Unknown Dry Substance / Suspected Anthrax Response Advisory

Bureau of EMS Policy Statement
Policy Statement #01-08
SubjectRe: Unknown Dry Substance / Suspected Anthrax Response Advisory
Supercedes/Updates96-02 & 88-15



This advisory is being sent to you to assist when responding to an emergency call involving a package, envelope or substance suspected of being Anthrax. Also attached are Anthrax advisories/protocols developed by the Department of Health to assist you in understanding what Anthrax is, mail handling protocols, recommended patient/equipment, decontamination guidelines, specimen handling and criteria for lab testing.

There are some primary things to understand about responding to an emergency medical response which involves a call site alleged to contain Anthrax or involving an unknown powder/substance:

  1. Confirm scene safety and type of incident. Responding EMS agencies are NOT advised to enter an affected area until a competent authority has determined the scene to be safe.
  2. If your arrive on the scene first, notify competent authority
  3. If an unknown substance has been found in the air handling system, evacuate the premises immediately and notify the competent authority.
  4. Anthrax is NOT contagious. Person to person transmission has never been reported.
  5. There will be little or no need for prehospital medical care. Do not transport the individual to a hospital, unless other medical conditions need to be addressed (i.e., chest pain, severe anxiety). Patients should not be transported to a hospital.
  6. If patient insists on being transported to the hospital, contact medical control for physician consultation.
  7. If you transport to the hospital, notify the receiving hospital that you are bringing a patient who has been exposed to a powder/unknown substance and request the hospital to have staff meet you outside of the Emergency Department.
  8. Create a list of individuals who were in area of exposure to be given to the incident commander or local police and shared with local public health officials. All, or most individuals, should be released home with the self-monitoring instructions attached.
  9. The need for testing of the substance will be determined by appropriate authorities following risk assessment.
  10. Unless a lab test confirms the nature of the powder substance, there is no need to immediately initiate prehospital medical treatment. These lab tests take at least 24 hours to complete. There is no harm to an individual waiting for lab results before beginning appropriate medical treatment.
  11. The Centers for Disease Control (CDC) has advised that no treatment is necessary for Anthrax in an otherwise healthy person exposed to an unknown powder/substance.
  12. If you arrive at the scene and patient(s) have been decontaminated, you should follow the above guidelines, but assist in addressing individual concerns about infection and treatment.
  13. If you enter a scene and the patient has not been decontaminated and there is an observable substance, contact a competent authority and perform the following:
  14. If the patient has a powder or other substance on their skin or clothing, ask the patient to remove their outer clothing. If the patient is not able to undress themselves, put on PPE1 and remove the patients outer or exposed clothing.
  15. Provide the patient with a disposable garment or a sheet.
  16. The patient's clothing should be secured by the patient (if possible), in a clear plastic bag and left with the competent authorities on the scene.
  17. See attached Decontamination Advisory. This should be followed by the appropriate local agency responsible for decontamination. EMS is not generally responsible for decontamination.
  18. Remember you are considered health care providers who the public expects will be knowledgeable about Anthrax. Often, you will be the highest medical authority at the scene. Please review the attached materials and be prepared to work with local or state public health officials in calming public fears regarding these incidents.

NOTE: This guideline is being provided to your local REMAC for incorporation into local protocol.

1Personal Protective Equipment (PPE) - Gloves, mask and eye protection. These may not be necessary on every call. Use the appropriate PPE based on the patient assessment and the presence of blood or body fluids and pertinent past medical history.


cc:Regional Emergency Medical Advisory Committees
County EMS Coordinators
Regional DOH Offices
State Emergency Management Office
County Emergency Managers
County Fire Coordinators
County Hazmat Teams
County/City Health Departments
New York State Police
Sheriffs Association
Hospital Emergency Departments

Authorized & Issued By:
Edward G. Wronski, Director
Bureau of Emergency Medical Services