Terror Is Real !
-
Upload
beatrice-antwan -
Category
Documents
-
view
24 -
download
0
description
Transcript of Terror Is Real !
Terror Is Real !
Terrorism: Are We Ready?
Barbara Russell, RN,MPH,CIC,ACRN
Biological and Chemical Terrorism:
How Real is the Threat?
What is Terrorism?
No single definition FBI: “The unlawful use of force or violence
against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”
“Kill 1, Frighten 10,000”
Sun Tzu
Anthrax 2001 22 confirmed or suspected cases
11 inhalation (confirmed)
11 cutaneous (7 confirmed, 4 suspected)
Inhalation Anthrax (11)
9 confirmed - exposed to mail (other 2 possible)
55% (6) survived
Types of Terrorism
Biological Nuclear Incendiary Chemical Explosive
B-NICE
Target SelectionSSymbolic target to audience or terrorist
Economic, political, social or religious value
Highly visible and photogenic
Random: To create confusion
Diversionary
Asymmetrical attack
Timing
Anniversary of significant historical event
Highly visible event in the area
Increase in international tensions
Chemical & Biological Terrorism
1984: The Dalles, Oregon, Salmonella (salad bar)
1991: Minnesota, ricin toxin (hoax)1994: Tokyo, Sarin and attack1995: Arkansas, ricin toxin (hoax)1995: Ohio, Yersinia pestis (sent in mail)1997: Washington DC, “Anthrax” (hoax)1998: Nevada , non-lethal strain of B. anthracis1998: Multiple “Anthrax” hoaxes
Chemical Warfare Agents
Tokyo Subway Attack
•Odon March 20, 1995, terrorists released sarin, an organophosphate (OP) nerve gas at several points in the Tokyo subway system, killing 11 and injuring more than 5,500 people.
Concealed in lunch boxes and soft-drink containers and placed on subway train floors. It was released as terrorists punctured the containers with umbrellas before leaving the trains. •.On April 19th, 1995 repeat attack in subway which the same terrorist group killed seven and injured more than 200 people.
Chemical Warfare Agents (CWA)
Lethal CWA’s Nerve gas (Sarin, Tabun, soman, and VX)
Organophosphates- anticholinesterase Colorless, odorless, tasteless
Cyanides
Vesicants (=blistering ) agents – mustard gas
Nerve Gas Agents All nerve agents belong chemically to the group of organo-phosphorus compounds.
Stable and easily dispersed, highly toxic and have rapid effects both when absorbed through the skin and via respiration.
Nerve agents can be manufactured by means of fairly simple chemical techniques. The raw materials are inexpensive and generally readily available.
Chemical
Chemical agents are toxic, but…
- They can be detected
- You can protect yourself
- Victims can be decontaminated Can be inhaled, absorbed through the skin or
injected
Nerve Agent Symptoms Salivation Lacrimination Urination Defecation Gastrointestinal pain Emesis
SLUDGE
Decontamination
Removes the agent from the patient
Reduces the chance of secondary spread
Helps the victim psychologically
Nerve Gas Poisoning Eyes: excessive lacrimation
and pain.
Skin: excessive sweating
Muscles: involuntary twitching
Respiratory: Mucous secretion, dyspnea
Digestive: excessive salivation, abdominal pain
Symptoms: minutes to 2 hours
Treatment: Atropine, 2-PAM (pralidoxime-2-chloride)
Decontamination: Soap & Water, Chlorox
Sulfur Mustard Poisoning Eyes: reddening, congestion,
pain 1/2 -12 hours
Skin: itching, burning, erythema, large blisters (1-12 hours)
Respiratory: burning throat, cough, dsypnea. (2-12 hours)
Digestive: abdominal pain, nausea, blood stained vomiting and diarrhea
Treatment: none
Decontamination: Soap & Water, Chlorox
Care: watch for leukopenia, debride bullae
“I’m confident that we can defend against chemical warfare. The one that really scares me to death is biological”
Colin Powell - 1993
Potential Biological Weapon Agents
Characteristics of a Biological Attack:
Civilian Targets Likely. Possibility of Large Numbers of Casualties. Symptoms May Not Appear For Days. Initial Symptoms Likely to be Non-Specific. Diagnoses Will Depend Heavily Upon Laboratory Tests. Complex Epidemiology. Ongoing Need to Care for Large Numbers of Patients Concerns About Availability of Drugs, Supplies, Staff Members. Legal Considerations. Coordination with Local, State, and Federal Authorities.
Potential Bioterrorism Agents Bacterial Agents
Anthrax Brucellosis Cholera Plague, Pneumonic Tularemia
Viruses Smallpox VEE VHF
Biological Toxins Botulinum Staph Entero-B Ricin T-2 Mycotoxins
Source: U.S.A.M.R.I.I.D.
Biological Agents of Highest Concern
Variola major (Smallpox) Bacillus anthracis (Anthrax) Yersinia pestis (Plague) Francisella tularensis (Tularemia) Botulinum toxin (Botulism) Filoviruses and Arenaviruses (Viral hemorrhagic
fevers) ALL suspected or confirmed cases should be
reported to health authorities immediately
Anthrax - The Weapon
Bacillus anthracis (coal = anthrakis) because of black coal like lesions
Aerobic, gram-positive, spore forming, non-motile bacillus species.
Inhalation Anthrax: Most morbidity and mortality as aerosolized biological
weapon. Disease occurs 2 to 43 days after exposure.
Anthrax - The Disease
Inhalation anthrax: Hemorrhagic thoracic lymphadenitis Hemorrhagic mediastinitis Hemorrhagic meningitis
Two Stages 1. Fever, cough, dyspnea, headache, vomiting, chills, weakness 2. Sudden fever spikes, dyspnea, shock, cyanosis, hypotension
Mortality: 89%!!!!
Anthrax:Diagnosis, Prevention, Treatment
CXR: widened mediastinum Blood culture shows growth after 2-6 hours Vaccine: Licensed since 1970, 88% effective, not
available! Treatment: PNC, Doxycycline, Ciprofloxacin,
first generation cephalosporin, vacomycin, clindamycin
AnthraxAnthraxCause Bacillus anthracis
Incubation 1-60 days, average 7 days
Mortality (without treatment)
Cutaneous: 20%Intestinal: 25%-60%Inhalation: Usually fatal
Infectious Dose Varied; 8,000-50,000 spores (inhalation)
Treatable? Yes; antibiotics and supportive care
Human to Human Transmission?
No
Anthrax (bacillus anthracis)
Anthrax (bacillus anthracis)
What is smallpox?
Serious, contagious, viral disease that causes a fever and distinctive rash
Treatment: supportive Historically, 30% of smallpox patients died,
many developed scars especially on face, some became blind
Prevented by smallpox vaccine (>95% effective)
How is smallpox spread?
By direct, prolonged face-to-face contactLess commonly, indirectly by
contaminated bedding or clothingRarely spread by airTransmission prevented by using airborne
and contact precautions in health care settings
What is the risk of smallpox?
1972: routine smallpox vaccination discontinued in U.S.
1977: last naturally-acquired case in world Deliberate release is possible but risk is unknown Health care workers at higher risk due to exposure
to most severely ill patients In Europe from 1950-71, 50% of smallpox
transmission was in hospitals
How the skin looks with successful vaccine “take”
SmallpoxCause Variola major
Incubation 7-17 days, average 12-14 days
Mortality (without treatment)
30%
Infectious Dose Small
Treatable? Supportive care; vaccine after exposure
Human to Human Transmission?
Yes - Airborne
Smallpox vs. ChickenpoxSmallpox Chickenpox
Distribution of pox
Centrifugal distribution (face, arms, legs)
More covered parts of body, trunk
Stage of pox development
All at same stage of development
Various stages of development
Unique presentation
Pox found on palms and soles of feet
Uncommon to find pox on palms and soles of feet
Smallpox (variola major)Smallpox (variola major)
Treatment
Treatment of smallpox is limited to supportive therapy and antibiotics as required for treating secondary bacterial infections.
There are no proven antiviral agents effective in treating smallpox.
Plague
Found in rodents and their fleas in many parts of the world
Bites from an infected flea Bubonic, septicemic, pneumonic Seen in rural areas (US: 10-15 cases per year) Two recent human cases of primary pneumonic
plague contracted from cats
Plague (cont)
US: 390 cases from 1947-1996
- 84% bubonic (standard precautions)
- 13% septicemic (standard precautions)
- 2% pneumonic (droplet precautions) Patients may present with GI symptoms (N/V, abd
pain) Treated with antibiotics
Plague (cont)BBiological terrorism release clues:- Pneumonic plague outbreak 1-6 days after exposure- Initial severe respiratory illness- Death occurs quickly after onset of illness- Infection in persons with no known risk factors
Plague (cont)
BBiological terrorism release clues (cont)- Occurrence of cases in areas not known to have previous cases- Absence of prior rodent deaths (which may be present after natural disaster)Plague vs. Anthrax presentation
Plague (yersinia pestis)Plague (yersinia pestis)
PlagueCause Yersinia pestis
Incubation 2-6 days
Mortality (without treatment)
50% (bubonic); near 100% (pneumonic)
Infectious Dose Small
Treatable? Yes; antibiotics and supportive care
Human to Human Transmission?
Pneumonic: YesBubonic: No
Botulism Most potent naturally occurring lethal substance
known to man Possible routes of exposure: Ingestion (food),
Inhalation (terrorist), Injection (drug users), dirty wound
In 1999…………. 174 cases26 food borne107 intestinal / infant41 wound
Botulism (cont)CCardinal Signs- Fever is absent (unless infection is present)- Neurological symptoms are symmetrical- Patient remains responsive- Heart rate normal or slow- Sensory deficits do not occur (except for blurred vision)
Botulism (cont)IIncubation period
- Food borne: 12-36 hours (preformed toxin)- Intestinal (Infant): 1-2 weeks- Wound: 4-14 days
Botulinum ToxinCause Clostridium botulinum
Incubation 2 hours – 8days, average 12-72 hours (foodborne)
Mortality High
Lethal Dose 1 ng/kg (about 0.00000009g/200lb person)
Treatable? Yes; antitoxin and supportive care
Human to Human Transmission?
No
TularemiaTularemia
Reservoir: Numerous wild animals (i.e.: rabbits, beavers, some ticks)
Can also be found in contaminated water, soil, vegetation
Infections occur in North America (US: 171 cases / year) – AKA Rabbit Fever, Deer Fly Fever
Infection caused by handling infectious animal tissues or fluids, direct contact with contaminated water, food, soil and inhalation of aerosols.
Tularemia (francisella tularensis)
Tularemia (francisella tularensis)
TularemiaCause Francisella tularensis
Incubation 1-14 days, average 3-5 days
Mortality (without treatment)
Varies; 5%-60%
Infectious Dose 10 organisms
Treatable? Yes; antibiotics and supportive care
Human to Human Transmission?
No
Hemorrhagic Fevers
Ebola, Marburg, Lassa, Junin & related viruses Presentation: Initially febrile illness, malaise, myalgias, H/A, vomiting, diarrhea followed by bleeding, hypo tension, shock Mode of Transmission: Contact with infected blood or other materials, higher risk at late stages of illness
Hemorrhagic Fevers (cont) Incubation period (days):
- Ebola 2-21,
- Marburg 3-9,
-Lassa, commonly 6-21 - Junin 7-16
Diagnostic Tests Available
Significant number of people with hemorrhagic fever symptoms
Intensive supportive care
Standard and Contact Precautions
Hemorrhagic FeverCause Varies; viral
Incubation Varies; days to weeks
Mortality (without treatment)
Varies; high (as much as 80%)
Infectious Dose Unknown
Treatable? No; supportive care only
Human to Human Transmission?
Yes
Key Points
Increase Level of Awareness
Be familiar with Workplace Plan
Be familiar with County Plan
Have a Family Plan
No “I” in Response – It’s a Team Effort
Personal Protective Equipment
Be sure that it is Appropriate to the hazard(s)