Jim Martin, Commissioner

Kathleen E. Toomey, M.D., M.P.H., Division Director

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:

During business hours:                                            Non-business hours

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)