Version 0 (January 2017) Emergency Responder Health and Safety Manual

APPENDIX B

Chemical and Biological Agents:
Documentation of Additional Policies and Procedures

The procedures and tasks outlined in the Chemical and Biological Agents chapter represent the minimum requirements that each EPA organization must meet. If organizations advocate the use of additional policies and procedures, they must document them in the table below. After doing so, they must also:

Ensure that any of the additional policies and procedures that are added to the table below are also addressed in the main text of the Chemical and Biological Agents chapter. This can be accomplished by either (1) inserting the additional policies and procedures directly into the relevant portions of the main body of the chapter or (2) adding a sentence within the main text that directs readers to Appendix B for more information.

Update Appendix A to capture any additional tasks that are listed in the table below and ensure that each task is assigned to a specific individual.

Topic	Please document the additional elected policies and procedures required for Organization Name here.
Section 3.0 Awareness Training
Section 5.1 Medical Surveillance
Section 5.2 Hazard Evaluation
Section 5.3 PPE
Section 5.4 Decontamination
Section 6.0 Recordkeeping
Other topics __________________________________________________

APPENDIX C

Glossary

GLOSSARY
Acetylcholinesterase

An enzyme that degrades the neurotransmitter acetylcholine in the brain and other tissues of the body. Acetylcholine is a chemical substance that sends signals between nerve cells (called neurotransmission). Neurotransmitters are secreted by neurons (nerve cells) into the space between neurons called the synapse. Acetylcholine is a primary neurotransmitter in the brain, and is associated with memory and cognition. When acetylcholinesterase breaks down the neurotransmitter acetylcholine, the signal between the nerve cells is effectively terminated. Nerve agents are organophosphate-based chemical agents that inhibit the action of the acetylcholinesterase. The result is a buildup of acetylcholine in the neural synapse causing a massive, uncontrolled neurotransmission of nerve signals leading to uncontrolled muscle movements, convulsions, and eventual death. An acetylcholinesterase test may be used to measure potential nerve agent exposures in workers.

Aerosol

A collection of fine liquid or solid particles suspended in air. An aerosolized substance is easily dispersed through the air and can be spread over a wide area.

Antibiotic

A substance that inhibits the growth of or kills microorganisms.

Anthrax

A non-contagious, infectious, often fatal, naturally occurring disease caused by the bacterium Bacillus anthracis that may be contracted by humans or animals via exposure through inhalation, the skin, or the gastrointestinal tract.

Bacillus anthracis

A spore-forming bacterium that causes anthrax. The spore form is about 1 by 2 microns in size and can easily be inhaled. In a warm, moist environment (such as the lungs), spores grow into vegetative, rod-shaped cells that multiply and cause hemorrhage, edema, and necrosis in humans and animals.

Biotoxin

A toxic substance that is either produced by, or extracted from, living or dead bacteria, fungi, plants, or animals.

Biological Incident

A natural or human-caused incident involving microbiological organisms (bacteria, fungi, and viruses) or biologically-derived toxins that pose a hazard to humans, animals, or plants.

BioWatch

A nationwide bio-surveillance system that is designed to detect the individual release of select aerosolized bioagents using a coordinated team of field, laboratory, and response personnel from city, state, and federal organizations.

Chemoprophylaxis

A method of preventing disease by the use of chemicals or drugs.

Contagious

Capable of being transmitted from one person to another. A contagious disease is easily spread from one person to another by contact with the infectious agent that causes the disease. The agent may be in droplets of liquid particles made by coughing or sneezing, contaminated food utensils, water, or food.

Decontamination

The process of inactivating or reducing a contaminant in or on buildings, humans, animals, plants, food, water, soil, air, areas, or other items through physical, chemical, or other methods to meet a cleanup goal (EPA, DHS, November 2008).

Disinfection

A chemical or physical agent that destroys pathogenic or other harmful microorganisms, but not bacterial spores on inanimate surfaces (EPA, DHS, November 2008).

Immunization

A technique used to cause an immune response that results in resistance to a specific disease, especially an infectious disease. Immunization (through vaccinations) works by stimulating the immune system, the natural disease-fighting system of the body. The healthy immune system is able to recognize invading bacteria and viruses and produce substances (antibodies) to destroy or disable them. Immunizations prepare the immune system to ward off a disease. In addition to the initial immunization process, it has been found that the effectiveness of immunizations can be improved by periodic repeat injections of vaccines or “boosters.”

Infection

The invasion and multiplication of disease-causing microorganisms in the body. Infections can occur in any part of the body, and can be localized or systemic.

Infectious

Capable of being transmitted by infection, with or without direct contact.

Laboratory Response Network (LRN)

An organization of public health laboratories established by the Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) in accordance with Presidential Decision Directive 39, which outlines national anti-terrorism policies and assigns specific missions to federal departments and agencies. The LRN and its partners maintain an integrated national and international network of laboratories that are fully equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, and other public health threats and emergencies. (CDC, 2005)

Latency

The time between exposure and the first appearance of an effect. In the case of exposure to a pathogenic microorganism, latency is the state in which the organism is present in the body but not actively replicating or causing illness.

Medical Monitor

A Medical Monitor must be a competent health and safety professional (e.g., a local emergency medical technician [EMT], a nurse, or a nurse assistant) who knows how to measure and interpret vital signs, recognize the symptoms of physical stress-related disorders, and monitor work/rest cycles.

Medical monitoring

The early detection and treatment of injury or illness in individual workers.

Morbidity

Morbidity is the state of being ill or diseased. The term also refers to the extent of illness, injury, or disability in a defined population.

Mortality

Mortality is synonymous with death. Mortality is also a measure of the rate of death from a disease within a given population.

Secondary explosive device

A bomb placed at the scene of an ongoing emergency response intended to cause casualties among responders. Secondary explosive devices are designed to explode after a primary explosion or other major emergency response incident has attracted large numbers of responders to the scene to inflict additional injury, damage, and fear.

Sterilization

A process intended to remove or destroy all viable forms of microbial life, including bacterial spores, to achieve an acceptable sterility assurance level. (AAMI, 1995)

Vaccine

A suspension of attenuated live or killed microorganisms, administered to induce immunity and thereby prevent infectious disease.

Volatility

A measure of how readily a substance will vaporize. Substances that are highly volatile easily become airborne.

APPENDIX D

Aerosolized Anthrax:
Emergency Response Resources

Aerosolized Anthrax: Emergency Response Resources
The NRT’s Quick Reference Guide: Anthrax.
NIOSH’s Emergency Response Resources: Anthrax.
The National Research Council’s Reopening Public Facilities After a Biological Attack: A Decision-Making Framework. Committee on Standards and Policies for Decontaminating Public Facilities Affected by Exposure to Harmful Biological Agents: How Clean Is Safe?, available in PDF format from the National Academies Press.
Anthrax-Contaminated Facilities: Preparations and a Standard for Remediation, December 16, 2005, Michael M. Simpson, Resources, Science, and Industry Division, Congressional Research Service, Library of Congress, available in PDF format at http://www.wbdg.org/pdfs/crsreport_anthrax_lessons.pdf.
Interagency Biological Restoration Demonstration’s Capstone Exhibition, available in PDF format at http://www.itsallon.tv/media/slides/10.09.21.ibrd.s.1015progman.pdf.
OSHA’s Model Health & Safety Plan (HASP) for Clean-up of Facilities Contaminated with Anthrax Spores.
DHS and EPA’s Draft, Planning Guidance for Recovery Following Biological Incidents, May 2009.
Interagency Report (published jointly by EPA and DHS). Remediation Guidance for Major Airports After a Bioterrorist Attack, November 2008.
CDC and EPA, Interim Clearance Strategy for Environments Contaminated with Bacillus anthracis, July 2012
EPA’s Bioresponse Operational Testing and Evaluation (BOTE)-related materials, including:

• 
  Technical Brief (January 2012) and video
  

1^ Research is being conducted on the re-aerosolization of anthrax.

2^ Refer to the Glossary, Appendix C, for the definition of a Medical Monitor.

3^ EPA has formed a Medical Countermeasures Workgroup to ensure that antibiotics are available to EPA’s emergency responders.