preparing for chemical terrorism response at the centers ... · chemical terrorism events. ct...

Emergency Response and Air Toxicants BranchDivision of Laboratory Sciences

National Center for Environmental HealthCenters for Disease Control and Prevention

David L. Ashley. Ph.D.

Preparing for Chemical TerrorismResponse at the Centers for

Disease Control and Prevention

Assess dangersStabilize victimsSecure the areaAssess symptomsField testing

First responders -Law enforcement, EMTs, firefighters

Identify specific agentIdentify worried wellRetrospective analysisEvaluate long-term health effects

of low level exposure - registriesDetermine temporal or geographical

exposure distribution

Analysis of Clinical Samples forPublic Health Response to Chemical

Terrorism

Goal

Produce interpretable laboratory results on a limited number of clinical samples as quickly as possible

Flexible laboratory capabilities that can respond to the complete range of chemical terrorism events

CT Laboratory ResponseTeam

Prepared for immediate travel to event site20 minute response, 1 hr arrival at CDCSample supplies in emergency packsSupport collection of clinical samplesProvide tracking information

for samplesCDC Air Transport

Specimen ReceiptSpecimens received at CDCTreated as toxic and infectiousCDC BPRP tests for infectious riskAliquots heated, if analytes are heat-stableAutomated sample

aliquotingCleared samples given

to analysts

Rapid Toxic Screen

150 chemical agents or their metabolites

In urine, serum, whole blood

Rapid Toxic ScreenChemical warfare agents Nerve gases, e.g. sarin, soman, VX

Sulfur mustards, e.g. HDNitrogen mustards, e.g. NH1, NH2CyanideLewisite

Toxins Ricinine (marker for ricin)SaxitoxinNatural toxins

Incapacitating agents Drugs of abuse, e.g. cocaine, opiates, PCPOthers, e.g. scopolamine

Industrial chemicals Volatile organic compounds, e.g. benzene,carbon tetrachloride

Pesticides, e.g. malathion, parathionHeavy metals, e.g. lead, arsenic, mercuryOthers

Time0 50 100 150 200

Con

cent

ratio

n

0

2

4

6

8

10 Toxic Compound

Metabolite

Adduct

Non-persistent Biomarkers

Sample Analysis

Immediate ResponseSamples collected while eventin progress or within 72 hours

Retrospective AnalysisEvent occurred previously

Immediate Response

Level 1 response – 1 instrument for every method,CW agents in response lab, 40 samples/day

Level 2 response – 3-4 instruments for 1-2methods, CW agents in response andtraining labs, up to 200 samples/day –sustained

Level 3 response – 20-30 instruments for 1 method,all DLS resources, greater than 200samples/day - sustained

Full-use equipmentgives us

expanded capacityEnvironmental

Instrument Number CT Methods Exposure MethodsAPI 4000 14 Nit mustards CotinineLC/MS/MS Incap agents Phytoestrogens

TSQ 7000 13 Nerve agents OP PesticidesGC/MS/MS Sulfur mustards Phenols

GC/MSD 16 Cyanide VolatilesLewisite Pesticides

Elan DRC II 10 Heavy Metals ArsenicICP/MS Cadmium

Developing New Methods

Additional Threat AgentsNon-Traditional AgentsMethod Alteration

Exercises

3-4 per yearActive exercises, not table-topTesting lab responseTesting data transmission, approval

and reportingTesting personnel and sample transport

Exercises

• Notification from the DEOC• DLS Phone tree• Response team transport• Analyst notification• Support services (IT, Engineering,

Cardkey) notification• Lab lockdown• Analytical method validity checks• Epi information collection• Epi information transmission• Sample transport to DLS• Sample receipt at DLS• Chain of custody procedures• Secure sample storage• Sample id assignment

• Sample sterilization• Sample aliquoting• Sample analysis – entire RTS• Personnel and equipment backups• Quality control evaluation• Analytical results into database• Analytical results compilation• Analytical results interpretation• Results reporting• Results communication to state• Results communication to management• Media communications• Sample shipping to surge labs• Data transmission - states to CDC

Interpretation of ResultsBackground levels

Unexposed reference range

Exposed populationsHistorical reportsExposure incidents

MetabolismAnimal studies

Ingestion of Castor Beans

Time after ingestion (hrs)0 20 40 60 80

ug R

icin

ine/

g C

reat

inin

e

100

200

300

400

500

600

700

800

Laboratory Response Network –Chemical

Level 2 Labs (41)

Level 3 Labs (16)

Level 1 Labs (5)Also:American SamoaChicagoGuamMicronesiaMarshall Is.N. Mariana Is.New York CityPalauPuerto RicoUS Virgin Islands

District ofColumbiaLos Angeles Co

Computer Based Training Vendor Training Lecture

Hands-on OperationHands-on Sample Prep Video Reinforcement

Training

Proficiency Testing

IntramuralExtramural

SBMTECyanideRicinineHeavy metalsNerve agent metabolites

Every method 4 times/year

Proficiency Testing

LRN Chemical Website

Coordination with otherFederal Agencies

• Environmental Protection Agency• Food and Drug Administration• Department of Homeland Security• Department of Defense• Federal Bureau of Investigation

Questions?