REMEMBERING THE TEN YEAR ANNIVERSARY OF THE ANTHRAX ATTACKS:
How a grass roots development of a bioterrorism response capability assisted south florida.

Ten years ago, September 11th changed the United States as we knew it. But there was also "the other terrorist attack" that paralyzed our nation and struck fear into millions of Americans just a few weeks later. Known as "Amerithrax" from its FBI case file, letters containing weaponized anthrax spores were mailed to several news media offices and two US Senators, killing five people and infecting 17 others.

Many will recall that one of the first anthrax letters was discovered in South Florida, at the American Media International (AMI) office building in Boca Raton. What is not widely known is that South Florida was one of the very few regions in the country that was adequately prepared to handle such a response. The following article recounts how the Miami-Dade "Bio-Terrorism Center" (the name of our division at the time and located within the Miami-Dade County Health Department) prepared for, and responded to, the attacks. At the time I was the Primary Coordinator for Bioterrorism Response in South Florida for Public Health.

Early Preparations

On Wednesday, April 14 1999, at about 1:30 p.m., while attending a coordinating meeting at our office in Miami-Dade County Emergency Management, our team at the Bio-Terrorism Center received a call from the Florida Poison Control Center, saying that Palm Beach County authorities were handling a "white powder" incident at an attorney's office. Apparently, a delivered envelope had some powder in it, the substance had gotten dispersed, and there were some "victims" who were starting to feel sick; Poison Control found out about it when the attorney's office called Poison Control for guidance. Poison Control was concerned that it was not being handled appropriately and wanted us to do something, as they knew that we were in the early stages of developing a response capability to these types of events and had already had some experience with managing them.

The meeting that we were having at the time was for the coordination of an up-coming chemical attack field exercise scheduled for April 29, 1999 at the Orange Bowl in Miami. In attendance at this meeting were the emergency management training coordinator, a representative from Miami-Dade Police Department, and a Special Agent assigned to WMD response from the FBI. Upon hearing the incident, the FBI agent immediately left for the scene. On his way out the door, he tasked me to find a place to have the powder analyzed.

I was new at Emergency Management (EM) and I understood that prior to my arrival at EM there had been a "white powder" incident at an Ocean Drive business that published a weekly magazine for the South Beach audience, which led to the public decontamination of many people and their transport to Mt. Sinai Hospital. After 28 hours at the incident, they still did not know what the powder was, although they could determine what it was not. So with that in mind, intent on doing better, I started looking through the phone book (the Internet back then was not what it is today) for some kind of laboratory that could be used to "analyze" the white powder and tell us what it was.

I quickly found seven (7) laboratories listed in the phone book. Some even had large ads, but after calling all seven I was back to square one. None of the labs would accept a substance that could be dangerous. None were set up to give us a quick identification; most said that it could take several weeks to identify a substance positively, and, most importantly, they wanted to be paid up-front and their fees were expensive. Within days I had ruled out the Police Lab, the Medical Examiner's Lab, the Water Department's Lab, the Agricultural Department's Lab, Jackson Memorial Hospital's Lab, and the Veteran's Administration Hospital Lab, which is where I was storing one of our local pharmaceutical stockpiles for WMD response. All of these labs were ruled out for similar reasons, plus there was the issue of jurisdiction as the "cross jurisdiction" & "multi-agency" concepts were still not in the common everyday dictionary. I did however find receptive ears at the Miami-Dade Hazardous Material Team, the Miami-Dade County Public Health Office of Emergency Preparedness and the Miami-Dade County Branch of the Florida Public Health Lab. The HazMat Team had run into these types of situations before and they were looking for an operational solution.

The Public Health Office of Emergency Management and the Public Health Lab were starting to be tasked with the early bio-initiatives, but really had no field muscle and most of their equipment was for medical type lab work and water testing for wells. Both, however, had some equipment and more importantly, they had experience and talent! The problem was that they had never worked together as a unit and were skeptical that an alliance of some sort could be formed. There were believed to be just "too many obstacles."

Although all of the HazMat Team members contributed to the effort, a Captain and a Lieutenant, both of whom had had many years of field experience and blessed with encyclopedic knowledge of chemicals and their reactions to other chemicals, primarily headed the team. On the Public Health Lab side of the equation we had Dwight Frazier, Director of the Miami Branch of the Public Health Laboratory, and his small group of talented but overworked scientists, who worked at the Miami Branch Lab. The most important thing was that none of these individuals was afraid to think outside the box.

Within days of this incident in Palm Beach, I started to write the protocols for managing the white powder incidents in our jurisdictions. I also coordinated the training for the players involved, such as getting the lab personnel certified in the appropriate personal protection equipment that they would need if and when they were called to analyze a substance and introducing the HazMat folks to the protocols in place at the lab. At the same time I started to order some of the appropriate equipment using money from the several grants that I was administering; there wasn't much available back then but there were some things that could be purchased that could enhance the capability that we had at the time in a cost-effective way.

Some of the items on my shopping list for the joint HazMat - Public Health Lab were:
1) HAPSITE (field-portable gas chromatograph/mass spectrometer) for analysis of volatile organic compounds.
2) The HAPSITE Headspace Sampler to provide analysis of volatile organic compounds (VOCs) in soil or water.
3) The R.A.P.I.D. (Idaho Technology's LightCycler) and the following reagents.
a) Bacillus anthracis (Anthrax)
b) Brucella species (Brucellosis)
c) F. tularensis (Tularemia)
d) Y. Pestis (Plague)
4) Olympus phase contrast microscope kit
a) 21" Monitor
b) Video Camera and adapters
5) Incubator - large refrigerator type
6) Bio Germ Free Hood System
7) SAS 1800 Air Sampler
8) HazCat Chemical Classifier Kit
9) Personal Protection Equipment

We were keeping the existence of this project on a need-to-know basis to avoid press coverage because we really did not want potential terrorists (domestic threats from "militia" and anti-abortion type groups were big back then) to know that we were developing this type of response capability. In fact, the address I used in describing the lab's location on most documents was smack in the middle of Biscayne Bay!

About the Author

Pablo Gonzalez is the Director of Crisis Management for Security Management International, LLC. and has been selected by both Oak Ridge National Laboratories and Pacific Northwest Laboratories as their incumbent Subject Matter Expert on "Pre-Hospital Emergency Medical Services," "Firefighting," and "Urban Search and Rescue" components of The Department of Homeland Security's National Regional Technology Initiative planning team.

From 1998-2003 Pablo Gonzalez was the MMST Coordinator for Miami-Dade County, Florida and eventually became the primary coordinator of Bioterrorism Response Development for the South Florida area Public Health Departments, which responded to the first anthrax attack in the history of the United States. He can be reached at pgonzalez@smiconsultancy.com

First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach, Florida, 2001. Emerging Infect Diseases [serial online] 2002 Oct 8.
Available from: URL: http://www.cdc.gov/ncidod/EID/vol8no10/02-0354.htm

Lessons from the Anthrax Attacks, Implications for U.S. Bioterrorism Preparedness. 2002 Center for Strategic and International Studies and the Defense Threat Reduction Agency: April 2002

---