Dr. Steven Hatfill has been reported to be a prime candidate for mailing anthrax:
Emerging Threats of Biological Terrorism: Recent Developments
Co-Sponsored by The Terrorism Studies Program at The George Washington University
The Potomac Institute for Policy Studies
June 16, 1998
[Excerpts, pp. 38-49]
PROF. BRENNER: We'll now hear from Dr. Steven J. Hatfill. He's been connected with the National Institutes for Health for some time, working on child health development and the laboratory for cellular and molecular biophysics. He's a medical doctor with certification in hematology and pathology. He has a Ph.D. degree in molecular cell biology. He has a diploma in aviation medicine. He has a diploma in diving and submarine medicine. He has served with the U.S. Army Special Forces. He was on a 14-month duty as medical officer and science team leader at the Antarctic research station. He also conducted research while there for the NASA Johnson Space Center Solar System Exploration Division. He's been involved in research involving serious problems such as Lyme disease, Ebola and the Marburg virus. Dr. Hatfill.
[Slides cited were not in the original.]
DR. HATFILL: We've heard the threat today from Dr. Alibek, Dr. Patrick, and Dr. Huggins for biological threats of biological terrorism. We've heard conventional countermeasures. We've heard of a number of programs of advanced countermeasures. It now becomes necessary to discuss worst-case scenarios and that concerns ways of management, or possible ways of management, of large areas covered by biological agent.
I've been working with Brigadier General [sic] Third Army Medical Command in the United States Army Reserve to try to develop a system for flexible and rapid transportation of mass casualties from a contaminated area to a rear area while maintaining life support and critical care functions for the casualties.
When we're dealing with a large area of coverage event, this can be exceedingly complex. A single area of a city may be affected or multiple areas of the city at the same time or closely thereafter, and terrorists may be involved with both chemical weapon release as well as with the biological agent.
One of the most dramatic open source experiments that have been described for a large area of coverage occurred on September 21, 1950, where a naval vessel did an open air simulation test releasing spores of the same size and weight as anthrax, but nonpathogenic to humans, over the city of San Francisco. This was conducted off a naval vessel two miles offshore and the results are illustrated in this diagram. Had this occurred with actual anthrax, there's a possibility that several hundred thousand people could have contracted a fatal pulmonary infection.
These types of dispersal scenarios in the most part are covert. There's no indication that a biological agent release has occurred until the incubation period for the particular disease has expired. This is a typical case history. An emergency department, normal operations and patients begin to appear. The terrorist event has occurred the week before. The incubation period for the agent is now open and these previously healthy individuals start coming in requiring rapid intensive care including mechanical life support, mechanical ventilation.
The situation of a large area of release in many ways would resemble a modern battlefield, disrupted lines of communication, poor coordination. Any changes that were apparent in peacetime would tend to be amplified during their affect during the natural biological agent pattern.
Consequently it is illustrative to look at how massive casualties have been handled on the battlefield before. In the 1850s, we saw the first large-scale systematic development of ways of transporting casualties from a high concentration on the battlefield to a low concentration in rural areas. This was during the Crimean War. The British Army instituted an eight-mile railway line during this conflict. This was also the time when the Florence Nightingale nurses came into effect in the first early field ambulances.
This concept became so effective that by the early 1900s during the Boer War in South Africa, the British army had prepositioned a number of specialized hospital trains all along the areas of fighting. Each of these passenger cars has been converted to handle up to 25 stretcher cases, and these were prepositioned along different areas of the conflict. Patients were brought to these trains and taken to various treatment centers.
The concept was further developed and by the onset of World War I, was in a highly effective manner. Patients could be taken directly from the trenches in the battlefields moved by an organized ambulance system, and deposited in what had now become hospital trains.
Some of these cars contain surgery units or supporting care to stop bleeding, regain respiration, and resuscitate the patient. There were also provisions for walking cases and for other casualties. The system was so effective that during the four days of the battle of the Somme, there were 13,392 cases that were transported from the front-line battlefields to rural hospital areas in France.
Special frames were developed to cushion the patients as they rode on the trains. This is one of the first hospital trains in operation.
By World War II, a number of trains were in operation both on the battlefront and for cities, because of advances in air power, cities now became a target, specifically London. Hospital trains were used to evacuate thousands of casualties from London hospitals to outlying areas, in addition to receiving casualties from across the channel and redistributing it within the country.
This is an interior of one of these trains. It's a three-tiered system to provide adequate access to the patients for their transportation.
This was even continued up until the 1950s with the British Army of the Rhine. This was the advent of federal medical transportation medication; the hospital trains went into disuse. At this time there's only one in use in England which is used by a reserve army medical unit.
With a biological attack, these patients are going to require even more intensive care than trauma management. This is a slide of inhalational anthrax. We only have a few hours once predominantly respiratory symptoms develop. The patient needs to be intubated; they need to be mechanically ventilated. Their blood pressure needs to be supported with medications.
Some cutaneous cases may appear. This is cutaneous anthrax, the vegetative bacteria multiplying in the blood stream and the tissues release a number of toxins, with a massive edema, malignant edema.
Over 50 percent of those exposed to the agent plume end up with inhalation anthrax. Over 50 percent of the inhalation anthrax develop cases associated with hemorrhagic meningitis. This is the membrane covering the brain. A great deal of these patients will be brought in as casualties probably all having epileptic fits. Surrounding area and surface contamination is possible as well as intestinal cases may appear. This is hemorrhagic infection of the lymph nodes and intestines and a small destruction section of the bowel through disruption of his blood supply.
Until recently, the medical trains would not have been sufficient for the mass evacuation of casualties from a high concentration attack area to rear definitive area treatments. Recently, Northrop Grumman has come out with a specialized stretcher. This is called LSTT stretcher. It stands for Life Support and Trauma Transport. Essentially, this is a self-contained unit with a giant ventilator I.V. fluid infusion pump and with full monitoring capability. Patients put on the stretcher can be intubated, stabilized, and transferred.
The second concept that's become important is that of intermodal transportation. This is the use of containers of goods or contents by a variety of different methods.
This can be by land, air, and sea in standardized containers. There's a whole subsection of the container transport industry, and they will make containers how you want. If you want a bathroom in it, they'll put a bathroom in it. If you want it a certain size, they'll construct it a certain size, economically and standardized. There are some methods for unaccompanied freight, and at the bottom slide you can actually have these on lorries, semi-trailer trucks, that are driven on and then off again.
By combining the systems, it becomes possible to design a disaster car, a disaster evacuation train. The train would look something like this. Head cars are the ones that stay with the containers. They transport the rest of the train. This is a locomotive, a container for medical personnel. Bulk stores, which could feature antibiotic stores or injectors with deployable vaccination stations. And a staff and manned control communications and intelligence sections.
The staff car could act as the nucleus of a command center to coordinate effectively with first responders.
For a proper coordinated response, it's envisioned that the first responders, the fire, police, and ambulances need to be connected with military resources, with government and state resources, and with satellite.
Currently, a piece of technology called the alert system has been developed by the Texas Department of Transportation. Essentially, this is a laptop computer built into the trunk of a patrol car. It's digital and operating on the mobile system. Already digital images have been transmitted from a patrol car in Florida to a patrol car in Alexandria. This allows some interoperatability between all first response vehicles.
By linking into the Internet, a commonality can be provided. A previous mass casualty or possible mass casualty incident such as the World Trade Center or Oklahoma City bombing shows that the cellular system tends to go down right after an accident. Everybody's trying to log on and use it, and the system collapses. The train would carry a useful piece of technology with it. Manufactured by Celltel, this is a mobile system. Unless you have a chip for your cell phone, you cannot talk.
This entire system provides a satellite link to other federal responders in transit to the site as well as coordinating local first responders. This will cover about a 60-mile radius.
Maps of each area can be used so all response forces are clearly in contact with each other. You can play road status, you can put meteorological and weather information on these maps and GPS coordinates are part of the alert system.
Defense Special Weapons Agency have an enormous amount of experience modeling downwind areas. They have computer programs that can model fairly quickly possible downwind affected areas.
The second section of the train would be the intensive care patient cars. The intensive care ward coaches would be specially built containers with a shock absorbing system able to handle the LSTT stretchers. It can be mounted on lorries or it can be driven on and off with a semi-attached tractor-trailer. Patients would be brought from out of the WMD site on the LSTT stretchers. They would then be loaded into these special containers. A center monitoring station, this has already been designed, and one doctor and five or six orderlies could effectively monitor 40 or 50 patients. These things can be driven off or taken straight to the facility.
The last portion of the disaster train would consist of cutout cars. These would be left on-site. It features a security element, another command control, communications information element, ambulance trucks with the LSTT stretchers already loaded that can drive into the site and bring the patients back to the side of the train and a deployable field hospital.
The inside of these hospital cars can be made to different sizes. Along with this comes a mortuary embalming station. This was originally developed by Arms Corps in South Africa with the concept that patients are embalmed onsite. This negates mass burials or graves. The remains are preserved. It can handle 800 bodies an hour. The bodies are embalmed, put into body bags, and stored at room temperature for later burial when the incident is over.
The system would work like this: If these trains are placed -- and we'll estimate you'll need somewhere around 27 trains to cover the United States -- but if all other traffic is cleared off of the rails, you'll be no more than four to six hours rail travel to a major metropolitan area.
Notification. We are estimating this will be the Reserves or the National Guard handling these trains. The train would travel to the disaster site to a predetermined spot. It will be loaded. Ambulances and a helipad will be set up back on the train, and an on-site army field site hospital would be deployed. The patients would be brought out on the LSTT stretchers and then loaded onto the train. From there, the train would leave full.
This is an artist's conception of such an incident. This deploying field hospital is covered with a charcoal and peroxide blanket. Patients are brought out of the area by air or by ambulances on the train on the LSTT stretchers. These can be at a positive pressure or negative pressure. We show the assistants here in Level A gear because a chemical attack could have occurred at the same time, and the patient is loaded onto the containers and we distribute it out of the incident site.
The disaster train concept could provide a number of things. The ability to rapidly transport large quantities of antibiotics, vaccines, personnel and protective equipment to a WMD site within a matter of hours, the ability to rapidly transform sitting stretcher and critical care patients on life support from congested nonfunctional hospital areas to health care facilities outside of the target area.
And this response capability would be independent of normal road transportation. Some scenarios suggest that with a large area of coverage, one third of the population may attempt to flee the city. This could mean both sides of the beltway congested. Bringing these medical facilities in by train, that avoids this traffic jam. The country could be at war at the same time. There could be limited air assets. It provides, above all, a starting point to coordinate other federal response forces. Thank you very much.
Questions and Answers
PROF. BRENNER: We now commence the discussion period.
Q. My question is to the last gentleman. I'm Dave Ruppe with Defense Week. How much would this concept that you just described cost for the U.S. to place, and also a more general question for the three of you: Who exactly, what agency is in charge of developing or is currently advocating organizing civilian research and development and equipment purchasing efforts, all of that? I see the military has several agencies doing it for that side, but who's actually responsible on the civilian side?
DR. HATFILL: Answer to the first part of your question, we've had some talks with Northrop Grumman, and we estimate that each train would cost approximately half that of an F-14 jet fighter. For two squadrons of fighters, it would cover 27 cities. We'll have 27 trains which would cover a number of cities. It would be state-based. Each train would be responsible for four or five metropolitan areas.
[Q&A provided only for the disaster train and Dr. Hatfill's comments.]
PROF. BRENNER: Other questions. I'll ask one of Dr. Hatfill. Can you give us an explanation of what kind of chain of command we're looking at for these 27 trains? Who do the people report to and who controls them and what's the organization structure? Is it civilian, military or hybrid?
DR. HATFILL: It would be hybrid with some qualifications on that. The DOD seems intent in involving the National Guard in that with respect to the rapid assessment teams. A pre-placed train on a siding would be an ideal place for these RAID teams to operate from. You can move three people very rapidly anywhere and in the midst of a WMD crisis in one of our metropolitan areas, it would be useful if the top three people of the RAID team could advise, see what the first responders are doing, is there a need for follow-on forces, is there a need for greater federal intervention and this -- you're not going to do too much with 22 men in a WMD incident. If it's a small-scale event, local authorities should be able to handle it. If it's a large-area coverage, these RAID teams would be trained in NBC reconnaissance detection and could very rapidly call the disaster train in as a follow-on force.
PROF. BRENNER: Do we have additional questions or comments?
Q. Yes, David Mahoney with Defense News. I have a question. At certain levels it seems with different asymmetric threats, bioterrorism, obviously, being one of them, at what level is there a breakdown between sort of the traditional way the military has looked at threats as over there somewhere before it's projected to start being threats where we really have to start worrying about a mix between civil defense as an aspect of military defense against outside aggression? I'd like to open this up to any of the panelists who spoke today.
DR. HATFILL: We are living as a species at this time in population densities that have never ever been seen before. This brings in the concept of emerging diseases. We're seeing on the average every two to three years one new pathogen we never really recognized before or a variant strain of a known pathogen. And as we live in these terribly increased densities, which are projected to increase even further in the next century, the whole concept of the emerging infectious disease becomes a major public health problem. Anything that we spend on biological weapons defense can have direct transference to the concept of public health and infectious disease management.
PROF. BRENNER: Additional comments.
Q. Yes. Captain Lisa Forsythe, U.S. Army. My question is for any of the panelists. Have you analyzed our existing plan such as the Federal Response Plan and how the Emergency Support Functions and those Lead Federal Agencies such as the Department of Transportation has an ESF leadership role and how DOD fits into our current plans and how we support those plans, not necessarily DOD taking a lead such as the railroad system but actually supporting Department of Transportation in those leadership roles that have already been established?
DR. HATFILL: The National Security Council has formulated an interagency working group to address these problems. When is the handoff from FBI to FEMA? How will federal assets coordinate with state and local -- there is a working group at present working on this.