1. You local fire department responded to an incident at the courthouse where about ¼ teaspoon of white powder spilled from an envelope that contained payment for a parking ticket. What level of decontamination is required for the person handling the letter and those in the room?

A. No decontamination.

B. Soap and water wash of hands and areas where powder contaminated.

C. Soap and water wash of everyone in the room.

D. Quarantine the entire building and burn it to prevent spread.

Answer B. Any person in direct contact with the powder should do soap and water cleansing and visibly contaminated clothing should be removed and bagged. This has less to do with anthrax than preventing chemical reactions, as if it is a harmful substance, it’s more likely to be a chemical compound than a biologic. These instances are common, and what occurred in St. Paul yesterday is that a provisional field test identified the substance as a potential biohazard (these tests are notoriously unreliable – very poor specificity). MDH did initial testing that confirmed within hours that it was not anthrax, (final cultures and processing take about 5 days though). Given that weaponized anthrax isn’t exactly easy to obtain, unless a nationally prominent target is selected, these are assumed to be false alarms until proven otherwise, so decontamination isn’t performed and on the off chance it would be a hazard, names and contact information are taken so that MDH can follow up and provide appropriate prophylaxis as needed.


2. The Fire Department notifies you that they are responding to an alarm at the downtown post office. The detector has alerted on a small package being sent to the special agent in charge of the FBI and contains a threatening letter as well as white powder. Three postal employees have arrived at the ED and are requesting decontamination. What do you do?

A. No decontamination.

B. Soap and water decontamination, control clothing.

C. Bleach decontamination of skin.

D. Prescribe Percocet and follow up with Medicine Direct clinic.