detect to Treat, which relies on the ability of

medical personnel to recognize the symptoms of infected patients. While this paper will focus

on biological, chemical weapons will be discussed for reference purposes. Many biological

agents have the ability to rapidly spread, and if the detection process is slow, these agents can

overtake the ability of a community to treat the illness. The best way to ensure the community is

prepared for a biological agent outbreak is to give First Responders the knowledge to identify

threats before they spread. While technology is useful, having the knowledge to identify

ingredients, tools, and symptoms of biological agent production will decrease the likelihood of

secondary contamination and response time. Training First Responders can be costly, but

utilizing Reserve Soldiers will not commit additional resources and will develop the relationships

necessary for ensuring success in securing the homeland. The US Army Reserves has the

capability and manpower to ensure proper training and support for all State and Local agencies

to ensure the nation has a strong defense against biological agent outbreaks - whether natural or

intentional.


Introduction: First Responders in a Biothreat Environment

The threat of extremists attacking major American population centers with chemical or

biological weapons has increased since the September 11th Terrorist attacks on the Pentagon and

the World Trade Center. The US Congress’s Commission on the Prevention of Weapons of

Mass Destruction Proliferation and Terrorism, which Congress established in fulfillment of a

recommendation of the Final Report of the National Commission on Terrorist Attacks Upon the

United States (the 9/11 Commission Report), declared “biological weapons are the most

dangerous threat the United States is facing,” making it clear the threat of biological attack is

taken seriously. (Bucci, 2013, pg. 11) Consequently, the need for our Nation’s First Responders,

police, fire, and Emergency Medical Service (EMS) personnel to be trained to recognize this

unconventional threat and respond to it accordingly has grown as well.

Because it may become the responsibility of State and Local health agencies to discover

these threats after they occur, and because such discovery is unlikely to occur until a substantial

number of individuals become infected, it is reasonable to question whether American First

Responders have the knowledge and the organizational capacity to recognize threats such as

biological weapons in a diverse, dispersed, and highly populated area. First Responders such as

police, firefighters and emergency medical services personnel can play a critical role in

identifying a potential outbreak since they are the most likely to encounter and be exposed to a

patient before he or she arrives to a hospital, and they are also at high risk because they will

likely not be wearing appropriate protective gear. If first responders have the knowledge to

recognize symptoms and alert medical personnel of the need for further diagnosis and

appropriate laboratory processes, they can speed up the detection process significantly. This

paper will focus on police, fire, and EMS personnel, who are likely to arrive at a small-scale


biological attack conducted in a manner similar to the Aum Shinrikyo incident in Japan, before

creation of an Incident Command post at the incident site.

Using the latest policy options, and with a basic understanding of biological warfare

agent production methods, materials, and equipment, a simple low cost solution to enabling and

enhancing the knowledge of First Responders can be accomplished. Using the Military and its

vast array of personnel and material, as well as online self-paced learning, First Responders can

keep up to date on the latest threats and methods of detection and production. Based on the gaps

in the literature and the lack of understanding of the threat seen in the media during the 2014

Ebola outbreaks, there is not enough solid expertise to deal with a large outbreak of biological

agents, whether the attack be natural or manmade.


Significance of Research

Cities have turned to technology to fill the current gap in training exists for first

responders. While many technologies exist to detect these threats, the primary method of

detection is Detect to Treat (DTT) which relies on “local doctors and nurses to serve as the initial

‘detection’ screen”. (Bucci, 2013, pg. 11) This means once an outbreak or attack occurs the

threat will be analyzed by medical centers and then the appropriate treatments will be

administered. DTT is an effective method of dealing with biological attacks yet DTT still has

immense risks for the population. Many biological agents have the ability to rapidly spread, and

if the detection process is slow, these agents can overtake the ability of a community to treat the

illness. Perhaps the best known example of an illness outbreak overwhelming a community’s

ability to identify and treat the victim’s condition is the Spanish Flu pandemic of 1918.

Originating at Fort Riley KS, the movement of infected troops to New York and then to Europe

in support of World War I allowed the flu to spread and infect over 500 million people ultimately

resulting in around 50 million deaths worldwide or about 3% of the world’s population at the

time. (Tauberger, 2006) Although medical facilities and diagnostics have changed dramatically

since this time, this event serves as lesson on the dangers of transmission prior to detection.

Another technology being used to help protect populated areas is the BioShield system.

Unfortunately about 90% of the $3.3 Billion earmarked for spending on protection against

threats such as Ebola was spent on only three biological warfare agents: anthrax, small pox, and

botulism. (Quinn, 2014) While these represent a much higher likelihood of occurrence it shows

how the system has been weakened toward certain threats and is not the catch-all system needed.

Additionally, the BioShield systems use filters which need to be manually collected and then


analyzed for the presence of agents. While cost effective, significant gaps of time may exist

between collections and testing.

Given the advances in global transportation since 1918 one can easily comprehend the

impact which slow detection can have on the world’s population. Fortunately along with

advances in transportation, significant advances in medicine and hygiene have been achieved

around the world since the Spanish Flu epidemic of 1918. These advances in medicine, in

hygiene, and in health organizations’ knowledge of the dynamics of epidemiology have served to

counter or mitigate (but not eliminate) the potential for the rapid spread of infectious diseases. In

2009 when the H1N1 Flu virus was thought to be on the brink of epidemic outbreak the world’s

health organizations rapidly offered measures to help slow the spread by infected persons,

especially those traveling by air. While these measures did not entirely halt the spread of the

virus, they helped limit the spread and keep H1N1 at a more manageable level.

While the frightening examples above are not the result of attacks, a coordinated effort to

infect a large population and cause widespread panic is the stuff of nightmares. With the world’s

intelligence apparatus primarily focused on the threats of more ‘traditional’ terrorist activities

such as bombings or targeted killings taking place overseas, many domestic events such as small

and highly focused attacks using non-nuclear WMDs in the homeland may be left up to state and

local responders both to detect and to address after the event occurs. This is not to say the

Federal Bureau of Investigation (FBI) or other Federal Agencies, such as the Centers for Disease

Control and Prevention (CDC), and the National Biosurveilliance Integration Center (NBIC) are

not focused on preventing or interdicting threats before they occur, but they do not play a

substantial role in DTT until a significant number of patients begin to develop and seek treatment

for their illness.


The 1994 and 1995 Sarin gas attacks in Japan by the religious cult Aum Shinrikyo killed

dozens of people and injured about 5000 others. (Seto, 2001, pg. 1) Sarin Gas is a colorless,

tasteless, odorless nerve agent created in 1938 as a pesticide. Once air, water, food, or clothing

is contaminated people can get exposed to the agent’s effects, which include nausea, vomiting,

confusion, paralysis, and respiratory failure leading to death. While treatable, the antidotes to

Sarin must be administered quickly in order to be effective. According to the Organization for

the Prohibition of Chemical Weapons’ Yasuo Seto (2001), these attacks introduced the Japanese

police to “a new type of crime.” (pg. 1)

The Nagano Prefectural Police officers assigned to the Matsumoto Police Station

received a call from an ambulance team alerting them of injuries and patients needing help.

Patients were suffering from ocular pain and numbness in the hands. For the next two days

further casualties were brought into the hospital with an unknown cause of death. Investigations

discovered plants and animals had died all in a 150 meter radius of a local pond and people near

open windows, air conditioned rooms and moving near the pond all had serious symptoms. In

all, 274 people were treated with symptoms including “darkened vision, ocular pain, nausea,

myosis, and a decrease in serum cholinesterase (ChE) activities” and “autopsy findings showed

intense post-mortem lividity [bruising], myosis [severe pupil constriction], pulmonary edema

[swelling], increased bronchial secretion, and congestion of the parenchymatous [functional

tissue] organs.” (Seto, 2001, pg. 1) The local police assumed the source of the toxic gas must

have been the pond and began testing to determine the cause. Eventually the Sarin was detected

and samples were sent to a laboratory for confirmation. The attack occurred 50 minutes before

the police were alerted and a number of changes occurred to agent. When mixed with water, the

agent will hydrolyze into a compound unique to each carrier. On plants the agent will synthesize


and become an acid, killing the plants. These indictors and the patient symptoms should have

tipped off the responders to the presence of an agent. However, since Sarin is banned under

international treaty, and the likelihood of a Sarin attack is low, it took several days to get a

presumptive analysis and samples to send to the laboratory. As it turned out, the lessons of this

attack would greatly help the Tokyo Metropolitan police the next year.

On March 20th, 1995 Aum Shinrikyo cult members released Sarin gas on five subway

cars at approximately 8:00 AM. The number of victims began to overwhelm local hospital’s

capacity and the symptoms reported were the same as those reported in the attack at Matsumoto

in Nagano Prefecture. Armed with this knowledge, Tokyo Metropolitan Police officers donned

protective suits to continue rescue efforts and conduct their investigations. Soon after this

realization, the Japanese Ministry of Defense, equivalent to the US Department of Defense,

arrived on scene with military support to aid in the inspections of the site and conduct

decontamination of the area. (Seto, 2001, pg. 1)

This incident is taught at the US Army Chemical, Biological, Radiological, and Nuclear

(CBRN) Center and School at FT Leonard Wood, MO to all officers in the Chemical Branch as

the model for non-state attacks. The lessons learned from this event are used to demonstrate the

ease of production by non-state actors of, as well as the dangers faced if the chemical weapons

are released in a populated area. Had Japan not been prepared, or had its responders not

recognized the signs of an attack, the outcome would have been far worse. This level of

recognition and understanding by first responders is required to quickly and decisively undercut

the effects of biological attacks on the homeland. In this attack, the gas was released by

puncturing plastic bags with the tips of umbrellas. This allowed the members of Aum Shinrikyo

to surreptitiously attack the subway system. People normally look for men in masks unlocking


pelican cases with green mist in glass vials as the sign of a gas attack. While surgical masks are

popular in Japan, the culprits were average looking people with umbrellas, which are also

popular in counties utilizing outdoor public transportation.

On February 2004 Senator Bill Frist’s mail room at the Dirksen Senate Office Building in

Washington DC received a letter containing a white powdery substance later confirmed to be

Ricin. This event shut down other Senate buildings and required several staffers to be

decontaminated. This event came on the heels of a November 2003 ricin-laced letter sent to the

White House demanding changes to trucking regulations. The 2003 letter was not made public

until February 2004 and to date no connection has been made between the two. The Centers for

Disease Control and Prevention (CDC) advised “Clinicians and public health officials should be

vigilant for illnesses suggestive of ricin exposure.” (Gibson, 2013, pg. 1129) The 2004 ricin

attack was similar to the 1994 and 1995 Sarin attack in Japan, insofar as it involved the use of a

public vector, (i.e. mail in 2004 and public transportation in 1994 and 1995), providing attackers

the opportunity to increase dissemination due to the fact, contaminated mail comes in contact

with sorting machines and other mail.

In late September 2014 Thomas Eric Duncan was diagnosed with Ebola in Dallas, Texas.

(Darcy, 2014) Ebola is an extremely contagious hemorrhagic fever believed to be spread by

animals to humans. The disease is native to the African Continent and was first discovered in

1976. Hemorrhagic fevers are transmitted by body fluid and cause headache, muscle pain,

diarrhea, vomiting, and bleeding. (CDC, 2014) Duncan lied on his entrance documents from

Liberia, stating he did not care for sick patients from the region’s Ebola epidemic. (Darcy, 2014)

Duncan apparently contracted the disease in Liberia from helping carry a sick pregnant woman.

Duncan flew to the United States a few days later to stay with relatives. After becoming sick,


Duncan went to the local hospital where he was seen and discharged with antibiotics. When he

returned a few days later, Duncan was admitted for Ebola. (Darcy, 2014)

This is a classic example of how the Detect to Treat (DTT) process operates in the real

world, and it illustrates how the process can fail to operate efficiently: An infected individual

becomes ill following a latency period, and upon presenting his or her symptoms to medical

personnel the individual patient is misdiagnosed. Due to the misdiagnosis, the contagious

individual is not quarantined and he or she may continue to serve as a vector spreading the

illness to others. There is no perfect solution for patients lying to care providers, or human error,

but education for the public about the threats and who may be at risk can be helpful. This case

also illustrates how easily a suicide terrorist willing to be infected with Ebola could conduct a

biological terrorism attack on a US population center. Commencing the attack at the end of

September, when the flu season is starting, might cause local hospitals to misdiagnose the

symptoms of nausea and fever as influenza rather than Ebola. If a terrorist infected with Ebola

(or another highly communicable and deadly virus) circulated among the population, he or she

could potentially infect a substantial number of individuals. These individuals infected with

Ebola virus, who had no recent travel history to West Africa, might not be suspected of having

anything more than the flu until it was too late. Only when the number of fatal cases (the

number of Ebola cases misdiagnosed and treated as the far less deadly influenza virus and

ultimately result in death) reached a critical mass might the proper laboratory tests and screening

algorithms be applied to those presenting themselves with flu-like symptoms. The situation

might be further confused and complicated once the Ebola outbreak becomes public knowledge

and patients with influenza believe they may have Ebola.


If first responders know to recognize the symptoms of biological agents, they would give

the medical system an additional “sensor” to identify and speed up the process of DTT. In other

words, first responders who are alert to the possibility of biological terrorism and are trained to

distinguish indicators of biological terrorism from ‘ordinary’ illnesses and infections can serve as

an early warning system bringing these events to the attention of medical personnel capable of

accurately screening for and diagnosing infections from a deadly biological agent. In Duncan’s

case, the hospital did not relay his travel from Liberia to the administrative personnel who made

the decision to send him home. This decision increased the number of people he may have

infected, including the sick people in the waiting and pharmacy areas of the hospital.

While four of the 24 weeks of the Chemical, Biological, Radiological, and Nuclear

(CBRN) Center and School are devoted to operating in a simulated contaminated environment,

all Chemical Corps officers spend at least a day in the Chemical Defense Training Facility

(CDTF) which boasts live CBRN agent and source training. This live training is conducted in

protective equipment ranging from the lowest level of protection known as Mission Oriented

Protective Posture (MOPP) Zero, which provides no splash or vapor protection, all the way up to

Level A, fully encapsulated self-contained breathing apparatus (SCBA) with splash protection.

MOPP equipment levels start at carrying the entire suit, MOPP 1has protective pants and top,

MOPP 2 adds protective overboots, MOPP 3 adds the mask, and MOPP 4 finalizes with gloves.

A significant amount of class time is devoted to identifying the symptoms, visual description,

and methods of delivery of conventional CBRN agents as well as many of the next-generation

CBRN warfare agents. Despite the length of this training, the course does not address how to

conduct operations in a populated environment with armed threats, or live casualties, who might,

like a drowning person, try to tear a first responder out of the protective suit to save themselves.


Select US Army Special Forces teams receive training on operating in MOPP 4 or Level B,

splash protection with SCBA, in a threat environment.


Literature Review

There is a plethora of material on the internet pertaining to biological warfare agents.

From hefty tomes on the history of biological warfare to small journal entries expounding on the

need for more resources to ensure protection from the same, there is no shortage of reading

materials. Knowing this it takes a significant amount of time to sift through the dross and find

the sources with both accurate information and the clarity to explain the importance of the threat.

The Center for Disease Control (CDC) is a great source for anything biological as the CDC’s

mission is protecting from infectious disease. The CDC produces a number of journals relating

to various causes and factors of infection. The Department of Defense has a significant amount

of information classified Official Use Only or higher on all subjects related to all warfare agents

including next generation agents available to the appropriate personnel. With the outbreak of

Ebola in the United States, the CDC and other government agencies have published guidelines

and information designed to minimize the fear and myths surrounding this hemorrhagic fever.

Medical associations have published a significant number of articles supporting or refuting the

CDC’s and some State’s measures regarding Ebola as well. As the government and Medical

communities expand public awareness of biological events, the media also weighs in, pointing

out faults and successes. Since the public tends to believe what is presented on the news, the

desire for greater security due to the now visible threat or Ebola, and by extension biological

warfare agents, Security organizations are beginning to discuss how to protect assets from

biological threats.

Centers for Disease Control (CDC) has published a significant amount of information

about diseases and publishes a weekly report focusing on Morbidity and Mortality across the


spectrum. This is a short document containing many authors and opinions and represents a great

place to starting research.

In 1999 the CDC released an issue of the Morbidity and Mortality Weekly Report

focusing on anthrax attacks around the nation along with guidelines to prepare for attacks and

how to cope afterward. The report focuses on “letters alleged to contain anthrax sent to health

clinics on October 30, 1998, in Indiana, Kentucky, and Tennessee. During December 17-23 in

California, a letter alleged to contain anthrax was sent to a private business…” (Bioterrorism,

1999) After giving a synopsis of the events, the CDC provides guidelines for response planning

and post-exposure protection. The crux of the guidance is “public health response to

bioterrorism requires communication and coordination with first responders and law enforcement

officials…” (Bioterrorism, 1999)

In 2003 the CDC published a short review of the events surrounding a possible ricin

contamination of the Greenville, SC mail distribution center. After a suspicious package was

identified and quarantined, the plant was reopened when “all workers who had worked at the

facility since the package was discovered had been contacted and confirmed to be well and

environmental samples for ricin were negative.” (Gibson, 2003) This event shows how easily an

attack could occur and how quickly one could be thwarted by alert people in the field.

In Science Magazine Dr. Henderson writes about biological weapons and how they have

garnered attention. Dr. Henderson writes “Discerning the nature of the threat of bioweapons as

well as appropriate responses to them requires greater attention to the biological characteristics

of these instruments of war and terror.” (Henderson, 1999) Dr. Henderson writes his work

before the attacks of September 11, 2001 however he argues “the paradigm of a weapon as a


nuclear device that explodes or a chemical cloud that is set adrift leaves us ill-equipped… to

assess and thus to prevent the potentially devastating effects of bioterrorism.” (Henderson, 1999)

Dr. Christopher Richards points out in the Annals of Emergency Medicine in 1999 “only

the military has some capability to actually detect a bioagent in the field.” (Richards, 1999)

Since the attacks on September 11, 2001, this has changed but his policy focus is more on the

necessary steps taken once a patient enters a hospital system as opposed to detection before

infection. Another author who writes before the September 11, 2001 attacks is Keim, who

discusses how to respond to bioterrorism. Keim also focuses on “Emergency physicians, first

responders, and hazardous materials response teams need[ing] a standardized approach to the

management of patients who may have been exposed to biological threat agents.” (Keim, 1999)

However, he maintains “Currently recommended hospital infection control procedures seem

appropriate for the level of risk involved…” (Keim, 1999) Given the more appropriate level of

attention bioterrorism has garnered this may no longer be accurate.

Dr. Yasuo Seto of the Organization for the Prohibition of Chemical Weapons discussed

the Sarin gas attacks in Japan by Aum Shinrikyo. If the Japanese police had not been able to

determine Sarin had been used in a test run earlier, the subway attack would have been much

more effective. Kaplan and Marshall also provide exhaustive details about the history and

background of this cult in their work The Cult at the End of the World. The authors also describe

how the cult was planning to obtain Russian nuclear weapons and even attack and overthrow the

Japanese parliament.

Organizations such as the Heritage Foundation can be great sources of data on any

number of subjects. However, one must always read what is published with an understanding of

the bias the organization has. Mayer and Erickson write for the Heritage Foundation about Law


Enforcement Education “The education obtained throughout the academy, directed through

POST [Peace Officer Standards and Training] mandates, helped to form the functioning law

enforcement officer’s working character.” (Mayer, 2011) If First Responders can be taught the

signs and symptoms associated with bioterrorism, correct responses can then be expected.

Risk is always involved when using media sources. During the Ebola outbreaks in 2014

almost all news outlets carried stories about the various patients infected and how some were

improperly diagnosed or quarantined. Depending on the news outlet, President Obama’s

handling of the possible Ebola pandemic was either spot on or moving the nation closer to the

edge of chaos. The Blaze and the Heritage Foundations’ Daily Signal both carried articles on the

Ebola outbreak of 2014, specifically the death of Eric Duncan. The primary crux of the articles

is Duncan walked into a hospital and was sent home despite his symptoms and his travel history.

The lack of proper care he received is directly related to his death.

In the end, there is a gap in current literature. This gap has grown since September 11,

2001 and the realization the homeland is no longer secure. While technology and awareness

have grown to help combat emerging threats, most medical research and defensive techniques

are decades old. Lastly, as the policy section of this paper will show, the advent of new

Department of the Army policies combined with US Army Reserve Command re-alignments

provide a new tool in the fight against biological warfare agent attack.


Methodology

This Thesis will attempt to fill the training gap identified earlier by presenting a policy

option enabling State and Local organizations to receive training on any Chemical, Biological,

Radiological, and Nuclear (CBRN) threat, without incurring significant additional costs. First,

an outline of the current system for detection and treatment of biological attack, and how they

are lacking in the light of the recent Ebola cases will be presented. The method for increasing

the knowledge base for First Responders will be discussed based on the unique mission sets and

threats faced. Included in this discussion will be the effect of pay and hours available.

Breakdowns of what type of training and when in a responder’s career the training should be

applied will be covered. A proposed solution to the training gap will be laid out, showing how

this training supports National Goals as well as State and Local needs. This solution will allow

for greater interoperability and standardization of methods and techniques across the spectrum of

emergency response.

A catalog of biological warfare agents, production methods, materials, and equipment

will be laid out to demonstrate the ease of production and identification. This section will

include history and signs and symptoms of the major warfare agents along with treatment options

currently available. Images for the agents will be included to demonstrate the terrible nature of

these threats. The equipment required for agent production will also be discussed with pictures

for general identification. The recipes for these agents will be presented in an abbreviated format

due to classification issues and the desire to not enable threat production.

In the end, this thesis will answer the question “Do American First Responders have the

knowledge to recognize threats such as biological weapons in a populated area?” This answer

must meet certain criteria in order to be valid. Given the austere financial times the solution


must be fiscally responsible, as well as feasible and suitable to the issue at hand. The solution

put forth in this Thesis will cost little to no money not already being paid out to employees of the

federal government. Additionally, all training conducted will support overall national level

needs nesting all training objectives with higher level’s strategic goals.


Types of Biological Warfare Agents

The CDC divides Biological Threat Agents into three nominal categories - the A, B, and

C categories. Category A agents are characterized by the ease with which they can be

disseminated or transmitted, they have high mortality rates, and widespread infection might

cause public panic. Category B agents have easy to moderate transmission, and they involve

moderate morbidity (rate of sickness) and low mortality. Category C agents are emerging or

future threats based on availability, are relatively easy to produce and disseminate, and have the

potential for high morbidity and mortality. For this paper, Category C agents will not be

discussed due to classification rules.

Category A Agents are further broken down in three subsidiary categories: bacteria,

toxins, and viruses. Common Bacteria agents are Anthrax, Plague, and Tularemia. The common

Toxin agent is Botulism or Botox. Common Virus agents are Smallpox, and Hemorrhagic Fever

(Ebola). While not all of these agents can be made in clandestine labs, this paper will familiarize

the reader will the major agents.

Bacillus Anthracis or Anthrax is a naturally occurring spore forming soil based bacteria

which is very stable in the environment and is easily disseminated. The three main forms of the

disease are cutaneous, ingestion, and inhalation. Treatment for Anthrax is Doxycycline,

Ciprofloxin, and Penicillin, usually intravenously. Cutaneous infection occurs via breaks in the

skin or from biting flies. The symptoms include rapid necrosis, and black necrotic lesions with a

20% untreated mortality rate and a near 1% for treated persons. Gastrointestinal Anthrax results

from ingestion of contaminated food, usually meat, or water. The symptoms include sore throat,

fever, swollen lymph nodes, nausea, bloody diarrhea, toxemia, shock, and death. This form of

the disease has a greater than 50% mortality rate. Inhalation Anthrax results from the inhalation


of spores into the lungs. While the incubation period is 1-6 days persons will see mild symptoms

it may be hard to diagnose (Henry, 2001). These include abrupt onset of fever, non-productive

cough, chest pain, and sweats. Shock and death occur 24-36 hours after abrupt onset with a

100% mortality rate. What make anthrax so dangerous is the ability of the bacteria to grow

spores. Usually found in long “string like” formations the bacteria can last for centuries when

placed in less than ideal conditions. When the bacteria detects the environment around it is

dangerous, the strings begin to break apart and form “seeds” which grow a protective shell. This

shell, or spore, allows the bacteria to remain safe and dormant for extremely long periods. Once

the spore is placed into warm, moist conditions, such as lungs, the spores dissolve and the seeds

begin to reform strings.

Anthrax under Microscope (CDC, 2014)


Yersinia pestis or Plague, commonly known as the Black Death, is a historically deadly

bacteria. Famously known for killing millions of people starting in China and spreading to

Europe in the middle ages. (History, 2012) Plague is passed from person to person or through

fleas and is relatively stable in the environment. The three primary forms of the disease are.

Bubonic, Septicemic, and Pneumonic. Plague is usually treated with Tetracline and

Streptomycin. Bubonic Plague symptoms are swollen lymph nodes, fever, chills, and weakness

and has a greater than 50% mortality rate if untreated and 10% if treated. Septicemic Plague

adds abdominal pain, shock, and bleeding underneath the skin or organs and has a 100%

untreated mortality rate. Pneumonic Plague presents with severe pneumonia and shortness of

breath, necrosis of the small blood vessels (hence the “black death”) and productive cough and

also has a 100% untreated mortality rate. Pneumonic Plague is also the most likely to cause a

contagious epidemic.

Plague Signs (CDC, 2014)


Francisella Tularensis or Tularemia commonly known as Rabbit Fever is highly prevalent

in the US in the Arkansas, Oklahoma, Missouri, and Kansas areas but can be found throughout

the country. Tularemia is spread by direct contact, inhalation or ingestion and can remain viable

in soil or water for weeks. The most common form of the disease is Ulcerograndular at 75% and

Typhoidal-Systemic at 25%. The standard treatment is Tetracycline or Streptomycin. Tularemia

is contracted through contact or arthropod bites. It shows with ulcer development, lymph node

enlargement, back pain, fever, chills, exhaustion, non-productive cough, and nausea.

Ulcerograndular has a 5% untreated mortality rate while Typhoidal has a 50% rate.

Tularemia Outbreak (CDC, 2014)


Clostridium Botulinum Toxin or Botox is the most potent biotoxin currently known and

effects the nervous system. The most common forms are Food Born, Wound, and Infant. The

route of infection is ingestion or direct inoculation (purposefully injected) with symptoms

showing 12-36 hours after ingestion. Symptoms include Weakness, dizziness, weariness,

constipation, difficulty speaking, descending paralysis, and respiratory paralysis. Botox has a

significant mortality rate.

Wound Botulism of Right Arm (CDC, 2014)


Variola Virus, known as smallpox is known only to humans and is passed among

unvaccinated populations. Route of infection includes contract with pulsates, whether direct or

indirect, or through respiration. The symptoms include high fever headache, chills, back pain,

exhaustion, body rash blistered lesions leading to scabs with a fatality rate of 30%.

Man with Smallpox (CDC, 2014)


Hemorrhagic Fevers include Marburg, Junin, Lassa, and Ebola viruses, usually having a

low infections dose. While passed from person to person, inhalation is also a risk. Symptoms

include high fever, internal bleeding and hemorrhaging (bleeding profusely) from orifices with

various mortality rates.

Isolated Female Patient Diagnosed with Crimean-Congo Hemorrhagic Fever (CDC, 2014)


Category B Agents are broken down in two categories, bacteria and toxin. Common

Bacteria agents are Cholera, Typhoid Fever, and Typhus Fever. The common Toxin agents are

Ricin and Staphylococcus Aureus. While not all of these agents can be made in clandestine labs,

this paper will familiarize the reader will the major agents.

The Category B Bacteria Agents are not normally used for biological weapons. Vibrio

Cholerae or Cholera is transmitted through food or water contamination with symptoms water

diarrhea, vomiting, low blood pressure, thirst, restlessness, and dry mucous membranes. Cholera

is easily treatable with antibiotics. Salmonella Typhi or Typhoid Fever lives only in humans and

is transmitted through food contamination. Typhoid symptoms include fever, weakness, stomach

pains, and flat rose colored spots and is treated with antibiotics. Rickettsia Prowazekii or Typhus

Fever is spread by body lice, and flying squirrel ectoparasites. Typhus symptoms include fever,

headache, malaise, vomiting and rashes. Typhus can be deadly in 20%-60% of untreated cases.

Loss of Skin Elasticity seen is Cholera (CDC, 2014)


Ricinus Communis or Ricin is made from Castor Bean plants. Ricin is transmitted

through inhalation, injection, or ingestion. The Castor plant is easily available and the process of

production is not difficult to find. Ricin symptoms include fever, weakness, non-productive

cough, pulmonary edema, respiratory distress, vascular collapse, and death within 36-72 hours.

Mortality is dependent on dose and there is no known antitoxin.

Castor Beans (CDC, 2014)


Staphylococcus Aureus or SEB Toxin is usually inhaled or ingested and is stable and

water soluble. Ingestion symptoms include intense nausea, vomiting, abdominal pain, and

diarrhea. In this form the disease is debilitating rather than deadly. If inhaled, a sign of

intentional poisoning, SEB Toxin symptoms include fever, headache, nonproductive cough,

chills, shortness of breath, and chest pain. Symptoms will lead to respiratory failure.

Effects of SEB Toxin (CDC, 2014)


As stated above, Category C agents are under specific classification, however this

category includes specific forms of: Influenza, SARS, Encephalitis, and Tick-borne Hemorrhagic

Fevers. This category will also include hybrid agents which will either evolve naturally or as the

result of specific experimentation.

Biological weapons are not difficult to create. Some of the procedures below will be

described in abbreviated detail because the source of the information is For Official Use Only or

Law Enforcement Sensitive. The point of this section is not to be a primer for weapons

production but rather provide the reader an understanding of the ease of production on the non-

state level.

Bacterial production requires either liquid or solid cultures to grow the agent. As the

agent grows, it can be transferred to larger vessels as needed. Obviously the larger the vessel the

more ingredients are required as well as risk of detection. Bacterial growth follows a predictable

pattern starting with the inoculation of the growth media, and then an exponential growth phase,

leading to death of the bacteria. The growth phase can be sustained as long as the bacteria is

given sufficient space and food. When sufficient bacteria has been grown it is harvested in

centrifuges and then dried for dissemination. Once dried the bacteria is milled to the correct size

and prepped into the dissemination method.

Viral production requires hosts to grow, usually live chicken eggs. The viral source is

inoculated in live tissue such as animals or eggs and allowed to incubate. Once the virus is

sufficiently developed, it is harvested from the live subject and can be immediately used for wet

dissemination. If a dry dissemination is desired then the virus is dried and milled to the

necessary size.


Toxins are harvested from their source and prepared for distribution through

fermentation. Once isolated the toxin is extracted, purified, and dried for dissemination. The

fermentation process allows the toxin to be separated from other impurities present in the source

plant, animal, or bacteria. Once dried the toxin is milled to the necessary size.

Once a First Responder understands the symptom and the nature of the illness that he or

she is encountering, further confirmation must be sought on scene if possible based on

production methods. The symptoms and production methods are two significant indicators for

initial analysis, and can be useful to determining that protective equipment is required on the

scene.


Biological Warfare Agent Production by Agent

This section will cover the production processes for various compounds and the inherent

dangers. While the focus of this paper is risk and dangers posed by biological agents, many of

the precursors for these agents are shared with illegal narcotics as well. This section does not

contain the exact recipes for biological warfare agent production, but does provide sufficient

representation of the required processes. The information below is available on the internet;

please do not attempt to make any of these substances at home.

Ricin

Ricin attacks the vascular system of the body and has no anti-toxin. Ricin can be

extracted from castor seeds, a plant which can be bought from local plant stores and is used as a

decoration. Ricin is extracted from the castor seeds much like the meat of a sunflower. Once the

seeds are soaked they can be broken open, and the meat can then be ground and dried into

powder. Pure ricin powder is white, if discolored then the process is either incomplete or

rudimentary. One Castor bean plant yields approximately 1300 seeds or roughly 2.75 cups of

seeds. One cup of seeds, roughly 500 seeds, weighs 130 grams and can yield up to three grams

of pure ricin. Lab processes require some easily-obtained ingredients such as vinegar, acetone,

bleach, and Epsom salts, as well as some more difficult to obtain ingredients, such as DEA List

II regulated chemicals hydrochloric acid and sulfuric acid. Responders can easily identify a

location where ricin is being produced by the presence of Castor Seeds, coffee filters, and

blenders. Dead animals in the vicinity are also a good indicator of the agent.

Botulinum Toxin

Clostridium Botulinum Toxin or Botox is the most potent biotoxin currently known and it

effects the nervous system. While primarily used to fix wrinkles and signs of aging, if given in


sufficient doses the toxin can shut down the body’s ability to use the nervous system to function.

Botulinum bacteria can be extracted from soil where it grows naturally, or the bacteria can be

grown in fatty beef without oxygen and is stable is tap water. The bacteria can be placed into

beef, placed into an airtight container such as a mason jar, and allowed to grow. Once the

bacteria has consumed the beef it can be purified and then given to the target. As it is grown in

rotting meat the toxin will have a putrid odor and can be part of a slurry or dried to a refined

powder. Responders can identify the botulinum toxin process by the presence of jars, pressure

cookers, raw and rotting meat, and the DEA List II regulated chemical hydrochloric acid.

Anthrax

Bacillus Anthracis is a naturally occurring spore forming soil based bacteria. What

makes anthrax so dangerous is the ability of the bacteria to grow spores. Usually found in long

“string like” formations the bacteria can last for centuries when placed in less than ideal

conditions. When the bacteria detects the environment around it is dangerous, the strings begin

to break apart and form “seeds” which grow a protective shell. This shell, or spore, allows the

bacteria to remain safe and dormant for extremely long periods. Once the spore is placed into

warm, moist conditions, such as lungs, the spores dissolve and the seeds begin to reform strings.

Once a sample of anthrax is obtained, it is placed into an incubation media, easily purchased

from laboratory supply companies, and allowed to grow. Once a sufficient amount is grown the

bacteria is introduced to less than ideal conditions so the spores will form. The spores are the

best way to disseminate the agent across a large area in any environment. The most deadly way

to contract the bacteria is through the lungs with death occurring 24 to 36 hour after symptom

onset at a 100% mortality rate. The most common route of infection is though food, usually

meat, which can lead to toxemia and death if untreated. Anthrax spores are usually white to gray


in color and look like a powder. Responders can identify this process because of the hazardous

material items such as incubators, growth media, storage units, and glove boxes. The DEA List

II regulated chemical, hydrochloric acid will also be found on site along with bleach and acetone.

Nicotine

Nicotine is a poison commonly inhaled, usually in cigarettes, or readily absorbed through

the skin and mucous membranes. Nicotine Sulfate is usually sold under the trade names Black

leaf 40 or Tender Leaf Insect Spray. Nicotine can also be extracted from tobacco products if

required. In this process tobacco is heated and filtered, with the extract containing the poison.

Responders can identify this process through the trade labels, large quantities of tobacco

products, and the DEA List II regulated chemical, ethyl ether, along with calcium hydroxide

(lime water) and isopropyl alcohol.

Once a First Responder understands the processes for the biological warfare agent that he

or she is encountering, further confirmation can be found by analyzing the equipment on scene.

The production process and equipment on scene are important for initial analysis, and can be

useful to confirming that a biological warfare agent is or was present.


Biological Warfare Agent Production Equipment

As a first responder entering a location the ability to identify glassware and clandestine

laboratory processes, including precursors, is vital to determining the nature of the hazard one

may be facing. This section will cover the basic lab glassware and equipment most commonly

found in clandestine laboratories. All of the items listed below are available for purchase from

reputable sellers on the internet and ownership of these devices does not represent a crime.

SHEL LAB Economy Lab Incubator with Digital Controller, 1 Cu. Ft. (28 L) (Shel Lab, 2014)

Incubators: Incubators allow for the control and regulation of temperature, humidity, and

other environmental factors effecting the growth and development of biological agents. While

the presence of an incubator is not a definite sign of biological agent production, it is a red flag

and an indicator of the type of agent may be present. Anthrax, Botox, and Plague are among the

agents requiring incubation.


Celestron Advanced Biological Microscope 1000 (Celestron, 2014)

Microscopes: Microscopes are used to see very small things. In biological agent

production, being able to see the development of the agent as different environmental factors

change, or ensuring the host media is properly infected with the agent before dissemination are a

few uses for this piece of equipment. The existence of microscopes is not a defining indicator of

wrong doing but when added to other laboratory equipment it can paint a clearer picture.


BioRad Centrifuge (BioRad, 2014)

Centrifuges: Centrifuges are devices designed to separate items, usually by size or

weight. Agents with impurities can be subjected to centrifuge processes allowing the production

of more pure substances. This item is also found in drug labs. Additionally, depending on the

type of centrifuge, separation of the agent from an existing host’s body fluids, like blood, can be

done allowing for a cleaner, more pure agent.


Magnetic Mini-Stirrers with Speedsafe (Magnetic, 2014)

Magnetic Stir Plates: Magnetic Stir Plates are used to mix ingredients for agent

production. Whether mixing two liquids or a liquid and a powdery substance the magnetic stir

plate allows for a constant speed for the solution. Additionally, magnetic stir plates have very

few moving parts, allowing them to run constantly with little to no maintenance, meaning this

stage of agent production can be performed simultaneously with other stages if necessary. There

are not many at home uses for magnetic stir plates, so this is a major indicator of wrong doing,

however this item is not a definite weapons only item.


Bio Fermentation Tank (BioFermentation, 2014)

Fermenters: Fermenters are used to allow bacteria and other organic substances to grow

in non-oxygen environments. They can be used for food production, but are rarely seen in

private homes. Fermenters allow the agent to grow at accelerated rates by regulating the oxygen

content and providing temperature control throughout the growth media. This allows the agent

production process to advance rapidly once a suitable agent is produced and introduced to the

fermentation process. This apparatus is a strong indicator of biological agent production but the

other laboratory items must be present to confirm the substances existence without sampling.


Tuttnauer 2340M Manual Autoclave (Tuttnauer, 2014)

Autoclave: In order to maintain a sterilized environment autoclaves are used to subject

instruments and tools to steam at extreme pressure. While many models are not stable at high

temperature, such as rubber gloves, most biological agent production items are made of glass or

metals. Many hospitals and research facilities are beginning to employ one time use materials

such as injector kits for medicines, and surgical tools, reducing the need to use autoclaves for

sterilizations. Despite this, a clandestine laboratory with limited funds would benefit from the

ability to use materials several times. While autoclaves are not common household items, they

are found in tattoo and piecing shops, and barber and hair salons. If found in the presence of

other laboratory equipment this device is a good indicator of nefarious or illegal activities.


Thermo Scientific HERAtherm General Protocol Ovens (HERAtherm, 2014)

Drying Systems: The proper and rapid drying of biological agent production glassware

and tools is vital to maintaining a sterilized environment. If the glassware or tools are

improperly dried or left out to dry in the elements, impurities and other contaminates could be

introduced into the agent production process damaging or rendering useless the agent being

produced. Additionally, dirt and dust can be introduced to the agent production systems

mentioned above and can cause significant damage causing delays and high replacement costs.

This device is not widely used in homes and when seen with other laboratory equipment is not

illegal but is an indicator of medical level activities.


Ceramill Motion 2 Milling Machine from AmannGirrbach GmbH (Ceramill, 2014)

Milling Systems: Milling systems are used to grind solids used in biological agent

production to the correct size. This allows for the agent to be manufactured to combat the

specifications of any protective equipment and detectors. While not many homes have this level

of mill, certain cultures mill food stuffs such as corn to make certain dietary items. Knowing

this, first responders should know the difference between a laboratory mill and a home mill, and

taken with other laboratory equipment this can be a signal of criminal activity. As with other

equipment listed here, mills can be used for drug as well as biological agent production.


The lists below are for High School laboratory equipment. While not a complete list of

what can be purchased online, the list is representative of what can be bought and how much it

could cost. Seeing many of these items outside of a designated laboratory location such as a

school, would be a serious indicator of wrong doing, but as with the above items does not

represent a crime. First Responders should know and be able to recognize the items listed below

are not normally for cooking food and could be used to make drugs as well as biological warfare

agents. The presence of these items should indicate further sampling and testing maybe required

and follow on agencies should be called on scene to determine the product being made.


Frey Scientific Lab Lists, 2013

First Responders who understand the symptoms, processes, and equipment for biological

warfare agents can aid in decreasing the recognition time for all elements of emergency

management. How to train a First Responder to be aware and ready is vital to the success of the

emergency management enterprise.


Policy Options and Recommendations

Emergency room personnel need not be the only human indicator of biological attacks.

In order to function effectively to inhibit or prevent the deaths and illnesses resulting from a

biological attack, and to ensure the prompt and effective operation of the DTT process, the

Nation’s First Responders must be able to identify the signs a CBRN attack has occurred and

recognize the laboratory processes and precursors necessary to conduct these attacks. The

capacity to identify these indicators at the earliest stages of a biological attack or outbreak is

essential so follow on entities such as hospital personnel, healthcare professionals and crime

scene investigators can take the appropriate steps to protect themselves or others from secondary

contamination. In the end suspects, bystanders, and responders can be cleared of contamination

and placed back into general population. Secondary contamination will increase the burden on

the response system as the contamination spreads to greater areas and population counts. If the

type of contaminate is extremely contagious, the risk of widespread panic increases dramatically.

Training first responders to recognize and identify biological agents as well as their

precursors and symptoms is relatively simple and can be implemented at relatively low cost.

Training can be accomplished in two phases across a responders’ career. The first could be basic

awareness-level training taking place at during the first responders’ initial entry-level training,

such as the police or fire academy. This training might consist of one or more modules of

training on CBRN agent symptoms and precursors, laboratory process recognition, and high risk

entry training using a protective mask. The second phase could be provided in annual in-service

refresher, followed by a written exam on symptoms, precursors, dissemination methods, and

visual identification of laboratory processes. Finally, all in-service responders would have to

demonstrate they have maintained the ability to operate in a protective mask.


The high risk training would be significantly different for different categories and roles of

First Responders, and the specific elements of this training should vary depending upon the first

responders’ task environment. Police, for example, are likely to encounter the indicators of a

biological weapon under different conditions and circumstances than firefighters, simply because

their roles and operating environments are so different. To be effective and relevant, the training

provided to different first responder occupational groups should align with the realities of the

work they do.

For Police the high risk entry training would include training on tactics to enter and clear

a structure with both threat and non-threat targets while wearing a protective mask, and might

include tactical training concerning the rescue of a downed officer. For Firefighters, who already

wear SCBA into high risk situations, the training might focus on firefighting operations in areas

with dangerous chemicals and biological hazards. For EMS personnel, the training might focus

on entry into a location with victims who are panicking as well as on treating patients while

wearing a protective mask and the safe evacuation of casualties to avoid secondary

contamination. Many state and local agencies do not have sufficient training dollars to give this

threat the proper amount of time and man power necessary to ensure minimum risk is achieved

by a potential attack. According to Long Island University’s Dr. Vincent Henry, “Particularly in

an era of fiscal austerity, one of the critical issues municipal public safety agencies have to deal

with is justifying the need and expense of training." Because biological events are very low risk,

very high consequence events, municipal agencies may not give high priority to training for

these events. Agencies must recognize the effects of an attack in an American city would be

devastating, despite the actual rate of incidence of biological attacks being low. State and local

agencies must maintain a requisite level of manpower “on the streets” to maintain law and order


and perform other public safety functions while still providing sufficient time for First

Responders to receive proper training. Cognizant of these constraints and requirements, the

Department of Defense (DOD) typically maintains a 10% overage of Commissioned Officers in

order to keep duty positions filled and maintain professional military education. For many state

and local agencies this number can drop to one third of the force in school with no overages.

The issue of maintaining sufficient ‘minimum manning’ can be complicated and made more

expensive by the rotating shifts many first responders work and the seven day, 24-hour

operations first responder agencies conduct. As a result, First Responders working the overnight

shift, for example, may have to work a double shift (perhaps incurring overtime) to get daytime

only training. While budget shortfalls may lead to departments cutting unnecessary training to

levels that meet, rather than exceed, their liability requirements, effective biological threat

training can be accomplished at relatively low expense. By giving the basics of this training in

the academy, or even through Internet-based training modules First Responders can complete on

their own, only refreshers would be needed annually.

Defense Support to Civil Authorities is a newly revamped doctrine in the Department of

the Army (DOA) under Army Doctrine Publication (ADP) 3-28 placing federal soldiers into the

Incident Command System after a major incident occurs. While Federal Troops and support

have been used for years to reinforce State and Local events such as hurricanes and forest fires,

the DOA has finally put Defense Support to Civil Authorities (DSCA) on the same level as

Offensive and Stability Operations. Under the terms of DSCA doctrine and policy as well as the

legislation enabling its conduct, states can request an appropriately-trained National Guard or a

local Reserve Training Support Battalion to deliver a standardized training program to local

agencies. Because the DOD has already paid the costs of training development for its own


Soldiers, local agencies would realize substantial savings, at the same time helping to build the

relationships required to conduct Civil Support operations in the event a disaster or attack does

occur. Army Reserve Training Support Battalions have various skill sets geared toward

providing relevant effective training for Soldiers preparing for and going into combat. These

Battalions like all Reserve units must provide their Soldiers with 24 days of Battle Training

Assemblies (BTA) and 14 days of Annual Training (AT). This is the one weekend a month and

two weeks a year mantra from the commercials. This is in addition to the regular work schedule

the Reservists have in their non-military careers. A First Responding agency could request the

local Training Support Battalion come for a given length of time to give classes and training

without adding cost to the military by simply having Soldiers conduct their monthly BTA or AT

during this same period. An argument can be made for using these Soldiers for current mission

requirements, but with the drawdown in Afghanistan and the lack of mobilizations for Reserve

Soldiers opens a great amount of personnel for other missions.

The Reserve Battalion is required to conduct annual Chemical, Biological, Radiological,

and Nuclear (CBRN) training and can request the requisite materials to accomplish this training.

If the Reserve Battalion aligned its CBRN training with the First Responders training both could

use the materials at nominal to no additional costs. Furthermore, as stated above, the DSCA

Doctrine requires Local, State, and Federal organizations work together during emergencies.

Using this requirement, States could fund additional materials and pay using Federal money for

Emergency Preparedness. All of these steps would meet the Federal goal of well trained and

coordinated emergency responses, the State goal of better training with less waste and the local

goal of better training with less cost. Furthermore, these units could train first responders on all

aspects of CBRN threats not just biological.


Little to no biological threat training is conducted for the majority of First Responders

based on discussions with Dr. Vincent Henry, retired New York Police Department, Katrina

Morgan of the Richland County, SC Sheriff’s Office, and Benjamin Hann of the Charlotte NC

Police Department. For most agencies this is born out of the lack of tangible threat and for

others it is born out of time and budget constraints. Both are understandable and given the

budget crisis facing most municipalities’ citizens prefer agencies do not waste resources for low

or non-existent threats. Even the United States Army is downsizing the amount of CBRN

Soldiers contained within the ranks as well as cutting training money for national level

Emergency Scenarios. Organizations make up for these adjustments through the use of computer

based training events allowing organizations spread across large geographical areas to come

together and train without spending thousands of dollars on travel, maintenance, and lodging.

The current policy options for dealing with natural or intentional biological agent

outbreaks lack the depth to ensure preparedness for the future and rely on the hospital system to

detect the threat and develop treatment plans. While this system does work, and given the right

amount of time can solve the problem, Detect to Treat is not effective if any one piece of the

system fails as seen in the Duncan Ebola case. While the Duncan case was not a failure on the

part of first responders, it is an example of how a Detect to Treat failure can leave civilians open

to threats. First Responders need the tools to identify threats before a crisis develops while being

able to defend themselves from the same threats.

Other options for solving this problem include Responders paying for training on their

own time, private organizations teaching classes at cost to the agency, or providing training only

at the academy and relying on internet based training to maintain the knowledge. Responders

paying for their own training puts a double burden on the Responder. First the Responder will


not be at work, or if off shift, will not be at home with the family. For many Responders, Union

rules come into play when doing work related training on personal time. The second impact felt

by Responders will be from their personal bank account unless they can receive reimbursement

from the agency. Private training organizations are a great resource to provide specialize

training, but they cost significant amounts of money, and still require Responders to be available

when the organization can provide the training. Relying on internet based training to maintain

knowledge and skill sets is dangerous because Responders can find ways to ensure success

without significant work or study, the online training costs money to build and maintain, and

agencies will likely have to pay for Responders’ time spent online.

A new paradigm in national level training must be established to keep the nation’s

defenses firmly rooted in current threats without incurring significant cost increases. Currently

individual agencies must either pay to send their people to schools or pay to have experts come

teach at the local agency school house. This means the local Police department would have to

pay to have a Deputy fly to a training site, pay for hotels, food, and training aids in order to

receive training which will make the nation as whole more secure. The military uses this model

as well even though the money all comes from the same place.

The new training model should look more seamless and allow for more continuity of

training. As discussed above the use of Reserve Training Support Battalions would reduce the

costs and aid in maintaining a high level of training readiness. Rather than having the local

Police have to scrounge up the money to send a Deputy to the New York Police Department’s

Biological Agent Protection course for a long weekend, a Reserve Unit could schedule their

mandatory two week Annual Training or a weekend Battle Training Assembly at the local Police

Office and conduct training. Using a US Army Reserve Soldier at the rank of Sergeant First


Class, or E7, with 10 years of service is costs $499.60 plus food and around $35-$40 for lodging

for a Battle Training Assemble. If this same Soldier was tasked to train a local Responder

organization during this same time period, the cost would be exactly the same. Active Duty

Soldiers may require Temporary Duty funds to cover the cost of living away from home.

Reserve Soldiers receive this pay simply by attending the BTA regardless of where it is held. No

additional cost would have to be spent on the Soldier to conduct this training so the US Army

Reserves budget would remain the same. Normally State and Local organizations would have to

reimburse Federal or out of State organizations for their work under the Stafford Act. Since

State and Local organizations receive money to support training, either this money could be

used, or since the money is going to be spent on the Soldier anyway an amendment could be

made to exempt this type of activity. This would ensure all organizations who need or want

training will receive the training using the same materials, tests, and procedures across the

nation. Unity of method will allow different organizations to seamlessly integrate during time of

national emergency. To ensure this training is correct and based in the most accurate science the

Center for Disease Control should be the lead effort to design and build the courses.

The Center for Disease Control (CDC) is the primary organization for the US

Government’s efforts to “protect America from health, safety and security threats, both foreign

and in the U.S.” from diseases which “start at home or abroad, are chronic or acute, curable or

preventable, human error or deliberate attack.” (CDC, 2014) This means the CDC is the primary

federal organization for the protection of the American people against illness whether natural or

intentional. Based in Atlanta, GA, the CDC has departments for Global Health, Occupational

Safety, Infectious Disease, Noncommunicable Disease, Health Preparedness, and Health Science

among others, and it publishes various health related reports and research studies as well as the


Morbidity and Mortality Weekly Report (MMWR). This weekly report touches on current

events and important topics facing the health community as it relates to disease. The MMWR of

October 21, 2014 featured data on the epidemiological spread and the casualty and fatality rates

of Ebola in Africa.

The course of action that will allow State and Local agencies to prepare for biological

warfare agent outbreaks while ensuring minimum cost and maximum effect starts with the CDC

developing a national response standard for domestic outbreak. This should include

identification of symptoms, ingredients, laboratory processes and equipment, and likely method

of infection for the First Responder. Once the First Responder has identified a possible event,

the CDC guidelines should provide a clear step by step process for reporting the data that led to

the suspicion to the medical facility responding to an event so proper testing, evaluation, and

quarantine can begin. The CDC should also develop a training curriculum supporting these

procedures for all agencies so any responding organization in the country has the same

knowledge and operating procedures. The Department of the Army, and the primary CBRN

response force for the Federal Government in Civil Support operations should conduct the

training for all agencies utilizing the Army Reserve Training Support Battalions across the

country. Using these Battalions will not only keep costs low, as discussed above, this training

will also strengthen Civil Support relationships and ensure preparedness for other National

Emergency Scenario events. The CDC should revise the training every three years, as well as

support development of new techniques and procedures for outbreak response alongside the

Federal Emergency Management Agency, and the Department of Homeland Security.

Other Options for providing training to State and Local First Responders exist but have

drawbacks that would limit their use. The State National Guard Units could be used given their


prominence in disaster events for states, but as they are primarily combat focused the cost to

adjust missions and create a competent cadre of DSCA trainers would be unnecessary given the

Army Reserves current adaptation to the mission. FEMA could offer grants to local

organizations to send Responders to schools, but this plan does not address the lack of unified

curriculum, the limited number of responders being trained, and time available to receive the

training in a given period. The DoD has developed the CBRN Response Enterprise on which all

Federal Forces operate, however Local and State elements that are not military rarely get access

to this network and system. The Army Reserve Training Support Battalion is designed and

tasked to teach and instruct students on any military mission including CBRN operations and

DSCA making it the most appropriate choice. This is accomplished through AT and BTAs all

across the country supporting Active Duty, National Guard, and other Reserve organizations.

Adding Local and State organizations to the list, meeting the requirements for Total Force

Integration, is the best way to increase education without significant disruption in operations

given that the Reserves have lost many of the significant missions it held over the last ten years

including Bosnia and Kosovo support, the Sini mission, and mobilization for combat

deployments. While the approval of the Secretary of Defense is usually required to send Reserve

Soldiers on missions (meaning longer than the two week Annual Training) or to Federalize a

Reserve Solider this type of training would not require approval due to the short duration and the

already existing relationships required under the DSCA doctrine.


Conclusion

Biological attack whether from a state level adversary or from a non-state actor is one of

the greatest, yet least protected against, threats our Nation faces. As this paper has shown a

determined group of non-states actors could easily produce biological warfare agents in the

privacy of a kitchen in much the same way criminals make methamphetamines. With the

internet, and various dark networks, offering a near endless stream of information a determined

person could find the appropriate recipes for various biological warfare agents and the restricted

materials needed to make them. While cities have the BioShield systems to protect against

significant attack, BioShield has significant limitations and, as with all government programs, is

effected by budgets and training.

The more recently published literature on the subject of biological warfare agent attack is

usually focused on the threat and how it will effect society. Older literature tends to focus on

how hospitals can prepare for the influx of patients will accompany an outbreak. Even movies

such as Outbreak or World War Z which show the rapid spread of disease reveal the gap in

knowledge of rapid identification and response by first responders. Unfortunately, old literature

and movies are the basis for most thought processes on health protection. Rather than allowing

the Center for Disease Control or Health and Human Services develop and support health

protection standards, citizens will attempt to emplace whatever they saw on TV or read in a book

to protect themselves.

This paper has proposed a low cost high payoff method to ensure at least the First

Responders who stand between the sheep and wolves can be as prepared as possible for

biological threats. By providing First Responders with current and useful training the gap

between recognition of a threat and the threat’s spread are dramatically reduced. The


Department of the Army has significant resources and responsibility in supporting Civil

Authorities before, during, and after an event or attack. Using these resources State and Local

responders can become better prepared and trained allowing for a more rapid response. As

demonstrated above the US Army Reserve is the most cost effective, appropriate, and capable

organization to support local Responders with training.

While other options are available to State and Local agencies to fill the gaps in

knowledge and skills discussed above, very few have the low cost and require long hours and

dedication from the individual responder on his or her own time. Using resources for which the

federal or state government already pays, such as pay for attending a Battle Training Assembly,

allows for responders to maximize their efforts without undue burden to the taxpayer, or at the

expense of more common and likely threats. The best system to combat the threat of attack no

matter what kind it may be, is between the ears of every citizen in the nation. A well-educated

populace dramatically increases the likelihood nefarious activities will be identified in the early

stages and stopped before the danger becomes lethal. Just as citizens are trained to look for the

signs of sickness to avoid spreading colds and the flu, people should be trained to notice the

signs of more significant illness. Additionally, a populous with more knowledge about illness

will be less likely to emplace useless health protection measures or panic when an outbreak

occurs.


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bucci_liu_thesis

Documents

biothreat environment

biological weapons

biological agents

biological threats

biological agent outbreaks

chemical weapons

thesis advisor

threat of extremists