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Department of Public Health & Human Services
Anthrax Threat Guide for Montana
(xesisea 10/10/01)
ATTENTION-In the event of any TERRORISM THREAT: CALL OR HAVE
SOMEONE CALL the people below and tell them the manner of the threat and the specifics
about what is going on; and give them your exact location so they can find you; GO TO
"Immediate Actions" on Page 2 of this guide!
1. 911 or Sheriff's Dispatch and explain you have this threat. This usually dispatches
Fire, Law, EMS, and maybe hazmat team and public health;
2. FBI at 406-443-3617 (West Montana) or 406-248-8487 (East Montana), or the
Salt Lake City Office after normal office hours 1-801-579-1400;
3. State DES Duty Officer at 406-841-3911 and explain you have this threat, the
Duty Officer has a SOP and will make a series of additional calls and has additional
information the responders may want to access.
This advisory is intended to provide potential recipients of letters or packages containing an anthrax threat with useful
information and guidance to help them deal more effectively with such incidents, should they occur. [If you have any
questions about this guide or need further assistance with anthrax threat planning, please call: Todd Damrow, DPHHS
State Epidemiologist at 406444-3986, Lorrie Leighton-Boster, DPHHS Public Health Disaster Coordinator at 406-
444-1305 or Sheri Medow Smith, MTDES Terrorism Liaison at 406-841-3969.1
Background
Throughout the U.S. there have been numerous threats of exposure toAnthrax through letters and phone calls. During
threatening phone calls, the person answering the call has usually been told that anthrax was somewhere in the building
or the ventilation system. Typically, threats by letter have advised the reader that anthrax was present in the envelope.
Some of these envelopes contained nothing other than a threatening note, while others were found to contain a variety of
non-toxic substances (i.e., detergents, baby powder).
Anthrax is a disease caused by a bacteria (Bacillus anthracis) that can be spread in its dormant, or spore, form and is
harmful only if a sufficient dose is inhaled, ingested, or introduced into an open cut or wound. If inhaled, the disease
may characteristically begin with mild flu-like symptoms (i.e., muscle aches, fever, fatigue, slight cough) usually 1-6
days after exposure, which may then progress after 2-4 days to more severe symptoms (i.e., high fever, shortness of
breath). Anthrax is treatable with available antibiotics!
Anthrax is NOT contagious (Le., not spread from person-to-person); therefore, potentially exposed individuals
need not necessarily be isolated or quarantined after being properly decontamkiated.
Anthrax Threat Guide for Montana
Pre-incident Phumina: While it is difficult for most facilities to fully prepare for such incidents, there are a few things
that can be done before an incident, especially for those at higher risk facilities (i.e., health clinics, government
facilities), to promote an effective and orderly response.
X Discuss this issue ahead of time and create a response plan that everyone understands and can follow.
X If you want, discuss your plan with local authorities and have their phone numbers readily available.
X Be suspicious of letters that do not have a return address and consider opening all mail in pre-selected areas
(i.e., away from main work areas) of the facility.
X Pre-identify nearby showers that can be used for decontamination in the event of an incident. Have soap and
shampoo readily available.
X Consider keeping a change of clothes (in a triple plastic bag (i.e., trash bag)) at work or in your car. The triple
plastic bag can then be used for your old clothes.
X Facility managers should have extra plastic bags and gowns/garments readily available for staff.
X The facility manager and others designees should be familiar with the ventilation system controls in the event
the system needs to be turned off.
Immediate actions: If you receive a letter or package containing an Anthrax Threat.
X Close the envelope/package and gently put it down. Do not blow into the envelope or examine the contents
further (leave it alone for the appropriate authorities to handle).
X Walk promptly out of the room and advise others in the immediate area (sharing enclosed airspaces) to leave at
once. Close the door. No one should be permitted to re-enter. (Note: those not in the immediate area of the
opened package have very little risk of exposure.)
X The person(s) who directly handled the contents of the package should immediately wash their hands and arms
thoroughly with soap and water.
Evacuation (orderly movement of individuals to a safe distance from a hazard):
X Of immediate concern is having people remove themselves from risk of exposure, however, nobody should
leave the grounds! The extent of a building evacuation will depend on the circumstances of the situation and
the comfort level of the individual(s) in charge. When in doubt, moving individuals outside or to an adjacent
building is an acceptable option
X While waiting for authorities, make a list of the names, addressee, and phone numbers of all persons in
the immediate area of the incident to provide to the official in charge.
X If possible, have the facility manager turn off the ventilation to the involved area(s).
X Upon arrival, the authorities will provide assistance with appropriate evacuation procedures, collect pertinent
information surrounding the incident and exposed individuals, and facilitate decontamination activities (if
necessary).
X The authorities will remove the package from the facility and decontaminate the affected area Instructions will
be provided as to when the affected area may be re-occupied to resume normal activities.
Decontamination (removal of Potentially harmful substances from the skin and clothes):
X Decontamination may be necessary for those person(s) who directly handled or who may have come into
contact with the package contents.
X If necessary, potentially exposed individuals should proceed calmly (this is not an emergency procedure) to the
nearest showering facility or home, when instructed to do so by authorities.
X Remove clothing and personal effects and place in a sealed, air-tight triple plastic bag (i.e., trash bags). Plastic
bags with personal effects should be clearly labeled with the owner's name, address, phone number, and an
inventory of the bag's contents.
X Individuals should shower with soap and water, focusing on exposed skin surfaces such as hair, face, neck,
and arms. Bleach solutions are NOT necessary and should not be used to decontaminate individuals.
X For those individuals undergoing decontamination, your personal effects may be held by the authorities or
returned to you_ In the event that your personal effects are not taken, your clothing should be routine
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Anthrax Areat Guidefor Montana
X The Next Steps: (medical treatment and follow-up)
X The authorities will have the contents of the package tested in a laboratory within 48 hours to ensure that you
have not been exposed to any harmful substances. In the unlikely event that you have been potentially exposed
to a harmful substance you will be contacted immediately and given further instructions for appropriate medical
follow-up.
X Under most circurnstances, those people potentially exposed to the contents of a threat letter do NOT need any
further medical evaluation by a physician or treatment (i.e., medications). However, if you develop symptoms
or even a mild fever (greater than 100.0 F) before laboratory results are available, you should immediately call
MT-DPHHS (Todd Damrow, 406-444-3986) and your personal physician and inform them about your
potential exposure. Individuals that are uncomfortable waiting for lab results and wish to consult with their
local physician should also have them contact the state health department (above) for appropriate medical
information.
A threat involving Weapons of Mass Destruction is a Federal Offense.
Advisory Information
Additional federal technical assistance is available thro
National Response Center: Hotline (800) 424-8802
CDC Enigum Respmc Coordination Grogp: (770) 488-7100
US Public HealthService. Reaon 8 Office: (303) 844-6163; contact:
Stan Krol, Regional Emergency Coordinator @ (303) 844-7855, Pager - 1(800) 759-8888, Pin# 1359968,
Dr.Aubrey Miller, USPHS Medical Coordinator for Environmental Emergencies @ (303) 844-7857,
pager -1 (800) 759-8888, Pin # 1704786 or
Dr. Hugh Sloan @ (303) 844-7860
US EPA. Region 8 Hotline: (800)-227-8914 (Chris Weis or Jim Knoy)
This advisory has been prepared as a public health service to assist state and local health departments in providing
urgently needed guidance to groups within their jurisdictions that are at risk for anthrax threats. This advisory is the
product of an ongoing collaborative effort by researchers from the US Public Health Service, US Environmental
Protection Agency, and various state health and emergency response departments.
We believe the above information and recommendations to be accurate and prudent based upon a review of recent
anthrax advisories and information sheets, CDC recommendations, and journal articles (see references below).
Recommendations, such as these, are currently being developed around the country and will most likely undergo a series
of changes as more information becomes available.
We appreciate any additional comments or contributions. For comments or questions please contact Aubrey Miller, MD
at (303) 844-7857; Fax (303) 844-2019; E-Mail AMiller@jirsa.gov.
Anthrax Threat Guide for Montana
Contributors include.
Aubrey Miller, MD, USPHS (Region 8)
Steve Scott, NO, USPHS (Region 10)
Stan Krol, USPHS (Region 8)
Chris Weis, PhD, USEPA (Region 8)
Todd Damrow, PhD, Montana Department of Public Health and Human Services
Fred Cowie, PhD, Montana Disaster and Emergency Services Division
References include-
1. FBI National Domestic Preparedness Office; Anthrax Advisory (December 4, 1999)
2. State of Montana Public Health Advisory for Anthrax Tbreats (January 4, 1999)
3. Bioterrorism Alleging Use of Anthrax and Interim Guidelines for Management-United States, 1998. MMWR
Morb Mord Wkly Rep 1999;48 (No. 4).
4. Anthrax General Information on the mtemet (November 29, 2000); CDC, National Centers for Infectious
Diseases; http://www.odc.gov/ncidod/dbmd/dise&wWo/anthrax_g.htm
5. Pile JC, Malone JD, Eitzen EN, Friedlander AM Anthrax as a potential biologic warfare agent. Arch Intern
Med 1998;158:429-34.
6. LaForce MF. Anthrax. Clin Infect Dis 1994;19:1009-14.
7. Watson A, Keir D. Information on which to base assessments of risk from exposure to environments
contaminated with anthrax spores. Epidemiol Infect 1994;113:479-490.
Feel free to use all or any part of this document for planning purposes. If you would
like this document (antrhaxl in MSWord) electronically to insert into your planning
document, e-mail Sheri Smith at sheris@state.mt.us.
Antlirax Threat Gaidefor Montana 4