National Academies Press: OpenBook

A Guide to Transportation's Role in Public Health Disasters (2006)

Chapter: Appendix D - TERET Tool Users Manual

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Suggested Citation:"Appendix D - TERET Tool Users Manual." National Academies of Sciences, Engineering, and Medicine. 2006. A Guide to Transportation's Role in Public Health Disasters. Washington, DC: The National Academies Press. doi: 10.17226/13944.
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Suggested Citation:"Appendix D - TERET Tool Users Manual." National Academies of Sciences, Engineering, and Medicine. 2006. A Guide to Transportation's Role in Public Health Disasters. Washington, DC: The National Academies Press. doi: 10.17226/13944.
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Suggested Citation:"Appendix D - TERET Tool Users Manual." National Academies of Sciences, Engineering, and Medicine. 2006. A Guide to Transportation's Role in Public Health Disasters. Washington, DC: The National Academies Press. doi: 10.17226/13944.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

D-1 APPENDIX D TERET Tool Users Manual

D-2 Preliminary Draft Final Report NCHRP Project 20-59(19), FY 2004 TRANSPORTATION RESPONSE OPTIONS: SCENARIOS OF INFECTIOUS DISEASES, BIOLOGICAL AGENTS, RADIOLOGICAL, CHEMICAL AND OTHER HAZARDOUS MATERIALS: A GUIDE TO TRANSPORTATION’S ROLE IN PUBLIC HEALTH DISASTERS Task 9: User Manual for the Transportation Emergency Response Effects Tracking (TERET) Tool Prepared for: National Cooperative Highway Research Program Transportation Research Board National Research Council TRANSPORTATION RESEARCH BOARD, NAS-NRC PRIVILEGED DOCUMENT This report, not released for publication, is furnished only for review to members of or participants in the work of the National Cooperative Highway Research Program (NCHRP). It is to be regarded as fully privileged, and dissemination of the information included herein must be approved by the NCHRP. Submitted by: Science Applications International Corporation 8301 Greensboro Drive McLean, Virginia, 22102 (703) 676-4559 September 2005

D-3 Table of Contents Preface .............................................................................................................................................................1 1.0 Introduction ............................................................................................................................................. 2 1.1 Overview of TERET..............................................................................................................................2 1.2 Customizing and Using TERET............................................................................................................ 3 1.3 User Proficiency with MS Excel ............................................................................................................4 2.0 Worksheet 2 -- Essential Services............................................................................................................5 2.1 Essential Services List (Column A) ....................................................................................................... 5 2.2 Pre-Event Information (Columns B through N) .....................................................................................6 2.3 Affected Zones (Columns O through AA).............................................................................................8 2.4 Essential Services Contacts (Column AB) and the Contacts Worksheet .............................................10 2.5 Command Chain Contacts (Column AC) .............................................................................................11 3.0 Worksheet 3: Mass Care ........................................................................................................................12 3.1 Mass Care Needs and Hours until Need (Columns A through C)........................................................13 3.2 Hours of Need for Mass Care (Columns D through J) .........................................................................13 3.3 Mass Care Contacts (Column K) and the Contacts Worksheet............................................................14 3.4 Command Chain Contact (Column K, Rows 5 to 8) ............................................................................15 4.0 Threat-Specific Scenarios.......................................................................................................................16 4.1 Scenario 1: Chemical Attack (Blister Agent) .......................................................................................16 4.2 Scenario 2: Biological Attack (Contagious Virus) ...............................................................................22 4.3 Scenario 3: Radiological Attack (Dirty Bomb) ...................................................................................25

D-4 Preface TERET is one of three products developed under the National Cooperative Highway Research Program (NCHRP 20-59 (19)) of the Transportation Research Board. The project’s overall objective is to develop a guide to assist state and local transportation managers in the development of transportation response options to extreme events involving chemical, biological, or radiological (CBR) agents. The project is applicable to all civilian sites (not just transportation sites) and focuses on the impact and role of transportation during such an event. TERET is intended to be used as a guide during emergency response planning stages, as well as during an emergency response exercise or actual event. The primary users are expected to be transportation planners and managers at emergency management centers. The other products of the project are: (1) A report titled: Transportation Response Options: Scenarios of Infectious Diseases, Biological Agents, Radiological, Chemical and Other Hazardous Materials: A Guide To Transportation’s Role in Public Health Disasters.This report contains technical information on chemical, biological, and radiological threats including vulnerabilities of the transportation system to these agents and consequence minimization actions that may be taken within the transportation system in response to these events.The report also includes a summary of the US transportation system and an overview of mode-specific emergency response plans. (2) A slide presentation titled: An Introduction to Biological, Chemical, and Radiological Threat Agents. This MS PowerPoint presentation includes presenter notes, and is designed as an executive communications tool based on summary information from the previously listed report. TERET User Manual 1

D-5 1.0 Introduction Transportation Emergency Response Effects Tracking (TERET) is designed to assist transportation and emergency managers in projecting potentially critical conditions that may develop as a result of changes in transportation services due to a large emergency event. During both response and recovery from an emergency event, traffic patterns are altered by emergency response actions that cause traffic detours and lane re-directions, restricted access, reduced or suspended service, equipment and personnel re-allocations, etc. These changes or disruptions in traffic patterns may have critical effects on deliveries and worker transport for essential services that must be continuously maintained despite emergency events. Altered traffic patterns may also influence, and be influenced by the use of the transportation system for mass care needs associated with an emergency event. 1.1 Overview of TERET TERET is a Microsoft Excel ™ workbook designed to help managers and planners assess the effects of emergency response actions on transportation at state and local levels. TERET has two separate components. These components and their objectives are: • Essential Services Transportation – This refers to the use of the transportation system for providing essential services for community health and sustenance. TERET’s objective is to assist in identification of criticalities that may arise in essential services as a result of traffic pattern changes and associated delays in deliveries and services, and to facilitate the identification of solutions to prevent or mitigate these criticalities. • Mass Care Transportation – This refers to transportation system use for the transport of people to decontamination, triage, and medical service/hospital sites, and the provision of supplies needed for populations in shelter-in-place; temporary shelter; and quarantine shelter. TERET’s objective is to provide a list of some of the types of transportation that may be needed for these actions, and to calculate the remaining time these transportation services will be needed based on command chain estimates of the overall duration of these needs. TERET has four basic worksheets: (Figure 1) • Worksheet 1 -- provides summary instructions for the use of TERET. • Worksheet 2 -- contains a template for assessment of criticalities that may arise in essential services as a result emergency response effects on traffic patterns. This worksheet may be copied for use in new scenarios. • Worksheet 3 -- contains a template for assessment of mass care transportation needs. This worksheet may be copied for use in new scenarios. • Worksheet 4 -- contains a template for user-developed lists of contacts that can provide data for Worksheets 1 and 2. TERET User Manual 2

D-6 Figure 1. Schematic Layout of the TERET Worksheets Worksheets found after Worksheet 4 contain copies of Worksheet 2, filled in with hypothetical data to represent scenarios described in Section 4 of this manual. These should be used only for instructional purposes. 1.2 Customizing and Using TERET Prior to use of TERET during an event or exercise, users must collect and enter area-specific data. Time required for collecting this information will vary substantially among users, but in general, expect initial data collection to take in the range of 6 to 16 hours spread over a week or more. (Subsequent updates should be much quicker.) New users should begin their data entry on the blank templates in Worksheets 2 and 3. The scenario worksheets contain copies of these templates with hypothetical data that should not be used as default or surrogate values. Side-bars, such as the example to the right, draw attention to sections that discuss data needed as pre-event information. Pre-event data that users must enter is briefly listed in Table 1, and explained in greater detail in the following sections. Table 1. Type of Pre-Event Information Collection Needed, by Worksheet Worksheet Data Needed Prior to TERET Use 2 – Essential Services Modes used; time to criticality; severity level; potential solutions; command chain contact for a pending criticality. 3 – Mass Care Command chain contact for estimation total hours of site activation; lead time between mass care site activation and supply need. 4 – Contacts Contact information for data needed in “Essential Services” and “Mass Care” worksheets. Sheet 4: Basic Services Contacts (User developed list) Sheet 1: Introduction Provides summary instructions SUMMARY OF TERET SHEETS -- LAYOUT Sheet 2: Basic Services Assess criticalities that may develop from ER changes in traffic patterns. Sheet 6: Mass Care Contacts (User developed list) Sheet 3: Mass Care Assess needs during shelter-in-place, temporary shelters, or quarantine shelter. Sheet 5: Command Chain Contacts (User developed list) ! Pre-Event Information These are alerts for information you must add before applying TERET. TERET User Manual 3

D-7 Adding and Deleting Rows and Columns Adding – For adding a row, left click on the row number at the far right side of the worksheet that is immediately below the place where you would like to add a row. For adding a column, left click on the column number at the top of the worksheet that is immediately to the right of the place where you would like to add a column. This should highlight the entire row or column. Keeping the cursor over this number, right click on the mouse and a drop box will appear. Select “insert” to add the new row or column. The new row or column will have the same formatting (colors and lines) that are in the proceeding column or row. Deleting – Left click on the row number at the far right side of the worksheet, or the column number at the top of the worksheet that is to be deleted. This should highlight the entire row or column. Keeping the cursor over this number, right click on the mouse and a drop box will appear. Select “delete” to remove the entire row or column. Comment Pop-up Boxes A small red triangle in the upper right corner of a cell indicates a comment box that contains notes. Some of these notes are lists that the user should edit and add to. Viewing – The comment box will appear by passing the mouse cursor over the red triangle. To retain view of the comment box after the mouse has moved to another cell, first view the comment box by passing the mouse over the red triangle, then single click the right mouse button, another pop-up box will appear, click on “show comment”. To remove the retained view of a comment box, left-click on the worksheet cell the box is coming from, then right-click, another pop-up box will appear, click on "Hide comment". Editing – To edit the contents of a comment pop-up box, move the mouse over the cell, left click on the mouse to select the cell, then right click and select “edit comment” on the pop-up menu. Move the cursor around in the box and make desired edits. When done, move the mouse cursor off the comment box and left click on the mouse. Creating – To create a comment box in a cell that does not already have one, move the mouse over the cell, left click on the mouse to select the cell, then right click and select “insert comment” on the pop-up menu. A comment box will appear. The contents of another comment box can be cut and pasted into the new comment box. Fonts can be changed using the “format” tab (at the top of the page) while editing the box. A comment box can be copied by cutting and pasting the entire cell, or by copying the comment box contents in “edit comment box”, and then pasting this into a newly created comment box. (Note: this later method will not retain the original comment box fonts.) MS Excel Notes 1.3 User Proficiency with MS Excel Use of TERET requires a basic level of proficiency with MS Excel. In addition to basic data entry, file saving, and cutting and pasting, the user should be able to add new rows and columns, and should be familiar with the use and creation of comment boxes. For users not familiar with these Excel features, some explanatory notes are provided in the boxes below. TERET User Manual 4

D-8 2.0 Worksheet 2 -- Essential Services Worksheet 2 contains a template for assessment of criticalities that may arise in essential services as a result emergency response effects on traffic patterns. This worksheet may be copied for use in new scenarios. The top rows of Worksheet 2 provide space for users to fill in the objectives received from the Incident Command (IC) during an emergency event. Under each of these objectives, the user is to fill in the actions that have been taken to fulfill these objectives. This list of actions is to be considered throughout the use of this worksheet during an exercise or event to track the effects of changes in traffic patterns on essential services. Many of the column headers on this worksheet have comment boxes (indicated by small red triangles in the upper left corner of the cell) that contain notes describing what should be entered in the cells below. Comments boxes are also attached to some of the cells in the rows below the header rows–these comment boxes are for notes and lists to be edited and created by the user. Section 4.0 provides views of the Essential Services Worksheet completed for several hypothetical scenarios. 2.1 Essential Services List (Column A) This column lists categories of essential services that may be affected by changes in traffic patterns. This is an example list of services that are essential for community sustenance and health. It should be modified by the user to better reflect their community, and updated as needed. The example “Essential Service” categories of Column A are listed in Table 2. Table 2. Essential Service (Column A) Categories Column A: Essential Services Description Critical Supplies Water  Local water treatment facilities  Regional water treatment chemical suppliers Food  Local food suppliers (retail)  Regional food distributors or producers Medical  Local medical supplies at pharmacies, hospitals, medical centers, etc.  Regional distributors and manufacturers of medical supplies Vehicle/ Generator Fuel   Local retail gasoline and diesel supplies Regional distributors of gasoline and diesel fuel Electricity  Local power transfer stations  Regional power plants Heating Fuel  Heating fuel suppliers to local end-users  Heating fuel suppliers to distributors and/ or regional end-users. Essential Workers/ Service Medical personnel   Commuting of medical personnel Refuse   Transport of refuse TERET User Manual 5

D-9 2.2 Pre-Event Information (Columns B through N) Information in the pre-event columns (Figure 2) is collected from discussion with the essential service providers representing the services (and supplies) listed in Column A. As this information is collected and periodically updated, the Contacts worksheet (Worksheet 4) should be concurrently updated. Note: these columns are not the only ones that require pre-event information–the comment boxes under “Hours to Solve” (Columns S, W, and AA, addressed in Section 2.3) should also be completed as prior to an event or an exercise Figure 2. A View of the Pre-Event Information Columns in TERET Worksheet 2. TERET User Manual 6

D-10 • Modes (Columns B though G) -- For each row (i.e., essential service), indicate the transportation modes that provide final deliveries of supplies or personnel access with “1”. Indicate mode(s) that feed these modes within your region with a 2. If there is a feeder to the feeder mode in your region, indicate it with a 3. Add notes in these cell comment boxes as needed to help explain the transportation of these supplies or services, and indicate potential alternative routes. • Hours to Criticality (Columns H through M) -- A “criticality” is an exhaustion of supplies or shortage of service that may have serious consequences in terms of human health or sustenance. For each essential service, the time to “criticality” is estimated as the shortest “hours to criticality” based on typical minimum supplies, or maximum time that shift workers can be held overtime. These estimates only apply to the modes that are involved in each essential service. Thus, for each row, the modes that provide final deliveries and feeder modes as indicated in Columns B through G should have an “hours to criticality” estimates entered in Columns H though M. The same essential service may have different hours to criticality at local and regional levels as a result of different storage capabilities. For these cases, local and regional services should be listed on separate rows. To provide an easy check for use during an emergency, the user should edit the comment boxes of the cells in this column to list the possible criticalities and their direct impact for each row (e.g., loss of drinking water and diseases from poor water quality; or extreme worker fatigue and unacceptable level of medical errors). The box below provides an example of cell entry for modes and hours to criticality. Example: Pre-Event Criticality Information – Modes and Hours to Criticality A water treatment plant may receive chlorine gas shipment by truck (highway) every week, and if a delivery does not occur, chlorine supplies will be exhausted within 1 to 2 days of the missed delivery. Thus, the minimum time to criticality is entered as 24 hours, and there may be no alternative delivery modes, only alternative routes. Some alternative routes may be included in the comment box for this cell. The chlorine comes from a regional supplier that received their shipments by rail. Based on normal delivery rates, the regional supplier will exhaust their supply of chlorine within 72 hours if rail shipment is lost. For the regional supplier, the highway mode could provide alternative deliveries, and this should be stated in the comment box for this cell. During an exercise or actual event, the plant operator could be contacted to update this estimate, which may be longer if they have just received a shipment, or may be shorter if they have had atypical storage, delivery, or demand issues. TERET User Manual 7 ! Pre-Event Information Time to Criticality -- these vary both among communities and over time. ! Pre-Event Information Modes -- these vary both among communities and over time.

D-11 • Severity Level (Column N) -- This column is to rank the seriousness of a criticality caused by a transportation-related action in a “worst case scenario”. Ranking may be based on projected deaths, injury, economic damages, etc. Some examples possible severity level ranks are shown in Table 3. Table 3. Examples of Severity Level Rankings Example 1 Example 2 3 = more than 1,000 hospital patients 2 = 101 to 1,000 hospital patients 1 = 0 to 100 hospital patients 4 = deaths exceed 1,000 3 = deaths from 100 to 1,000 2 = deaths from 10 to 100 1 = deaths from 1 to 10 Users should establish their own ranking system based on their priorities to better focus their attention during an emergency event or exercise. 2.3 Affected Zones (Columns O through AA) Transport delays due to emergency response activities vary with distance from the incident area. TERET allows the user to assess the effects of these changes in traffic patterns in three general zones (Figure 3): 1. Restricted Zone (Columns O through S) – areas with restricted access as designated by the incident command. Egress may or may not be restricted depending on whether the objective is to evacuate, shelter-in-place, or quarantine. Transportation on some modes and/or routes will likely be suspended. 2. Adjacent Zone (Columns T through W) – areas surrounding the restricted zone where travel time may be increased as a result of altered traffic patterns to provide detours around the restricted zone, resource reallocations to enable objectives such as evacuation, and to facilitate first-responder access to the restricted zone. Some transportation may be suspended in this zone (e.g., hazmat shipments). 3. Peripheral Zone (Columns X through AA) – areas surrounding the adjacent zone. While traffic patterns and travel time are generally less affected in this zone, criticalities may arise when critical resources for the peripheral zone are located in the restricted or adjacent zone, and when there has been substantial resource reallocation to the restricted and adjacent zones. The peripheral zone may be contained entirely within a state or region, or it may be expanded to include nationwide transportation. During events that cause nationwide increases in the Department of Homeland Security (DHS) threat advisory levels (i.e., to orange or red), transportation delays across the nation may substantially affect deliveries of critical supplies. TERET User Manual 8

D-12 Figure 3. A view of the Affected Zones Columns on TERET Worksheet 2. Event-specific information is entered in the “Affected Zones” columns during emergency response and recovery. This includes the following: • Columns O, T, and X: Service Present? – User entry for this column is either YES or NO, using capital letters. This cell entry is to answer the question: Is this essential service located in this zone? • Column P: Provide Access? -- User entry for this column is either YES, or NO, using capital letters. This cell entry is to answer the question: Is this essential service (listed in Column A) to have access to the restricted zone? In the restricted zone, some essential services may be suspended if the population has evacuated. During shelter-in- place scenarios, many services may need access and egress to prevent criticalities. In other scenarios, certain types of shipment (i.e., Hazmat) may be suspended. • Columns Q, U, and Y: Hours Delay? -- User entry for these columns is the estimated delay in deliveries of critical supplies and transport of critical personnel needed for the essential services provided by this row category (listed in Column A). Delay estimates are often given as a range. In these cases, the upper boundary of the range should be entered. Thus, if a 12 to 24 hour delay in deliveries is expected, delay hours should be entered as 24. • Columns R, V, and Z: Is it Critical? -- This column (shaded in yellow) automatically generates “YES” if the “hours delay” in this zone equals or exceeds the “hours to criticality” for any mode. “NO” is generated if “hours delay” is less than the “hours to criticality” for all modes, and dashes (i.e., ---- ) are generated when no hours delay have been entered. In the Restricted Zone (Column R), “no access” is generated if “NO” has been entered in Column P as answer to the question “Provide Access”. TERET User Manual 9

D-13 Note that this rough assessment of a criticality is based on the a priori estimation of the time an essential service can function without new deliveries assuming a delivery is due (and delayed) on the day the incident occurs. If no critical shipments were expected on the day of the incident, the time to criticality may be longer than the estimate. Thus, for essential services that do not receive critical shipments every day, the essential service provider should be contacted to adjust the hour to criticality as appropriate for the specific scenario. • Columns S, W, and AA: Hours to Solve – Comment boxes for these cells should be completed as pre-event information. Data entry for the cell box is entered during an exercise or event. Prior to an exercise or event, the user should edit the comment boxes for these cells to provide a list of possible solutions for provision of critical transportation services to the essential service indicated in Column A. The purpose of this list is to provide a quick checklist of possible options, thus it may include solutions that may only be viable under some scenarios. The list of possible solutions may be the same for each of the zones, and the comment box contents can be copied between these columns. During an exercise or event, the user should examine each row, and if the previous column is “YES” (it is critical), the user should edit the cell contents under “Hours to Solve” to indicate estimated hours to implement a solution to prevent or minimize a criticality. This time estimate should be determined from discussions with field personnel. 2.4 Essential Services Contacts (Column AB) and the Contacts Worksheet For each essential service listed in Column A, the general category of the contact person for pre-event information should be listed in Column AB. By clicking on the tab for the Contacts Worksheet (at the bottom of the worksheet), the list of all contacts is displayed. (Note: the user may prefer to use other contact management software.) The Contacts Worksheet column labeled “Contact Category” (Column A), allows organization of contact information based on categories rather than names of individuals or organizations. This allows users who are not readily familiar with all contacts to quickly find the information needed based on the information category. TERET User Manual 10 ! Pre-Event Information The Contact List developed by the user, will need frequent updating to be helpful. ! Pre-Event Information Hours to Solve Comment boxes – These lists of possible solutions for delays may change over time.

D-14 Name, Organization, Address, E-mail, Telephone, etc.) and additional information essential for maintaining good records of information sources. This includes a column labeled “Notes”, to be used for more detailed information on the contacts or recent communications. The column labeled “Date” should be used to track when information is received from the contact. Maintaining a dated record of these contacts is very important both for rapid recognition of more and less recent information during an event or exercise, and for post-event assessments of information handling. 2.5 Command Chain Contacts (Column AC) Command Chain Contacts (Column AC) should be notified as soon as it is recognized that a critical situation may arise in an essential service under the current conditions, considering the mitigation ability of the user. The greater the lead time provided on potential criticalities, the greater the chance of mitigating or preventing the critical situation. For some users, the command chain contact may be the same for all criticalities, e.g., the Emergency Operation Center (EOC) Logistics Chief. The user is encouraged to re-organize the remaining columns in the Contacts Worksheet to best meet their preferences. These column headers are for standard contact information (i.e., TERET User Manual 11 ! Pre-Event Information Command Chain Contacts should be identified before an event

D-15 3.0 Worksheet 3: Mass Care The top rows of Worksheet 3 provide space for users to fill in the mass care shelter objectives received from Incident Command (IC) during an emergency event. These possible objectives include decontamination and medical care, shelter-in-place, temporary shelter, and quarantine shelter. In terrorism events (known or suspected), the FBI may require screening of evacuees which may add to the time people are held at exit points such as decontamination sites. Note that evacuation does not require mass care needs in itself, but only as decontamination and medical care sites, and temporary shelters are established in response to evacuation. Thus, this worksheet addresses transport of people to mass care facilities, but does not address self- evacuation to places other than mass care facilities. Figure 4 shows Columns A through J of this worksheet. Figure 4. A View of TERET Worksheet 3. TERET User Manual 12

D-16 3.1 Mass Care Needs and Hours until Need (Columns A through C) As described below, pre-event information in required in Column B, and other entries are made during an exercise or event. Cell C5: Number of Hours since Mass Care Activation – During and exercise or event, the user should enter the number of hours that has elapsed since opening mass care sites, and update this number as response and recovery continue. Mass Care Needs Column A -- This column provides an example list of essential mass care transportation-dependent needs related to decontamination, triage, and pre-hospital treatment (Rows 10 to 28); shelter-in-place locations (Rows 30 to 46); temporary shelters (Rows 48 to 64); and quarantine shelters (Rows 66 to 82). These are divided into “Standard Needs” that are always required, and additional needs that may be required during “Reduced Power or Water Conditions” (e.g., Column A, Lines 22 to 27). Column B: Initial Hours until Need – In this column, enter the estimated number of hours from the designation of mass care sites until the supplies and services listed in Column A will be needed. These estimates should be developed based on pre-event discussions with local and regional mass care agencies. The “contact category” for this information should be listed in Column K of these rows to facilitate rapid location of the contact information (see Section 3.3, below). Column C: Current Hours until Need -- This column contains an automatic calculation of hours remaining until the listed supplies and services are needed, based on the user entry of “initial hours to need” (Column B) and “Number of hours since mass care activation” (Cell C5). 3.2 Hours of Need for Mass Care (Columns D through J) Each of these columns is for a different type of event. These events types include physical destruction (e.g., hurricane, explosion, etc.), radiological releases, chemical releases, or biological releases. Chemical events are divided into two categories: persistent and not persistent, while biological events are divided into three categories based on both persistence and contagiousness. These sub-categories for chemical and biological event are based on essential characteristics of the event that will affect the response and associated mass care needs. Comment boxes associated with the headers of these columns provide some notes on the types of threats that fall in these categories the types of medical care that may needed. The Attention! Cell C5 should be frequently updated during an event because it is used to calculate the number of remaining hours for mass care needs. TERET User Manual 13 ! Pre-Event Information Initial Hours until Need for a mass care site to receive supplies, etc.

D-17 report produced as another part of this project (described in the Preface) provides additional information on chemical, biological, and radiological threats and their relationship to the transportation system. "Total Hours" of site activation (Rows 9, 29, 47, and 65) -- The user should enter in these rows (Columns D through J) the period of time, or duration, during which mass care sites will be required. For general planning purposes, an emergency management office may be able to provide some estimates of typical expected shelter times during some types of events, but any entry of these numbers should be adjusted on an event-specific basis, and may be readjusted as more accurate information becomes available. During an exercise or event, these estimates should be obtained from the command chain, typically within the Emergency Operations Center (EOC). These estimates will likely to need modification as response to the event proceeds. Note that when there is only one type of threat, only one of the Columns D through J will need to have numbers. Remaining hours of transportation-dependent mass care needs (Rows 10 to 28, 30 to 46, 48 to 64, and 66 to 81) -- The un-shaded rows in Columns D to J (located below the shaded rows for “Total Hours” of site activation) automatically calculate the number of hours for which mass care transportation will be needed. This calculation is based on the difference between the estimated “Total hours” of site activation (Rows 9, 29, 47, and 65); “Initial hours until need” (Column B); and the “Number of hours since mass care activation” (Cell C5). 3.3 Mass Care Contacts (Column K) and the Contacts Worksheet For each “Mass Care Need” listed in Column A, the general category of the contact person for pre-event information should be listed in Column K. By clicking on the tab for the Contacts Worksheet (at the bottom of the worksheet), the list of all contacts is displayed. The Contacts Worksheet column labeled “Contact Category” (Column A), allows organization of contact information based on categories rather than names of individuals or organizations. This allows users who are not readily familiar with all contacts to quickly find the information needed based on the information category. The user is encouraged to re-organize the remaining columns in the Contacts Worksheet to best meet their preferences. These column headers are for standard contact information (i.e., TERET User Manual 14 ! Pre-Event Information Identify the contact person who will provide estimates of “Total Hours” of site activation ! Pre-Event Information Contact Lists -- developed by the user, need frequent updating to be helpful.

D-18 Name, Organization, Address, E-mail, and Telephone) and additional information essential for maintaining good records of information sources. This includes a column labeled “Notes”, to be used for more detailed information on the contacts or recent communications. The column labeled “Date” should be used to track when information is received from the contact. Maintaining a dated record of these contacts is very important both for rapid recognition of more and less recent information during an event or exercise, and for post-event assessments of information handling. 3.4 Command Chain Contact (Column K, Rows 5 to 8) A Command Chain Contact that can provide estimates of the total hours that mass care sites may be activated should be identified prior to an exercise or event. This contact will likely be someone at the Emergency Operations Center (EOC). ! Pre-Event Information Command Chain Contacts should be identified before an event TERET User Manual 15

D-19 TERET User Manual 16 4.0 Threat-Specific Scenarios From a functional perspective, TERET is an all-hazards tool that may be applied during any large emergency event, regardless of cause, size, or complexity. It is designed to work under the Incident Command System in support of the National Incident Management System. This section presents three threat scenarios for terrorist attacks: a chemical attack, biological attack, and radiological attack. These scenarios are similar to planning scenarios that have been developed by the DHS. As shown below, the scenarios exemplify the varied transportation effects that may be identified with TERET use. Each scenario is briefly described below and followed by views of completed example worksheets. 4.1 Scenario 1: Chemical Attack (Blister Agent) On a chilly autumn day with very little wind, a light aircraft sprays a mist of garlic-smelling “oi” over Freedonia University’s outdoor stadium during the season playoffs. The stadium is immediately contaminated with the substance, along with surrounding areas including parking lots, an arterial, and a mass transit station. The crowd panics and evacuates the stadium within 30 minutes. First-responders arrive in 10 minutes, after some stadium evacuees have already driven out of the parking lot. There are immediate reports of respiratory and eye irritations, and within minutes, there are reports of stinging skin pain. Hazmat team detection kits identify the chemical mixture of Lewisite and sulfur mustard. Shelter-in-place is ordered based on the plane’s observed flight path within roughly a 1/2 mile of the stadium, and evacuation from 1/2 to 1 mile, see Figure 5. Decontamination and triage sites are established for stadium evacuees and rapid transportation to hospitals for critical injuries. A moratorium is placed on regional Hazmat shipments. Figure 5. Scenario #1 -- Schematic Presentation of a Chemical Attack Area W M F W Hf P F F P P Shelter-in- place Evacuate Flight Path C M Stadium H HH H W Perimeter Arterial Freedonia Metro Area Map of Essential Service Locations W = water treatment C = water chemical supply H = hospital F = food distributor M = medical distributor Hf = heat fuel distributor KEY M

D-20 When the evacuation from 1/2 to 1 mile is near complete (approximately 3 hours), first-responders begin systematic, assisted evacuation of the shelter-in-place zone, which takes approximately 48 hours. Cool temperatures and low winds retard natural volatilization and degradation, causing projections of the hazardous levels on surfaces to last for 8 to 12 weeks without active decontamination. Decontamination of the stadium, arterial, mass transit station, and other contaminated areas can be achieved with application of bleach solutions, but chlorine runoff poses serious environmental concerns and active decontamination efforts are delayed while technical options are assessed and means for runoff collection are constructed. The TERET Essential Services worksheets shown in Figures 6 and 7, has been filled in for this hypothetical scenario. Figure 6 displays some of the notes the user made in comment boxes to better guide their actions. Rows 3 through 8 contain the objectives from Incident Command and a brief summary of the transportation actions taken to achieve these actions. Based on a map of the restricted zone, see Figure 5, essential services located in the restricted zone are indicated with a “YES” in Column O. For each service provider in this zone that provides an essential service to areas beyond the restricted zone, a new row was created to better track the effects of the delayed or suspended service from these providers. The adjacent zone is considered as the entire Freedonia Metropolitan Area. The duration of the moratorium on Hazmat shipments is estimated as 10 days, thus 240 (hours) has been entered for water treatment chemical delays (Row 16) in the adjacent zone. The moratorium on Hazmat shipments does not extend to the peripheral zone. In the restricted zone, the Incident Command has determined that access should be provided for operation of the water treatment plant, recognizing that the water treatment process will destroy the blister agent contaminants, and water will likely be needed for decontamination of other areas in this zone, not to mention the effects of loss of potable water on the adjacent zone population served by this plant. After discussions with the water treatment chemical supplier and their command chain contact, the user determined that appropriate waivers and plans for dealing with the contaminated truck after deliveries in the restricted zone would cause no more than a 24 hour delay. Similar accommodations will be made for any necessary maintenance at the local power transfer station in the restricted zone. Remaining services in the Restricted Zone are not further considered because these services are not needed for the evacuated population, and access for them was not designated by Incident Command, as indicated in Column P as answer to the question: “Provide access”. In the adjacent zone, notes have been made in the comment boxes of Column T (“Service Provided”) regarding regional suppliers that are either in or near the restricted zone, see Figure 6. General transportation delays in the adjacent zone are estimated to be up to 3 hours, primarily due to the closure of nearly a quarter of the perimeter arterial and detours and related congestion around the restricted zone. At this stage of response to this event, a detailed contaminant survey is pending, thus the exact borders of the restricted zone are expected to shift soon. Potential criticalities in the adjacent zone, indicated by “YES” in Column V, include water, medical supplies, food, and electricity that are provided by suppliers in the restricted zone. Solutions for water and electricity in the restricted zone will allow timely provision of these services to the adjacent zones. For food and heating fuel supplies that are delivered to the adjacent zone from the restricted zone, agreements have been made with suppliers in other regions to provide alternative sources of these supplies. The greater distance of these suppliers will cause some delays (as entered in Cells W20, W24, and W32), but a visual comparison of the “Hours to Solve” (Column W) to the “hours to criticality” (Columns H through M) suggests that these potentially critical conditions can be avoided with good communication regarding supply needs and alternative routes. The moratorium on Hazmat shipments will affect the TERET User Manual 17

D-21 regional water chemical supplier (Cell U16) and the deliveries to water treatment facilities (U14). However, a waiver can prevent this criticality, which will take no more than 2 hours, as indicated in Cell W14 and W16. This entry does not include the general 3 hour delay expected for deliveries within the adjacent zone, but together, these delays are still substantially less than the hours to criticality (Column H and I). In the peripheral zone, some water treatment facilities receive chemicals from the water chemical supplier in the adjacent zone, thus potential hours delay are the same as the duration of the moratorium on Hazmat shipments in the adjacent zone. As in the adjacent zone, this criticality can be averted with waivers. The peripheral zone is also is projected to be affected by suspended service from the medical supplier in the restricted zone (indicated in Cell Y24), however, as in the adjacent zone, suppliers in other regions should be able to provide similar supplies before critical conditions are reached. The TERET Mass Care worksheet is shown in Figure 8, has been filled in for this hypothetical example. Pre-event information was already in Columns B and C. The user enters the current number of hours since mass care sites were established in Cell C5. This incident involves the release of persistent chemicals with no other threat categories, thus the user provides estimates obtained from incident command on the number of hours that decontamination and triage sites are expected to be needed in Cell F9. This entry leads to an automatic estimation of the duration transportation is needed at these sites in Cells F11 to F27. Similarly, an estimate from incident command on the duration temporary shelters will be needed is entered in Cell F29 for automatic estimation of the duration transportation is needed for temporary shelters. TERET User Manual 18

D -22Figure 6. View of the Essential Services Worksheet for Scenario 1, With Some Comment Boxes Displayed. TERET User Manual 19

D -23 Figure 7. View of the Essential Services Worksheet for Scenario 1. TERET User Manual 20

D -24Figure 8. View of the Mass Care Worksheet for Scenario 1. TERET User Manual 21

D-25 4.2 Scenario 2: Biological Attack (Contagious Virus) During flu season, the medical facilities in Freedonia record an abrupt onset of flu-like symptoms including fever, headache, muscle aches, joint pain, and sore throat. Samples are sent to the CDC, but firm viral identification will take 5 to 7 days. In the meantime, symptoms progress to vomiting, diarrhea, stomach pain, and on the third day of illness, hemorrhaging is seen as tiny red dots in the skin. This later symptom, in particular, allows presumptive identification of a hemorrhagic fever virus and recognition of a biological attack. The DHS elevates the national threat advisory level to orange. Timelines obtained from patients enable identification of likely release sites as the HVAC systems of Freedonia's City Hall, Convention Center, and International Airport, from which travelers and convention-goers dispersed throughout the country prior to attack recognition. The originally released agent has degraded beyond recognition at the presumed sites, thus the attack sites cannot be confirmed, and there are concerns regarding the possibility of other release sites, particularly within the mass transit system. Public communication campaigns are initiated to identify initial victims who may not have sought medical care or have delayed symptoms, and to identify secondary victims infected from originally exposed persons. Freedonia’s mass transit system is closed due to concerns of additional releases and vigilante violence in the self-policing of riders in which persons with any unhealthy signs are barred from entry. Hospitals are flooded with the worried-well. Parents withdraw children from school, which are soon closed. Worker absenteeism in Freedonia drastically increases as many people voluntarily evacuate. Truckers refuse to make deliveries to Freedonia. Production at regional facilities within Freedonia drops drastically due to reduced number of workers, and soon thereafter, reduced supplies. The CDC finally confirms the Marburg hemorrhagic fever virus, which can be transferred from person to person with direct or close contact and may cause 25 to 70% fatalities. Treatment is limited to supportive care including blood transfusions, IV fluids, ventilators, and dialysis and regional supplies for these treatments quickly run short as deliveries are not made. Voluntary quarantine/observation centers are established in many of the schools and churches of Freedonia, as well as nationwide for people with flu-like symptoms. Vigilante policing promotes a rapid increase in the voluntary quarantined within the Freedonia region. Checkpoints for egress from the Freedonia Metropolitan Area are established for directing obviously symptomatic people to medical care and obtaining contact and destination information from evacuees. These control points also control access to essential workers and deliveries, and provide bio-level protection suits for those required to enter the region. The TERET Essential Services worksheet shown in Figure 9, below, has been filled in for this hypothetical scenario. Rows 3 to 8 contain the objectives from Incident Command, and brief lists of actions taken to meet these objectives. The restricted zone becomes the entire Freedonia Metropolitan Area. Suspension of mass transit affects commuting of essential workers, but does not create a critical condition (shown in Row 35). However, delayed supplies received from other regions (due to access checkpoints, dispersal of protective ware, etc.), lead the user to estimate a 48 hour delay in all deliveries within this region (Column O). As indicated in Column R, these delays suggest the potential for criticalities within the restricted zone in local water treatment supplies, vehicle and generator fuels, and heating fuel. Additional criticalities are indicated for both local and regional food and medical supplies. Because the user was unable to implement solutions that would reduce these delays, the command chain contacts are TERET User Manual 22

D-26 notified, and may use severity level information in Column N to help prioritize address of these potential criticalities. The user added rows to distinguish supplies that move from the restricted zone to the outlying zones. These supplies include treated water, water treatment chemicals, food, medical, and heating fuel supplies. Delivery of the supplies from the restricted zone is expected to be delayed 48 hours due to the installed checkpoints, as indicated in Column U. In this scenario, adjacent zone delays can be reduced by obtaining supplies from other regions with which previous agreements have already been made. Delays in the peripheral zone are due to the increase in the DHS threat advisory level, but in this scenario, none of these delays are expected to cause critical conditions. TERET User Manual 23

D -27 Figure 9. View of the Essential Services Worksheet for Scenario 2. TERET User Manual 24

D-28 4.3 Scenario 3: Radiological Attack (Dirty Bomb) A truck bomb explodes in Freedonia’s city center. First-responders rush to aid blast victims. After 15 minutes, Cesium-137 (half-life = 33 years) is detected by first-responders with portable radiation detectors. Initial readings of radioactivity and a moderate, steady wind (4 to 8 mph) from the southeast leads the Incident Commander to order evacuations from the detonation site to mile downwind, and shelter-in-place from to 1 mile downwind, as illustrated in Figure 10. Decontamination and triage sites are established for all evacuees, who are not permitted to leave until they are cleared by the FBI. Department of Homeland Security (DHS) elevates the national threat advisory level to orange. A sewage treatment plant in the initial shelter-in-place zone is found to have insignificant levels of contamination, but a more detailed radiological survey shows that buildings and topography have caused wind eddies and vortices that create highly variable and unpredictable levels of contamination, and that some buildings in the shelter- in-place zone have significant contamination, creating multiple patches of hazardous areas (i.e., restricted zones). Hospitals are flooded with the worried-well. It is determined that most of the Cesium-137 particles were larger than 10 micron (i.e., not inhalable), and they have largely bound to concrete and other masonry. A long and costly clean-up is projected (i.e., 2 to 3 years) for most buildings and roads in the evacuation zone and some buildings in the shelter-in-place zone. No symptoms of acute radiation sickness are found, however the area where this may have occurred had fatalities due to the explosion. The lifetime cancer risk is increased proportionate to the doses of radiation received. Figure 10. Scenario #3 -- Schematic Presentation of a Radiological Attack Area KEY Perimeter Arterial W M F W H P F F P P Shelter-in- Place M M Hf HH H W = water C = water chemical supply H = hospital F = food distributor M = medical distributor Hf = heat fuel P = power Initial Zones: W Evacuate Freedonia Metro Area Map of Essential Service Locations WIND C TERET User Manual 25 1 2/ 12/ Blast Damage

D-29 The TERET Essential Services worksheet shown in Figure 11, below, has been filled in for this hypothetical scenario. Rows 3 through 8 show the objectives from incident command and the actions taken to meet these objectives. The user added new rows for the supplies and services in the restricted zone that are provided to the outlying areas. These include water treatment, and electricity from a local transfer station (the incident comment has allowed access to maintain these services), and medical services from a regional hospital is in the restricted zone. For hours delay in service from the restricted zone, the user enters a large number (i.e., 1000) in Columns Q, U, and Y. Obtaining waivers and procedures for vehicle decontamination after deliveries to the restricted zone is estimated to take 48 hours for continued water and power service (Column S). For the lost regional medical services provided by the hospital in the restricted zone, public announcement are made to direct patients to other facilities. General delays in the adjacent zone due to detours and associated congestion are estimated to be 4 hours (Column U), which is not projected to cause any criticalities. The only services to the peripheral zone that originate in the restricted zone are those of the closed hospital. As in the adjacent zone, public announcement are made to direct patients to other providers. TERET User Manual 26

D -30Figure 11. View of the Essential Services Worksheet for Scenario 3. TERET User Manual 27

A Guide to Transportation's Role in Public Health Disasters Get This Book
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TRB’s National Cooperative Highway Research Program (NCHRP) Report 525: Surface Transportation Security, Volume 10: A Guide to Transportation's Role in Public Health Disasters examines development of transportation response options to an extreme event involving chemical, biological, or radiological agents. The report contains technical information on chemical, biological, and radiological threats, including vulnerabilities of the transportation system to these agents and consequence-minimization actions that may be taken within the transportation system in response to events that involve these agents. The report also includes a spreadsheet tool, called the Tracking Emergency Response Effects on Transportation (TERET), that is designed to assist transportation managers with recognition of mass-care transportation needs and identification and mitigation of potential transportation-related criticalities in essential services during extreme events. The report includes a user’s manual for TERET, as well as a PowerPoint slide introduction to chemical, biological, and radiological threat agents designed as an executive-level communications tool based on summary information from the report..

NCHRP Report 525: Surface Transportation Security is a series in which relevant information is assembled into single, concise volumes—each pertaining to a specific security problem and closely related issues. The volumes focus on the concerns that transportation agencies are addressing when developing programs in response to the terrorist attacks of September 11, 2001, and the anthrax attacks that followed. Future volumes of the report will be issued as they are completed.

The National Academies has prepared, in cooperation with the Department of Homeland Security, fact sheets on biological, chemical, nuclear, and radiological terrorist attacks. They were designed primarily for reporters as part of the project News and Terrorism: Communicating in a Crisis, though they will be helpful to anyone looking for a clear explanation of the fundamentals of science, engineering, and health related to such attacks. TRB is a division of the National Academies, which include the National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council.

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