bioterrorism and weapons of mass destruction

Bioterrorism and Weapons of Bioterrorism and Weapons of Mass DestructionMass Destruction

John van der Steeg MDJohn van der Steeg MD

In peace the sons bury their In peace the sons bury their fathers, but in war the fathers fathers, but in war the fathers

bury their sons. bury their sons.

CroesusCroesus

Naturally the common people don't want war; neither Naturally the common people don't want war; neither in Russia, nor in England, nor in America, nor in in Russia, nor in England, nor in America, nor in

Germany. That is understood. But after all, it is the Germany. That is understood. But after all, it is the leaders of the country who determine policy, and it is leaders of the country who determine policy, and it is

always a simple matter to drag the people along, always a simple matter to drag the people along, whether it is a democracy, or a fascist dictatorship, or whether it is a democracy, or a fascist dictatorship, or a parliament, or a communist dictatorship. Voice or a parliament, or a communist dictatorship. Voice or no voice, the people can always be brought to the no voice, the people can always be brought to the

bidding of the leaders. That is easy. All you have to bidding of the leaders. That is easy. All you have to do is to tell them they are being attacked, and do is to tell them they are being attacked, and

denounce the pacifists for lack of patriotism and denounce the pacifists for lack of patriotism and exposing the country to danger. It works the same in exposing the country to danger. It works the same in

any country.any country.

Categories of Weapons of Mass Categories of Weapons of Mass DestructionDestruction

B BiologicalB Biological N NuclearN Nuclear I incendiaryI incendiary C ChemicalC Chemical E ExplosivesE Explosives

History of Biological WeaponsHistory of Biological Weapons

184 BC Hannibal ordered pots of venomous snakes thrown of decks of enemy 184 BC Hannibal ordered pots of venomous snakes thrown of decks of enemy ships.ships.

Tartar army catapulted bodies of plague victims into the city of Caffa in 1346Tartar army catapulted bodies of plague victims into the city of Caffa in 1346 British army provided blankets to Delaware Indians in 1763…after they were British army provided blankets to Delaware Indians in 1763…after they were

used by smallpox patients.used by smallpox patients. During WW II Japanese utilized Yersinia pestis containing rice and fleas spread During WW II Japanese utilized Yersinia pestis containing rice and fleas spread

by airplane against Chinese and Russian troops.by airplane against Chinese and Russian troops. America had prepared 5000 anthrax bombs at Camp Detrick, Maryland in 1942. America had prepared 5000 anthrax bombs at Camp Detrick, Maryland in 1942.

(none used during the war)(none used during the war) Aum Shinrikyo religious cult contaminated a Tokyo subway with Sarin gas in Aum Shinrikyo religious cult contaminated a Tokyo subway with Sarin gas in

1995. (5500 hospital visits and 5 deaths)1995. (5500 hospital visits and 5 deaths) Aum Shinrikyo make several unsuccessful attempts to release anthrax or Aum Shinrikyo make several unsuccessful attempts to release anthrax or

botulinum toxin to other areas around Tokyobotulinum toxin to other areas around Tokyo Anthrax laden envelopes sent via US mail in 2001, resulting in 11 cases of Anthrax laden envelopes sent via US mail in 2001, resulting in 11 cases of

inhalational anthrax (including 5 deaths) and 12 cases of cutaneous anthrax.inhalational anthrax (including 5 deaths) and 12 cases of cutaneous anthrax.

History of Biological WeaponsHistory of Biological Weapons

Many countries agree to stop research and development of Biological weapons Many countries agree to stop research and development of Biological weapons in 1972.in 1972.

Many smaller countries continue to develop biological warfare programs.Many smaller countries continue to develop biological warfare programs.

A little perspectiveA little perspective

200lbs of aerosolized anthrax spread over a 200lbs of aerosolized anthrax spread over a city the size of Omaha on a clear breezy city the size of Omaha on a clear breezy night could kill as many as 2.5 Million night could kill as many as 2.5 Million people.people.

200lbs of Botulinum toxin could kill as many 200lbs of Botulinum toxin could kill as many as 40,000 people in an area the size of the as 40,000 people in an area the size of the Mall of America.Mall of America.

200lbs of VX gas sprayed over Disney land 200lbs of VX gas sprayed over Disney land could kill 12500 people.could kill 12500 people.

Critical Biological Agents Critical Biological Agents

The CDC published a list of Critical The CDC published a list of Critical Biological Agents in 2000.Biological Agents in 2000.

List is divided into categories A, B, and C.List is divided into categories A, B, and C. Category A agents are of the highest priority Category A agents are of the highest priority

and Category C are of a lesser priority.and Category C are of a lesser priority.

Category ACategory A

Pose a risk to national security.Pose a risk to national security. Spread easily by person to person contact.Spread easily by person to person contact. Cause a high death rate.Cause a high death rate. Require special action for public health Require special action for public health

preparedness.preparedness.– Bacillus anthracisBacillus anthracis (Anthrax) would be a (Anthrax) would be a

category A biological agent.category A biological agent.

Category A ThreatsCategory A Threats

AnthraxAnthrax Botulism Botulism Plague Plague Small poxSmall pox TularemiaTularemia Viral hemorrhagic feversViral hemorrhagic fevers

Category BCategory B

Fairly easy to disseminate.Fairly easy to disseminate. Cause moderate illness and have a lower Cause moderate illness and have a lower

death rate than Category A agents.death rate than Category A agents. Require an enhanced diagnostic capacity Require an enhanced diagnostic capacity

and disease surveillance.and disease surveillance.– Coxiella burnetii (Q fever) is an example of a Coxiella burnetii (Q fever) is an example of a

Category B biological agent.Category B biological agent.

Category CCategory C

Include new pathogens which could be Include new pathogens which could be engineered for mass dissemination in the engineered for mass dissemination in the future.future.

Widely available.Widely available. Easy to produce and dispense.Easy to produce and dispense. Potential to cause high rate of death and Potential to cause high rate of death and

sickness.sickness.– Nipah virusNipah virus is an example of an Category C is an example of an Category C

biological agentbiological agent

DisseminationDissemination

Biologic agents designed to enter the body Biologic agents designed to enter the body one of three ways.one of three ways.

InhalationInhalation– All category A agents may be aerosolizedAll category A agents may be aerosolized

IngestionIngestion– Contaminated food and waterContaminated food and water

Skin contactSkin contact

AerosolizationAerosolization

Aerosols may be delivered in wet or dry Aerosols may be delivered in wet or dry forms.forms.

May be used in closed or open spacesMay be used in closed or open spaces Crop dusting planes, ventilation systems in Crop dusting planes, ventilation systems in

buildings, fine powder that are easily buildings, fine powder that are easily aerosolized when disruptedaerosolized when disrupted

AnthraxAnthrax

Not just the name of a speed metal bandNot just the name of a speed metal band Discovered in 1877, may have been cause Discovered in 1877, may have been cause

of plague described in Egypt 4000yrs. Ago.of plague described in Egypt 4000yrs. Ago. Also known as wool sorters of black bane dzAlso known as wool sorters of black bane dz Weaponized in 1950’s & 1960’s in the USWeaponized in 1950’s & 1960’s in the US 70 Russians died in 1979 after aerosol 70 Russians died in 1979 after aerosol

release by military facility in Svedlovskrelease by military facility in Svedlovsk Weaponized by Iran in 1995Weaponized by Iran in 1995

AnthraxAnthrax

Caused by spore forming bacterium Caused by spore forming bacterium B. B. anthracis.anthracis.

Symptoms occur approximately 7 days post Symptoms occur approximately 7 days post exposure.exposure.

Most common form is cutaneous anthraxMost common form is cutaneous anthrax Symptoms of inhalational anthrax initially Symptoms of inhalational anthrax initially

mimic common cold and progress rapidly to mimic common cold and progress rapidly to resp. distress and sepsis.resp. distress and sepsis.

AnthraxAnthrax

Direct person to person spread does not occur.Direct person to person spread does not occur. Fatality Rate Fatality Rate

– Cutaneous :untreated 5-20%, treated 1%Cutaneous :untreated 5-20%, treated 1%– Inhalational :untreated 100%, treated >80% if >48hrs Inhalational :untreated 100%, treated >80% if >48hrs

after symptom onsetafter symptom onset

Infective dose 2500-80,000 spores by inhalationInfective dose 2500-80,000 spores by inhalation Spore viability >40yrs in soil and resistant to sun Spore viability >40yrs in soil and resistant to sun

light, heat and disinfectantslight, heat and disinfectants

AnthraxAnthraxTreatmentTreatment

Ciprofloxacin 400mg iv q 12 hrs ORCiprofloxacin 400mg iv q 12 hrs OR Doxycycline 100mg iv q12 hrs ANDDoxycycline 100mg iv q12 hrs AND

– One or two additional antimicrobials i.e. One or two additional antimicrobials i.e. Rifampin, vancomycin, penicillin, ampicillin, Rifampin, vancomycin, penicillin, ampicillin, clindamycin, clarithromycin, chloramphenicolclindamycin, clarithromycin, chloramphenicol

Cutaneous AnthraxCutaneous Anthrax

Inhalational AnthraxInhalational Anthrax

BotulismBotulism

BotulismBotulism

Researched by Iraq in 1991Researched by Iraq in 1991 Weaponized & deployed in 100 munitions in Weaponized & deployed in 100 munitions in

1995 by Iraq1995 by Iraq Nerve toxin produced by Nerve toxin produced by Clostridium Clostridium

botulinum botulinum whichwhich produces a descending produces a descending paralysis.paralysis.

The most potent and lethal substance The most potent and lethal substance known to manknown to man

BotulismBotulism

Gram + anaerobic bacillus which forms sporesGram + anaerobic bacillus which forms spores Block presynaptic ACh releaseBlock presynaptic ACh release Infective dose 0.001mcg/kg, Infective dose 0.001mcg/kg, lethal lethal

dosedose .09-.15mcg/kg IV or .7 mcg IM .09-.15mcg/kg IV or .7 mcg IM Pt’s are alert, oriented and afebrilePt’s are alert, oriented and afebrile Pt can require vent. Support for 2-3 MONTHS due Pt can require vent. Support for 2-3 MONTHS due

to resp. failureto resp. failure– Occurs in 20 – 60 % of casesOccurs in 20 – 60 % of cases

BotulismBotulism

Signs and symptoms can include nausea, Signs and symptoms can include nausea, dry mouth, blurred vision, dysphagia, dry mouth, blurred vision, dysphagia, fatigue, and dyspnea which may begin fatigue, and dyspnea which may begin several hours to days after the exposureseveral hours to days after the exposure

Botulism Botulism TreatmentTreatment

Not spread from person to personNot spread from person to person If diagnosed early food and wound botulism If diagnosed early food and wound botulism

may be treated with antitoxinmay be treated with antitoxin Recovery may take several weeks.Recovery may take several weeks.

PlaguePlague

Used as a weapon in the 14Used as a weapon in the 14thth century century (Infected corpses catapulted into enemy (Infected corpses catapulted into enemy strongholds)strongholds)

One of the greatest engines of One of the greatest engines of socioeconomic changesocioeconomic change

Potential agent in 1950’s & 1960’s by USAPotential agent in 1950’s & 1960’s by USA Investigated by Japan in WWII (unit 731)Investigated by Japan in WWII (unit 731)

PlaguePlague

PlaguePlague

Caused by Caused by Yersinia pestisYersinia pestis, a gram negative , a gram negative bacteria found in rodents and their fleas.bacteria found in rodents and their fleas.

Bacteria may be grown in large amounts Bacteria may be grown in large amounts and aerosolized.and aerosolized.

Aerosolization allows for pneumonic form of Aerosolization allows for pneumonic form of disease with potential for secondary disease with potential for secondary contamination. (resp. droplets are infectious contamination. (resp. droplets are infectious until pt gets therapy for 72 hrs) until pt gets therapy for 72 hrs)

Infective dose <100 organismsInfective dose <100 organisms

PlaguePlague

Aerosol of bacillus viable for 1 hr at Aerosol of bacillus viable for 1 hr at distances of 10 kmdistances of 10 km

MoralityMorality– Untreated bubonic plague: 50 – 60 %Untreated bubonic plague: 50 – 60 %– Untreated pneumonic plague or septicemia: Untreated pneumonic plague or septicemia:

100%100%– Treated pneumonic plague (<24hrs) 10 – 20 %Treated pneumonic plague (<24hrs) 10 – 20 %

PlaguePlague

Pneumonic plaguePneumonic plague– incubation in 2 – 4 daysincubation in 2 – 4 days– Rapid onsetRapid onset– High fevers, chills, hemoptysis, bloody sputum, High fevers, chills, hemoptysis, bloody sputum,

dyspnea, stridor, cyanosisdyspnea, stridor, cyanosis– Death from resp. failure, circulatory collapse Death from resp. failure, circulatory collapse

and bleeding diathesisand bleeding diathesis

Plague Plague TreatmentTreatment

Preferred choicesPreferred choices– Streptomycin 30mg/kg div bid IM x 10dStreptomycin 30mg/kg div bid IM x 10d– Gentamycin 5mg/kg IM or IV QD x 10dGentamycin 5mg/kg IM or IV QD x 10d

Vaccine: effective against bubonic plague Vaccine: effective against bubonic plague notnot against aerosol exposure against aerosol exposure– Not approved for peds < 18 y/oNot approved for peds < 18 y/o

PEP: doxycycline 100 mg po bid x 7d ORPEP: doxycycline 100 mg po bid x 7d OR– Ciprofloxacin 500 mg po bid x 7dCiprofloxacin 500 mg po bid x 7d

RicinRicin

RicinRicin

Significant due to the wide availability of; 1 Significant due to the wide availability of; 1 million tons of castor beans processed million tons of castor beans processed annually in production of castor oil.annually in production of castor oil.

Used in assassination of Bulgarian exile Used in assassination of Bulgarian exile Georgi Markov in London in 1978.Georgi Markov in London in 1978.

RicinRicin

Ricin is part of the waste “mash” produced Ricin is part of the waste “mash” produced when castor oil is made.when castor oil is made.

May be produced in the form of a powder, May be produced in the form of a powder, mist, or a pellet or it can be dissolved in mist, or a pellet or it can be dissolved in water or a weak acid.water or a weak acid.

Depending on route of exposure, inhalation Depending on route of exposure, inhalation vs ingestion, it can take as little as 500 mcg vs ingestion, it can take as little as 500 mcg to kill a person. (about the size of the head to kill a person. (about the size of the head of a pin)of a pin)

Ricin Ricin respiratory exposurerespiratory exposure

Results in pulmonary toxicity with sever Results in pulmonary toxicity with sever resp. symptoms within 8 hrs.resp. symptoms within 8 hrs.

Followed by respiratory failure in 36 – 72 Followed by respiratory failure in 36 – 72 hrs. (marked by nonspecific findings such as hrs. (marked by nonspecific findings such as weakness, fever, vomiting, cough, weakness, fever, vomiting, cough, hypoxemia, hypothermia, and hypotension)hypoxemia, hypothermia, and hypotension)

RicinRicingastrointestinal exposuregastrointestinal exposure

Rapid onset of gastrointestinal symptoms Rapid onset of gastrointestinal symptoms such as nausea, vomiting, abdominal such as nausea, vomiting, abdominal cramps, and severe diarrhea.cramps, and severe diarrhea.

Followed by vascular collapse and death.Followed by vascular collapse and death.

RicinRicinTreatmentTreatment

No antidote, vaccine or prophylactic No antidote, vaccine or prophylactic antitoxin availableantitoxin available

Treatment aimed at avoiding exposure and Treatment aimed at avoiding exposure and eliminating toxin from the body as quickly as eliminating toxin from the body as quickly as possible.possible.

SmallpoxSmallpox

SmallpoxSmallpox

Considered by Japan in WWIIConsidered by Japan in WWII Global eradication program began in 1967Global eradication program began in 1967 Declared eradicated in May 8, 1980 Declared eradicated in May 8, 1980 In 1996 WHO recommends all stockpiles be In 1996 WHO recommends all stockpiles be

eradicated by 1999eradicated by 1999 Still exists in government labs of US and Still exists in government labs of US and

RussiaRussia

SmallpoxSmallpox

Variola virus which causes disease is very Variola virus which causes disease is very stablestable

Infectious dose is very small (10-100 Infectious dose is very small (10-100 organisms)organisms)

Virus spread from person to person via resp. Virus spread from person to person via resp. droplets. (w/in 3 meters), their bedding or droplets. (w/in 3 meters), their bedding or clothingclothing

Incubation 7 – 19 daysIncubation 7 – 19 days

SmallpoxSmallpox

Signs and symptoms include high fever, Signs and symptoms include high fever, fatigue, head and back aches.fatigue, head and back aches.

Followed w/in 2 – 3 days by smallpox rash Followed w/in 2 – 3 days by smallpox rash and skin lesions.and skin lesions.

Mortality:Mortality:– 3% vaccinated3% vaccinated– 30% if unvaccinated30% if unvaccinated– 50% if develop secondary bact. Pneumonia50% if develop secondary bact. Pneumonia

SmallpoxSmallpox

At this time the government does not At this time the government does not recommend prophylactic vaccination of recommend prophylactic vaccination of healthcare workers or the general publichealthcare workers or the general public

SmallpoxSmallpoxTreatmentTreatment

No proven treatment of smallpox.No proven treatment of smallpox. Patients affected with smallpox require Patients affected with smallpox require

supportive care and quarantine.supportive care and quarantine.

TularemiaTularemia

TularemiaTularemia

First found in Tulare County, CaliforniaFirst found in Tulare County, California Found in Japan in 1800’s and Russia in Found in Japan in 1800’s and Russia in

19261926 Caused by Caused by Francisella tularensis, Francisella tularensis, a gram a gram

negative bacterium found in animals, negative bacterium found in animals, especially in rodents, rabbits and hares.especially in rodents, rabbits and hares.

Common in people who skin rabbits, Common in people who skin rabbits, rodents.rodents.

TularemiaTularemia

Highly infectious disease and some strains Highly infectious disease and some strains are resistant to antibiotics.are resistant to antibiotics.

Bacterium may be delivered by aerosol and Bacterium may be delivered by aerosol and infection by inhalation or from skin, mucus infection by inhalation or from skin, mucus membrane, or gastrointestinal being membrane, or gastrointestinal being exposed.exposed.

Transmission of the disease from person to Transmission of the disease from person to DOES NOT occurDOES NOT occur

TularemiaTularemia

Pulmonary form:Pulmonary form:– Most likely bioterrorism formMost likely bioterrorism form– Aerosol exposureAerosol exposure– Presents with fever, chills, headache, weight Presents with fever, chills, headache, weight

loss, non productive coughloss, non productive cough– Pneumonia in 30 – 80%Pneumonia in 30 – 80%

TularemiaTularemia

Inhalation Inhalation – Sudden febrile illnessSudden febrile illness– Pharyngitis, bronchiolitis, pneumonitis, pleuritisPharyngitis, bronchiolitis, pneumonitis, pleuritis– Hilar lymphadenitis and/or sepsisHilar lymphadenitis and/or sepsis

TularemiaTularemiaTreatmentTreatment

Streptomycin 1g IM bid x 10 D until afebrile Streptomycin 1g IM bid x 10 D until afebrile for 5 – 7 days ORfor 5 – 7 days OR

Gentamycin 5mg/kg/d IM or IV QD x 10d Gentamycin 5mg/kg/d IM or IV QD x 10d OROR

Cipro 400 mg IV BID ORCipro 400 mg IV BID OR Doxycycline 100 mg IV BID for 14dDoxycycline 100 mg IV BID for 14d

TularemiaTularemiaTreatmentTreatment

PEPPEP– Cipro 500 mg po BID for 14 d ORCipro 500 mg po BID for 14 d OR– Doxycycline 100 mg po BID for 14 dDoxycycline 100 mg po BID for 14 d

Viral Hemorrhagic FeversViral Hemorrhagic Fevers(VHF)(VHF)


VHF group of illnesses caused by a distinct VHF group of illnesses caused by a distinct family of viruses which include arenaviruses, family of viruses which include arenaviruses, filoviruses, bunyaviruses, and flavaviruses.filoviruses, bunyaviruses, and flavaviruses.

Most are highly infectious if spread by Most are highly infectious if spread by aerosolization, some can cause infection just aerosolization, some can cause infection just by touching corpse at burial! by touching corpse at burial!

Cause multisystem syndrome characterized Cause multisystem syndrome characterized by hemorrhagic disease.by hemorrhagic disease.


Signs and symptomsSigns and symptoms– Fever, fatigue, dizziness, muscle aches, loss of Fever, fatigue, dizziness, muscle aches, loss of

strength, exhaustion, bleeding from mucous strength, exhaustion, bleeding from mucous membranes, internal organs, or from mouth, membranes, internal organs, or from mouth, eyes, or ears. eyes, or ears.

– Shock, renal failure, CNS dysfunction, coma, Shock, renal failure, CNS dysfunction, coma, and seizures may develop as welland seizures may develop as well


TreatmentTreatment Supportive Supportive quarantinequarantine

Nuclear and Radiological ThreatsNuclear and Radiological Threats


Most likely scenario involving terrorist use of Most likely scenario involving terrorist use of radioactive material would involve use of a radioactive material would involve use of a Radiation Dispersion Device (RDD) also Radiation Dispersion Device (RDD) also known as a Dirty bomb or Dirty nuke.known as a Dirty bomb or Dirty nuke.

Require little technical knowledge to build Require little technical knowledge to build and deploy and do not require relatively and deploy and do not require relatively difficult to obtain weapons-grade plutonium difficult to obtain weapons-grade plutonium or uranium.or uranium.


Main type of RDD combines an explosive with Main type of RDD combines an explosive with radioactive material.radioactive material.

Extent of contamination would depend on a Extent of contamination would depend on a number of factors such as size of the explosive, number of factors such as size of the explosive, amount and type of radioactive material used and amount and type of radioactive material used and weather conditions.weather conditions.

Detonation of an RDD releases radioactive fallout Detonation of an RDD releases radioactive fallout which could cause radiation sickness, severe which could cause radiation sickness, severe burns, and long term cancer fatalities.burns, and long term cancer fatalities.


In most cases the conventional explosive In most cases the conventional explosive will cause more deaths than the exposure to will cause more deaths than the exposure to the radioactive material.the radioactive material.


Principles of time, distance, and shielding Principles of time, distance, and shielding should be used for personal protection and should be used for personal protection and the protection of othersthe protection of others– Limit time at sceneLimit time at scene– Increase distance from sceneIncrease distance from scene– Shield self with appropriate personal protective Shield self with appropriate personal protective

equipment, geography, or structural materials equipment, geography, or structural materials whenever possible.whenever possible.


Rad (radiation absorbed dose):Rad (radiation absorbed dose):– Special unit of absorbed doseSpecial unit of absorbed dose

Rem (roetgen equivalent man):Rem (roetgen equivalent man):– Biologic effect of radiationBiologic effect of radiation– Unit of radiation dose equivalentUnit of radiation dose equivalent– Equal to absorbed dose in rads x relative Equal to absorbed dose in rads x relative

biological effectiveness of radiation in questionbiological effectiveness of radiation in question


Exposure levelsExposure levels– Sleeping next to a human 0.1 mRSleeping next to a human 0.1 mR– Flying in an aircraft 0.5 mRFlying in an aircraft 0.5 mR– 3 mile island accident 1.5 mR3 mile island accident 1.5 mR– Nuclear weapon fallout 4.5 mRNuclear weapon fallout 4.5 mR– Single Cxr 12 -17 mRSingle Cxr 12 -17 mR– Cosmic rays & terrestrial sources 25 mR/yrCosmic rays & terrestrial sources 25 mR/yr– Radon 200 mR/yrRadon 200 mR/yr– Smoking 280 mR/pack yrSmoking 280 mR/pack yr– Cancer Rx 5000RCancer Rx 5000R

Nuclear and Radiological ThreatsNuclear and Radiological ThreatsSymptoms by DoseSymptoms by Dose

(whole body dose in rem)(whole body dose in rem) 5 – 100 asymptomatic-decr leuks/plat, 5 – 100 asymptomatic-decr leuks/plat,

chromosomal aberrationschromosomal aberrations 100 – 200 n/v, anorexia, decr lympocytes w/i 48 100 – 200 n/v, anorexia, decr lympocytes w/i 48

hrshrs 200 – 400 n/v for 2 – 4 days, skin erythema, 200 – 400 n/v for 2 – 4 days, skin erythema,

epilationepilation 400 – 600 n/v/d, 50% mortality w/i 30d, 400 – 600 n/v/d, 50% mortality w/i 30d, 600 – 1000 acute radiation syndrome, n/v/d, GI 600 – 1000 acute radiation syndrome, n/v/d, GI

hemorrhage, incr. mortality w/i 14 dhemorrhage, incr. mortality w/i 14 d >1000 rapid onset GI symptoms, cns, cvs >1000 rapid onset GI symptoms, cns, cvs

complications, 100% mortality w/i 72 hrscomplications, 100% mortality w/i 72 hrs

Nuclear and Radiological ThreatsNuclear and Radiological ThreatsExposure risksExposure risks

1 R over a few mins: incr risk of CA btwn 1 1 R over a few mins: incr risk of CA btwn 1 in 2000 and 1 in 100,000in 2000 and 1 in 100,000

10 R: incr. risk of genetic abn. btwn 1 in 300 10 R: incr. risk of genetic abn. btwn 1 in 300 to 1 in 20,000; can cause prenatal deathto 1 in 20,000; can cause prenatal death

15 R: decrease in sperm count15 R: decrease in sperm count

Nuclear and Radiological ThreatsNuclear and Radiological ThreatsTreatmentTreatment

No symptoms 6hr post exposure: exposure < 50 No symptoms 6hr post exposure: exposure < 50 remsrems

Symptoms 2 – 6 hrs post exposure: exposure 200 Symptoms 2 – 6 hrs post exposure: exposure 200 remsrems

Symptoms <2 hrs: exposure > 400 rems, acute Symptoms <2 hrs: exposure > 400 rems, acute radiation syndromeradiation syndrome

Follows abc’s stabilize pt, Potassium iodide may Follows abc’s stabilize pt, Potassium iodide may protect thyroidprotect thyroid

Containment and monitoring of radioactive fallout, Containment and monitoring of radioactive fallout, evacuation, and decontamination.evacuation, and decontamination.

Incendiary threatsIncendiary threats

Range of device from the simple molotov Range of device from the simple molotov cocktail to larger more sophisticated devicescocktail to larger more sophisticated devices

The main use in terrorism is to generate The main use in terrorism is to generate panic (weapon of mass disruption)panic (weapon of mass disruption)

Primary concerns include:Primary concerns include:– Possible large number of injured victims and Possible large number of injured victims and

fatalityfatality– Overwhelming of local resourcesOverwhelming of local resources– Public fearPublic fear

Incendiary threatsIncendiary threatsManagementManagement

Dependent on nature of attackDependent on nature of attack First responders should not approach until First responders should not approach until

scene is safe.scene is safe. High probability of second device designed High probability of second device designed

to injure/kill emergency response personnel.to injure/kill emergency response personnel. Biological, chemical or nuclear materials Biological, chemical or nuclear materials

may have been used in the explosion.may have been used in the explosion.

Chemical ThreatsChemical Threats


Developed in pre WWII GermanyDeveloped in pre WWII Germany US stockpiles contain nerve agents Sarin US stockpiles contain nerve agents Sarin

(GB) and VX(GB) and VX Matsumato GB attack in 1994Matsumato GB attack in 1994 Tokyo subway GB attack in 1995Tokyo subway GB attack in 1995


Most toxic and rapidly acting of the known Most toxic and rapidly acting of the known warfare chemical agentswarfare chemical agents

Nerve agents work similarly to Nerve agents work similarly to organophosphates in terms of how they organophosphates in terms of how they work and what kind of harmful effects they work and what kind of harmful effects they cause. (inhibit effect of acetylcholinesterase, cause. (inhibit effect of acetylcholinesterase, leads to cholinergic overdrive)leads to cholinergic overdrive)


Sarin (BG) clear, colorless, and tasteless Sarin (BG) clear, colorless, and tasteless w/o odor; can evaporate into a vapor rapidly w/o odor; can evaporate into a vapor rapidly and mixes easily with water.and mixes easily with water.

Anyway you can contact this stuff, it can kill Anyway you can contact this stuff, it can kill you.you.

Symptoms start w/in min. to hours dep on Symptoms start w/in min. to hours dep on dose: headache, salivation, chest pain, dose: headache, salivation, chest pain, abdominal cramps, fasiculations, sz, resp. abdominal cramps, fasiculations, sz, resp. failure and deathfailure and death


Soman (GD) and Tabun (GA) Soman (GD) and Tabun (GA) Similar to Sarin except GD has odor similar Similar to Sarin except GD has odor similar

to Vicks vapor rub or a rotting fruit odor.to Vicks vapor rub or a rotting fruit odor. GA has a faint fruity odor.GA has a faint fruity odor. Effects similar to SarinEffects similar to Sarin


VX thick amber colored odorless liquid. VX thick amber colored odorless liquid. Most potent of all nerve agentsMost potent of all nerve agents

– Considered much more toxic than other agents Considered much more toxic than other agents when absorbed thru the skin and somewhat when absorbed thru the skin and somewhat more toxic when inhaled than the other agentsmore toxic when inhaled than the other agents

Symptoms appear w/i seconds after to Symptoms appear w/i seconds after to exposure to vapor and w/i min. to hrs after exposure to vapor and w/i min. to hrs after exposure to the liquid formexposure to the liquid form

Chemical ThreatsChemical ThreatsTreatmentTreatment

Rapid decontamination, clothing can release Rapid decontamination, clothing can release agent for about 30 min. after exposureagent for about 30 min. after exposure

Atropine and pralidoxime chloride are Atropine and pralidoxime chloride are antidotes. (available in auto injector kits ie. antidotes. (available in auto injector kits ie. Mark I)Mark I)

Large and repeated doses of these drugs Large and repeated doses of these drugs may be requiredmay be required


Lethal dermal dose for 70 kg adultLethal dermal dose for 70 kg adult– Sarin 1.7 gSarin 1.7 g– Tabun 1 gTabun 1 g– Soman 100 mgSoman 100 mg– VX 1 mgVX 1 mg

Persistence in environmentPersistence in environment– Sarin 5 dSarin 5 d– Tabun 1 – 2 dTabun 1 – 2 d– Soman 1 – 2 dSoman 1 – 2 d– VX 6dVX 6d

Chemical ThreatsChemical Threats(poisonous gases)(poisonous gases)

Popular weapons in WWIPopular weapons in WWI Produced in large quantities worldwide for Produced in large quantities worldwide for

use by the industrial sectoruse by the industrial sector


Chlorine gas- yellow green gas, odor of Chlorine gas- yellow green gas, odor of pineapple and pepper.pineapple and pepper.

Shipped as a liquid under pressure, quickly Shipped as a liquid under pressure, quickly aerosolizes when releasedaerosolizes when released

Exposure thru skin, inhalation, or eye Exposure thru skin, inhalation, or eye contactcontact

May also be released in water as wellMay also be released in water as well


Exposure:Exposure:– 1 – 3 ppm: mild mucous memb. Irritation after 1 hr1 – 3 ppm: mild mucous memb. Irritation after 1 hr– 5 – 15 ppm: mod. Irritation of upper resp. tract5 – 15 ppm: mod. Irritation of upper resp. tract– 30 ppm: immediate chest pain, vomiting and coughing30 ppm: immediate chest pain, vomiting and coughing– 40 – 60 ppm: toxic pneumonitis & pulmonary edema40 – 60 ppm: toxic pneumonitis & pulmonary edema– 430 ppm: lethal after 30 min.430 ppm: lethal after 30 min.– 1000 ppm: fatal w/i a few mins.1000 ppm: fatal w/i a few mins.


Phosgene (CG)Phosgene (CG)– Gray/white cloud and smells of freshly mown Gray/white cloud and smells of freshly mown

hayhay– Shipped as a liquid under pressure but changes Shipped as a liquid under pressure but changes

to vapor when releasedto vapor when released– Stays close to the ground and spreads rapidlyStays close to the ground and spreads rapidly– Can be mixed with water as wellCan be mixed with water as well


Both chlorine and phosgene gas produce Both chlorine and phosgene gas produce similar symptoms:similar symptoms:– Chest painChest pain– Burning sensation in nose, eyes, or throatBurning sensation in nose, eyes, or throat– GI distress, dermal burnsGI distress, dermal burns– Sob/dyspnea, pulmonary edemaSob/dyspnea, pulmonary edema– Phosgene also causes hypotension and heart Phosgene also causes hypotension and heart

failurefailure


TreatmentTreatment– No specific treatmentNo specific treatment– Remove from exposureRemove from exposure– Do not induce vomitingDo not induce vomiting– O2 and bronchodilators for bronchospasmO2 and bronchodilators for bronchospasm– Steroids of no proven benefitSteroids of no proven benefit– Treat pulm. Edema with cpap or peepTreat pulm. Edema with cpap or peep

Explosive ThreatsExplosive Threatsclassificationclassification

Unconventional: conventional object used in Unconventional: conventional object used in an unconventional way…think 9/11an unconventional way…think 9/11

Vehicle bombVehicle bomb Pipe bombPipe bomb Satchel charge: old military term for Satchel charge: old military term for

explosives carried in a canvas satchel, now explosives carried in a canvas satchel, now any backpack/daypack bombany backpack/daypack bomb

Package or letter bombPackage or letter bomb

Explosive ThreatsExplosive Threats

Same warnings from incendiary bombs Same warnings from incendiary bombs applyapply

Hermann GoeringHermann Goering

bioterrorism and weapons of mass destruction

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