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Homeland Security

Scenario 2: Biological Attack -
Aerosol Anthrax

Executive Summary

Casualties 13,000 fatalities and injuries
Infrastructure Damage Minimal, other than contamination
Evacuations/Displaced Persons Possibly
Contamination Extensive
Economic Impact Billions of dollars
Potential for Multiple Events Yes
Recovery Timeline Months

Scenario Overview:

General Description -

Anthrax spores delivered by aerosol delivery results in inhalation anthrax, which develops when the bacterial organism, Bacillus anthracis, is inhaled into the lungs. A progressive infection follows. This scenario describes a single aerosol anthrax attack in one city delivered by a truck using a concealed improvised spraying device in a densely populated urban city with a significant commuter workforce. It does not, however, exclude the possibility of multiple attacks in disparate cities or time-phased attacks (i.e., "reload"). For federal planning purposes, it will be assumed that the Universal Adversary (UA) will attack five separate metropolitan areas in a sequential manner. Three cities will be attacked initially, followed by two additional cities 2 weeks later.

Timeline/Event Dynamics -

It is possible that a Bio-Watch signal would be received and processed, but this is not likely to occur until the day after the release. The first cases of anthrax would begin to present to Emergency Rooms (ERs) approximately 36 hours post-release, with rapid progression of symptoms and fatalities in untreated (or inappropriately treated) patients.

The situation in the hospitals will be complicated by the following facts: The release has occurred at the beginning of an unusually early influenza season and the prodromal symptoms of inhalation anthrax are relatively non-specific. Physician uncertainty will result in low thresholds for admission and administration of available countermeasures (e.g., antibiotics), producing severe strains on commercially available supplies of such medications as ciprofloxacin and doxycycline, and exacerbating the surge capacity problem.

Secondary Hazards/Events -

Social order questions will arise. The public will want to know very quickly if it is safe to remain in the affected city and surrounding regions. Many persons will flee regardless of the public health guidance that is provided. Pressure may be placed directly on pharmacies to dispense medical countermeasures directly, and it will be necessary to provide public health guidance in more than a dozen languages.

Key Implications:

This attack results in 328,484 exposures; 13,208 untreated fatalities; and 13,342 total casualties. Although property damage will be minimal, city services will be hampered by safety concerns.

There is the potential for a huge sell-off in the economic markets; moreover, the stock exchange and large businesses may be directly affected by the attack. There may also be a decline in consumer spending and a loss of revenue for the metropolitan area. An overall national economic downturn is possible in the wake of the attack due to loss of consumer confidence. The costs of the closure of a large section of the city and the decrease in revenue from tourism for an indeterminate period would be enormous, as would the costs of remediation and decontamination.

Mission Areas Activated:


Prevention/Deterrence/Protection - This area requires knowledge of those with the ability to grow and aerosolize anthrax, reconnaissance of equipment and laboratories, and public health protection measures.

Emergency Assessment/Diagnosis - It will be necessary to monitor attack impact, determine resource needs, classify the type of event, and identify other events (if any). Environmental sampling for exposure risk assessment, identification of anthrax strain, and determination of any drug resistance will also be required.

Emergency Management/Response - Management and response will require public alerts, mobilization of the Strategic National Stockpile, activation of treatment sites, traffic/access control, special population protection, protective measures (e.g., shelter-in-place), requests for resources and assistance, and public information activities.

Incident/Hazard Mitigation - Mitigation will require PEP and PPE provision, environmental testing/decontamination, care of ill persons, victim treatment, site remediation and monitoring, notification of airlines/transport providers, public information provision, and coordination with public health agencies.

Public Protection - In order to protect the public, it will be necessary to provide symptom/exposure information, warnings, and shelter-inplace/ evacuation notification, as well as to manage traffic/access flow and mobilize the Strategic National Stockpile.

Victim Care - Care to the ill must be provided and should include disbursing PEP/vaccinations and establishing treatment/distribution centers.

Investigation/Apprehension - Law enforcement will investigate the attack in collaboration with public health officials working to identify populations at risk of disease. This also requires epidemiological trace-back of victims, parallel criminal investigations, and laboratory analyses.

Recovery/Remediation - The Environmental Protection Agency (EPA) and the CDC will coordinate this area. Extensive decontamination and cleanup will be required (anthrax is long-lived in the environment) costing billions of dollars. Remediation will also require environmental testing, highly contaminated area closures, and public information provision.




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