Ronald R. Blanck, D.O.
LTG, USA (Retired)

“…any explosive, incendiary, or poison gas, bomb, grenade, rocket having propellant charge more than four ounces, missile having an explosive charge of more than one quarter ounce, mine or device similar to the above…poison gas…disease organism…radiation.”
“…any weapon or device that is intended, or has the capability, to cause death or serious bodily injury…through the release of…poisonous chemicals…disease…or radiation….”

Significant casualties from terrorist use of:
 Nuclear Device
 Chemical Device


Tabun (GA)
Sarin (GB)
 Soman (GD)
 Biological Device




Botulism Toxin
Anthrax
Plague
Ricin
 Large Conventional
Explosive Device

“Warfare deliberately waged against civilians with the purpose of destroying their will to support either leaders or policies that the agents of such violence find objectionable.”
Lessons of Terror
- Caleb Cobb

-- Tom Clancy
The Sum of All Fears

Presidential Decision Directive 39
U.S. Policy on Counterterrorism
June 21, 1995
PRESIDENT
HOMELAND DEFENSE
Governor Tom Ridge
NATIONAL SECURITY COUNCIL
Coordination of Federal Agencies
FEMA
FBI
INCIDENT
CONTINGENCY PLANS
Crisis Management
FEDERAL
RESPONSE PLAN
Consequence Management

• Crisis Management
– Measures to anticipate, prevent, and/or resolve a terrorist threat or incident
• Primary Responsibility: Federal Government
• Lead Federal Agency: FBI
• Consequence Management
– Measures to alleviate the damage, loss, hardship, or suffering caused by incident
• Primary Responsibility: State/Local Government
• Lead Federal Agency: FEMA, coordinating Federal
Consequence Management support to the state

Programs
• Domestic Preparedness
 Interagency effort directed by Congress
 AKA: Nunn-Lugar-Domenici City Training
• Consequence Management Program
Integration
 DoD efforts directed by SECDEF (DRID #25)
 Improve DoD Support for Response to WMD attacks
 Integrate National Guard and Reserve
Components

Purpose of Nunn-Lugar-
Domenici
• To enhance the capability of the Federal
Government to prevent and respond to terrorist incidents involving weapons of mass destruction
• To provide enhanced support to improve the capabilities of state and local emergency response agencies to prevent and respond to such incidents at both the national and local levels

Domestic Emergency Continuum
Greatest
Most Likely
Probability
IED --
Least Likely
-- IND
IBD --
ICD --
Impact
Civil Demo --
HURRICANE
Civil Disturbance --
HAZMAT --
Severe T-Storm --
MAJOR
FLOODING
-- Aircraft Accident
STATE & LOCAL FEDERAL
WMD

Tiered Disaster/Emergency Response
Federal Response
State Response
Local Response
Incident Commander
• Full response requires local, state, and federal assets
• State response includes National Guard
• Military support requires Total Force involvement

Federal WMD Response Assessment
Scenario
Radiological Threat
(Plutonium)
Summary: Terrorists place a radiation Dispersal Device which distributes plutonium over a populated area.
Nuclear Explosion Threat
(Uranium)
Summary: An improvised nuclear device (1.5KT) is exploded at midday in the vicinity of a state capitol building.
Biological Agent Threat
(Anthrax)
Summary: 100 grams of anthrax released into the air distribution system at a major airport.
Chemical Nerve Agent
Threat (GB)
Summary: 10 Gallons of Sarin is released on a busy morning in trash canisters at 5 Subway stations in a major city.
Chemical Nerve Agent
Threat (VX) (Persistent)
Summary: M23 Land mines (.8lb) placed in suitcases at major airport and exploded at midday
It’s not IF, It’s WHEN and WHERE?
* Bottom Line - we are not ready!

The intentional use of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants

• 14th Century: plague at Kaffa
• 18th Century: smallpox blankets
• 1943: USA program established
• 1953: Defensive program established
• 1969: Offensive program disestablished
• 1979: Sverdlovsk Anthrax incident
• SE Asia: Yellow Rain
• London, Virginia: Ricin

• 1925 Geneva Protocol
• 1969 Nixon renounces BW
• 1972 Biological Weapons Convention
• 1975 Geneva Conventions Ratified

• No use under any circumstance
• Research limited to defensive measures
• We possess NO weaponized biologicals
• Previous weapons stocks destroyed
• Destruction supervised:
– USDA
– Dept of HEW
– DNR of AR, CO, MD

• Lethal
– B. anthracis
– Botulinum toxins
– F. tularensis
• Anticrop
– wheat stem rust
– rye stem rust
– rice blast
• Incapacitating
– Brucella suis
– VEE virus
– SEB
– Q fever agent

• April-May 1979
– 66 Anthrax fatalities
• 1988
– Soviets present data:
• 96 cases
• 79 gastrointestinal
• May 1992
– Yeltsin admits
“military developments”

“Agents Likely to be Used”
• Smallpox
• Plague
• Anthrax
• Botulism
• VEE
• Tularemia
• Q Fever
• Marburg
• Influenza
• Melioidosis
• Typhus

-- Dr Ken Alibek

Are Biologicals the Ultimate Weapon?
• agents easy to procure
• inexpensive to produce
• can disseminate at great distance
• agent clouds invisible
• detection quite difficult
• first sign is illness
• overwhelms medical capabilities
• simple threat creates panic
• perpetrators escape before effects
• ideal terrorist weapon

Acquisition of Etiologic Agents
• Multiple Culture Collections
• Universities
• Commercial Supply Houses
• Foreign Laboratories
• Field Samples or Clinical Specimens

50 kg agent, 2 km front, upwind of city of 500,000
Agent
RVF
TBE
Reach
1
1
Typhus
Brucella
5
10
Q fever >20
Tularemia >20
Anthrax >>20
KIA
400
9500
19000
500
150
30000
95000
WIA
35000
35000
85000
100000
125000
125000
125000

• Letters
• Packages
• Cultures
• Person – to - Person

• Not Typical First Responders
• BIO First Responders
- Physician’s Office
- ER
- Clinics
• All Organizations Involved

• Rapid Detection
• Public Health
• Hospital Capacity
• Stockpiling
• Vaccine Production

 Awareness
 Presumptive Diagnosis
 Reporting
 Epidemiology
 Response
– Triage
– Prophylaxis
– Immunizations
– Treatment
 Risk Communications

26 February 1993, New York
20 March 1995, Tokyo
It’s not even a question of when…
11 September 2001, New York