For five seasons of Fox’s hit television show “24,” lead character Jack Bauer and his colleagues at the Counter Terrorism Unit have struggled to protect the United States from threats ranging from bio-terrorism to nuclear attack.  This makes for great entertainment, but it also reflects the real threats that the American people and their Free World allies now face every day.   The plotline for this season’s “24” has focused largely on a terrorist threat involving a chemical nerve agent.  Although not considered as high-impact as a nuclear device or biological agent, a chemical nerve agent is a much more probable weapon of choice for the practical terrorist.   Unlike nuclear or biological weapons, chemical nerve agents are relatively easy and inexpensive to produce and deploy. These poisons – which include organophosphorous insecticides such as malathion, parathion, and diazinon –are readily available in many communities throughout the country, and travel via road and rail through American cities every day. Chemical nerve agents already have been used successfully in terrorist attacks.  In 1995, members of the Not as high-impact as a nuclear device or biological agent, a chemical nerve agent is a more probable weapon of choice for the practical terrorist.  Japanese cult Aum Shinrikyo released the nerve agent sarin into a Tokyo subway, killing 12 people and poisoning 5,500 others.  The year before, members of the same cult released sarin into a residential apartment building in Matsumoto, Japan, killing seven and poisoning more than 200.   Two Shortages: Time, and Antidotes “Planning Scenarios,” a report issued by the Homeland Security Council in July 2004, outlined a terrorist attack scenario in which a chemical nerve agent released in three large office buildings could kill 95 percent of the occupants – i.e., nearly 6,000 people.  The report estimated that first responders would arrive on the scene in 10-15 minutes. But that seemingly fast response would likely to be too little and too late, given the rapidity of onset of nerve-agent poisoning symptoms and the extremely difficult if not impossible logistical challenge of providing immediate medical assistance to large numbers of victims. In the event of a chemical nerve agent attack on a public transit system, indoor stadium, amusement park, or office building, those who have been poisoned may have only minutes to receive the antidote. Emergency responders in the United States have access to auto-injectors that contain the antidotes for chemical nerve agent poisoning.  The problem is that, in many cities, the emergency responders may have only enough antidotes to treat themselves, and would not be able to treat victims in time. Hurricane Katrina underscored the fact that local emergency responders must be prepared to manage a disaster for a period of 24 to 72 hours before federal assistance arrives.  Unfortunately, most state and local emergency-management agencies do not have a standardized protocol to guide their response to a chemical nerve agent attack.  Most are depending on having access to federal government stockpiles of antidotes, which are stored in strategic holding sites throughout the country. But those caches would not be immediately available, if only because it would be logistically impossible to transfer the antidotes from the holding sites to the attack sites in the short amount of time required for the antidote to take effect.  Moreover, most of the antidote stockpiles do not have adequate supplies of infant and pediatric dosages. NYC Sets the Example Even before the 9/11 terrorist attacks, New York City implemented a layered inventory and response system designed to meet the nerve-agent challenge. Every ambulance in the city now carries an inventory of chemical nerve agent antidote kits as standard equipment. The victims who are most severely affected by a nerve agent would receive their initial antidote treatment from the first ambulances to arrive on the scene. Logistical Support Units – specialized teams that ensure responders have the supplies they need – represent the next layer of logistical support, with pre-positioned caches of antidotes serving as the third layer. These local layers of reinforcement would be used before federal assets, such as the chem-packs supplied by the Centers for Disease Control and Prevention, would be required. For planning purposes it is obviously of vital importance, in the event of an emergency, that local first responders have immediate access to the antidotes. State and local emergency-response agencies now have the opportunity to purchase chemical nerve agent antidote kits through federal Office of Domestic Preparedness grants, at no cost to the state or local community. This change gives emergency-planning and response-agency leaders the opportunity to partner, in advance, with other state and local government officials to assess the risk of a chemical nerve-agent emergency occurring in their home communities, and to develop standard response protocols similar to those now in place in New York City. During an emergency is not the time to realize that local responders do not have a plan in place. And Hollywood heroes such as “24”s Jack Bauer will not be there to save the day. ____________________________________ For more information on first-responder grants, visit the Department of Homeland Security Web site at https://www.dhs.gov/science-and-technology/frg-grants. Jerome Hauer is former director of the New York City Office of Emergency Management and former assistant secretary, Department of Health and Human Services, Office of Public Health Emergency Preparedness

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Jerome Hauer

Jerome Hauer is former director of the New York City Office of Emergency Management and former assistant secretary, Department of Health and Human Services, Office of Public Health Emergency Preparedness.

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