June CEUs
Weapons of Mass Destruction
Weapons of Mass Destruction
After reading this article you will be able to:
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Define Weapons of Mass Destruction.
Explain the different types of Warfare.
Discuss the different delivery systems for each type of warfare.
Discuss the routes of exposure to an attack of Weapons of Mass Destruction.
September 11, 2001, is a day that will forever be
infamous for heartbreak, tragedy, and an all too realthreat of terrorism within the formerly unbreakable
United States. Not only were thousands of innocent
citizens killed, but hundreds of emergency workers
trying to help the wounded and save those in danger.
This tragedy, as well as other terrorist incidents have
brought new attention to the threat of Weapons of
Mass Destruction. This non-traditional form of
warfare is a bigger threat now than ever before. As
EMS workers, education and preparedness are key
elements to a successful response to a catastrophic
attack of biological warfare.
Weapons of Mass Destruction (WMD) are weapons
designed to kill large numbers of people, usually
civilians but also potentially military personnel. They are generally considered to be of
limited military usefulness because their destructiveness is likely to trigger an extreme
response. They are also known as weapons of indiscriminate destruction, weapons of
mass disruption and weapons of catastrophic effect.
WMDs are categorized into four distinct groups: Biological, Chemical, Nuclear, and
Radiological devices. The threat is terrifying in that the attack is not obvious like
traditional warfare of guns and loud explosions. While the attack could be a catastrophic
blast, it could also be a silent but deadly release of a poisonous gas. The desired effect is
to kill, but in addition to death, it is to strike panic among the entire community and the
rest of the world. As EMS workers, it is important to have an understanding of the
different types of WMDs so that the mechanism can be properly identified. Each type of
warfare has different signs, symptoms, and treatment interventions.
Toxicology
In the event of an attack of a WMD, the emergency management personnel must
understand the basic toxicology principals. The first principal is to be able to distinguish
whether the effect is acute (sudden) or is the effect delayed. This will make a difference
on how to set up a triage area and determine priority. Also, EMS personnel must
understand the routes of exposure. These include:
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Inhalation
Absorption
Ingestion
Through an open wound/Injection
EMS personnel should have an understanding of how triage should be constructed, what
appropriate field treatment is required and which hospitals are equipped to handle a mass
casualty and have a necessary antidote.
EMS Safety
There is no single ensemble that provides first responders the "ultimate" WMD response
protection; therefore, the EMS workers should cautiously approach each situation upon
the guidance of medical control. As with all situations, the safety of the EMS worker
always comes first. The EMS community must therefore carefully study the WMD
response scenarios most likely to occur in their community and prepare to the best of
their ability. EMS should never approach a suspicious situation or object without
guidance from medical control and the proper protective gear. EMS workers should
immediately evacuate the area until further direction. The last thing that the EMS workers
want to do is disturb the possible weapon allowing for a bigger release or injury to
themselves or more civilians.
Biological Warfare
A biological weapon uses a bacteria or virus or in some cases toxins to kill people. If you
were to dump a load of manure or human waste into a town's well, that would be a simple
form of biological warfare -- human and animal manure contain bacteria that are deadly
in a variety of ways.
Terrorism involving biological weapons is the least effective as far as mass murder, but is
very cost effective and able to be spread in a discreet uncomplicated fashion. Biological
weapons are referred to as “the poor man’s nuclear weapon.” This type of weapon can
range from tainting a water or food supply, to an aerosolized release over a chosen area.
Weapons
Ideal characteristics of biological weapons are low visibility, high potency, accessibility,
and easy delivery.
Diseases most likely to be considered for use as biological weapons are contenders
because of their lethality (if delivered efficiently), and robustness (making aerosol
delivery feasible).
The biological agents used in biological weapons can often be manufactured quickly and
easily. The primary difficulty is not the production of the biological agent but delivery in
an infective form to a vulnerable target.
For example, anthrax is considered an excellent agent. First, it forms hardy spores,
perfect for dispersal by aerosols. Second, pneumonic (lung) infections of anthrax usually
do not cause secondary infections in other people. Thus, the effect of the agent is usually
confined to the target. A pneumonic anthrax infection starts with ordinary "cold"
symptoms and quickly becomes lethal. Finally, friendly personnel can be protected with
suitable antibiotics or vaccines.
A mass attack using anthrax would require the creation of aerosol particles of 1.5 to 5
microns. Too large and the aerosol would be filtered out by the respiratory system. Too
small and the aerosol would be inhaled and exhaled. Also, at this size, nonconductive
powders tend to clump and cling because of electrostatic charges. This hinders
dispersion. So, the material must be treated with silica to insulate and discharge the
charges. The aerosol must be delivered so that rain and sun does not rot it, and yet the
human lung can be infected. There are other technological difficulties as well.
The center for disease control has categorized the long list of biological weapons into
three distinct categories. Category A, which are weapons most likely to be used. Category
B, which is the second highest priority, and Category C, which are “emerging infectious
disease threats.”
Category A
These are the weapons that are most likely to be used in a biological attack. They can do
the most amount of damage in terms of death rates and how fast they can spread and be
distributed. Examples of Category A weapons:
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Anthrax : Anthrax is a bacteria with a highly resistant spore form. It is highly
infectious and lethal when inhaled. It is a one-time agent that does not spread
from one person to another. An anthrax vaccine does exist but requires many
injections and has enough side-effects that it is considered unsuitable for general
use.
Botulism: Botulism is one the deadliest toxins caused by a bacteria. Botulism
causes respiratory failure and paralysis.
Plague: Plague is a highly contagious bacteria. It causes a type of pneumonia and
may be fatal.
Smallpox : Smallpox is a highly contagious virus. It transmits easily through the
atmosphere and has a high mortality rate. Smallpox was eliminated in the world in
the 1970s thanks to a worldwide vaccination program. However, some virus are
still available in Russian and American laboratories. It is also believed it could be
available in other labs.
Category B
This form of biological weapons is the second-highest priority to the Center for Disease
Control. They are fairly easy to spread, but cause only moderate amounts of disease and a
low fatality rate. The diseases caused by category B’s are treatable if early detection is
successful. Proper diagnosis requires specific public health action and aggressive
treatment. Examples of Category B weapons:
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Q Fever: Q fever is found around the world and affects sheep, goats, cattle, dogs,
cats, birds, rodents and ticks, as well as some other animals. Infected animals shed
this bacteria in urine, feces, birth products and milk. Humans usually acquire Q
fever by inhaling contaminated droplets excreted by infected animals.
Viral Encephalitis: Viral encephalitis is inflammation of the brain caused by a
virus. Some viral diseases, such as measles and rubella can also progress to
involve inflammation of the brain. Other micro-organisms, such as bacteria, fungi
and parasites are capable of triggering encephalitis.
Typhus: Typhus also known as war fever has always been associated with war.
Humans become infected by rubbing or scratching the feces of lice, mites,
chiggers or fleas into their skin or into their mucous membranes.
Category C
This form of biological warfare is described as “emerging infectious disease threats.”
They are the most easy to obtain and produce extremely high rates of mortality and
disease. Examples of category C weapons:
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Hantavirus: Hantavirus is a deadly disease transmitted by infected rodents through
urine, droppings, or saliva. Humans can contract the disease when they breathe in
aerosolized virus.
Nipah virus: Nipah virus was identified in 1999 when it caused an outbreak of
neurological and respiratory disease on pig farms in peninsular Malaysia resulting
in 105 human deaths and the culling of one million pigs.
Other Types of Biological Agents
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Ebola: Ebola is a viral hemorrhagic fever. It is extremely lethal, with no cure. The
symptoms are profuse bleeding from the orifices.
Marburg: Marburg is a viral hemorrhagic disease. It is extremely lethal, with no
cure.
Tularemia: Tularemia is a bacteria, responsible for non-lethal but extremely
incapacitating diseases (weight loss, fever, headaches, and often pneumonia).
Agricultural Bioterrorism
Another form of biological attack is to contaminate animals. This not only can kill our
food supply by diseasing their drinking water or the grass they eat, but it can also cause
death if diseased meat is processed and ingested by humans. An example of this is Mad
Cow Disease.
Delivery Systems
Biological weapons are relatively easy to spread. They can be ingested, such as the
successful contamination of food or water. They also can be aerosolized, which means
they can be released into the air and contaminate people when they breathe. Many of the
biological weapons can cause harm just by contact with human skin.
Symptoms
The signs and symptoms of biological warfare can include flu-like symptoms,
exhaustion, pneumonia, weight loss, stomach pain, diarrhea, respiratory failure and
shock.
Treatment
Biological weapons are not easily diagnosed. Usually patients do not exhibit the full
extent of their problem until weeks or months after the initial exposure. Public health
officials often can't pinpoint bio-terrorism right away because symptoms often mirror
ones exhibited by a person with the common cold or the flu.
In-hospital treatments include antidotes, antibiotics, vaccines and pumping of the
stomach. EMS treatment usually just requires oxygen and transport, as it is not easily
diagnosed in the field what exposure has occurred.
Chemical Warfare
A chemical weapon is any weapon that uses a manufactured chemical to kill people. The
first chemical weapon used effectively in battle was chlorine gas, which burns and
destroys lung tissue. Chlorine is not an exotic chemical. Most municipal water systems
use it today to kill bacteria. It is easy to manufacture from common table salt. In World
War I, the German army released tons of the gas to create a cloud that the wind carried
toward the enemy.
Modern chemical weapons tend to focus on agents with much greater killing power,
meaning that it takes a lot less of the chemical to kill the same number of people. Many
of them use the sorts of chemicals found in insecticides. When you spray your lawn or
garden with a chemical to control aphids, you are, in essence, waging a chemical war on
aphids.
Chemical weapons are a little bit different in that there are known stockpiles of it through
out the world. It is constantly questioned how secure it can be kept. It is highly desired by
terrorist groups because it is easy to replicate, fairly cheap to obtain, has a violent
instantaneous effect, and the supplies are inexpensive as well. It is believed that in the
future chemical agents will be vastly pursued by terrorist organizations. It is widely
believed that Al Queda, the terrorist network held accountable for the September 11
attacks, has actively tried to make their own chemical weapons.
Weapons
The most well known chemical agent is mustard gas. Chemical agents run in all types
from blood agents, to respiratory agents, to choking agents.
Nerve agents are the most toxic of the known chemical warfare agents. Depending on the
type of nerve agent, they can be absorbed through the skin, respiratory tract,
gastrointestinal tract and the eyes. Chemical Nerve Agents kill by disrupting the
metabolic processes, causing a buildup of a chemical messenger (acetylcholine) by
inhibiting the production of acetylcholinesterase, a key regulator of neurotransmission.
Lethal exposure to chemical nerve agents is generally characterized by drooling,
sweating, cramping, vomiting, confusion, irregular heart beat, convulsions, loss of
consciousness and coma. Little is known, however, about the long term effects of nonlethal exposure.
Blood agents were used to a limited extent in World War I. They are fast-acting, highly
poisonous chemicals. Blood agents, sometimes referred to as Cyanides, affect an enzyme
allowing the red blood cells to acquire oxygen, preventing the transfer of oxygen to other
cells. Consequently, body tissue decays rapidly due to a lack of oxygen and retention of
carbon dioxide, initially affecting the heart and then the brain. About 15 seconds after
inhalation of concentrated vapor, abnormally deep breathing is followed in about 15 to 30
seconds by convulsions, with respiratory activity stopping about 2 to 3 minutes later.
Subsequently, cardiac activity ceases several minutes later.
Blister agents were initially used by Germany in World War I. Vesicants/blister gases
first affect the eyes and respiratory tract when inhaled, along with reddening of the skin,
followed by ulcerations and systemic poisoning. Death results from respiratory failure,
bacterial pneumonia or immune system failure. There is no specific antidote and
decontamination is the only way to reduce damage.
Choking agents are the oldest known chemical warfare agents. Choking agents, such as
Phosgene, irritate the alveoli in the lungs and cause the constant secretion of fluid into the
lungs. As a result, the lungs slowly fill with fluid and the victim dies from the lack of
oxygen. Choking agents are heavy gases and tend to stay close to the ground but tend to
dissipate rapidly in a breeze. There is no antidote for choking agents. Skin and eye
decontamination should be performed immediately after exposure.
Sarin: A colorless and practically odorless liquid, Sarin dissolves well in water and
organic solvents. The basic military use of Sarin is that of a gas and a persistent aerosol.
A highly toxic agent with a clearly defined myopic effect, symptoms of intoxication
appear quickly without any period of latent effect. Sarin has a cumulative effect,
independent of its method of entry into the body. The progressive signs of initial Sarin
intoxication include myosis (contraction of the pupil), photophobia, difficulty breathing
and chest pain.
Ricin: Ricin is a glycoprotein toxin from the seed of the castor plant. It blocks protein
synthesis by altering the rRNA, thus killing the cell. Ricin's significance as a potential
biological warfare agent relates to its availability world wide, its ease of production, and
extreme pulmonary toxicity when inhaled. A Ricin paste can be placed on inanimate
objects (Door knobs, steering wheels, etc...) and is a powerful contact poison.
It was used with great success by KGB agents to eliminate their foreign counterparts
during the cold war. Using an umbrella with a Hypo like device at its tip, an amount of
Ricin the size of this [o] was injected into an unwary victim. (Usually a harmless "Bump
and run" maneuver at a train or bus station.) Stymied by these patients rapid downward
spiral, physicians could only watch as these people died within three to six days from an
unknown etiology. A sharp medical examiner discovered the remnants of the tiny Ricin
capsule imbedded in the leg of one such person-and the secret was out.
People have been known to buy castor plants in order to improve their landscape-and do
away with their significant other.
All "reported" serious or fatal cases of castor bean ingestion have taken approximately
the same course: rapid onset of nausea, vomiting, abdominal cramps and severe diarrhea
with vascular collapse; death has occurred on the third day or later. Following inhalation,
symptoms include weakness, fever, cough, hypothermia followed by hypotension and
cardiovascular collapse. High doses by inhalation appear to produce severe enough
pulmonary damage to cause death. Therapy is supportive and should include maintenance
of intravascular volume. Standard management for poison ingestion should be employed
if intoxication is by the oral route. There is presently no antitoxin available for treatment.
Mustard Gas: A Blister Agent, which is a colorless, oily liquid that dissolves poorly in
water, but relatively well in organic solvents, petroleum, lubricant products, and other
toxic agents. The injurious effect of mustard gas is associated with its ability to inhibit
many enzyme systems of the body. This, in turn, prevents the intra-cell exchange of
chemicals and leads to necrosis of the tissue. Death is associated mainly with necrosis of
the tissue of the central nervous system. Mustard gas has a period of latent effect (the first
signs of injury appear after 2 to 12 hours), but does not act cumulatively. It does not have
any known antidotes. In military use, it can come in gas, aerosol, and droplet form. It
therefore acts through inhalation, cutaneously, perorally and directly through the blood
stream. The toxic and physico-chemical properties of mustard gas allow it to be used in
all types of munitions.
Cyanogen Chloride: The French first suggested the use of cyanogen chloride as a toxic
agent. U.S. analysts have reported that it is capable of penetrating gas mask filters.
Partially soluble in water, it dissolves well in organic solvents. It is absorbed easily into
porous materials; its military state is a gas. Cyanogen chloride is a quick acting toxic
agent. Upon contact with the eyes or respiratory organs, it injures immediately. Lethal
exposures result in loss of consciousness, convulsions and paralysis.
Hydrogen Cyanide: There is some evidence that the World Trade Center bombers added
cyanide to the bomb that blew up in the parking garage under that building, apparently in
the hope of killing more people.
This colorless liquid smelling of bitter almonds, hydrogen cyanide is a very strong, quick
acting poison. Hydrogen cyanide affects unprotected humans through the respiratory
organs and during the ingestion of contaminated food and water. It inhibits the enzymes
which regulate the intra-cell oxidant-restorative process. As a result, the cells of the
nervous system, especially those affecting breathing, are injured, which in turn leads to
quick death. An important feature of hydrogen cyanide is the absence of a period of latent
effect. The military state of hydrogen cyanide is as a gas. The toxic and physiologic
properties of hydrogen cyanide permit it to be used effectively in munitions
(predominantly in rocket-launched artillery). Death occurs after intoxication due to
paralysis of the heart. Non-lethal doses do not cause intoxication.
Delivery Systems
Chemical warfare is especially dangerous in that it can be
spread in a variety of ways. Inhalation, skin or eye contact
is among the most common of desired delivery systems.
Another popular way to spread chemical agents is through
agricultural systems such as crop dusters or other
sprayers. Chemical contamination can also occur through
food and water contamination. An easy way to
contaminate a large number of people is by opening an
aerosol container in a busy area such as a subway or a park.
Symptoms
The signs and symptoms of chemical poisoning are easier for EMS workers to recognize.
First of all, once on scene, the environment can give many indicators. For example, there
may be an excessive amount of dead animals, an odd odor, an unexplainable film on
everything, or more obvious, numerous dead human bodies. Unlike other types of
poisoning, chemical poisonings can result in immediate death.
The physical symptoms of chemical exposure are external as well as internal. They can
range from burns and blistering of the skin and eyes, to coughing, respiratory distress,
vomiting, nausea, excessive tiredness, involuntary defecation and or urination, seizures,
excessive eye contraction or severe headache.
Treatment
Methods EMS can use to relieve suffering include dressing any exposed wounds such as
burns. Pain medicine (if indicated), rinsing of the eyes if affected. In hospital treatment
will include antibiotics and any known antidotes. Treatment is mainly supportive.
Nuclear Warfare
Perhaps the most feared and definitely the most deadly type of attack are those that
involve nuclear war. Nuclear weapons produce devastating and long-term effects on
human and animal life as well as the environments in which they live. These are the
hardest and most complex of all types of weapons to make because of the critical nuclear
elements. Plutonium and/or highly enriched Uranium make up most of a nuclear weapon
and are very hard to come by, complex to understand, dangerous to work with and are
very expensive.
Traditional nuclear weapons are not the only threat. Officials are concerned terrorists
might also target the world's nuclear power plants and supplies. It is estimated that a
standard attack with known existing weapons can kill at least 250,000 people on impact
and injure millions more.
Current fears of nuclear war are mainly centered around India and Pakistan, two nations
whose majority religions and histories, as well as a territorial dispute in Kashmir and
mutual possession of substantial (though probably numbered in dozens rather than
thousands) nuclear arsenals makes many extremely nervous. In the case of Pakistan, their
unstable government and the threat of radical Islamists seizing power and thus control
over the nuclear arsenal has raised additional fears, compounded by the fact that a senior
member of the development program, Sultan Bashiruddin Mahmood, is a strong Taliban
sympathizer.
Another flashpoint which has analysts worried is a possible conflict between the United
States and the People's Republic of China over Taiwan. Although economic forces have
decreased the possibility of military conflict, there remains the worry that a move toward
Taiwan independence could spin out of control.
A third potential flashpoint lies in the Middle East, where Israel is thought to possess on
the order of one hundred nuclear warheads (although this has never been officially
confirmed). Israel has been involved in wars with its neighbors on numerous occasions,
and its small geographic size would mean that in the event of future wars the Israeli
military might have very little time to react to a future invasion or other major threat; the
situation could escalate to nuclear warfare very quickly in some scenarios.
In addition, there is the worry that so-called rogue states such as Iran and North Korea
may acquire nuclear weapons. Nuclear terrorism by non-state organizations could well be
more likely, as states possessing nuclear weapons are susceptible to retaliation in kind.
Geographically-dispersed and mobile terrorist organizations are not so easy to discourage
by the threat of retaliation. Furthermore, while the collapse of the Soviet Union ended the
Cold War, it greatly increased the risk that former Soviet nuclear weapons might become
available on the black market.
Weapons
Examples of nuclear weapons include:
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Atomic Bombs
Hydrogen Bombs
“Loose Nukes”
“Suitcase Bombs”
Delivery Systems
One of the biggest fear boosters with Nuclear weapons is the fact that they are so
incredibly deadly, but relatively small. Most nuclear weapons can fit in a truck or car.
This creates fear in the possibility that a terrorist can launch an attack by simply driving
into a large city and parking in a public area and then detonating the bomb. Many experts
agree that this creates cause for much concern. However, it is more likely that if a nuclear
bomb were detonated, it would be delivered in the form of a bomb or a missile dropped
from a bomber plane.
Another form of created nuclear war that is less obvious but just as deadly, is by targeting
our nuclear power plants for attack. America has nuclear materials all over. There are
always trucks carrying nuclear waste on the road. There are many nuclear power plants
across the country and most hospitals have the service of nuclear medicine for certain
testing.
Symptoms
As a first responder to a nuclear accident, more than likely at the point of impact there
will be no survivors. However, victims that survive may exhibit vomiting, headache,
extreme fatigue, weakness, burnt skin, and burning eyes. There are also long-term effects
such as secondary infections, hair loss, excessive bleeding, birth defects and speech
difficulty.
Treatment
It is imperative that EMS workers not approach any scene unless they have the go ahead
from medical control and the scene is secure. If they are able to approach the scene to aid,
any clothes the victim is wearing must be removed immediately and placed in a sealed,
locked, air tight container. The patients must then be washed completely with soap and
water. This must be completed before the patient can enter the ambulance or the hospital.
In some instances stomach pumping is necessary, as are laxatives. This intervention is to
limit the amount of nuclear material into the bloodstream and cells of the exposed patient.
Treatment is mostly supportive.
Radiological Warfare
Radiological warfare is any form of warfare involving deliberate radiation poisoning,
without relying on nuclear fission or nuclear fusion.
It is widely believed that if the United States were under an attack, it would be in the
form of radiological warfare. This would be the weapon of choice for the terrorists for
many reasons. Unlike most weapons, radiological weapons spread their wrath onto
everyone and everything. They actually spread radioactive material onto equipment,
facilities, food, land, and acts as a toxic chemical. It is in many cases fatal, but it also
causes various forms of cancer and a variety of illnesses.
Radiological weapons are normally considered weapons of mass destruction, and are very
commonly equated with a radiological bomb often mis-called a "dirty bomb" (which
refers to a nuclear weapon with a radiological side effect. However, bombs are very
inefficient ways to spread radiation, and all such special weapons have problems that
render them likely impractical for military uses.
Rather, radiological warfare would be of vastly more use to terrorists spreading or
intensifying Fear, Uncertainty, and Doubt. The release of radioactive material may
involve no special "weapon" and include no direct killing of people, but rather make
whole areas or structures unusable or doubtfully useful for the support of human life, due
to the exposures of staying too near them for long periods. For instance, a city such as
Washington DC could perhaps be rendered uninhabitable or at least quite undesirable radiation being extraordinarily difficult to remove once it is released into the built
environment, and perhaps taking a long time to fully decay in the natural environment.
Like land mines, it can be an area-denial method.
Weapons
A radiological weapon is any weapon that is designed to spread radioactivity, either to
kill or to deny the use of an area (a modern version of salting the earth) and consists of an
device (such as a nuclear or conventional explosive) which spreads radioactive material.
They have recently been called "dirty bombs", although that term more correctly refers to
a type of nuclear weapon.
Radiological weapons are widely considered to be militarily useless for a governmentsponsored army and are not believed to have been deployed by any military forces.
Firstly, the use of such a weapon is of no use to an occupying force, as the target area
becomes uninhabitable. Furthermore, area-denial weapons are generally of limited use to
an attacking army as it slows the rate of advance so the need for a radioactive denial
system is limited. Finally, like biological weapons, radiological weapons can take days to
act on the opposing force. They therefore not only fail in neutralizing the opposing force
instantly, but they also allow time for massive retaliation.
Means of radiological warfare that do not rely on any specific weapon but rather on
spreading radiation poisoning via a food chain or water table, seem to be more effective
in some ways but to share problems with chemical warfare.
History has proven Iraq under the rule of that Saddam Hussein tested a radiological
weapon in 1987 for use against Iran. This weapon was found to be impractical because
the radioactive isotopes in the weapon would decay quickly, rendering it useless within a
week after the weapon was manufactured. Furthermore, it was found that for the
radioactive material to spread, weather conditions had to be ideal. These problems are
shared by all forms of air-borne radiological warfare.
Useless as they may be to an ordinary military force, the weapons have been suggested as
a possible terror weapon in order to create panic in densely populated areas. They do not
require weapons-grade materials and common materials such as Cesium-137 used in
radiological medical equipment, could be used. In fact even very mild sources would
likely be enough to cause panic. Anything from dynamite to compressed air could be
used to create an aerosol of the material or it could be dumped from the air using crop
dusters - the latter use however being not a weapon so much as a means of warfare
involving many different components.
Delivery Systems
One difference in a dirty bomb versus the other types of warfare is that radioactive
material is not usually dissolvable in water. Therefore, that eliminates contamination of
the water supply or reservoirs through direct contamination. Methods of detonating a
dirty bomb include artillery shells or explosives.
Symptoms
The symptoms of radiological poisoning can range widely. They can result in cancer or
death or just cause mild skin reddening. One of the most common deadly result of
radiation poisoning in called Acute Radiation Syndrome (ARS) which is defined as a
high dose of radiation in a small amount of time which results in nausea, vomiting and
diarrhea. Later, post-exposure, ARS can result in bone loss, loss of appetite, flusymptoms, severe infection and bleeding.
EMS workers should always be suspicious of material that seems to emit heat without
any sign of external heating source, as well as any glowing materials or particles. If the
package is glowing this indicates a strong radioactive substance. If you ever come upon a
suspicious package, leave the area immediately.
Treatment
EMS should properly decontaminate the victim, provide o2 and transport. Radiation
victims should take off their clothes and wash with soap and water. Hospital workers will
provide treatment depending on the amount of radiation received. Treatment is mostly
supportive.
Triage
While biological warfare is a concern for many reasons, how to triage is a huge concern.
The threat of a weapon of mass destruction attack is bigger now than ever before. While
our government is on high alert for suspicious activity related to possible terrorism, the
possibility of an attack is very real. The reality then becomes that the burden at the point
of an attack will lie on the shoulders of the EMS workers. As EMS workers, you must be
able to recognize the different weapons as well as how to keep yourself safe and how to
properly treat the victims. The first five steps to triage a suspected terrorist attack remain
constant and are similar to a mass casualty not of a terrorist type. The first steps that must
be taken involve:
1.
2.
3.
4.
Assess the immediate area and determine the incident.
Scene Control/establishment of perimeters.
Proper identification of the agent.
Pre-entry exam and determination of appropriate protective clothing &
equipment.
5. Establishment of a decontamination area
6. Entry planning/preparation of equipment
The triage process is slightly different with a terrorist biological attack as opposed to a
mass casualty such as a bus wreck because the threat to the EMS workers is greater.
When dealing with any suspected terrorist attack, the first and most important task after
the initial assessment is to secure the area and determine how and where the perimeters
should be set. While physically securing the area, the EMS worker should also consider
what the possible source of the threat is and how severe the outcome could be. Any
suspicious activity or objects are cause for immediate concern as terrorist threats have
included secondary attacks to specifically target the EMS worker.
With a release or attack with a biological agent, a primary and a secondary perimeter
need to be established. An immediate priority needs to be a thorough search of both
perimeters for suspicious people, packages, or any activity that should not be happening
post evacuation. Also, it is imperative during this phase that the wind is considered.
Especially in the event of a chemical or biological attack, considering the downwind must
be immediately addressed. For example, EMS would not want to set up triage in an area
that the wind is carrying the attacking agent. Also, if the wind is blowing towards a
populated area, that area should be immediately evacuated to avoid any more casualties.
Identify the Problem
A major problem in the war against terrorism and the constantly pressing problem of an
attack with a harmful agent of any sort is that of the ability of EMS workers to identify
what specifically the problem is. As is the case in most common industrial hazardousmaterials accidents, the first priority in the management of the incident involves
ascertaining the identity and physical properties of the substance that has been released.
Once this has occurred, then the EMS workers collectively can determine the best route
to properly protect the environment. For example, it must be identified so that the triage
area is set up properly and so that the EMS workers are dressed in appropriate protective
gear. It is only after the proper identity is determined that an effective outer perimeter can
be established, neutralizations plans formulated, decontamination procedures entertained,
emergency medical treatment plans made and environmental preservation precautions
taken.
The question then becomes, how do EMS workers perform field-testing to determine
what is in the air? This is one of the biggest concerns of this problem and threat. The fact
is, that most civilian EMS agencies, even with sophisticated biohazard response teams,
do not have the equipment necessary to properly identify a harmful agent. This issue is of
the most serious consideration because unless the WMD are properly identified none of
the appropriate actions can take place to set up a triage or to distinguish the proper
perimeters. It is currently widely suggested that federal funding be made available to the
local agencies that are providing the EMS service to ensure that the EMS workers are
properly trained to test and identify a potential attack of chemical or biological warfare.
They need funding for the training as well as the expensive monitoring and detection
devices. Of course, the first priority of the EMS worker is to ensure his or her own safety
first and foremost.
References:
Paramedic Emergency Care, Brady, third edition.,
Basic and Advanced Pre-hospital Trauma Life Support, Mosby, Fourth Edition.
cdc.gov
emergencydispatch.org
netrac.org
fact-index.com
fema.gov
emsmagazine.com