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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

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Terror Is Real !

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  1. Terror Is Real !

  2. Terrorism: Are We Ready? Barbara Russell, RN,MPH,CIC,ACRN

  3. Biological and Chemical Terrorism:How Real is the Threat?

  4. 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.”

  5. “Kill 1, Frighten 10,000” Sun Tzu

  6. Anthrax 2001 • 22 confirmed or suspected cases • 11 inhalation (confirmed) • 11 cutaneous (7 confirmed, 4 suspected)

  7. Inhalation Anthrax (11) 9 confirmed - exposed to mail (other 2 possible) 55% (6) survived

  8. Types of Terrorism • Biological • Nuclear • Incendiary • Chemical • Explosive • B-NICE

  9. Target Selection • SSymbolic target to audience or terrorist Economic, political, social or religious value Highly visible and photogenic Random: To create confusion Diversionary Asymmetrical attack

  10. Timing • Anniversary of significant historical event • Highly visible event in the area • Increase in international tensions

  11. Chemical & Biological Terrorism 1984: The Dalles, Oregon, Salmonella(salad bar) 1991: Minnesota, ricin toxin (hoax) 1994: Tokyo, Sarin and attack 1995: Arkansas, ricin toxin (hoax) 1995: Ohio, Yersinia pestis (sent in mail) 1997: Washington DC, “Anthrax” (hoax) 1998: Nevada , non-lethal strain of B. anthracis 1998: Multiple “Anthrax” hoaxes

  12. Chemical Warfare Agents

  13. 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.

  14. 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

  15. 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.

  16. 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

  17. Nerve Agent Symptoms • Salivation • Lacrimination • Urination • Defecation • Gastrointestinal pain • Emesis • SLUDGE

  18. Decontamination • Removes the agent from the patient • Reduces the chance of secondary spread • Helps the victim psychologically

  19. 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 Nerve Gas Poisoning

  20. 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 Sulfur Mustard Poisoning

  21. “I’m confident that we can defend against chemical warfare. The one that really scares me to death is biological” Colin Powell - 1993

  22. Potential Biological Weapon Agents

  23. 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.

  24. Bacterial Agents Anthrax Brucellosis Cholera Plague, Pneumonic Tularemia Viruses Smallpox VEE VHF Biological Toxins Botulinum Staph Entero-B Ricin T-2 Mycotoxins Potential Bioterrorism Agents Source: U.S.A.M.R.I.I.D.

  25. 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

  26. 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.

  27. 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%!!!!

  28. 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

  29. Anthrax

  30. Anthrax (bacillus anthracis)

  31. 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)

  32. How is smallpox spread? • By direct, prolonged face-to-face contact • Less commonly, indirectly by contaminated bedding or clothing • Rarely spread by air • Transmission prevented by using airborne and contact precautions in health care settings

  33. 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

  34. How the skin looks with successful vaccine “take”

  35. Smallpox

  36. Smallpox vs. Chickenpox

  37. Smallpox (variola major)

  38. 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.

  39. 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

  40. 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

  41. 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

  42. 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

  43. Plague (yersinia pestis)

  44. Plague

  45. 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 cases • 26 food borne • 107 intestinal / infant • 41 wound

  46. 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)

  47. Botulism (cont) • IIncubation period • - Food borne: 12-36 hours (preformed toxin) • - Intestinal (Infant): 1-2 weeks • - Wound: 4-14 days

  48. Botulinum Toxin

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