Terrorism

1. Terrorism Chemical, Biological and Other Weapons of Mass Destruction and the implications to medical response personnel

2. Called as a result of increased Airline hijacking Terrorism is the act of kidnapping, hostage-taking, bomb attacks on innocents, hijacking or the assassination while being a political tool 1978 Bonn Summit

3. Terrorism • The intentional use of threat of politically, socially, economically, or religiously-motivated violence initiated by a non-state or state-sponsored organization in which the Proximate Target is exploited, injured, or destroyed so as to influence a separate, distinct Principal Target

4. Title 22 of the United States Code, Section 2656f(d) • terrorism: premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents, usually intended to influence an audience • international terrorism: terrorism involving citizens or the territory of more than one country • terrorist group: any group practicing, or that has significant subgroups that practice terrorism

5. FBI definition of terrorism • 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

6. Dept of Defense Definition of Terrorism • the calculated use of violence or the threat of violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological

7. Other Forms of Terrorism • Religious Terrorism • based on intolerance or racial, ethnic and religious differences • EcoTerrorism • any crime committed in the name of saving nature • Tree spiking, Tire studs, etc. • Computer / Electronic Terrorism • Any crime committed against a computer / information system with the intent to cause havoc

8. Weapons of Mass Destruction • The weaponization of nuclear, biological or chemical (NBC) agents and the manipulation of computers or other technological devices so as to cause death, destruction, and infrastructure disruption of a principal target

9. History of terrorism

10. Before the 19th Century • Frequently, terrorism was incidental to other forms of violence, such as war or insurgency • terrorists usually granted certain categories of people immunity from attack. Like other warriors, terrorists recognized innocents • radicals planning the assassination of Tsar Alexander II aborted several planned attacks because they risked harming innocent people • Early Chem/Bio terrorist acts • 423 B.C.: allies of Sparta in the Peloponnesian War took an Athenian-held fort by directing smoke from lighted coals, sulfur, and pitch through a hollowed-out beam into the fort • Catapulting of bodies infected with plague into cities under siege • British colonialists giving the American Indians blankets infected with Smallpox

11. Traditional terrorism (pre-1990’s) • Constrained or modulated violence, usually against a political leader • Committed to gain attention • Terrorists unwilling to cause mass casualties. Could backfire by losing popular support and by unleashing governmental forces that could wipe out the group • The act itself is a means to gain attention to spotlight grievances so terrorists usually identify themselves

12. Post-Modern Terrorist (1990s +) • Oftentimes with a religious foundation. Could lead to copy-cat secular terrorism • No distinction between proximate and principal targets • To kill en-masse to please God and comrades becomes an end in itself • Usually silent, anonymous • Easy access to material, funds, and technical expertise to develop a WMD

13. the death of a single individual, even a monarch, doesn’t necessarily produce policy changes attack people previously considered innocents to generate political pressure indirect attacks create a public atmosphere of anxiety and undermine confidence in government. Their unpredictability and apparent randomness make it virtually impossible for governments to protect all potential victims. The public demands protection that the state cannot give. Frustrated and fearful, the people then demand that the government make concessions to stop the attacks The sophisticated terrorist knows:

14. Break-up of the USSR and the resulting imbalance of world power as well as the termination of the usual checks and balances existing during the Cold War Mushrooming of a weapons black market throughout the world Desire for and unwillingness to modify individual and societal freedoms. Augments terrorist’s ability to learn, travel, act, and escape Urbanization-Industrialization: A plethora of random targets all within reach of terrorists and with limited security measures Diffusion of Technology: The terrorist has access to media and other educational modalities that can enhance the development and utilization of tactical and strategic weapons Facilitators for significant acts of Terrorism

15. Theories of Terrorism • Political: To advance a group’s vision of a better world in timely manner • Individual Psychological: Terrorists suffer from incomplete psychosocial identities which lead them to affiliate with similar sociopath and to blame their own inadequacies on society • Group Psychological: The longer a group is in existence, the need to keep and maintain its solidarity will supercede the initial primary mission

16. More acute now- why? • Media proliferation and trying to “make news” • Knowledge of foreign threats in other countries • Awareness of a lack of protection and vulnerability • Greater ability to cause mass casualties: • population density • American psyche unprepared

17. Examples of some Foreign and Domestic Terrorism

18. Aum Shinrikyo Cult • Worldwide cult responsible for the 3/20/95 sarin attack in Tokyo, Japan. Also known to have been working on weaponizing anthrax and botulinum toxin. Once tried to disseminate anthrax spores from the roof of a building but wind currents rendered the operation useless. Tested Sarin on a sheep farm in Australia. Also attacked Matsumoto 6/27/94, Yokohama (3/6/96) and leak in SATAYAM 7 - Kamakuishiki (7/14/94) and suspected of the Tokyo briefcase duds on 3/15/95

19. Hizballah • A Lebanese Shi’ite group created in 1983 whose main objective is the creation of an independent, Islamic Lebanon. Its military wing, The Islamic Resistance Movement, has been implicated in a series of bombings (e.g. U.S. Marine barracks, 1983) as well as rocket attacks on Jewish settlements. Synonyms: Party of God, Islamic Jihad.

20. Conventional Weapons Chemicals Blood agents (Poisons / Toxins) - Cyanide, Ricin Blistering / Choking Agents - WWI - Chlorine gas, sulphur mustard (HD), nitrogen mustard (HN), the arsenical vesicants such as lewisite Nerve Agents - Tabun, Sarin, VX, Pesticides (malathione) Biologicals Anthrax, Brucellosis, Botulism, Plague, Q-fever, Tularemia Terrorist Weapons

21. Closer to home • World Trade Center • Oklahoma City (Murrah Building) • Anthrax Scare in Las Vegas

22. Chemical Weapons Classifications • Lethal • The dose causes death • Incapacitating • less than 1/100 of the lethal dose causes incapacitation • through nausea, visual or GI problems

23. Chemical weapon classifications (cont.) • Harassing - Tear gas in schools & movie theaters • Also classified as Volatile(evaporate and contaminate the air) and Persistent (cover surfaces) • Volatile / Non-Persistent: disperse rapidly and short duration - airborne particles absorbed through inhalation • Persistent: Slowly vaporize due to thickening agents - contact hazard

24. The agent must not only be highly toxic but also "suitably highly toxic" so that it is not too difficult to handle The substance must be capable of being stored for long periods in containers without degradation and without corroding the packaging material It must be relatively resistant to atmospheric water and oxygen so that it does not lose effect when dispersed It must also withstand the heat developed when dispersed (ie: explosive dispersal: rides the shock wave, not burned up in the explosion as commonly thought To be considered for a weapon:

25. Effectiveness Effectiveness is the capacity of an agent to produce the maximum number of casualties or amount of disruption of operations with the least amount of agent Physical & chemical properties of the agent as well as meteorological conditions Gaseous molecules are well behaved and have a high rate of diffusion Rate of droplet evaporation dependent on particle size, number density, heat of vaporization Factors that alter a chemical weapon’s effectiveness

26. Winds, Temperature, Rain, Atmospheric Stability (inversion layer) • Outside: winds, solar heating and a large volume to diffuse to - therefore, not as effective • Inside: barriers, forced air currents, finite source of air, little dilution • concentration remains lethal longer, accumulated dosage increases, lethality efficiency increases

27. Poor man’s atomic bomb • for a large-scale operation against a civilian population, casualties might cost • $2,000 per square kilometer with conventional weapons • $800 with nuclear weapons • $600 with nerve-gas weapons • $1 with biological weapons • CIA report "concluded that 'clandestine production of [chemical and biological weapons] for multiple casualty attacks raises no greater technical obstacles than does the clandestine production of chemical narcotics or heroin"

28. droplets must be sufficiently large to ensure that they fall within the target area and do not get transported elsewhere by the wind increase; thus complicates decontamination. achieved by dissolving polymers (e.g., polystyrene or rubber products) in the CW agent to make the product highly-viscous or thickened persistence time and adhesive ability Dispersal of chemical weapon

29. Poisons / Toxins Cyanide, Hydrogen Cyanide, Cyanogen, Ricin

30. Ricin • Ricin is a protein toxin which acts as a cellular poison and is readily produced from castor beans (Ricinus communis), which are ubiquitous throughout the world • Waste from the commercial production of castor oil contains 5% ricin, making it easy for such a substance to fall into the hands of terrorists • 6000 times more toxic than cyanide and with no antidote

31. Ricin (cont.) • toxic by numerous exposure routes • its use by belligerents might involve poisoning of water or foodstuffs, inoculation via ricin-laced projectiles, or aerosolization of liquid ricin or lyophilized powder.

32. History of Ricin • This toxin has been used in the past to assassinate political enemies and is considered a useful weapon for terrorists • In Minnesota, 1992, 4 members of the Minnesota Patriots Council militia mixed ricin and a solvent with the intent of smearing the concoction on doors and steering wheels in order to assassinate a deputy U.S. marshall and a sheriff who had served tax violation papers on 1 of them. They had enough of the toxic agent to kill 125 people. The 4 members were the first to be convicted under the Biological Weapons Antiterrorism Act (1989)

33. Clinical features of Ricin exposure • When inhaled as a small particle aerosol, ricin would likely produce symptoms within 8 hours • Fever, cough, dyspnea, nausea, and chest tightness are followed by profuse sweating, the development of pulmonary edema, cyanosis, hypotension, and finally respiratory failure and circulatory collapse • Time to death would likely be 36-72 hours, depending on the dose received

34. Diagnosis of Ricin exposure • Naturally-occurring cases of ricin intoxication involve ingestion of castor beans, and are marked by severe gastrointestinal symptoms, vascular collapse, and death • The diagnosis of ricin intoxication is largely clinical and should be suspected in a setting of mass casualties with a similar and appropriate clinical picture • Failure to respond to antibiotics helps to differentiate ricin exposure from pulmonary infections produced by bacterial agents • An ELISA exists and may be performed on paired acute and convalescent sera

35. Treatment of Ricin Exposure • No specific treatment exists, and care is thus supportive. In cases of gastrointestinal exposure, gut decontamination via lavage, activated charcoal, and cathartics is warranted • Large amounts of volume replacement may be necessary

36. Ricin Treatment (Cont.) • Prophylaxis: A protective mask offers protection from aerosol exposure, but no specific vaccine or antitoxin exists • Decontamination and Isolation: Ricin may be inactivated with 0.5% hypochlorite. Since it is not dermally active and is involatile, decontamination may not be as critical as with certain other biological and chemical agents • Outbreak Control: Ricin does not, in general, pose a risk of secondary aerosolization

37. Cyanide • A poison that rapidly deactivates the cellular metabolism throughout the body. Within 30 seconds of inhalation, a victim loses consciousness, seizes, becomes apneic, and within 8 minutes is in cardiac arrest. Treatment must be prompt and consists of inhalation of amyl nitrite and i.v. administration of sodium nitrite and sodium thiosulfate

38. Hydrogen cyanide • A highly toxic agent that causes general poisoning and rapid death. It is a colorless, odorless liquid that is highly volatile. It can be absorbed by the skin or by inhalation. Treatment is based on hastening the body’s ability to excrete it.

39. Vesicant / Blistering Agents / Choking Agents Lewisite, Mustard, Phosgene, Chlorine, Chloropricin

40. Mustard • Chemicals that are characterized by the blistering that occurs on exposed skin, eyes, respiratory membranes, and internal organs. The onset of symptoms may be delayed up to 2-24 hours from exposure. Treatment is symptomatic. • Used during WWI & II • Used during the 1978 Iranian War

41. Effects of Blister Agents • Vesicants burn and blister the skin or any other part of the body they contact. They act on the eyes, mucous membranes, lungs, skin and blood-forming organs. They damage the respiratory tract when inhaled and cause vomiting and diarrhea when ingested • Exposure to mustard is not always noticed immediately because of the latent and sign-free period that may occur after skin exposure. This may result in delayed decontamination or failure to decontaminate at all • Within 2 minutes contact time, a drop of mustard on the skin can cause serious damage

42. Ordinary clothing gives little or no protection against mustard agents Special equipment including a respirator, NBC suit, gloves and over-boots are required Due to slow absorption of mustard by many materials, protective equipment must be changed regularly No drug is available for the prevention of the effects of mustard on the skin and the mucous membranes It is possible to protect the skin against very low doses of mustard by covering it with a paste containing a chlorinating agent, e.g., chloramine The only practical prophylactic method is physical protection such as is given by the protective respirator and special clothing Protection

43. Blistering Agent Decontamination

44. Decontamination • The importance of early decontamination can not be over emphasized. Decontamination of the skin should be accomplished quickly if it is to be fully effective. Liquid agent may be removed by `fullers’ earth or chemically inactivated by the use of reactive decontaminants. • Decontamination personnel should use a respirator and full protective equipment whilst decontamination is performed • Once a casualty has been decontaminated, or the agent fully absorbed, no further risk of contamination exists. The casualty's body fluids, urine or feces do not present achemical warfare (CW) hazard

45. Decontamination of the Skin • Absorbent powders to pull agent from the skin • Chemical inactivation by chlorinating compounds incorporated into adsorbing powders, ointments, solutions or organic solvents • Mustards should not be decontaminated with water, except for the eyes, as this may spread the agent

46. Decontamination of Mucous Membranes and Eyes • The substances used for skin decontamination are generally too strongly irritant to be used on mucous membranes and the eyes. In this case the affected tissues should be flushed immediately with water. The eyes can be flushed with copious amounts of water, or, if available, isotonic sodium bicarbonate (1.26%) or 0.9% saline

47. Decontamination of Wounds • Mustard may be carried into wounds on fragments of cloth. These wounds should be carefully explored using a no-touch technique. Fragments of cloth should be removed and placed in a bleach solution. This removes the hazard from mustard vapor off-gassing • Wounds should be irrigated using a solution containing 3000-5000 ppm (parts per million) free chlorine (dilute "milton" solution) with a dwell time of approximately 2 minutes. The wound should then be irrigated with saline. Irrigation of the contaminated wound should not be used in the abdominal, or thoracic cavities, nor with intracranial head injuries.

48. Additional Procedures • Whatever means is used has to be efficient and quick acting. Chemical inactivation using chlorination is effective against mustard and Lewisite, less so against HN3, and is ineffective against phosgene oxime. In the case of thickened mustard, where the usual procedure is inadequate, the agent may be scraped off with a knife or similar hard object. This may be followed by wetting the surface with a cloth drenched in an organic solvent, e.g.,petrol (unleaded gasoline) and subsequent application of the usual decontaminating procedure. If water is available in abundant amounts these procedures should be followed by copious washing

49. Nerve Agents GA (Tabun), GB (Sarin), GD (Soman), GF and VX (methylphosphonothioic acid).

50. Developed just before and during World War II as German scientists were developing insecticides thus are related chemically to the organophosphorus insecticides. produce toxicity due to cholinergic overdive at Muscarinic, Nicotinic and CNS cholinergic sites. to inhibition of the acetylcholinesterase enzyme with accumulation of acetylcholine and excessive stimulation In the pure state nerve agents are colorless and mobile liquids. In an impure state nerve agents may be encountered as yellowish to brown liquids. Some nerve agents have a faint fruity odor OTC agents used as pesticides: malathion, parathion (distilled to make stronger) The nerve agents