1 An Introduction to the Threat of Bioterrorism What Every Health Care Provider Should Know The Ohio...

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An Introduction to the ThreatAn Introduction to the Threatof Bioterrorismof Bioterrorism

What Every Health Care Provider Should KnowWhat Every Health Care Provider Should Know

The Ohio Center of Excellence forThe Ohio Center of Excellence forBioterrorism Preparedness and ResponseBioterrorism Preparedness and Response

Bioterrorism Training and Curriculum Development ProgramBioterrorism Training and Curriculum Development ProgramPL 107-188, Section 105; 1-T01-HP-00091-01PL 107-188, Section 105; 1-T01-HP-00091-01

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An Introduction to the Bioterrorist ThreatAn Introduction to the Bioterrorist ThreatWhat Every Health Care Provider Should KnowWhat Every Health Care Provider Should Know

Purposes of PresentationPurposes of Presentation

• Overview of the ThreatOverview of the Threat• Bioterrorism - BNICE 101Bioterrorism - BNICE 101

• Biological - Anthrax, Smallpox, BotulismBiological - Anthrax, Smallpox, Botulism• Nuclear - Dirty BombNuclear - Dirty Bomb• Incendiary and ExplosionIncendiary and Explosion• Chemical - SarinChemical - Sarin

• Being preparedBeing prepared

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BioterrorismBioterrorism

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History of BioterrorismHistory of Bioterrorism

• The AssyriansThe Assyrians• Poisoned enemy wells Poisoned enemy wells

with rye ergotwith rye ergot

• Middle Ages 1300sMiddle Ages 1300s• Plague victims Plague victims

catapulted into Kafkacatapulted into Kafka

Sixth Century B.C.Sixth Century B.C.

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History of BioterrorismHistory of Bioterrorism

• French and Indian WarsFrench and Indian Wars• British forces distribute British forces distribute

smallpox-laden smallpox-laden blankets to native blankets to native American Indians loyal American Indians loyal to the Frenchto the French

17541754

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History of BioterrorismHistory of Bioterrorism• Rajneeshee cultRajneeshee cult• Contaminates salad bars in Contaminates salad bars in

an Oregon town with an Oregon town with Salmonella typhimuriumSalmonella typhimurium

• More than 750 people More than 750 people become seriously illbecome seriously ill

19841984

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National Security EnvironmentNational Security Environment

Cold-War EraCold-War Era19891989

• Nation-State Adversaries

• Focus on Communism

• Threat of Global Nuclear War

• Dangerous, but relatively predictable

• Forward Defense

• Short of global war, U.S. homeland perceived as secure from any major threat

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11 September 200111 September 2001The Attack on the USThe Attack on the US

Source: www.thaibase.com/news/wtc/imagesSource: www.thaibase.com/news/wtc/images

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National Security EnvironmentNational Security Environment

Cold-War EraCold-War EraWar on Terrorism EraWar on Terrorism Era19891989

9/11/01

• Fewer Nation-State Adversaries• No “peer competitor” - U.S. is only

remaining “superpower”• Trans-national extremist groups• Development and proliferation of “dual

use technologies” … WMD (“BNICE”)• Increase use of tactical terrorism• Homeland is non-secure and at risk

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Threat TrendsThreat Trends

Nation States

Trans-NationalGroups

Extremist/RadicalExtremist/RadicalOrganizationsOrganizations

IranIranIraqIraq

North KoreaNorth Korea

Al QaedaAl Qaeda

FBI MOST WANTED FUGITIVEFBI MOST WANTED FUGITIVE

Aliases: Usama Bin Muhammad Bin Ladin,Aliases: Usama Bin Muhammad Bin Ladin,Shaykh Usama Bin Ladin, The Prince,Shaykh Usama Bin Ladin, The Prince,

The Emir, Abu Abdallah, Mujahid Shaykh, Hajj, The DirectorThe Emir, Abu Abdallah, Mujahid Shaykh, Hajj, The Director

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Threat TrendsThreat Trends

BB

NN

IICC

EE

CyberCyber

Weapons ofWeapons of

Mass DestructionMass Destruction

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The greatest threat to the United States and its citizens The greatest threat to the United States and its citizens in the first decade of the 21st century will not come in the first decade of the 21st century will not come

from a military confrontation. Rather, it will come from from a military confrontation. Rather, it will come from an attack within our borders from a single individual or an attack within our borders from a single individual or group that has access to weapons of mass destruction, group that has access to weapons of mass destruction,

including large conventional explosives and nuclear, including large conventional explosives and nuclear, chemical or biological weapons.chemical or biological weapons.

COL Ed Eitzen, Senior Medical Advisor to the US Assistant Secretary for Public COL Ed Eitzen, Senior Medical Advisor to the US Assistant Secretary for Public Health Emergency Preparedness.Health Emergency Preparedness.

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Terror Is a Weapon ItselfTerror Is a Weapon Itself

““The real The real force multiplierforce multiplier in in bioterrorism is the panic, bioterrorism is the panic,

misinformation and paranoia misinformation and paranoia associated with it.”associated with it.”

Sidell FR, Patrick WC, Dashiell TR.Jane’s Chem-Bio Handbook.

Alexandria, VA, Jane’s Information Group, 1998.

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Reclaiming Reclaiming LifeLife

Reclaiming Reclaiming LifeLife

Anxiety Anxiety IntrusionsIntrusionsAnxiety Anxiety

IntrusionsIntrusions

Isolation Isolation Loneliness Loneliness DepressionDepression

Isolation Isolation Loneliness Loneliness DepressionDepression

SadnessSadnessDespair GuiltDespair Guilt

SadnessSadnessDespair GuiltDespair Guilt

ShockShock Denial Denial DisorientationDisorientationShockShock Denial Denial DisorientationDisorientation

Psychological Reactions to Psychological Reactions to Disaster EventsDisaster Events

Psychological Reactions to Psychological Reactions to Disaster EventsDisaster Events

DisbeliefDisbeliefOutcry Outcry HeroismHeroism

DisbeliefDisbeliefOutcry Outcry HeroismHeroism

RageRageAngerAngerBlameBlame

RageRageAngerAngerBlameBlame

Reconstructing A Reconstructing A New LifeNew Life

Reconstructing A Reconstructing A New LifeNew Life

EventEventEventEvent

0 to 7 Days 0 to 7 Days TIMETIME 2 to 5 Years 2 to 5 Years

Coming to Coming to Terms with Terms with

New RealitiesNew Realities

Coming to Coming to Terms with Terms with

New RealitiesNew Realities

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Terrorism forces us to make a choice. Terrorism forces us to make a choice. We can be afraid. Or we can be ready.We can be afraid. Or we can be ready.Tom Ridge, U.S. Department of Homeland Security, www.ready.govTom Ridge, U.S. Department of Homeland Security, www.ready.gov

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Defense Against BioterrorismDefense Against Bioterrorism

• Health care professionals Health care professionals are the 1st line of defenseare the 1st line of defense

• Education is keyEducation is key

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The Ohio Center of Excellence for Bioterrorism The Ohio Center of Excellence for Bioterrorism

Preparedness and ResponsePreparedness and Response • RationaleRationale

• A need exists to train healthcare A need exists to train healthcare professional students to be professional students to be prepared to respond to terrorist prepared to respond to terrorist acts and other public health acts and other public health emergenciesemergencies

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What Every Health Care What Every Health Care Provider Should KnowProvider Should Know

1.1. Early recognitionEarly recognition

2.2. Early managementEarly management

3.3. Whom to notifyWhom to notify

4.4. How to work together as a teamHow to work together as a team

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What do we mean by “prepared”?What do we mean by “prepared”?

…the “right place” on the continuum between mindless complacency and

all consuming paranoia

Dr. Irwin Redlener, Associate Dean & Director The National Center for Disaster Preparedness

Mindless Complacency

All Consuming Paranoia

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BNICE 101BNICE 101

• BBiologicaliological• NNuclearuclear• IIncendiary/firencendiary/fire• CChemicalhemical• EExplosivexplosive

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Bioterrorism DefinedBioterrorism Defined

• Unlawful release of biologic agents or toxinsUnlawful release of biologic agents or toxins• IntentIntent

• to intimidate or coerce a government or to intimidate or coerce a government or civilian population to further political or civilian population to further political or social objectivessocial objectives

• Targets - humans, animals, plantsTargets - humans, animals, plants• First recognized by the astute healthcare First recognized by the astute healthcare

provider in the communityprovider in the community

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Biological Agents as WMDBiological Agents as WMD

• Relatively easy to obtainRelatively easy to obtain• Technology easily concealedTechnology easily concealed

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Characteristics of a “Good” Characteristics of a “Good” Biological AgentBiological Agent

• Pathogenic at low dosesPathogenic at low doses

• High rate of morbidity & mortalityHigh rate of morbidity & mortality

• Highly infectiousHighly infectious

• Difficult to diagnose and treatDifficult to diagnose and treat

• Insidious at onsetInsidious at onset

• Easy, fast, and cheap to produceEasy, fast, and cheap to produce

• Concentrated for distributionConcentrated for distribution

• Adaptable to weapons systemsAdaptable to weapons systems

• Name causes fear and panic Name causes fear and panic

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Popular Interest in BioterrorismPopular Interest in Bioterrorism

Be Informed - Biological ThreatBe Informed - Biological Threat

http://www.ready.govhttp://www.ready.gov

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Biological AttackBiological AttackTransmissionTransmission

• AerosolAerosol• GastrointestinalGastrointestinal• TranscutaneousTranscutaneous

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Biological Attack - AerosolBiological Attack - Aerosol

• Effectively delivered as an Effectively delivered as an aerosolaerosol

• ProtectionProtection• Protective maskProtective mask• 2 to 3 layers of cotton2 to 3 layers of cotton• Several layers of tissue or Several layers of tissue or

paper towelspaper towels• Explosives are inefficient Explosives are inefficient

delivery systemsdelivery systems

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Biological AttackBiological AttackContamination of FoodContamination of Food

• Heat destroys Heat destroys most pathogens most pathogens and toxinsand toxins

• Raw foodRaw food• Added after food Added after food

is preparedis prepared

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Biological AttackBiological AttackContamination of WaterContamination of Water

• Water purification methods Water purification methods inactivate most pathogens and inactivate most pathogens and toxinstoxins

• Successful attack on water Successful attack on water supply would have to occur supply would have to occur after treatmentafter treatment

• Dilution reduces concentrationDilution reduces concentration

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Biological AttackBiological AttackContamination of MilkContamination of Milk

• Botulinum toxin Botulinum toxin

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Category A Biological AgentsCategory A Biological Agents• High-priority agentsHigh-priority agents• Risk to national securityRisk to national security• CharacteristicsCharacteristics

• Easily disseminated or Easily disseminated or transmitted from person to transmitted from person to personperson

• High mortality ratesHigh mortality rates• Major public health impactMajor public health impact• Public panic and social Public panic and social

disruptiondisruption• Require special action for Require special action for

public health preparednesspublic health preparedness

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Category A Biological AgentsCategory A Biological Agents• AnthraxAnthrax

• Bacillus anthracisBacillus anthracis• SmallpoxSmallpox

• variola majorvariola major• BotulismBotulism

• Clostridium botulinum Clostridium botulinum toxintoxin

• PlaguePlague• Yersinia pestisYersinia pestis

• TularemiaTularemia• Francisella tularensisFrancisella tularensis

• Viral hemorrhagic Viral hemorrhagic feversfevers

• filoviruses [e.g., filoviruses [e.g., Ebola, Marburg] Ebola, Marburg]

• arenaviruses [e.g., arenaviruses [e.g., Lassa, Machupo])Lassa, Machupo])

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• Acute infectious Acute infectious diseasedisease

• Spore-forming Spore-forming bacterium bacterium Bacillus Bacillus anthracisanthracis

• Most commonly occurs Most commonly occurs in wild and domestic in wild and domestic lower vertebrates lower vertebrates

• Can also occur in Can also occur in humanshumans

• exposed to infected exposed to infected animals or to tissue animals or to tissue from infected animalsfrom infected animals

• anthrax spores used anthrax spores used as a bioterrorist as a bioterrorist weaponweapon

FAQ about Anthrax http://www.bt.cdc.gov/agent/anthrax/faq/index.aspFAQ about Anthrax http://www.bt.cdc.gov/agent/anthrax/faq/index.asp

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• Three formsThree forms• cutaneous (skin)cutaneous (skin)• inhalationinhalation• gastrointestinalgastrointestinal

• NOT contagiousNOT contagious• Can NOT be transmitted from Can NOT be transmitted from

person to personperson to person• Household contacts do NOT Household contacts do NOT

need antibiotics unless also need antibiotics unless also exposed to the same source exposed to the same source of anthraxof anthrax

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• Weaponized anthrax sporesWeaponized anthrax spores• 1996 - Iraq1996 - Iraq• 2001 - spores intentionally distributed 2001 - spores intentionally distributed

through postal systemthrough postal system• 22 cases of anthrax, including 5 deaths22 cases of anthrax, including 5 deaths

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Cutaneous AnthraxCutaneous Anthrax

• Develops when Develops when bacterium enters a skin bacterium enters a skin cut or abrasioncut or abrasion

• Handling contaminated Handling contaminated wool, hides, leather or wool, hides, leather or hair products hair products (especially goat hair) of (especially goat hair) of infected animalinfected animal

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Cutaneous AnthraxCutaneous Anthrax

• Raised itchy bump like an Raised itchy bump like an insect biteinsect bite

• In 1-2 days develops into a In 1-2 days develops into a vesicle and then a painless vesicle and then a painless ulcer 1-3 cm in diameterulcer 1-3 cm in diameter

• Black necrotic centerBlack necrotic center• Local lymph glands may Local lymph glands may

swellswell• 20% will die if not treated 20% will die if not treated

with antibioticswith antibiotics

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Inhalation AnthraxInhalation Anthrax

• Initial symptoms may Initial symptoms may resemble a common coldresemble a common cold

• sore throatsore throat• mild fevermild fever• muscle achesmuscle aches• malaisemalaise

• Symptoms progress to Symptoms progress to severe breathing severe breathing problems and shockproblems and shock

• Usually fatalUsually fatal

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• Humans must inhale anthrax Humans must inhale anthrax spores to become infectedspores to become infected

• Inhaled anthrax must be 1 to 5 Inhaled anthrax must be 1 to 5 microns to reach alveoli (air sacs)microns to reach alveoli (air sacs)

• Size comparisonsSize comparisons micronsmicrons

• Dot ( . )Dot ( . ) 600 600• AnthraxAnthrax 5 5• Pollen Pollen 10 - 1,000 10 - 1,000• Human hair 40 - 300Human hair 40 - 300

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• Similar to common coldSimilar to common cold• ““Flu-like” symptomsFlu-like” symptoms

• Fever, muscle aches, Fever, muscle aches, coughcough

• No runny nose (rhinorrhea) No runny nose (rhinorrhea) with Anthrax infectionwith Anthrax infection

Mediastinal widening with Mediastinal widening with inhalational anthrax.inhalational anthrax.

JAMAJAMA 1999:281:1735-45 1999:281:1735-45

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Gastrointestinal Gastrointestinal AnthraxAnthrax

• Consume contaminated meatConsume contaminated meat• Acute inflammationAcute inflammation• Initial signsInitial signs

• nausea, loss of appetite, nausea, loss of appetite, vomiting, fevervomiting, fever

• Later signsLater signs• abdominal pain, vomiting abdominal pain, vomiting

of blood, severe diarrheaof blood, severe diarrhea• Death in 25% to 60%Death in 25% to 60%

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Anthrax TreatmentAnthrax Treatment

• Exposure - 60 days of RxExposure - 60 days of Rx• AmoxicillinAmoxicillin• DoxycyclineDoxycycline• CiprofloxacinCiprofloxacin

• Infection - IVInfection - IV• CiprofloxacinCiprofloxacin• DoxycyclineDoxycycline• Plus others…Plus others…

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Anthrax ImmunizationAnthrax ImmunizationWho Should Receive It?Who Should Receive It?

Advisory Committee on Immunization PracticesAdvisory Committee on Immunization Practices

• Work directly with the organism Work directly with the organism in the labin the lab

• Work with imported animal Work with imported animal hides or furs in areas where hides or furs in areas where standards are insufficientstandards are insufficient

• Handle potentially infected Handle potentially infected animal products in high-animal products in high-incidence areasincidence areas

• Military personnel deployed to Military personnel deployed to areas at high risk for exposureareas at high risk for exposure

Senior Chief Payhurst administers an Senior Chief Payhurst administers an anthrax vaccination to a sailor aboard anthrax vaccination to a sailor aboard

the USS John C. Stennis. the USS John C. Stennis.

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Anthrax and Mail SafetyAnthrax and Mail SafetyHandling of Suspicious Packages or EnvelopesHandling of Suspicious Packages or Envelopes

• Do not shake or empty the Do not shake or empty the contentscontents

• Do not carry it, show it to others Do not carry it, show it to others or allow others to examine itor allow others to examine it

• Put it down on a stable surfacePut it down on a stable surface• Do not sniff, touch, taste, or Do not sniff, touch, taste, or

look closely at it or at any look closely at it or at any contents which may have spilledcontents which may have spilled

• Alert others in the areaAlert others in the area• Leave the area, close any doors, Leave the area, close any doors,

and take actions to prevent and take actions to prevent others from entering the areaothers from entering the area

• If possible, shut off the If possible, shut off the ventilation system. ventilation system.

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Anthrax and Mail SafetyAnthrax and Mail SafetyHandling of Suspicious Packages or EnvelopesHandling of Suspicious Packages or Envelopes

• WASH hands with soap and water WASH hands with soap and water • Seek additional instructions Seek additional instructions • Notify the local health department Notify the local health department

immediately immediately • Create a list of persons whoCreate a list of persons who

• were in the room or area when it were in the room or area when it was openedwas opened

• may have handled itmay have handled it• Give this list to both the local public Give this list to both the local public

health authorities and law health authorities and law enforcement officialsenforcement officials

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Smallpox (Smallpox (Variola majorVariola major))

• DNA virusDNA virus• Serious, contagious, and Serious, contagious, and

sometimes fatal infectious diseasesometimes fatal infectious disease• NO specific treatmentNO specific treatment• Only prevention is vaccination. Only prevention is vaccination. • Name Name smallpoxsmallpox derived from Latin derived from Latin

word for “spotted”word for “spotted”• refers to raised bumps that refers to raised bumps that

appear on face and bodyappear on face and body• Humans are only known reservoirHumans are only known reservoir

• Not known to be spread by Not known to be spread by insects or animalsinsects or animals

Electron micrograph of Variola MajorElectron micrograph of Variola MajorCourtesy of CDC Public Health Image LibraryCourtesy of CDC Public Health Image Library

Dr. Fred Murphy, Sylvia WhitfieldDr. Fred Murphy, Sylvia Whitfield

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Smallpox EradicationSmallpox Eradication

• 1949 - last 1949 - last naturalnatural outbreak of outbreak of smallpox in the U.S.smallpox in the U.S.

• 1972 - routine smallpox vaccinations 1972 - routine smallpox vaccinations for children in the U.S. no longer for children in the U.S. no longer required required

• 1980 - “wiped out” worldwide1980 - “wiped out” worldwide• No cases of No cases of naturallynaturally occurring occurring

smallpox have happened sincesmallpox have happened since• 2004 - smallpox virus kept in two 2004 - smallpox virus kept in two

approved labs in the U.S. and Russiaapproved labs in the U.S. and Russia• But… credible concern exists that the But… credible concern exists that the

virus was made into a weapon by virus was made into a weapon by some countries and that terrorists some countries and that terrorists may have itmay have it

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The Spread of SmallpoxThe Spread of Smallpox

1. Prolonged face-to-face contact1. Prolonged face-to-face contact• Most common method of spread in the pastMost common method of spread in the past• Exposure does not necessarily result in Exposure does not necessarily result in

infectioninfection2. Direct contact with infected..2. Direct contact with infected..

• bodily fluidsbodily fluids• object such as bedding or clothingobject such as bedding or clothing

3. Aerosol (through the air)3. Aerosol (through the air)• Rare in the past - enclosed spacesRare in the past - enclosed spaces• Suspected method for terroristsSuspected method for terrorists• Virus is heat- & light-sensitiveVirus is heat- & light-sensitive

• 90% of virus dies within 24 hours of 90% of virus dies within 24 hours of exposureexposure

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Smallpox IncubationSmallpox Incubation

• Incubation periodIncubation period• Range 7-17 daysRange 7-17 days• Average 12-14 daysAverage 12-14 days

• No symptomsNo symptoms• Infected person NOT contagiousInfected person NOT contagious

Electron Microscope, Variola Major

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Smallpox InfectionSmallpox Infection• Prodrome period 2-4 daysProdrome period 2-4 days

• High fever, fatigue, head and body achesHigh fever, fatigue, head and body aches• Then, small red spots on tongue and mouthThen, small red spots on tongue and mouth

• Sores break open and spread large amounts Sores break open and spread large amounts of virus into mouth and throatof virus into mouth and throat

• At this time, the person becomes At this time, the person becomes most most contagiouscontagious

• Facial rash -> extremities -> trunkFacial rash -> extremities -> trunk• ““centrifugal” rashcentrifugal” rash• Involves palms and solesInvolves palms and soles

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The Smallpox RashThe Smallpox Rash

• 4th-5th day of rash4th-5th day of rash• pustules developpustules develop

• ““Umbilicated” rashUmbilicated” rash• Major distinguishing Major distinguishing

characteristiccharacteristic

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The Smallpox RashThe Smallpox Rash

• 2nd week of rash - scabs develop2nd week of rash - scabs develop• 3rd week of rash - scabs fall off3rd week of rash - scabs fall off

• Pitted scars developPitted scars develop• Person is contagious until ALL Person is contagious until ALL

scabs have fallen offscabs have fallen off

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CDC Guide - SmallpoxCDC Guide - Smallpox

Poster available at Poster available at http://www.cdc.gov/nip/smallpox/Providers.htmhttp://www.cdc.gov/nip/smallpox/Providers.htm

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Smallpox VaccinationSmallpox Vaccination

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Smallpox Vaccination Smallpox Vaccination

• 100% effective if given before exposure100% effective if given before exposure• Within 3 days of exposure will prevent or Within 3 days of exposure will prevent or

significantly lessen severity of smallpox significantly lessen severity of smallpox symptoms in vast majoritysymptoms in vast majority

• 4 to 7 days after exposure likely offers 4 to 7 days after exposure likely offers some protection from disease or may some protection from disease or may modify the severity of diseasemodify the severity of disease

Bifurcated needle

What you need to know about small pox vaccine: What you need to know about small pox vaccine: http://www.bt.cdc.gov/agent/smallpox/vaccination/vaccine.asphttp://www.bt.cdc.gov/agent/smallpox/vaccination/vaccine.asp

Nigeria 1969Nigeria 1969

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Botulism (Botulism (Clostridium botulinumClostridium botulinum))

• Spore-forming, anaerobic gram-Spore-forming, anaerobic gram-positive rodpositive rod

• Produces Produces botulinum toxinbotulinum toxin• Muscle-paralyzingMuscle-paralyzing• Most lethal substance knownMost lethal substance known

• FoodborneFoodborne• Illness occurs 6-36 hours of Illness occurs 6-36 hours of

ingestion of toxiningestion of toxin• NO human to human spreadNO human to human spread

Grams stain of Grams stain of C. botulinumC. botulinumCourtesy of CDCCourtesy of CDC

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BotulismBotulism

• SymptomsSymptoms• Visual disturbance, slurred speech, dry mouth, Visual disturbance, slurred speech, dry mouth,

difficulty swallowingdifficulty swallowing• Muscle weakness descends through the bodyMuscle weakness descends through the body• Respiratory paralysisRespiratory paralysis

• TreatmentTreatment• Supportive careSupportive care• AntitoxinAntitoxin• 8% mortality rate8% mortality rate• Recovery weeks to monthsRecovery weeks to months

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TularemiaTularemiaFrancisella tularensisFrancisella tularensis

• Gram-negative bacteriaGram-negative bacteria• Found in rodentsFound in rodents• One of the most One of the most

infectious agents infectious agents knownknown• Few organisms can Few organisms can

cause diseasecause disease

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TularemiaTularemiaFrancisella tularensisFrancisella tularensis

• Non-specific, “flu-like” symptomsNon-specific, “flu-like” symptoms• Fever, chillsFever, chills• HeadacheHeadache• Muscle achesMuscle aches• Non-productive coughNon-productive cough

• Deadly if not treated!Deadly if not treated!• Diagnosed by index of suspicion Diagnosed by index of suspicion

and confirmed by laboratoryand confirmed by laboratory

Whom to Contact for Suspected Whom to Contact for Suspected Biological Threat?Biological Threat?

Your Local Health Department!Your Local Health Department!

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BBNNICE - The Nuclear ThreatICE - The Nuclear Threat

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BBNNICE - Dirty BombICE - Dirty Bomb• Radiological dispersion deviceRadiological dispersion device• Conventional explosives with Conventional explosives with

radioactive materialsradioactive materials• PurposesPurposes

• Fear, panicFear, panic• Disruptive, not necessarily Disruptive, not necessarily

destructivedestructive• Make buildings, land, food Make buildings, land, food

and water unusable for long and water unusable for long periods of timeperiods of time

Old transport container. Old transport container. Photo from: Center for Photo from: Center for

Nonproliferation StudiesNonproliferation Studies

http://www.ready.gov/radiation.htmlhttp://www.ready.gov/radiation.html

http://www.bt.cdc.gov/radiation/index.asphttp://www.bt.cdc.gov/radiation/index.asp

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BBNNICE - Nuclear ThreatICE - Nuclear Threat

ShieldingShielding DistanceDistance TimeTime


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BNBNIICCEEIncendiary/Fire & Explosive ThreatIncendiary/Fire & Explosive Threat

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““I say goodbye with tears in my I say goodbye with tears in my eyes and heart, and I ask God eyes and heart, and I ask God for victory. Father, don't blame for victory. Father, don't blame yourself. I am happy to be here. yourself. I am happy to be here. Mother, don't be weak. Raise Mother, don't be weak. Raise your children to be martyrs for your children to be martyrs for the cause.”the cause.”

Letter found in abandon shed in Fallujah from suicide bomberLetter found in abandon shed in Fallujah from suicide bomberSource: Washington Post, April 2004Source: Washington Post, April 2004

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BNIBNICCE - The Chemical ThreatE - The Chemical Threat

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BNIBNICCE - The Chemical ThreatE - The Chemical ThreatSarin (GB)Sarin (GB)

• 1938 - pesticide1938 - pesticide• Nerve agentNerve agent

• ToxicToxic• Rapidly actingRapidly acting

• More potent than organophosphate More potent than organophosphate pesticidespesticides

• PropertiesProperties• Clear, colorless, tasteless liquidClear, colorless, tasteless liquid• No odor in pure formNo odor in pure form• Evaporates into a gasEvaporates into a gas

7575


• Binds to acetylcholine esteraseBinds to acetylcholine esterase• The body’s “off switch”The body’s “off switch”• Glands and muscles now Glands and muscles now

constantly stimulatedconstantly stimulated• Respiratory muscle fatigueRespiratory muscle fatigue

• Routes of exposureRoutes of exposure• Breathing contaminated airBreathing contaminated air• Eating contaminated foodEating contaminated food• Drinking contaminated waterDrinking contaminated water• Touching contaminated surfacesTouching contaminated surfaces

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• Symptoms within seconds of exposureSymptoms within seconds of exposure• Runny nose and watery eyesRunny nose and watery eyes• Drooling and excessive sweatingDrooling and excessive sweating• Rapid breathingRapid breathing• Diarrhea and increased urinationDiarrhea and increased urination• Loss of consciousness, seizuresLoss of consciousness, seizures• Paralysis, respiratory failure -> deathParalysis, respiratory failure -> death

• Prognosis based on exposurePrognosis based on exposure• Mild to moderate - complete recoveryMild to moderate - complete recovery• Severe - deathSevere - death

Agency for Toxic Substances and Disease Registry website:Agency for Toxic Substances and Disease Registry website:http://www.atsdr.cdc.gov/tfactsd4.htmlhttp://www.atsdr.cdc.gov/tfactsd4.html

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Working Together as a TeamWorking Together as a Team

Health CareHealth CareProvidersProviders

First RespondersFirst RespondersFire, Police, EMTFire, Police, EMT

FBIFBI

Public HealthPublic HealthOfficialsOfficials

IncidentIncidentCommanderCommander

8080

Terrorism forces us to make a choice. Terrorism forces us to make a choice. We can be afraid. Or we can be ready.We can be afraid. Or we can be ready.Tom Ridge, U.S. Department of Homeland Security, www.ready.govTom Ridge, U.S. Department of Homeland Security, www.ready.gov

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Be PreparedBe Prepared

• Review your local Disaster/Bioterrorism Safety PlanReview your local Disaster/Bioterrorism Safety Plan• Review the Ohio Department of Health Disaster Review the Ohio Department of Health Disaster

Preparedness & Response PlanPreparedness & Response Plan• http://www.odh.state.oh.us/alerts/alertmain.asphttp://www.odh.state.oh.us/alerts/alertmain.asp

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http://www.ready.gov/http://www.ready.gov/

http://www.redcross.org/services/disaster/beprepared/hsas.htmlhttp://www.redcross.org/services/disaster/beprepared/hsas.html

http://www.cdc.govhttp://www.cdc.gov

Be PreparedBe Prepared

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SummarySummary

• Be preparedBe prepared• Be alertBe alert• Manage initial casualtiesManage initial casualties• Know whom to contactKnow whom to contact• Know your team roleKnow your team role• Have ready references Have ready references

The Ohio Center of Excellence forThe Ohio Center of Excellence forBioterrorism Preparedness and ResponseBioterrorism Preparedness and Response

8484

Thank You!Thank You!Questions?Questions?

The Ohio Center of The Ohio Center of Excellence forExcellence forBioterrorism Bioterrorism

Preparedness and Preparedness and ResponseResponse

1 An Introduction to the Threat of Bioterrorism What Every Health Care Provider Should Know The Ohio...

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