Initial Report: Chemical and Biological Medical Treatment Symposium - Industry I

Zagreb and Dubrovnik, Croatia 25 - 30 October 1998.

Symposium Overview and Summary:

In the process of developing, producing and preparing their product for distribution, extremely dangerous conditions could exist within the complexes of all chemical, petrochemical, pharmaceutical and other related industries. The CBMTS-Industry I graphically demonstrated this. These dangerous conditions, which include the large-scale use of legitimate but very toxic chemicals, when triggered or aggravated by acts of terrorism, sabotage, combat or a large scale incident or accident, could lead to catastrophes, which would equal or exceed those expected of actual chemical or biological warfare attacks. As of this writing, there are no specific legal or technical safeguards that would prevent these acts from occurring, and therefore, the community must be that much more vigilant and comprehensive in their preparations to prevent and mitigate catastrophes.

This symposium showed that levels of preparations and responses can be represented as an inverted pyramid. The first responder, at the bottom of this inverted pyramid, is not prepared or supported to any real extent. For actions to commence at the regional and national levels, the first responder must report the specifics of the impending/actual catastrophe. Unfortunately, the first responder has been neither adequately trained nor equipped to do that in a timely manner, i.e., to save the maximum number of lives.

Terrorism, across both the chemical and biological arenas, is an increasing and also a much more understood phenomena. It is also recognized that an individual either acting alone or with others of the same persuasion, or as part of a state sponsored group, can be much more sophisticated in both the political and technical arenas. Preparedness by all of us is mandatory. International Terrorism Centers for data collection and dissemination have been called for, but it will take a mind set change by officials at the national and regional levels to share this sensitive information with the individuals who need that information the most, the first responders.

All participants agree that the problems highlighted by this extremely important gathering of the world’s recognized professionals will be difficult to solve and that although the road will be long - we have now taken that first step.

According to General, Professor Kresimir Cosic, Deputy Minister of Defense, the Republic of Croatia "With the success of this meeting, comes a responsibility for commitment and that commitment is that Croatia will support CBMTS-Industry II." CBMTS Industry II will be held in the Republic of Croatia in 2001. The specific dates will be announced at a later time.

  • Professionals at demonstration on 26 October = 165 from 32 countries
  • Science and medical professionals 27-31 October = 125 from 25 countries

"Absolutely Incredible"said Dr. David Moore (DVM) as he opened his Session "Understanding, Prevention and Minimization"; the first CBMTS-Industry I session to be held in Dubrovnik on 27 October 1998. Dr. Moore’s remarks referred to the previous day’s incredible series of symposium demonstrations which were held in Kutina and Kalinovac, Croatia. These same remarks were to be echoed from all participants for every Session series and for all of the many special events organized by the CBMTS Industry I Croatian Organizing Committee.

Day 1. General, Professor Kresimir Cosic, Deputy Minister of Defense, provided the Symposium’s opening address. Dr. Brian Davey, the OPCW representative then provided OPCW considerations for this symposium as well as a CBMTS overview. Dr. Davey had previously been Symposium Chair for CBMTS I and CBMTS II and has been an official member of every CBMTS meeting.

Dr. Gui Santana of Brazil gave a summary of many major industrial accidents and their responses or lack of responses which seemed to enhance crisis rather than assist crisis management. The last address was by Dr. Ahmad Al-Shatti of Kuwait who provided an overview of the Kuwait oil well fire conflagration. He discussed the long term measurements of health impact on the Kuwait citizenry as caused by these fires and the war.

This Symposium Opening was followed by a bus ride to Kutina and a well prepared observation post and reviewing stand in the hills above the Petrochemia industrial complex. Lt. Col. Zvonko Orehovec was Session Chair for the series of demonstrations. Petrochemia, one of Europe’s largest producers of fertilizers, had been a prime target for the enemy and had suffered several attacks by air to ground rockets and iron bombs as well as ground to ground rocket and artillery over a five year span. We were told what stores were normally required for production as well as what was actually available during each of the attacks. We witnessed fighter aircraft (MIG 21's) making actual runs but with simulated releases of weapons, and actual explosions taking place on the ground with previously buried munitions. The realism, the dynamics of the attacks and the new understanding of what could have been the result of these attacks had certain portions of the complexes been hit, had all of us riveted to the action around us. Helicopters helped fight the fires and evacuate the wounded. We witnessed the fire brigade in action at the Petrochemia complex and the deployment of the Army’s NBC teams into the area. A mobile field hospital was set up near the observation post and participants were able to witness the rapid triage, pre-treatment and initial care provisions of this professional medical organization.

Next: A bus ride to Kalinovac and the CROSCO complex, Croatia’s Integrated Drilling & Well Services Company - the oil patch professionals.

The first demonstration at Kalinovac involved Canada’s Blast-Guard system. This counter-terrorist system very quickly mitigates the possible chem/bio terrorist scenario where a suspect CB device is discovered and then neutralized. Mr. Douglas Eaton of Irving Aerospace used the Canadian Blast-Guard ballistic tent to cover a simulated CB device and within 45 seconds had filled the tent with a decontaminant, and then detonated a 1/2 pound plastic explosive inside the tent. The device was neutralized and all parts of the explosive were kept within the tent for further investigation. This whole event takes less than three minutes from arrival time of the team in the area.

Having been provided in-depth information on Kuwait’s oil fire conflagration by Dr. Al-Shatti earlier in the day, we were now to witness a demonstration on the ‘new’ way to extinguish oil well fires. An oil well was purposely set on fire and all of us could feel the heat from this fire about 75-100 meters away. Crosco’s track mounted equipmentmoved into the area and within minutes had first doused the fire and then brought the oil well under control. A great demo.

Day 2. Airlift to Dubrovnik: Session III "Understanding, Prevention and Minimization", Dr. David Moore, Chair.

This session brought together experts from eight nations to describe plans, programs, processes and organizations which focus on either assessment and planning of, training for or responses to the potential release of toxic chemicals as accidents, as strategic objectives of war, or tactical objectives of terrorists. Of particular note from this session were the significant similarities amongst the represented countries in understanding the vulnerabilities of chemical industries.

In Croatia during the war, petrochemical and pharmaceutical industries were the target of hostile attack by the enemy. This was an impetus to create a comprehensive and responsive organization to prepare and to respond. The Toxicology Service of the Ministry of Defense was established in coordination with the Croatian Ministry of Health, the Croatian Institute of Toxicology and the Croatian Ministry of the Interior. The scope of this organization is extremely broad encompassing aspects from first aid to protection of food, water and the environment. In Pakistan as in many countries, it is recognized that attacks on large chemical industries is a strategic wartime objective, however these same industries can make ideal tactical targets for terrorists.

A comprehensive assessment of the threat, vulnerabilities, security measures and response capabilities are required to minimize this threat. In the United States various federal agencies have responsibilities for counterterrorism including the Department of Justice, the Department of Defense and the United States Public Health Service (P.H.S.). The P.H.S. uses a 10-step process in assessing the terrorist threat, target vulnerability and consequence management requirements as they relate to large chemical industrial facilities. In Bulgaria where the threat of toxic industrial chemicals has received increasing national attention, an independent advisory committee comprised of senior scientists is assessing the nature and location of highly toxic chemicals produced and stored throughout the country. In the Czech Republic new legislation is being drafted which will satisfactorily address the hazards posed to the general public from large chemical industries. In Belgium a sophisticated analytical approach has been implemented to optimize the response of various parties to a terrorist incident or natural disaster.

The understanding of the dynamics of timetables for responses will allow for better coordination between first responders and medical care providers and will ultimately benefit the victims of the disaster. Also, in Georgia, it is recognized that the medical planners from the Disaster Medical Center should be involved in all aspects of the disaster response plan to better coordinate their efforts and increase efficiency. The issue of adequate quantities of antidotes and treatment drugs to protect the general population is of much concern in Romania.

Requirements of pharmaceutical companies to bear the costs of producing sufficient quantities of "Orphan" or less profitable drugs under accepted quality standards was suggested. Automated sensors linked to alarms and dispersion model software programs, rapid handheld chemical detection systems and new efficient disaster response equipment and procedures were presented in this session by representatives of large Croatian Industries and DrŠger of Germany.

Session IV. "Epidemiology, Bioterrorism and Biological Warfare" Dr. Sergey Netesov, Chair. Dr. Leo Laughlin, Session Co-Chair, wrote the Session summary.

Part One of this two part Session looked at organizations and methods to respond to public health issues that could or did arise during bioterrorism or war.

Dr. Petar Gotovac reminded us that BW is an increasing threat both to national security and to public health. Peacetime preparedness and local resources are central to a successful response. Even so, medical response differs from country to country and may not be sufficient in countries in transition. A new focus and preparedness, including legislation, is necessary to gather sufficient resources. Among the measures required are: assigning responsibility for response, improving epidemiological surveillance training, improving continuing medical education, and training first responders. The ultimate value of all these efforts will depend on how well they are implemented, especially at the local level.

Dr. Florin Paul described a series of epidemiological studies both in Romania and in two war ravaged countries under UN Humanitarian Assistance. Protection from indigenous diseases requires surveillance, training and protection.

Dr. Sergey Netesov proposed using as an international center, the facilities at his laboratories and the companion labs at Obelinsk. Because of the excellent capabilities and experienced workers in both labs, it makes sense to organize a series of labs that can function as rapid diagnosis and detection centers on an international cooperative basis.

Dr. Netesov then reminded us that biological warfare agents do not necessarily have to be exotic diseases. Epidemic viral diseases can be used by terrorists and could go unnoticed unless public health investigators use molecular biology techniques to identify and define causative agents in an outbreak.

Dr. Vladimir Zhukov presented a mathematical methodology for predicting the infectivity of animal viruses in humans. By looking at cellular virus absorption probability and average replication, it should be possible to predict the human infectivity compared to infectivity in the animal. Marburg infectivity for monkeys was extrapolated from guinea pigs.

Part Two of this Session examined specific agents and how they could be used as bioterrorism agents or biological warfare agents and then how the public health and emergency response should work.

Dr. Vaso Taleski discussed Brucellosis from the point of view of a continuing problem in Macedonia. He pointed out how difficult from a public health perspective, it is to diagnose and eradicate. As a potential BW weapon, it is almost as effective as anthrax in area covered and people incapacitated.

Dr. Elena Ryabchikova showed us how the Ebola virus could be converted to a highly contagious respiratory agent. Normally, Ebola is not transmitted this way. This change in transmission method has implication for bioterrorists and BW agents; the usual method of transmission may not be the method by which an agent is delivered/transmitted.

Prof. Lotfali Haghighi provided a discussion of Bacillus species, with emphasis on anthracis. After describing the diagnosis and identification of anthracis, he described how an anthrax had been used by the Japanese, the British, and the Russians. Finally, he described the amounts of anthrax found in Iraq.

Gary Eifried showed the differences between military CW use and terrorist use and described the need to clearly understand the differences so military and civilian response teams can work together.

Dr. Davorka Peric described how the Croatian public health service operated during the ‘91-’95 war. Although the hemorrhagic fever outbreaks were investigated as possible BW attacks, it was concluded that they were natural. Over all the public health service operated very successfully during the war, with few epidemics, probably due to the absence of refugee camps with all of their health problems. Dr. Peric made a significant point: War and public health are incompatible. And yet the threat and possibility of bioterrorism increases.

Day 3. Session V "Emergency Management", Dr. Brian Davey, M.D., Chair

The papers in the session on Emergency Management were divided into three main topic areas. The first group dealt with specific incidents, facilities or experiences during the war in Croatia. The second group included papers from both Croatian authors and others, addressing the topic of terrorism and industrial accidents from a more general perspective, and including an account of the recent Nairobi bomb blast. Finally, a paper described the effects of the new Canadian decontaminant on wound healing.

Topic area 1. The problems that can result from oil spills consequent to attacks on industrial facilities were highlighted in the first paper. Techniques for measuring PCB's in soil and oil extracts were discussed, and results from testing in the karstic area of Croatia were presented. Both positive and negative findings in different areas were analyzed for their significance.

Risks to populations surrounding chemical plants were vividly illustrated during a description of the potential consequences of chemical release from the PLIVA company when it found itself threatened by attack. The risk could only be minimized via extensive disruption to normal activities, and rapid reactive measures including transport of hazardous solvents and chemicals to other locations.

An overview of accidents and incidents with environmental consequences provided insight into the extent of non-military occurrences of this nature in Croatia. The potential for sometimes unexpected consequences of conflict was illustrated by an overview of the Croatian project to identify and recover radioactive sources released into the environment from damaged civilian facilities, particularly from damaged lightning conductors. The organization of this project revealed principles that can be applied to an emergency preparedness plan for prompt and efficient action in the case of disasters.

Discussion generated by these papers revealed the need for a clear analysis of the differences between standard safety and accident prevention/response measures that are routinely undertaken by chemical industry, and the additional considerations that arise when the facility becomes threatened by conflict or identified as a potential terrorist target. It is not necessary to reinvent procedures altogether, but rather to reapply existing abilities, supplemented where necessary by additional precautions.

Topic area 2. An overview of the possibilities that chemical and biological technologies offer terrorists included a range of examples, covering incidents such as the assassination of political targets using ricin.

Continued in ASA 99-1

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