Weapons of Mass Destruction: A Coordinated Response Effort Good Morning or Afternoon I am Capt Holly Shenefelt with the 84th Civil Support Team in Wyoming First, let me express my thanks to Northwest Center for Public Health Practice, particularly Francesca Holme and Dr. Paul Wiesner for allowing me to present today. In addition, a special thanks goes to NancyJo Ilminen, who is the Training and Education Coordinator for the Public Health & Terrorism Preparedness Wyoming Department of Health for her invitation to present and her help along the presentation journey. Keep this presentation informal…. If you have any questions during please feel free to ask them. Capt Holly Shenefelt Medical Operations Officer Wyoming 84th Civil Support Team

Agenda Brief introduction to the functions and capabilities of the Civil Support Team (CST) Partnerships Successes Questions

What Is a Civil Support Team? Are you familiar with Civil Support Teams (CSTs) or their functions? Yes No

Situation Example “We’ve just received a report there’s been an explosion at the intersection of Loop 101 and 202,” announced news anchor Forrest Sawyer with the Virtual News Network. “At this time, we are not sure if this explosion is related to the dirty bomb detonations we’ve seen today in Guam and Portland, OR.” With the Oct. 16, 2007, broadcast from VNN, first responder agencies in Arizona were thrust into the midst of Top Officials (TOPOFF) 4 Full-Scale Exercise. TOPOFF 4 Full-Scale Exercise was national-level, multi-agency, multi-jurisdictional, "real- time" exercise, designed to better prepare senior government officials to effectively respond to an actual terrorist attack. The exercise itself was the largest counterterrorism exercise held to date by Homeland Security and involved more than 15,000 participants representing federal, state, territorial, and local entities. For the first time, a U.S. Territory, Guam, also participated in the TOPOFF exercise, providing an opportunity to practice coordinated prevention and response activities between the continental U.S. and a U.S. territory. According to the U.S. State Department website: “TOPOFF exercises are designed to simulate actual WMD attacks by fictionalized international terrorist organizations and involve live-exercise play. In order to make the exercises as authentic as possible, participants are given little forewarning of what scenarios they will face, such as type of WMD involved, or specific location, date and time of the attacks.” During this exercise the first of three coordinated attacks occurred in Guam, with the simulated detonation of a Radiological Dispersal Device (RDD), or “dirty bomb,” causing casualties and wide-spread contamination in a populous area near a power plant. Similar attacks occur in the hours that follow in Portland and Phoenix.  In the case of Arizona, a radiological dispersion device was detonated at the intersections of Highways 101 and 202, major roadways in the Phoenix metro area. “This exercise is specifically designed to overwhelm the emergency response capabilities of all levels forcing them to ask for assistance from higher levels, all the way up to the federal level,” said MAJ Paul Aguirre, Arizona public affairs officer. Once it was determined the detonation contained radiological components, the Arizona National Guard’s 91st Weapons of Mass Destruction - Civil Support Team was activated.“ The 91st CST can be on scene, especially when the incident is so close to their home station, in a matter of minutes,” said Arizona adjutant general, MG David P. Rataczak. With their unique capabilities, the 91st CST can provide those in charge with a quick assessment of the contaminants in the device. “The CST can take a sample for analysis, they can predict, or at least forecast, the downwind plume, and they have limited ability to decontaminate the first responders as well as providing them with immediate feedback to the type of contaminants,” MG Rataczak said.

Mission “The WMD CST deploys to support civil authorities at a domestic chemical, biological, radiological, nuclear, and [high] explosive (CBRNE) incident site by identifying CBR agents/substances, assessing current and projected consequences, advising on response measures and assisting with appropriate requests for state support.”

What We DO… Confirm CHEM and RAD hazards Identify BIO agents Work directly as a state response asset with local, state, federal response agencies Provide recommendations on event mitigation, medical treatment, and follow-on state and federal resources Points per slide….

CST Locations 12th 11th 10th 15th 83rd 103rd 81st 55th 102nd 2nd 1st 82nd 101st 54th 13th 84th 51st 14th 3rd 71st 95th 21st 72nd 52nd 53rd 35th 31st 92nd 8th 5th 32nd 85th 34th 73rd 33rd 41st 7th 42nd 9th 63rd 45th 91st 93rd 61st 43rd 64th 47th 46th 4th The CST is a federally funded State National Guard unit established under Presidential Decision Directive 39…. They came to be after recognition of the growing threat for terrorism within the United States… The first ten teams entered service in 2000. We are now in the final phase of CST stand-up and full time operations… With the overall goal of have a minimum of one team in every state, with some states possess 2 Teams as is the case with California…South Dakota was the latest team which was certified on July 13, 2007 bringing the total number of teams certified by DoD to 52. Congress has authorized a total of 55 WMD-CSTs – Guam, Virgin Islands, and Puerto Rico have yet to be certified. In 2007, the 12th WMD-CST of N.H., the 15th WMD-CST of VT., the 31st WMD-CST of Del., the 81st WMD-CST of N.D., the 83rd WMD-CST of Montana; 84th WMD-CST of Wyo.; the 33rd WMD-CST of D.C; the 85th WMD-CST of Utah and the 92nd NV, were certified (9 total). Notice the highlighted red portion -- The U.S. has also been divided into 6 separate response sectors for a National Response Posture to ensure mutual coverage with one team in each region always on call for National Response and 2 additional Teams on Stand-by…. 62nd 6th 44th CST in every state and territory (total of 55 teams by 2007) Guam-94th Puerto Rico–22nd

Organization Army and Air National Guard members On call 24/7–365 Commander Deputy Commander First Sergeant Operations Element Admin/Log Element Communication Element Medical Element Survey Element Operations Officer Logistics Non-Commissioned Officer (NCO) Communication Team Chief P.A. Survey Team Leader Operations NCO/ Modeler Admin NCO /ASST Decon NCO System Information Tech. Medical Operations Officer Reconnaissance NCO 22 Full-time Active (AGR) Force Army and Air National Guard members On call 24/7–365 Asst. Operations NCO/Decon NCOIC Nuclear Medical Science Officer Team Chief Team Chief A CST is made up of 22 Full-time National Guard Soldiers and Airmen. Operational control of the team rests with the Governor of the state with authority delegated to the Adjutant General. Tactical control resides with the CST Commander or his representative. Team Member Team Member Medical NCO Team Member Team Member

Deployment Ground Air Local / regional response Times vary based on incident site location Goal is four hours presence on scene (advanced party) Partial- or full-team response *Local and regional capability *Goal is 4 hour response *Unit is air transportable via C-130 and larger USAF transport aircraft. *Request for assistance flows through normal Military Support to Civilian Authority (MSCA) channels. *Regional capability includes:Id, Mt, Wy, NV, Ut, Or (would require response Memorandum of Agreement between involved states) *The Civil Support Teams respond at the request of, and to support the local incident commander to assess, advise and assist. The CST’s also support other CST’s if requested and spend time coordinating and training with local emergency responders including law enforcement, fire, EMS, Public Health and HAZMAT teams. The teams are able to respond in a rapid manner compared to the response time of the average federal counterpart. The teams are on-call 24-7 and have an approximate four hour response to the incident scene via Advanced Party. Air

Basic Capabilities Hazard modeling Communications Field analysis Medical liaison Survey operations DECON Hazard Modeling- To advise and assist the IC for evacuation decisions of affected population or shelter in place.. Communications- Bringing response assets together onto a common net for increased awareness of all Field Analysis- Presumptive identification of agents and substances to ensure quick response ensure life safety.. Medical Liaison- Advise on potential treatment course of action for casualties Survey Operations- Entry into the “HOT ZONE” or contaminated area to locate sources and sample for positive identification Decontamination- Of CST members and other first responders following down range operations Training Exercise

Medical Section Medical surveillance and emergency treatment of team Training Exercise Training Exercise Medical surveillance and emergency treatment of team Advice on treatment of WMD casualties Liaison for medical support Analysis of WMD agents The medical team provides a unique response capability to the CST commander & ICS system. PA, Medical Ops Officer, Nuclear Medical Science Officer and Med Ops NCO. *Administration of the CST Medical Surveillance Program *Medical support and emergency treatment of CST personnel *Liaison between State Health Dept, local Public Health officials and other key individuals *Medical consultation support via electronic reach-back at the incident site *Advising on treatment of WMD casualties *Conducting laboratory based presumptive identification of collected samples

CST Involvement with Public Health How involved is the CST in your state or local public health office? Very involved Somewhat involved Not involved I don’t know

Analytical Lab System (ALS) Presumptive analysis of CHEM and BIO agents Two internal negative pressure glove boxes HAPSITE, FTIR, HAZMAT ID, HHA, Microscope, PCR Self-contained 15kw generator Operated in the COLD Zone *Conducting laboratory based presumptive identification of collected samples *Operated by a dedicated Nuclear Medical Science Officer assisted by Team Med NCO *Biological Samples split and sent to State Laboratory for confirmatory analysis

Incident Command and other responders Footprint Incident Command and other responders Civil Support Team Typical footprint of CST with local responders Training Exercise Hot zone

Questions? Do you have any questions? Training Exercise

Wyoming Partnerships State level All hazards line Monthly bioterrorism meeting Emergency Preparedness Advisory Committee Training Laboratory Glove box Sampling video Tabletops SNS training containers Burn Course ICS Courses Visual DX Software All hazards line – anytime the CST arrives on scene a call is placed to the all hazards line. This allows to place the lab on standby, epidemiologists to be available, reach back, processing of sampling guidance, help with the connection to the local Public Health offices, etc. Monthly bioterrorism meetings – the CST was invited by the State Health Dept to attend. This allows for exposure to what is going in various areas of the state, updates on tribal relations, input of what the CST is doing, updates on the SNS. In addition, other individuals attend the meetings (i.e. county Public Health, Homeland Security, FBI, District Attorney) Emergency Preparedness Advisory Committee – As a member of this committee, it has provided exposure to various individuals across the state – from local public heath officials to CEOs of private Hospitals. This Committee provides input and guidance to the State Public Health and Terrorism Preparedness Program, which is funded through a CDC cooperative agreement and the National Bioterrorism Hospital Preparedness Program, which is funded through what was known as the Health Resources and Services Administration (HRSA) cooperative agreement. Tabletop in Laramie that lead to discussions with the local hospital that lead to decon training hospital and the lessons learned were brought to the subsequent tabletop and shared with the group. That also lead to the inclusion of the local county Public Health individual – the table top familiarized her with our mission and put her in contact with State Public Health personnel. Face to fact time is vital. As a result, when the actual exercise occurred at the local basketball arena, the Public Health person was able to come out and view the CST Equipment, see how she would fit in, be a role player in the exercise and assist with input on what her actions would be.

Wyoming Partnerships (cont.) Local public health Exercises Call outs Equipment familiarity Prophylaxis Public communication Training First Responders Participation Role Play Local public health -- Recent postal exercise a couple of weeks ago. Laramie (Albany County) – came to exercise Tabletop and during the exercise was able to view equipment, look at the footprint, see the exercise in progress earlier this year. The interaction produced opportunities to identify how operations would work together, how they could help the situation, identified other agencies and personnel that would need to be involved in their county, and discussion occurred on the flow of information. Laramie County -- First responders – fire tower training, fire fighters coming with us to Dugway Proving Grounds, EMT training at Ivinson Hospital, teaching CPR courses.

Successes: North Dakota Instructors/evaluators Pandemic influenza scenario “Point dispensing” Triage lab In North Dakota they have a great working relationship with their public health office. Over the last year the 81st Civil Support Team has assisted with three exercises as Instructors/Evaluators. These three exercises were based on a Pandemic Influenza scenario and exercised "Point of Dispensing" for a medium sized community. Their mobile lab has a written agreement with our state health lab that states they will act as a "Triage Lab" or will screen any samples before they enter state health lab providing a secondary safety measure. The State Lab was about to build a $5 million dollar lab and then did a tour of the CST facility and discovered that the CST had all the equipment the State Lab desired for their "all hazards" triage lab and asked if we would assist them. Training Exercise

Successes: Idaho Networking Exercise involvement Training Collaborative medical surveillance Local Emergency Planning Committee (LEPC) meetings Training Exercise Capt Taylor with the Idaho CST explained that their Networking foundation has enabled to get to know their local public health coordinators in their state. When they the CST does tabletop exercises, local public health representatives are invited to participate in their job role and as evaluators. Then, during the field portion of an exercise week, the same public health representative are brought on-scene the day before an actual exercise where they have an opportunity to see and become familiar with CST equipment. This give an opportunity to see how both sides can assist each other in a real situation. This networking foundation has lead to some significant opportunities for training in their state. They have assisted with Strategic National Stockpile (SNS) projects through their “Point of Dispensing” exercises. Capt Taylor has had the privilege of going back East for CDC training as part of her relationship with the Public Health Dept. The collaborative effort continues through medical surveillance and attendance at LEPC meetings. She explains that when it comes to Idaho, CST and public heath representative are like minded in their disaster management and as a result they have a great sharing relationship. Even when it come to sharing information region to region, the state gets involved and makes sure that everyone has the information they need.

Successes: Guam Pandemic influenza preparation Airport disaster Mass immunization All hazards events BT lab set up Training Exercise Just a quick note about Guam. Guam is not even a certified team yet and they are out there forging relationships that will be vital if a real incident ever occurs. The CSTs interaction with Public Health has been the areas of Pandemic Influenza, Airport Disaster, Mass Immunization and All Hazards Events. Discussion also included capabilities, responsibilities and expectations. Sharing knowledge was recently apparent through the CST advisement on requirements of setting up the Guam Public Health Bioterrorism (BT) lab. Guam is in a great position to develop their team and their Public Health programs simultaneously. Further, it was noted by the Island’s Fire chief that during the TOPOFF exercise a strong partnership that formed between the Guam Fire Department and the 94th Civil Support Team of the Guam National Guard is testimony to how collaboration can work through sharing training methodologies and cross training with one another's equipment.

Successes: Colorado Typing resource database for public health/medical Slated to become the national model for resource typing Recently highlighted for their efforts in a documentary on 9NEWS out of Denver, CO Doing things new/different -- Colorado, one of the original 10 CST teams in the nation, has been very fortunate in the development of their relationships with local, state and federal agencies. In fact, they recently two members of their medical section worked closely with the Mike Moreland, CDPHE to develop a Typing Resource Database for Public Health/Medical. Resource typing is deals with the categorization and description of resources that are commonly exchanged in disasters via mutual aid, by capacity and/or capability. Initially they met every month, for several months, for 1-2 hours to develop a SWOT, which is a Strategic Management Technique that focus on strengths, weaknesses, and looks for opportunities and threats. The two members helped formulate the initial outline of the goals and how to accomplish the task. The State had contracted with an IT person that was creating an All Hazards Database for the State of Colorado, however, it was missing the PH/Med component. The collaboration between the CST and CDPHE helped identify and create new response resources (i.e. Strike Teams) and other resources that are ready and able to be rapidly deployed to assist the local IC. This collaboration on the database development was so successful that it is now slated to become the National Model for resource typing and this program was recently highlighted in a documentary by 9NEWS out of Denver, Colorado.

Successes: Louisiana Hand-in-hand relationship Katrina Pandemic flu preparation SNS coordination “Development of regional response plans for smallpox . . . to the coordination between public health, local hospital and the military for patient evacuation during a crisis . . . to dealing with Hurricanes Katrina and Rita . . . there is much to be said for developing a firm relationship with public health entities.” Training Exercise LT Perkins started working with the CST-Public Health relationship when he was on the public health side of the house. He worked as the emergency response operations officer for the Louisiana Office of Public Health for about two years before coming to the CST. He expressed that he is “really entrenched in his belief that the two should be constantly working hand in hand.” He currently maintains a very close friendship with most of the nine regional public health emergency response coordinators in Louisiana. There are several key missions that public health does that directly relate to the functions there on the CST and developing a relationship with local public health officials typically isn't that hard because of several factors. The first is that as a CST, we typically have a lot of "operational" "boots on the ground knowledge" type experience that most of public health doesn't. Secondly, CST's have a lot of time to research and become subject matter experts on things that public health normally doesn't like to talk about....like bio-warfare issues. Thirdly, being military people, we are used to having to move lots of people and things around.....and that experience can be a factor when discussing tasks such as mass vaccinations or distribution of medical supplies such as with the Strategic National Stockpile. And lastly, public health officials are great at handling the clinical stuff, but as we saw during Katrina, logistics can be an issue....a partnership between the military and public health kicks in gear naturally to get everyone through it....and we have found that they are very appreciative and humble. Katrina – LT Perkins shared with me that one of the first things that came to his mind when thinking about local public health was the coordination between the CST's and New Orleans Public Health after Katrina. Imagine a city that had been virtually destroyed and thousands of rescue and relief workers poured into the city. One of the critical pieces to supporting all those who came to help was ensuring the proper medical care, including preventative medicine, was available. Our CST PA's worked hand in hand with local public health workers to ensure that rescue and relief workers got vaccinated against the myriad of viral and bacterial threats that could have posed a risk to all those who came to help. Remember, New Orleans was flooded with lots of water and in that water was everything from chemicals to rotting food to raw sewage and even expired persons and animals. The threat was real and the CST's interaction with local health officials to assess, advise and assist definitely proved to be a success. Another example of interaction between our CST and public health is the work we have done to assist them in planning for pandemic influenza. The CDC is currently funding major efforts at the local level for planning and training for pan flu. As a CST Medical Operations Officer, the PA and him have spent a considerable amount of time attending workshops, tabletops, and other meetings to ensure that we know what the federal, state and local plans are for dealing with this issue. To further assist his own state in these preparations, he went to the USAF Academy on TDY for a week to meet with other DOD, NGB and state level reps in order to gain some clarity on what everyone else was planning to do. After that conference, he gained a lot of insight into the federal plan for pan flu and was able to relay that information down to public health officials at the state and local levels. Specifically, he mentioned how surprised he was at how many of local public health officials expected a Katrina type relief effort from the DOD and FEMA for pan flu. However, when he related to them that everyone in the country would be affected and that any DOD or NGB support would be sketchy at best, they realized that much more planning and coordination would be necessary at the local level to meet this challenge head on. From time to time, he is still called upon to advise local jurisdictions on the realities of a worldwide pandemic. The third example he mentions about pubic health and CST coordination is concerning the process of planning for and preparing to handle a deployment of the Strategic National Stockpile within Louisiana. He recalls that when he worked for Public Health, he often called upon the CST medical section for both clinical and logistical advice when developing LA's plan for getting it done. The key was that a foundation of working together had been developed and he continues to forge those relationships.

Summary Civil Support Team (CST) Partnerships Successes Plan Coordinate Communicate Training Exercise

Questions? Do you have any questions? Capt Holly Shenefelt Training Exercise Desire to train together now… Building a good working relationship within the first responder community in preparation for when we will respond with you in a real world incident… Enable responders to operate more effectively and efficiently!! Capt Holly Shenefelt (307)772-5386 holly.shenefelt@us.army.mil

Special Thanks for Contributions CPT Connelley Mr. Moreland 1LT Nordick CPT Perkins CPT Strawbridge CPT Taylor WY State Health Dept Public Health and Bioterrorism Program 84th Civil Support Team Training Exercise