California Commission on Emergency Medical Services
Michael Shannon, MD
American Academy of Pediatrics Task Force on Terrorism
February 26, 2003
T he threat of bioterrorism is real, and our government is expanding measures to protect us.
As with any disaster -- man-made or natural -- people can't rely solely on the government for protection. Here are steps you can take to protect yourself and your family...
PLAN AHEAD
Assemble an "evacuation kit." It should include prescription medications ... flashlight and extra batteries... first-aid kit... bottled water... a change of clothes and a sleeping bag and pillow for each household member -- preferably in airtight plastic bags... and key family documents, such as photo identification and Social Security cards.
In addition to your "evacuation kit," keep the following items on hand
Three-day supply of water. Plan on one gallon of water per person per day.
Three-day supply of food that does not require refrigeration, preparation or cooking, such as canned meats, fruits and vegetables.
Utensils and manual can opener.
Sanitation items, such as toilet paper, soap, a plastic bucket with a tight lid (for human waste), disinfectant and plastic garbage bags with ties.
Prescription drugs that you take regularly, as well as pain relievers, antidiarrheals and antacids.
Battery-powered radio to access emergency information if power is disrupted. Know your local emergency radio stations -- usually those that announce school closings.
Designate a "safe room" in your home. You will need 10 to 20 square feet per person.
Include materials to seal the room -- one large roll of two-inch duct tape to seal off doors and windows and cover electrical outlets... plastic bags or plastic sheeting to cover air vents... and towels to dampen and put under the door.
Ask the safety officer at your local hospital what plans are in place to deal with a bioterrorism attack. Since the medical community is the main line of defense against bioterrorism, your local hospital should have a plan for disseminating appropriate medication in case of emergency.
IN CASE OF AN ATTACK
Keep abreast of developments. Tune in to the radio or TV to learn whether it's safe to evacuate and what routes to take. The authorities will alert the public if a chemical, biological or nuclear attack has been waged.
Call your local Red Cross or emergency management office, listed in the blue pages of the phone book.
Have an agreed-upon meeting place near your home in case it is unreachable... and an out-of-state contact whom family members can call to find out one another's location.
Local phone lines often are jammed in an emergency, while long-distance lines are likely to remain open.
Take shelter. In case of an attack,
authorities may say to "shelter in place." If you have a cell phone, keep it with you.
If you're home, go to the safe room and seal it. If you aren't home, don't try to go home. If evacuation is impossible, you'll be forced to shelter in your home or office.
Cover your mouth and nose with a damp cloth. Close windows and air vents. Turn off all fans and heating and cooling systems, even if they don't connect to the outside.
Here are the specific steps for different types of terrorist attacks...
NUCLEAR ATTACK
The American Thyroid Association recommends keeping a supply of potassium iodide on hand if your community is within 50 miles of a nuclear power plant. Potassium iodide works as an antidote to the radioactive iodine released in a nuclear disaster. Without this antidote, anyone exposed will be at high risk for thyroid cancer.
Some on-line pharmacies sell potassium iodide pills over the counter for about $10 per 14 pills. Be wary of so-called "crisis kits," which can cost three times this amount. Pills should be taken within three hours after radiation exposure.
In case of a nuclear emergency, brick or stone buildings offer better shelter than wood. Get to a basement, if possible, or an interior room. Stay away from windows.
CHEMICAL ATTACK
If you have been exposed to a chemical agent such as nerve gas, mustard gas or chlorine, quickly undress, wash and change your clothes, if you are able. Many chemical agents are absorbed through the skin within minutes. If you are unable to wash your skin with water, wipe or blot it thoroughly with a clean cloth.
When seeking shelter from a chemical attack, do not go to a basement. Many chemical agents are heavier than air and will collect in the lower floors. Retreat to a windowless interior room, on the second story, or higher, if possible.
To protect your respiratory tract, put a wet towel under the door of your interior room and seal the edges of the door with duct tape. If you're in a bathroom, close the sink and bathtub drains.
Seek medical attention as soon as possible. The toxic effects of chemical exposure cause damage immediately. If you can leave your home safely, go to the closest health-care facility.
BIOLOGICAL ATTACK
An attack with a biological agent such as anthrax, smallpox or plague is the most difficult to protect against. That is because there typically is an incubation period that ranges from hours to days between exposure and the emergence of symptoms.
When seeking shelter from a biological attack, select a room above ground that has few or no outside windows or doors. Underground rooms such as basements may not have a sufficient supply of air.
If you suffer direct exposure to a bioterrorism agent, remove all clothing, including underwear. If the agents were released hours earlier, remove any clothing and bedding you may have used since. Put them in plastic bags, tie the bags securely and discard the clothing outside your home. Take a shower and shampoo thoroughly. Then go to your safe room.
If you suspect that you or a family member has been exposed to a biological agent, seek medical care promptly.
(Click here for information on specific biological threats.)
WHAT WON'T HELP
A home Geiger counter. Many smoke detectors and other household
devices emit low levels of radiation that activate Geiger counters.
Gas masks. These are effective only when put on before exposure occurs -- meaning you would have to carry one with you at all times. If a biological weapon is released, we will learn of it only when people become sick -- too late for a gas mask.
Also, more affordable models ($200 to $300) often fit poorly and are not designed for biological weapons.
Smallpox vaccinations. Unless you are a health-care worker or a member of the military, the Centers for Disease Control and Prevention recommends against smallpox vaccination.
For the average citizen, the current level of risk does not warrant the vaccine's potential for side effects.
Stockpiling antibiotics. Not all biological agents respond to the same antibiotic, so the chances of your choosing
exactly the right one are slim. Antibiotics also have a limited shelf life.
MORE INFORMATION
Find additional information about bioterrorism threats, supplies, etc....
American Academy of Pediatrics, 202-347-8600... www.aap.org/terrorism
American Red Cross, www.redcross.org
Centers for Disease Control and Prevention, 800-311-3435... www.bt.cdc.gov
Federal Emergency Management Association, www.fema.gov/areyouready
Infectious Diseases Society of America, www.idsociety.org/bt/toc.htm
Johns Hopkins University Center for Civilian Biodefense Strategies,
410-223-1667... www.hopkins-biodefense.org
Medical Nuclear/Biological/ Chemical Information Center, www.nbc-med.org
US Army Medical Research
Institute of Infectious Diseases, www.usamriid.army.mil
US Department of Homeland Security, 800-237-3239... www.ready.gov
Salvucci is author of Biological Terrorism: Responding to the Threat -- A Personal Safety Manual (Public Safety Medical).
Michael Shannon, MD, is a member of the American Academy of Pediatrics Task Force on Terrorism. He is also associate professor of pediatrics at Harvard Medical School, and the acting chief of emergency medicine at Children's Hospital, both in Boston.







