Physicians
and
WMDs
Prepared by Joshua G. Paschall
Physicians and WMD
“Weapons of mass destruction” (WMD) is a term used to describe a massive
weapon with the capacity to indiscriminately kill or incapacitate.1 WMDs can also be
described by another acronym, CBRNE (chemical, biological, radiological, nuclear,
and explosive), and most commonly refer to non-conventional warheads. Physician
preparedness for terrorist events involving WMDs is important. According to an
article in Disaster Management Response,
“… physicians can play a unique role in public health preparedness because they are among the most
trusted first receivers in a health-related incident, including CBRNE-inflicted events. Physicians may assist
health officials in dealing with patients who experience fear, confusion, concerns, and psychological stress
that normally arise in disasters and that often present significant management and emotional challenges. In
addition to providing early detection, treatment, and reporting, physicians can actively report and
collaborate with public health authorities to help augment services.” 2
Preparedness is key because a CBRNE event could occur at any time. Each
type of WMD attack is unique and will require specific skills, knowledge, as well as an
ability to handle the mass casualty challenges that come along with any major
disaster (natural or otherwise). The following paragraphs give a brief introduction to
each type of WMD and how they can impact physicians. In-depth discussion of these
WMDs and preparedness for them can be found in the resources section at the end of
this document.
Chemical
Mass chemical injuries may occur at any time from chemical spills in factories,
from tankers, etc., but these may also be a result of WMD attacks. Although
hospitals have plans to deal with such a massive influx of victims, it is important that
physicians are individually prepared to identify trends that point to a covert release
of chemical weapons. Since many early symptoms of chemical attacks may be mild
and similar to some common diseases, physicians must be alert to any significant
patient trends that might point to a chemical attack.
Biological
Biological weapons are one of the least common WMDs used by terrorists due
to the difficulty in culturing and distributing the various possible pathogens.
However, since it has major potential for widespread and self-propagating
destruction, a biological attack remains a potent option for terrorist use. In light of
the current increased risk for WMD attack, physicians must add possible WMDinflicted diseases into their differential diagnosis of many common flu-like symptoms.
In the case of a biological attack, a previously established understanding of common
biological agent symptoms may be critical in the early detection and control of
disease inflicted by these WMDs.
Radiological/Nuclear
Radiological and nuclear WMDs provide an entirely unique gamut of problems
to deal with. Nuclear WMDs are not likely to be used by terrorists due to their
complexity, but radioactive material combined with conventional explosives (a “dirty
bomb”) creates a relatively simple and effective method of affecting large
populations with lethal or debilitating doses of radioactivity. Physicians can approach
1
Wikipedia, Weapons of Mass Destruction, 5 July 2007, available from http://en.wikipedia.org/wiki/Weapons_of_mass_destruction;
Internet; accessed 5 July 2007.
2
Chiehwen Ed Hsu, et al, “Assessing the Readiness and Training Needs of Non-urban Physicians in Public Health Emergency and
Response,” Disaster Management and Response, Oct-Dec 2005, 106.
both nuclear and radioactive WMD events similarly, although nuclear WMDs will
cause a massively larger number of blast casualties than would a “dirty bomb” or
some other radiological WMD. Physicians must be aware of the likelihood of delayed
symptoms in the case of radiological dosing.
Explosives
The most common type of WMD due to their ease of use and procurement are
explosives. While there is no uncertainty as to the source or impact of these events,
the psychological trauma and sudden influx of injuries make them a challenge to deal
with. Blast injuries are classified by four mechanisms of injury: primary (blast
injury), secondary (flying debris), tertiary (blast wind), and quaternary (all others;
e.g., crush injuries or asthma attacks).3 Injury patterns can also vary significantly
depending on whether the explosive was high- or low-order, and whether it was
manufactured or improvised.
Resources
 An excellent resource from the AMA is the “Management of Public Health
Emergencies” CD that is designed to be a quick, easy reference tool that equips
physicians to properly identify and handle natural disasters and terrorism events.
This informational CD contains over 1,000 links to other useful resources, and it
is available for free.
Request a copy by contacting the AMA at disastercd@ama-assn.org.

Information regarding diverse elements of CBRNE attacks can be found out the
following eMedicine website. CME credit is available for all of the nearly fifty
different topics.
Go to http://www.emedicine.com/emerg/ and click on the “Warfare - Chemical,
Biological, Radiological, Nuclear And Explosives” link.

Physicians may earn up to 22.5 hours of CME credit through the following
resource that focuses on physician preparedness for chemical, biological, or
radiological contamination of U.S. water supply systems. This resource also
contains a significant amount of linked information to other WMD-preparedness
websites.
Go to http://www.waterhealthconnection.org/bt/tableofcontents.asp.
AMA Quick Reference Guides
The following pages contain quick reference guides for radiological, chemical, and
biological WMD attacks. These guides were produced by the AMA and are used with
permission.
They may also be referenced through the AMA website at http://www.ama-assn.org/
3
Centers for Disease Control, Explosions and Blast Injuries: A Primer for Clinicians, 14 June 2006, available from
http://www.bt.cdc.gov/masscasualties/explosions.asp; Internet; accessed 5 July 2007.