FROM THE BENCH
Ricin Exercise a Win-Win in Arizona
By Susan Runcorn, MS, chemical threat coordinator, Chemical Emergency Response Program, Bureau of State Laboratory Services, Arizona Department of
Every year Arizona infectious disease
epidemiologists put together an
exercise for the state’s public health
community. Typically, the exercise
involves identification and response
to a viral or bacterial outbreak but in
July of 2018, the Arizona Chemical
Emergency Response (CT) section was
invited to participate in development
and facilitation of the exercise involving
contamination of food with ricin. Ricin is
a toxin found naturally in castor beans.
When processed, it can harm people
if released into water, air or food.
At monthly meetings, the Arizona CT
section collaborated with other members
of the planning team to develop a realistic
scenario that would meet benchmarks
for a Homeland Security Exercise and
Evaluation Program (HSEEP) exercise.
The scenario centered on an intentional
ricin poisoning of parmesan cheese by a
couple of disgruntled former employees
at a distribution plant. The scenario began
with students getting sick at school,
which led exercise participants to believe
the poisoning was from food at a school
club party. Eventually it ended at a food
court in an Arizona expo center.
The Arizona CT section provided
guidance to the planning team to ensure
the accuracy of the scenario. It shared
recommended timelines, relevant
partners and specimen type, and
explained that in an actual event
initial analysis of clinical
specimens would occur at the US Centers
for Disease Control and Prevention
(CDC) with shipment facilitated by the
CT section. If a surge of specimens was
expected, the Laboratory Response
Network for Chemical Threats (LRN-C)
would activate all capable Level 1 and 2
labs across the country. The CT section
also detailed its sample submission
procedures, how long testing would take,
and matrix and shipping requirements.
The exercise brought together a diverse
group of 175 participants who were
divided into 10 groups. Each group
included a representative from first
responders (either law enforcement
or local fire department), county
epidemiology, environmental health,
infection prevention, preparedness and
public health nursing plus a health officer.
Groups were all assigned a facilitator and
an evaluator. A CT section representative
was one of the facilitators. During breaks,
all 175 participants met to discuss key
questions and determine lessons learned.
For example, though many jurisdictions
had good processes in place for shipping
of specimens from patients potentially
exposed to bioterrorism agents, some
were not prepared for this type of
response. The exercise briefback
allowed participants to discuss different
approaches to address this gap and to
share what they had learned in their
groups. In addition, the briefback gave
facilitators a chance to see where they
might be able to improve.
Overall, the exercise went well.
Participants successfully navigated a
novel (for Arizona) chemical exposure
event. They quickly identified that the
patients had been exposed to a toxin
based on the symptomology and were
eager to learn about proper response
and recovery from such an exposure.
At the end of the exercise, a panel of
representatives from Poison Control, the
FBI and Arizona’s CT program answered
questions about the exercise and chemical
exposures in general.
The introductory group session during the 2018 Arizona
Infectious Disease Exercise
As a result of the exercise, the
Arizona CT section has built
new relationships with state
epidemiologists, county public health
partners and poison control.
As a result of the exercise, the Arizona
CT section has built new relationships
with state epidemiologists, county public
health partners and poison control.
Local health workers are thinking about
how to respond to a toxin or chemical
exposure as well as a viral or bacterial
outbreak. Moreover, local hospital staff are
familiar with procedures for CT specimen
collection, packaging and shipment, and
with the capabilities and roles of the
Arizona state laboratory and the CDC.
Many thanks to Rebecca Kruc, a CDC Field
Preparedness Assignee, for including the
Arizona CT section in this exercise and
for spending so many hours in writing
and editing. Joli Weiss and her team of
epidemiologists also worked hard to put
the exercise and conference together.
Another thank you to the CDC for
providing support and guidance to the
Ricin is a toxin found naturally in castor beans.
LAB MATTERS Winter 2019