Birmingham, United Kingdom – Over the past few years, the term “asymmetry” has been applied many times to the emerging threat landscape to first responders and military personnel around the world. Asymmetrical means that two sides do not match or are uneven. Intelligence SEC’s 2019 European CBRNE Summit recently held in Birmingham, United Kingdom, highlighted two of the largest and most prominent chemical, biological, radiological, nuclear, high-yield explosive (CBRNE) incidents in the world: The 2018 Salisbury nerve agent attack and the 2017 Manchester concert arena bombing. Intelligence-SEC will be presenting the 2019 Asian CBRNE Summit to be held 3-5 December 2019 in Bangkok, Thailand.
Many articles and chat groups discuss the 2018 Salisbury nerve agent attack that left the emergency response world asking many questions and covering all response elements – from local Salisbury responders to British Military Special Operations Units. New response matrixes have been documented since this brutal attack involving the first publicly documented execution of a Generation 4 toxic warfare agent. CBRNE experts – from those at the DSTL in nearby Porton Down to major international counterterrorism experts – were called upon to determine what they were dealing with and who might have the capability and capacity to carry out such a surgically engineered attack. This recent incident in Salisbury was the major highlight of the European CBRNE Summit. More than 150 top international leaders and academic scientists gathered to discuss the events with actual incident commanders who worked to mitigate this CBRNE incident in the UK countryside.
The Asymmetric Threat Environment
Today’s geopolitical landscape is dynamic and volatile. The ease of deployment of asymmetric threats coupled with the technological advancement of science have created a heightened sense of awareness from local governments to top legislative bodies throughout most of the world. Security experts still warn that simple, practical, and easy-to-deploy metrics are the most probable hazards. However, despite much scientific validity to that point, there is growing concern that asymmetric threats are undergoing an emerging paradigm shift, with major incidents already affecting and likely to continue affecting governments and critical infrastructure – whether deployed as surgical strategic strikes on individuals or with the intent of inflicting a mass casualty effect. Both homegrown violent extremists and potential state-sponsored deployment of these modalities exponentially exacerbate the need for unified counterterrorism training and exercises pertaining to CBRNE prevention and mitigation matrixes. The complexity of the Salisbury incident enhances the need for continuous training and collaboration among all emergency response agencies and the private sector.
Wiltshire Chief of Police John Campbell led the Summit with a detailed presentation of the actual Salisbury response, and highlighted lessons learned and resilience projects that have been berthed from the incident, which affected the entire European Union. In 2011, the United Kingdom released a document, entitled “Contest: The United Kingdom’s Strategy for Countering Terrorism,” which included the National CBRNE Policing Center and overall strategy as well as roles that different agencies would play in response, consequence management, and forensic investigations – including the prosecutorial evidence gathering to bring those responsible to justice. Due to the ongoing investigation in Salisbury, evidentiary details that might affect that investigation are not listed here. However, response details and training opportunities will continue to emerge.
Salisbury Lessons Learned
The Salisbury incident presented three major takeaways that can be applied to emergency response personnel mitigating similar incidents in the United States.
- The lack of advanced technological detection and advanced countermeasure protocols at the local level hinder the U.S. response plan, mitigation, and treatment of fourth generation nerve agents. Post-9/11, many agencies discarded major supplies of pralidoxime (2-PAM) chloride and did not replace the cache for future attacks. In addition to these gaps, Dr. Laura Cochrane from Emergent BioSolutions highlighted the treatment methods of certain Oxime inhibitors to nerve agents currently being researched. The Homeland Defense and Security Information Analysis Center (HDIAC), which is sponsored by the U.S. Department of Defense, published (Vol. 6, Issue 1, Spring 2019) an article entitled “Next-Generation Nerve Agent Antidotes,” which provides a glimpse of advanced research currently being executed among the highest levels of government to combat these emerging threats.
- The need for more unified command exercises and the demand for National Incident Management System (NIMS) nomenclature to be used and exercised within major Urban Area Security Initiative (UASI) cities are well documented. However, many organizations still do not utilize incident action plans or information sharing as formal command tools to enhance community resilience and public safety. The complexity of Salisbury taxed the most robust and formal response protocols that the United Kingdom engaged in. In the first 72 hours, it was thought to be another opioid episode, perhaps involving one of the fentanyl analogs increasingly seen around the world. It was not until experts at the Defense Science and Technology Laboratory (DSTL) at Porton Down forensically identified the known classified agent that was deployed as an assassination attempt.
- During the summit, it became evident that asymmetric threats involving the senses that first responders are taught to enhance and inject in every incident they engage are the most serious. Such threats would tax the most robust and resilient emergency response plans and entities due to the multiple complexities involved. The National Response Framework and the U.S. mitigation method of starting with the locals and ending with the locals are different than response plans deployed elsewhere. Although the National Response Framework provides a robust and thorough response to many incidents, the increased reflex time in the deployment of Title 32 and Title 10 assets could have a major effect on incident stabilization and full-site characterization for asymmetric threats that pose an exponential mass casualty effect. The present threat level around the free world continues to increase in complexity due to the multiple modalities deployed quite often over a larger than usual geographic footprint. For example, almost two weeks after the first exposure to the agent, two bystanders casually walking through a park some 30 miles away from Salisbury were exposed to what is now known to be the original dissemination tool. The potential to respond to these events coupled with unknown limits of potential exposures support the need to train and equip highly advanced local CBRNE teams that can rapidly detect and characterize the scene, stabilize the incident, and deliver advanced agent-specific countermeasures in the hot zone.
Dr. Paul Russell, the primary medical microbiology and virology consultant for the Salisbury incident, presented on the nuances and complexities faced during the initial response and first few months following the incident. The fact this took place in vicinity of the DSTL Porton Down Salisbury and not another mass populated city such as London, New York, Dallas, and Los Angeles is a complexity that was discussed at length. Stakeholders noted that emergency responders do not have the luxury of picking the theater in which the event will unfold.
Recently, incidents occurring in unlikely places erase the modern threat matrix formula that utilizes population density as a major indicator of chance contact for such threats. The execution of this event in a town such as Salisbury confirms what many CBRNE experts have known all along: response, training, equipment, and consequence management must be deployed with the understanding that no place and no entity is immune in the modern global transport era. Attacks using never-before-seen agents have changed the emergency response landscape, thus increasing the complexity and adding to the importance of whole of community response and training.
Initial speculation was that the Salisbury incident was like the 2011 attack on Alexander Litvinenko in London using alpha radiation. Due to the 2011 incident, it is understandable why responders would naturally gravitate toward initial experience in previous deployments of CBRNE material. This natural phenomenon of cataloguing from past experiences is a classic example of why full-site characterization is mandatory in response to the dissemination of a substance with an unknown etiology among hazardous materials teams. These teams must rule out what is there, but also what is not there to give the incident commander a full spectrum of analysis to make the best public safety decisions.
Salisbury was exacerbated by many variables that affected the short-term acute response to the incident and long-term consequence management execution that would present 90,000 man-hours of scene remediation – expanding exponentially over a three-week span due to the peripheral exposure to the two other victims 30 miles away. The unknown dissemination device and unknown location of the agent’s inception synergistically complicated matters. Not having a clear picture of ground zero nor where the exposure area stopped delayed a major mode of operation in incident stabilization for two weeks after initial contact with the agent. Only when two later victims fell ill to the exposure did incident isolation take effect. This led to the long forensic investigation and quantification of exactly how much of the agent officials were dealing with.
Similar to the Kim Jong-nam assignation in Kuala Lumpur in 2017, the perpetrators responsible for delivering the weapons of mass destruction (WMD) entered the United Kingdom without any suspicion or detection en route to deliver the weapon. Asymmetric threats present a complexity to prevention and detection protocols. Criminals who execute asymmetric attacks are not bound by lists and entities that mankind produced. Kuala Lumpur was shut down for two weeks, with an economic loss and psychological impact that only dissolves as time goes on. Led by the lack of a triggering event, the emergency medical services (EMS) team that responded to the two victims in Salisbury initially assessed the case as an opioid overdose due to the similarities of presentation and lack of SLUDGE (salivation, lacrimation, urination, defecation, gastrointestinal distress and emesis), which is common with nerve agent exposure. This delay in the adrenergic response presented a complexity that continued for a few days until DSTL in Porton Down confirmed the presence of generation four nerve agent through forensic blood tests.
Almost two years post-incident, the emergency response community at the local level is having difficulty getting the information and training needed to classify and give some type of qualitative data for public safety consequence management. Detection capabilities continue to be a controversial topic as to which technology works best to detect these agents due to classification. To save lives, a tremendous amount of work is needed on the detection capabilities to be placed on the approved equipment list in the United States coupled with advanced countermeasures to combat these threats. Only the adversaries have the luxury of knowing when an attack will be deployed, so first responders deserve the latest and best technology to correctly classify threats present, minimize exposure to these agents, and avoid becoming victims themselves.
Manchester Lessons Learned
On the eve of the Ariana Grande concert on Sunday, 22 May 2017, the adversarial tactic for defeating security measures was to place improvised explosive devices and other potential WMD at the exit points of mass gatherings. This tactic caught security and emergency responders by surprise. The Manchester incident introduced the common theme that tactics, techniques, and procedures engaged in by the adversary are a dynamic and nonlinear delivery model that is constantly being enhanced and changed to produce a mass effect.
Allen Cordwell, head of the Northern Care Alliance NHS Trust, is a former British military operative who presented a humbling and grim scene of the tragic carnage left behind from the not-named adversary in the Manchester arena bombing. The Northern Care Alliance is comprised of four acute care hospitals in the northern region of the United Kingdom and one urgent care facility – including a staff of 17,500 workers supporting the mission of protecting and providing emergent care in all modalities related to asymmetric threats and CBRNE materials. The Manchester incident left 22 dead, 140 injured, with 23 of these patients triaged as critical care.
Deliberate attacks in the United Kingdom implement the “NCA Index of Suspicion Model – Level High,” with the first patients arriving at North Manchester undergoing radiological scans combined with detection of possible chemical contamination. Negative scans were initially reported as being absent and ruled out, leading one participant at the summit to ask how many emergency response protocols call for scanning initial victims for radiation and chemical agent contamination. Continuous reporting utilizing the Index of Suspicion canary model limited controlled movements of staff for the first 30 minutes with another assessment at 60 minutes. After all patients were cleared, surveillance was maintained throughout the clinical treatment phase of each patient. Observation of close proximity staff, responders, and volunteers continued throughout the event looking for early warning signs of CBRNE contamination and exposure to persistent chemical agents.
Following are lessons applicable to future mass casualty care in potential asymmetric attacks that include an explosive weapon delivering kinetic energy to inflict acute life-threatening traumatic injuries:
- Supply chain needs to ensure sufficient surgical instruments and implants available for maxillo-facial reconstruction, as well as sufficient wound care dressings.
- Continued training and implementation of tourniquets must be included for the whole community to save lives, much like the introduction of automated external defibrillators (AEDs) for treating ventricular fibrillation.
- Damage limitation surgery must be limited to a 1-hour maximum.
- All wounds from ballistic injuries that have removed shrapnel are part of forensic evidence – label and store.
- Daily trauma conference of all surgical specialties is needed.
Asymmetrical Threats to First Responders
The asymmetric threat landscape is more dynamic than ever and will continue to expand in complexity due to the ease of transport and increasing ease of delivery modalities for complex unseen asymmetric threats. For these reasons, more diligence and calculation in a unified and synergetic delivery method are needed to cover training as well as research and development in all metrics of response – including but not limited to personal protective equipment (PPE), detection equipment, and the ability to rapidly disseminate countermeasures in all asymmetric threat modalities that can be scientifically delivered.
As more data about emerging threats to critical infrastructure become available, the need for quick and decisive preventive countermeasures in public venues becomes more important. Protecting the public from population and critical infrastructure perspectives are vital components to incident stabilization. Since the European CBRNE Summit, there has been a rapid increase in the Ebola crisis in the Congo, an estimated 200 million pigs will be destroyed in China due to a rapid outbreak of the Africa swine influenza although scientists say that it is strictly relegated to animals only and has shown no signs of spreading to humans. Multiple U.S. law enforcement personnel continue to be exposed to fentanyl, typhoid fever, and other asymmetric threats while serving in the community. An increasing likelihood of exponential exposure and chance contact with an asymmetric threat outside of normally seen tactics, techniques, and procedures to first responders continue to dominate the current prevention and response landscape and will only increase with time.
This dynamic will continue to challenge stakeholders, as recently seen with the Los Angeles Police Department exposure to typhoid fever in downtown Los Angeles. The board of directors for the Los Angeles Police Protective League, the police labor union, said in a statement that officer safety must be considered. “At this point we don’t care who is at fault, we just want these toxic work sites cleaned and sanitized,” the statement reads. “Officers worry enough about being shot or injured policing the streets of Los Angeles, they shouldn’t also have to worry about being infected with diseases they can take home to their families simply by showing up to work. Our demand is simple; clean it up and provide preventive measures before there is a massive outbreak.” The common operating picture has changed dramatically, leading to two new operation level responder mission-specific competencies for diving in contaminated water environment and evidence collection were added to NFPA 472 2018.
The Salisbury incident demonstrates how a Salisbury police officer on patrol on a quiet Sunday afternoon was the first external exposure to the agent of record. The standard operating picture must be addressed for field patrol officers as to the correct PPE to be donned in the field to maximize protection for responders. The actual etiology of the symptoms to the victims transported had yet to be identified. However, this leads to the need that all first due responding personnel must be provided with basic all hazards training and personal protective equipment.
The asymmetric biological threat continues to dominate the current emergency planning docket around the world as biological pandemics affecting major countries rapidly rise. Adding a biological detection capability with in-field polymerase chain reaction (PCR) could help classify and prevent the presence of biological incidents such as Ebola and Anthrax. This would support the hazmat teams’ consequence management goals of life safety, incident stabilization, and critical infrastructure preservation, and increase the resilience and ability to return to normal daily operating routines. Biological asymmetric threats potentially could shut down and interrupt major critical operating modalities in a synergistic and cascading effect, thus increasing the potential life safety and economic disruption to the nation. Public safety sampling and the ability to rapidly deploy accepted scientific technology such as in-field PCR, with the goal of providing the incident commander and hazmat group supervisor a quick and accepted decision matrix for public safety should become the gold standard among first responders and hazmat teams nationwide. This technology enhances early notification of the Department of Justice WMD Directorate nationwide, combined with the totality of the circumstances to help implement Title 18 statutory command in the event it is classified as a terrorist event.
Continuous reporting of daily asymmetric threat execution is no longer mandated and separated by earlier geographic regions. Chance contact among various emergency response personnel – both in the homeland security arena and the military arena abroad – should encourage stakeholders as a group to continuously improve and enhance capabilities to mitigate current and future emerging asymmetric threats in all parts of the world.