Loss Control TIPS Technical Information Paper Series Innovative Safety and Health Solutions

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Preparing For and Responding to Incidents Involving Suspected Anthrax Since the terrorist attacks of September 11, 2001, the United States has witnessed several instances of the intentional use of weaponized anthrax against its citizens, where the delivery vehicle has been contaminated mail. In this same period, law enforcement and health officials have responded to a significant number of hoaxes and false alarms. It is essential that business owners understand the threat and respond accordingly to minimize risk to employees and prevent unnecessary business interruption. This paper provides business owners and managers with information and response protocols for incidents of suspected bioterrorism involving anthrax. (Response protocols for other biologic agents may or may not be similar, depending on their lethality and form. Consult local health officials for additional guidance.) Integrate these protocols with a comprehensive emergency preparedness planning program for your entire facility, and share information with law enforcement and other local officials. The response checklists provided at the end of this document are suitable for distribution to, and training of, your employees. In all instances, communication with affected employees is essential to minimize impact and keep your business running smoothly.

Background Anthrax has been known for centuries as an affliction of animals, and, rarely, of humans. To most military and civilian emergency planners, however, anthrax poses a significant biological warfare threat, particularly if it is used by a terrorist. The infectious agent of Bacillus anthracis (B. anthracis) is its spore, an extremely small (1.0 – 5.0 microns) and exceptionally durable particulate. Inhalation of, ingestion of, or skin contact with the spore provides B. anthracis a hospitable environment in which to germinate. It is estimated that a person must inhale many thousands of spores to contract the inhaled form of the disease; however, the small amounts of powder delivered in the recent contaminated letters may have contained billions of spores. Anthrax manifests itself in three distinct forms:

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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Cutaneous Anthrax A cutaneous (skin) infection occurs when the bacterium or spore enters a cut or abrasion on the skin. The infection begins with a raised itchy bump (similar to an insect bite) and progresses to an ulcer with a characteristic black center. Approximately 20% of untreated cutaneous anthrax cases may result in death. Deaths are rare, however, following appropriate antibiotic therapy. Gastrointestinal Anthrax Gastrointestinal anthrax infection may follow the consumption of contaminated food. Initial signs are nausea, loss of appetite, vomiting, and fever, followed rapidly by abdominal pain, vomiting of blood, and severe bloody diarrhea. The mortality rate is difficult to determine, but is estimated at 25% to 60% of untreated cases. Inhalational Anthrax Inhalation anthrax, caused by the inhalation of B. anthracis spores, is the most severe form of the disease. Following an incubation period of 1-6 days, the onset of the disease is gradual and flu-like. In many cases, a short period of recovery is followed by abrupt development of severe respiratory distress. Shock and death typically occur 24-36 hours after the onset of respiratory distress. While the disease responds to aggressive antibiotic therapy, a delay in diagnosis (such as when the symptoms are misdiagnosed as flu) may preclude recovery. Death is universal in untreated cases, and may occur in as many as 95% of treated cases if therapy is delayed for more than 48 hours after the onset of symptoms.

Prepare for Suspicious Incidents at Your Facility Take A Proactive Approach Take steps now to protect your employees, facilities, and other assets, and to guard against the loss of productivity caused by panic, evacuations, and media attention that often accompany these incidents. Develop an Emergency Preparedness Plan (EPP) If you have not already done so, prepare policies, procedures, and resources for preparation, response, and recovery from real and threatened emergencies. Include provisions for suspicious mail, packages, and substances. Appoint an Emergency Coordinator and an Emergency Response Team. Train security personnel to respond to contamination threats and suspicious situations. Keep employees, emergency responders, and community officials informed of your emergency preparedness plans so that affected individuals and organizations can act effectively should the need arise. Establish Evacuation Procedures Make sure all employees can get out, find shelter, and find a responsible person. Hold evacuation drills regularly so that all employees will know who is in charge, and become familiar with evacuation routes and routines. Review Security Policies and Procedures Ensure that bioterrorism situations are taken into consideration. Review safety and security in mailroom and delivery operations.

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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Develop Procedures For Dealing With Suspicious Items Suppose that a bioterrorism threat call is made to your facility’s switchboard operator. Following the predetermined plan, the operator gathers appropriate information (e.g., time of call, exact words of caller) and asks appropriate questions (e.g., “Where is the package? What does it look like?”). The switchboard operator immediately notifies the Emergency Coordinator and the police department; the Emergency Coordinator activates the Emergency Preparedness Plan.

Communicate with Employees, the Public, and the Media Your Emergency Preparedness Plan should include procedures to alert and warn employees of emergencies. Employees should understand the types of communication methods that are in place within their organization (e.g., public address system). Your EPP should also include a notification flow chart for the Emergency Response Team and other EPP members. The notification chart should include your emergency coordinator and response team, security, local law enforcement and health officials, senior management, employees, outside response organizations, and employees’ families if appropriate. Appoint a single person (with backup) to serve as your organization’s spokesperson for dealing with the media and the public. No one else should discuss the situation with outsiders or the media. This policy ensures that only accurate, consistent information will be issued to the media and to the public.

Options for Decontamination If your workplace has experienced an incident involving confirmed anthrax, local public health authorities will direct the clean-up of your facility. While a number of available disinfectants may be used effectively, the choice of agents will be determined by the specific circumstances and the scale of the contamination. Do not attempt to decontaminate anything without specific guidance from a public health professional.

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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Important Additional Resources Theodore J. Cieslak and Edward M. Eitzen, Jr. “Clinical and Epidemiologic Principles of Anthrax.” Emerging Infectious Diseases, vol. 5, no. 4, July-August 1999, pp. 552-555. http://www.cdc.gov/ncidod/EID/vol5no4/cieslak.htm Centers for Disease Control and Prevention. “Bioterrorism Alleging Use of Anthrax and Interim Guidelines for Management – United States, 1998.” Morbidity and Mortality Weekly Report, vol. 48, no. 4, February 5, 1999, pp. 69-74. www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056353.htm Occupational Safety and Health Administration. Facts About Anthrax. www.osha.gov/bioterrorism/aboutanthrax.html Occupational Safety and Health Administration. OSHA Fact Sheet and References on Worker Health and Safety for Anthrax Exposure. www.osha.gov/bioterrorism/anthraxfactsheet.html Occupational Safety and Health Administration. OSHA Recommendations for Handling Suspicious Letters or Packages. www.osha.gov/bioterrorism/pkghandling.html American Medical Association. Anthrax as a Biologic Weapon: Medical and Public Health Management. (JAMA Consensus Statement) www.jama.ama-assn.org/issues/v281n18/ffull/jst80027.html United States Postal Service. Information From the General Services Administration On How to Respond to an Anthrax Threat In A Mail Center (October 22, 2001) www.usps.gov/news/2001/press/pr01_1022gsa.htm Building Owners and Managers Association International. Terror and HVAC. www.boma.org/iaq/terror&hvac.htm

For more information, contact your local Hartford agent or your Hartford Loss Control Consultant. Visit The Hartford’s Loss Control web site at http://www.thehartford.com/corporate/losscontrol/ This document is provided for information purposes only. It is not intended to be a substitute for individual legal counsel or advice on issues discussed within. Readers seeking resolution of specific legal issues or business concerns related to the captioned topic should consult their attorneys and/or insurance representatives.

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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Response Protocols For Incidents Involving Suspected Anthrax IF YOU RECEIVE A SUSPICIOUS LETTER OR PACKAGE Leave the Item Alone Do not handle the suspicious mail piece or package. Just set it down gently. Do not try to open the item! You may spill or disperse contaminants contained within the letter or package. In addition, a letter bomb may be triggered by a pressure release activated when the package is opened or when a string is cut. Do not empty the item or try to look inside it, even if you have already opened the item. Do not shake the item. Do not walk around with the item. Isolate the item; keep it away from people, and keep people away from it. Do not put it into an enclosed space (such as a drawer or cabinet) or under water. Do not discard the item or any packing, notes, etc. The proper authorities (probably law enforcement officials) will remove the letter/package safely. If any substance leaks or spills from the item, do not touch, taste, smell, or try to analyze the substance. If any substance leaks or spills from the item, do not try to clean it up. Cover the spilled contents immediately with anything (e.g., clothing, paper, trash can, etc.) and do not remove this covering. Secure The Area Make sure that damaged or suspicious packages are isolated. Isolate the specific area of the workplace so that no one disturbs the item. Evacuate the immediate area. (Evacuation of the entire workplace is not necessary at this point.) Leave the room and close the door. Alert others to stay away from the area. If any substance has leaked or spilled onto you or others, remove any contaminated clothing as soon as possible and place in a plastic bag, or in some other container that can be sealed. Give this clothing bag or container to the emergency responders for proper handling. If you think the room or area may have been contaminated by aerosolization (for example: if a small device was triggered, or if you receive a warning that air handling system is contaminated, or a warning that a biological agent was released in a public space): Turn off local fans or ventilation units in the area. Leave the area immediately. Close the door, or section off the area to prevent others from entering (i.e., keep others away). Shut down the air handling system in the building, if possible. If possible, list all people who were in the room or area. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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IF YOU SEE A SUSPICIOUS SUBSTANCE AT WORK Don’t panic. Notify local law enforcement and/or health personnel. Follow their instructions completely and immediately. If instructed to do so, evacuate the building following your standard evacuation plan. Minimize the possibility of disturbing the powder, because creating an airborne particle may significantly increase the hazard. Close the door, or section off the area to prevent others from entering (i.e., keep others away). Do NOT touch, smell, or taste the powder. Identification of anthrax requires laboratory procedures and a skilled microbiologist. Treat all unidentified substances as hazardous. Do NOT remove, wipe, dust, sweep, or vacuum the powder. Treat the area as a crime scene, until told otherwise. Preserve all conditions and all evidence. Discard nothing. Anyone who has been contaminated with the powder should remove and bag their clothes, then wash their skin with copious amounts of soap and warm water. If possible, list all people who were in the room or area. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.

Remember, the likelihood that the unidentified substance is a biological hazard is remote, but you need to minimize risk until you’re sure.

IF YOU RECEIVE A THREAT BY PHONE OR E-MAIL Don’t panic. Treat a threatening phone call as you would treat a bomb threat. Make every effort to keep the caller talking and on the line (so that the call might be traced). Notify a supervisor or co-worker that a bomb threat is in progress. Keep calm, listen to the caller, do not interrupt, and remain courteous. Ask the caller to repeat information, as a means of prolonging the conversation. Pay attention to all aspects of the call (background noises, voice quality of the caller, etc.). Write down your impression of the call and the caller, recording as much information as possible. Notify local law enforcement authorities (call 9-1-1). Do not delete any threatening or suspicious phone mail or e-mail messages. Save all materials from written bomb threats (envelopes, containers, phone notes, etc.). Do not handle these materials more than necessary, to preserve fingerprints or other evidence, and to protect yourself from possible contamination. Activate your existing emergency plan and evacuate the building when told to do so. Re-enter the building only after cleared by local authorities.

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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IMPORTANT PHONE NUMBERS Please Post Prominently INTERNAL CONTACTS

WHO TO CONTACT

PHONE NUMBER

WHO TO CONTACT

PHONE NUMBER

Emergency Coordinator Emergency Coordinator Backup Head of Security Employee Health Service

EXTERNAL CONTACTS Local FBI Office Local Police Local US Postal Inspector Fire Department Ambulance Hospital Mayor or other local official

Preparing for and Responding to Incidents Involving Suspected Anthrax © 2002 The Hartford Loss Control Department TIPS S 570.052

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