Georgia
Department of Human Resources • Division of Public Health
Two
Peachtree Street NW • Suite 15-470 • Atlanta, Georgia 30303-3186 • Tel: (404)
657-2700 • Fax: (404) 657-2715
Advice for Emergency and First Responders (911, EMS,
Police, Fire), Public Health, and Medical Providers: Dealing With Suspicious
Letters and Packages, and Unknown Substances
Georgia
Division of Public Health
October
17, 2001
The threat posed by
the current flood of reports of suspicious letters, packages, and unknown
substances ranges from none to credible, and no set of guidelines can cover
every possible variation. Every report
will have unique features and the responder must use his or her own judgment in
applying these guidelines.
A.
Suspicious packages and letters:
It is important to assess the nature of the possible
exposure to anthrax. Factors that need
to be assessed include the credibility of the exposure and whether the exposure
might result in inhalational anthrax or cutaneous anthrax.
1. Notify local
law enforcement personnel who will conduct a credibility threat
assessment. Whether or not the
assessment should be conducted at the scene can be decided on a case-by-case
basis at the discretion of the law enforcement personnel. Either of the following circumstances may
indicate a credible threat:
§
A
letter/package (either opened or unopened) with material present. For example, it could be covered with
powder, or have a substance staining the letter or leaking from it.
§
A
threat accompanies the letter or package (substance need not be
present).
2. If the above
criteria for credible threats are met, the Federal Bureau of Investigation
(FBI) should be notified at 404-679-9000 (24/7).
If the FBI accepts the
situation as a credible threat, follow the steps below.
§
Notify local, district, and/or state public health (see
contact numbers at the end of this document).
§
Law enforcement personnel should double- or triple-bag
the letter or package in plastic bags using
latex gloves and a particulate (or TB) mask.
Do not smell, touch, taste, or shake the contents of the package or
letter. Wash hands with soap and
water. If a substance from the letter or package has
visibly contaminated a person’s clothing, the clothing should be removed and
laundered with usual cleaning methods appropriate for the clothing affected..
§
For credible threats,
substances in letters/packages can be tested at the Georgia Public Health
Laboratory (GPHL) according to the packaging/transport protocol below. Competent, trained and properly equipped
personnel, including HazMat teams, should appropriately prepare the
letter/package for transport. Unopened
packages should be screened for other hazards by local HazMat personnel or the
FBI on scene.
§
Decisions about the need for decontamination and
initiation of antibiotic prophylaxis should be made in consultation with public
health officials. In most
circumstances, the decision to begin prophylaxis can be delayed until the
presence or absence of Bacillus anthracis
can be determined.
§
Note: CDC currently does NOT recommend use of nasal swab
specimens as part of evaluating anthrax threats/implied threats or evaluating
concerned citizens who think they may have been exposed to anthrax.
Packaging/Transport Protocol
§
Coordinate with the GPHL at 404-327-7900
§
Local FBI personnel may be used to transport specimens if
bioterrorism is suspected (as above) according to “chain of custody” protocols.
§
Place the double- or triple-bagged suspicious letter or
package into a leak‑proof container with a tight cover that is labeled
"biohazard."
§
Place this container into a second leak proof container
with a tight cover that is labeled "biohazard." The size of the
second container should be no larger than one‑gallon paint can. No ice packs are needed.
§
Place the second container into a third leak proof
container with a tight cover that is labeled "biohazard." The third
container should be no larger than five‑gallon paint can.
§
All three containers should meet state and federal
regulations for transport of hazardous material, and be properly labeled.
If the FBI DOES NOT accept the situation as a credible threat, follow the
steps below.
If the risk is judged to be
extremely low (e.g., the substance in the letter/package is known to be
crushed candy, crushed Tylenol, etc.)
§
Place the letter/package in a plastic bag and discard as
routine trash.
§
Any substance not in the letter/package should be cleaned
up like a routine household spill.
If the level of risk is
uncertain
§
Clean and disinfect with 10% bleach using minimal
protective gear (e.g., NIOSH disposable mask, latex exam gloves).
§
Place in plastic bag and discard as routine trash.
If further information is
gathered that suggests that the FBI’s initial appraisal (not a credible threat)
was incorrect, go back to the steps under “If the FBI accepts the situation as
a credible threat” above.
3. If neither of
the two criteria for credible threats involving letters or packages are met:
Letters or packages that do not meet the criteria for
credible threats (no threat, no suspicious substance) are highly unlikely to
contain anthrax and do not need to be tested.
Public safety and public health officials do not need to provide
on-scene response. Callers should
be instructed to place the letter or package in a plastic bag and discard as
routine trash.
B. Suspicious substances not associated with
letters or packages:
Credible threat (examples: substance plus
threat, or no threat but high profile target—news media, government, sporting
event, abortion clinic)
§
The Federal Bureau of Investigation (FBI) should be
notified at 404-679-9000 (24/7).
§
Notify local, district, and/or state public
health officials (see contact numbers at the end of this document).
§
Ensure that all persons with possible exposure to the
substance remain on site until emergency personnel arrive; list all persons who
physically handled the letter (package) and provide the list to authorities.
§
Law enforcement or HazMat personnel should
double-or triple-bag the substance in plastic bags using latex gloves and a particulate (or TB) mask. Do not smell, touch, taste, or shake the
substance.
§
Substances can be tested at the Georgia
Public Health Laboratory (GPHL), according to the packaging/transport protocol
given above. Competent, trained and
properly equipped personnel, including HazMat teams, should appropriately
prepare the substance for transport.
§
Decisions about the need for decontamination
and initiation of antibiotic prophylaxis for individuals in contact with the
substances should be made in consultation with public health officials. If the substance has visibly contaminated a
person’s clothing, the clothing should be removed and laundered with usual
cleaning methods appropriate for the clothing affected. In most circumstances,
the decision to begin prophylaxis can be delayed until the presence or absence
of Bacillus anthracis can be
determined.
§
Note: CDC currently does NOT recommend use of
nasal swab specimens as part of evaluating potential human anthrax exposures
until possible exposure to known B. anthracis can be documented.
Low risk
(low-profile, low-risk target [not news media, not government] with no threat,
e.g., white powder in stairwell with no threat, white powder on mall floor with
no threat). Whether or not the assessment should be conducted at the scene
can be decided on a case-by-case basis at the discretion of the law enforcement
personnel.
§
Clean and disinfect with 10% bleach using minimal
protective gear (e.g., NIOSH disposable mask, latex exam gloves)
§
Place in plastic bag and discard as routine trash
Very low risk (obvious explanation, e.g.,
laundromat with powder on the floor, restaurant with powder on a counter). The assessment does not need to be
conducted at the scene.
§
Clean like a routine household spill.
Contact
Numbers:
Dr. Cherie Drenzek 404-657-6452 Answering
service
Dr. Susan Lance-Parker 404-657-2617 770-578-4104
Dr.
Julie Fletcher 404-657-2629
Dr.
Travis Sanchez 404-657-1105
Dr. Katie Arnold 404-657-6438
Dr. Paul Blake 404-657-2609
Lee Smith 404-463-2743
Other
Resources:
§
Georgia Division of Public Health Event Information Line,
operated by the Georgia Poison Center, at 1-866-752-3442
(toll-free, 24 hours/day, 7 days/week)—has recorded information
§
Georgia Division of Public Health bioterrorism webpage at
http://health.state.ga.us/programs/emerprep/bioterrorism.shtml
§
Georgia Division of Public Health Guidelines for Anthrax (B. anthracis ) Diagnostic Testing
(revised 10/16/01)(attached and on webpage)
§
Laboratory Procedures for the identification of Bacillus anthracis (on webpage)
§
Advice to the Public: How To Handle Anthrax
and Other Biological Agent Threats (on webpage)