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