Terrorism Response banner - emergency vehicle, emergency responders, worker wearing protective clothing

Terrorism Response

Preparation is always a key component to prevent, mitigate, control and recover from an emergency. Terrorist attacks are not an exception. No one wants to think about a terrorist attack but it is important to be prepared in case such an event happens. Terrorist attacks may include the use of explosives, flammable agents, biological and chemical agents causing detrimental impacts in multiple areas including infrastructure, economy, nature and human health. Adverse health effects resulting of this type of emergencies depend on the hazard and the type of attack, but hazards may include physical, biological, chemical, and nuclear hazards among others. Responding to these events requires a vast amount of resources. Emergency response and recovery workers should be trained to respond to these types of events and have access to recommendations for the selection and use of personal protective equipment against the different hazards they might face, such as biological and chemical agents.

This topic page provides information to help protect emergency responders in the event of a terrorist attack. Including relevant information regarding previous cases and responses that include the World Trade Center attacks and previous threats associated to anthrax. This page also offers access to information on other important elements of a terrorism response such as safety management, safeguarding building ventilation, bloodborne Infectious Disease, mail handling, and chemical hazards.

Anthrax is an infectious disease caused by the exposure through inhalation, gastrointestinal absorption or dermal contact to Bacillus anthracis spores. Exposure to Bacillus anthracis is concerning because infected patients have high fatality rates. Animals in the wild sometimes are exposed to B. anthracis spores and can get infected, later on exposing some workers that get in contact with infected animals, examples of workers at risk include veterinarians, farmers, livestock handlers, and laboratory workers. Etc.  There are different types of anthrax including cutaneous, inhalation, gastrointestinal and injection anthrax. The symptoms of anthrax depend on the route of exposure. Inhalation anthrax symptoms include fever and chills, chest discomfort, shortness of breath, nausea vomiting or stomach pains, sweats, and extreme tiredness. Gastrointestinal anthrax symptoms can include swelling of abdomen, flushing and red eyes, diarrhea, vomiting, fever, and chills. Cutaneous anthrax symptoms may include appearance of small blisters or bumps itching, swelling, and skin sore with a black center. The treatment requires the use of antibiotics and antitoxins.

Emergency response and recovery workers involved in an anthrax response, need to be properly trained in the use of personal protection equipment.

man in hazmat suit scraping anthrax off of floor

The following page provides information about anthrax including recommendations for protecting workers, environmental sampling, past responses and investigations, and other resources. The department of homeland security provides guidance for protecting responders’ health during the first week following a wide area aerosol anthrax attack available in the NIOSH Anthrax topic page. Other CDC and NIOSH materials are also available including the occupational health guidelines for remediation workers at anthrax contaminated sites, response guidelines on personal exposure and building contamination, recommendations for the selection and use of respirators and protective clothing for protection against biological agents, personal protective equipment for the protection of workers performing environmental sampling of Bacillus anthracis, Anthrax exposure management and prophylaxis, fact sheets on infection protection, and biosafety.
NIOSH Anthrax Topic Page

During emergencies exposure to blood and other body fluids are common. Emergency response and recovery workers are at risks of exposure to blood borne infectious diseases through contact with sharp objects and the potential contamination of open wounds. Concerns include the transmission of human immunodeficiency virus (HIV) and hepatitis. Therefore it is important to establish safety practices to prevent and control the exposure to blood and body fluids. Safety controls can include engineering controls, use of personal protective equipment but more importantly training for the safe handle of needles and sharps and guidelines for the management and treatment of incidents.

This topic page provides guidance to employers and employees on how to create an exposure control plan to prevent exposure to bloodborne pathogens. It also informs emergency response and recovery workers about their rights as workers such as the right to know when they have been potentially exposed to life-threatening diseases, known as the Ryan White treatment Extension Act of 2009. Other materials such as factsheets that offer practical advice on the disinfection and treatment of sharps and contaminated waste are also offered.  OSHA has recommendations and standards associated to the protection of workers from bloodborne infectious diseases, provided in this page.

finger prick showing blood drop

Health care workers are at special risks of exposure to blood borne infectious diseases. Concerns include the transmission of human immunodeficiency virus (HIV) and hepatitis. This webpage offers recommendations to establish work practices that prevent exposure to body fluids. Other resources offered include information on bloodborne pathogens, recommendations to prevent needle-sticks and sharps injuries, engineering controls, Personal protective equipment, and management and treatment guidelines.
NIOSH Emergency Responder Bloodborne Infectious Disease Page 

Chemical substances that have the ability to create a physical or health hazard are considered hazardous.  Due to their properties chemical hazardous substances may be, but are not limited to being toxic, explosive, flammable, self-reactive, oxidizing, or corrosive. Exposure to these substances by different routes including inhalation, dermal absorption, or ingestion can lead to adverse health effects, enhancing the need to know about the hazards associated to these substances beforehand.

Chemical agent information is needed for emergency response and recovery workers to appropriately plan for risks resulting from possible chemical incidents. Several organizations have developed information databases, including short-term and long-term criteria, each with specific purposes, exposure scenarios, and severity of adverse health effects considered in their development.

Databases offer their users the possibility to consult by name, the properties, physical descriptions, exposure routes, target organs, associated symptoms in case of exposure, personal protection recommendations, standards, and first aid for a particular chemical.

man in hazmat suit removing chemical hazards

The NIOSH chemical hazards webpage has available resources that offer detailed information about particular chemical agents. An example of this is the chemical hazards emergency medical management website, where there is information for first responders for how to prepare to respond, how to conduct themselves arriving in the scene, and how to conduct casualty triage, assessment, treatment and transport, and train and plan. Some substances included are ammonia, chlorine, hydrogen cyanide, mustard agents, nerve agents, phosgene and other hazardous chemicals. Other resources that offer similar information including PPE recommendations are the Emergency Response Safety and Health database and the NIOSH pocket Guide to Chemical Hazards. The last resource, has a printer version available and also provides an app that allows users to look for the chemical structures, exposure limits, chemical and physical properties, emergency treatment, respirators selection, and signs and symptoms of exposures.
NIOSH Emergency Response Chemical Hazards Page

In case of a terrorist threat, workers in mail offices and postal services could be in potential risks of exposure to agents that can be present in the mail. Accidental inhalation, dermal contact or ingestion of particles that may lead to the development of adverse health effects could happen, nevertheless there are procedures such as mail irradiation applied to prevent the presence of biological agents in the mail. Safety and health measures and controls should be used including the proper ventilation of mail handling facilities to reduce over exposure to potential contaminants. NIOSH conducted three health hazard evaluations following the anthrax attacks of 2001 of activities involving handling irradiated mail. NIOSH reports not detecting airborne contaminants above occupational exposure limits, and provides some recommendation for the proper manipulation of irradiated mail.

capital building, envelopes, man sorting mail in mail room

The following topic page contains information on health hazard evaluations NIOSH conducted for the U.S. Postal Service to assess the workplace hazards of handling irradiated mail and Health Hazard in response to requests from postal employees, federal workers, and Congressional employees. The page provides access to the reports from NIOSH, a health hazard evaluation report to the office of personnel management, and a report regarding formaldehyde results.
NIOSH Irradiated Mail Topic Page

Postal offices receive thousands of documents in one day, some of this mail could be contaminated with Bacillus anthracis which may expose unintentionally mail workers to the spores.

The CDC provides guidance for implementing engineering, administrative, and housekeeping controls; advice for mail workers. The recommendations include the implementation of engineering controls to prevent aerosolized spores, administrative controls, housekeeping controls, and use of personal protective equipment.
CDC Interim Recommendations for Protecting Workers from Exposure to Bacillus anthracis in Work Sites Where Mail Is Handled or Processed

This report describes the results of CDC’s evaluation of B. anthracis in the Brentwood Mail facility, which showed widespread contamination of the facility. The results of environmental sampling suggest that the use of wipes in surface for sampling and high efficiency particulate air (HEPA) vacuum samples complement each other in assessing contamination. This results might be used to increase the research focused on cleanup efforts and improve sampling methods.
Evaluation of Bacillus anthracis Contamination Inside the Brentwood Mail Processing and Distribution Center — District of Columbia, October 2001

Examines the development and use of Autonomous detection systems (ADS) to detect agents of biologic and chemical terror in the environment. These systems will eventually be able to detect biologic and chemical hazards reliably and provide approximate real-time alerts if an agent is present in a particular environment.
Responding to Detection of Aerosolized Bacillus anthracis by Autonomous Detection Systems in the Workplace

Terrorist attacks might impact outdoor and indoor air quality. Airborne agents might be chemical, biological or radiological. After the 2001 terrorist attacks the Office of homeland security formed an interagency workgroup aiming to create building air protection strategies. As a result, there are different guidelines available to provide recommendations to employers and workers on the prevention and protection of building environments, from an occupational health and safety dimension. These guidelines focused on the selection and proper use of air cleaning systems to protect the health of the workers.

building environments front cover of manual

This NIOSH publication provides recommendations to protect building air environments from a terrorist release of chemical, biological, or radiological contaminants. The guidelines offer preventive measures, recommendations, air-cleaning principles, and economic considerations for building owners and managers.
NIOSH Guidance for Filtration and Air-Cleaning Systems to Protect Building Environments from Airborne Chemical, Biological, or Radiological Attacks

This NIOSH publication identifies actions and recommendations as well as information on actions, measures and strategies building owners, managers, maintenance personal and general edifications can take to enhance protection from airborne chemical, biological or radiological attacks.  Recommendations cover physical security; ventilation and filtration; and maintenance, administration, and training for building owners or managers to quickly implement to enhance occupant protection from an airborne chemical, biological, or radiological attack.
NIOSH Guidance for Protecting Building Environments from Airborne Chemical, Biological, or Radiological Attacks

A main component of disaster management is safety. Safety management makes reference to all the possible strategies that can be implemented to assure the safety of workers while performing their jobs. The purpose of safety management is to prevent hazards and reduce potential harmful incidents that can occur in the workplace. The strategies implemented can include safety prevention measures such as the use of personal protective equipment or the establishment of health and safety policies.

NIOSH and RAND produced four reports in a series detailing previous emergency responses associated to terrorist attacks.

The first three reports provide recommendations and the need for research, training and other strategic approaches to help protect emergency responders in terrorist attacks. These reports describe the lessons learned from previous terrorist attacks, while making an emphasis in preparedness, suggesting the implementation of training and the use of personal protective equipment (PPE).

The fourth report is a technical source for emergency response following large structural collapse events. From the experience with collapsed buildings, the report provides examples of documented health effects, varying from evidence of respiratory and biological hazards to chemical and physical hazards. The report explains the need of establishing PPE guidelines and offers advice for its use and compatibility, and provides guidance on how to set safe exposure limits.

Each individual report can be accessed using the following links:

Protecting Emergency Responders Safety Management in Disaster and Terrorism Response

Personal Protective Equipment Guidelines for Structural Collapse Events, Rand Volume 4External

911 front cover of I Was There manual

After the terrorist attacks to the World trade center, the James Zadroga 9/11 Health and Compensation act of 2010 established the World Trade Center Health Program (WTCHP) to provide medical monitoring and treatment for responders who worked at the World Trade Center and related sites including New York City, Pentagon and Shanksville, Pennsylvania.

Currently, NIOSH funds programs that provide medical screening, monitoring, and treatment for responders who served at the WTC site. The website provides access to program statistics, quarterly reports, research projects, publications, benefits, and compensations programs.

Links to information about the NIOSH response, and World Trade Center health resources, can be found here.
NIOSH Safety and Health Topic: World Trade Center Response

Page last reviewed: November 30, 2018