chembio tutorial
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Tutorial on Chemical and Biological Warfare - Presented at The 1st Annual Symposium On Seaport Security given in Houston Texas Y2003TRANSCRIPT
Terrorist Use of Chemical & Biological Weapons -
A Tutorial Frank W Meissner, MD, MS, FACP, FACC, FCCP, CPHIMS
Terrorist - The Official Definition
FBI Definition - The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives.”
Why Terrorists Might Use
"Weapons of Mass Destruction"
Classically, terrorism was the act of making Political statement via violence
Political act designed to influence an audience
Levels of violence carefully calculated Draw attention but not so violent as too
Alienate supporters Trigger overwhelming response
Why Terrorists Might Use "Weapons of Mass Destruction”
Classical Terrorists have had substantively rational goals, e.g.,
Attaining national autonomy (Morocco)
Establish representative government (Palestinians)
Protest government policies & actions (Weatherman)
Why Terrorists Might Use "Weapons of Mass Destruction”
Candidates for use of Chem/Bio weapons represent the intersection of three sets of Groups
A B
C
A - Groups that want to use the agents despite the political risksB - Groups that can acquire the agent & dissemination technologyC - Groups whose organizational structure allows for covert delivery
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - Gaining Attention Bio-weapons ARE
Mysterious
Unfamiliar
Indiscriminate
Uncontrollable
Inequitable
Invisible
Factors that heighten FEAR, the Terrorists Goal State
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - Economic Damage Attack Crop, Livestock, Pharmaceuticals
Attack Corporate interests Potentially massive costs of clean up of a Bio-war attack
Recall that the Soviets lost the Cold War because we outspent them!
Could non-state Terrorists causes us to outspend our resources?
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - MillenarianismThe Millenarian idea- The present age is corrupt & a
new age will dawn after a cleansing apocalypseOnly a Chosen few (usually selected on the basis of adherence to doctrine or ritual) will survive the end
of time and experience paradisePrime motivator for some “ Domestic” Terrorists
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - Exacting Revenge or Creating Chaos
Politically motivated terrorists desire to change societies rather than destroy them
Thus avoid killing very large numbers of people Political costs exceed the benefits
Some terrorists wish to annihilate enemies or demolish societal order Ramzi Yousef, organizer of World Trade Center bombing, claimed he was exacting revenge
against the United States William Pierce, leader of neo-Nazi organization National Alliance, aims to initiate a worldwide
race war & establish an Aryan state Leon Czolgosz, assassin who shot President William McKinley was an anarchist, i.e., espoused a
political philosophy that believes all forms of governments are oppressive
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - Mimicking GodCreate an aura of divine retribution
Gods 5th plague on the Pharaoh in Exodus was murrain, a group of cattle diseases that includes anthrax
5th chapter of Samuel I, God turned against the Philistines and "smote them with emerods"
• Emerods=Bubo’s a symptom of bubonic plague
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - “Copycat” PhenomenaIncreased interest in Chem/Bio-weapons among
domestic extremists after Aum Shinrikyo incident
Surge in Anthrax hoaxes after both Aum Shinrikyo & Anthrax letters post-9/11
Why Terrorists Might Use "Weapons of Mass Destruction”
Motivational Factors - Technical AvailabilityWeapons of mass destruction & components are easier to acquire since Fall
of Soviet GovernmentFormer Soviet weapons experts may be providing biological weapons & expertise to Iran
Judith Miller and William J. Broad, "Bio-Weapons in Mind, Iranians Lure Needy Ex-Soviet Scientists," New York Times, 8 November 1998, A1; Miller and Broad, "Germ Weapons: In Soviet Past or in the New Russia's Future?" New York Times, 28 December 1998, A1.
South African biological weapons scientists have offered their expertise to Libya
19James Adams, "Gadaffi Lures South Africa's Top Germ Warfare Scientists," Sunday Times, 26 February 1995; Paul Taylor, "Toxic S. African Arms Raise Concern; US Wants Assurance `80s Program is Dead," Washington Post, 28 February 1995.
Why Terrorists Might Use
"Weapons of Mass Destruction"
In Summary, Postmodern or Super-terrorism
May aim to maximize number of casualties
Levels of violence carefully calculated Reflects a shift in the goal of terrorists
Maximizing damage to the target
This can become the end itself
Questions?
Is this terrorism?
Or is it asymmetrical warfare?
What exactly is a War on Terrorism?
Carl Von Clausewitz
Vom Kriege (On War) - 1832“War is Merely The Continuation of
Policy By Other Means”Can a state be at war with a non-state
actor?Or are we talking about Police actions?Can a War on Terrorism lead to a Police
State?
Hx of Chemical Warfare
Pre-WWI1000 BC - Chinese used arsenical smokes 600 BC - Solon of Athens put hellebore roots in the drinking water of Kirrha Thucydide's History of Peloponnesian War
429 & 424 BC, Spartans & Allies used noxious smoke and flame against Athenian-allied cities
660 AD Kalinkos invented "Greek Fire” Technical innovation extensively used by the Naval Fleet
of the Byzantine Empire for over 200 years Destroyed the naval fleet of Igor, Prince of Keiv, 941 AD
Hx of Chemical Warfare
Pre-WWI15th Century Leonardo da Vinci proposed military use of a powder of sulfide of arsenic and verdigris1618-48 - Thirty Years War - Toxic smoke projectiles designed & used 1899-1902 - Boer War - British troops fired picric acid-filled shells - munitions had little effect on the outcome of combat 1904-1905 - Russo-Japanese War - Japanese soldiers threw arsenal rag torches into Russian trenches
WWI
November 1914 - Dr. Hans von Tappen - designed 150-mm howitzer shell containing 7 lb of xylyl bromide and a burster charge for splinter effect
Operational tests of 18,000 of the shells at Russian positions near Bolimov - op failure 2° weather conditions
Tested again at Western front at Nieuport - March 1915 - also abysmal failure
WWI
Ypres, Belgium - 22 April 1915- 1st successful German chemical attack
Success of the attack was not capitalized upon by the Germans
July 1917- Germans introduced mustard agent
persistent vesicant that attacked the body in places not protected by gas masks
Intra-war period
Italian-Ethiopian War3 October 1935 - Benito Mussolini -invasion of Ethiopia from Eritrea, an Italian colony, and Italian Somaliland
Italians dropped mustard bombs and occasionally sprayed it from airplane tanks
Intra-war period
Japanese Invasion of China - 1937By 1939 Japanese were using mustard agent & Lewisite
Very effective against the untrained & unequipped Chinese troops
Chinese reported that their troops retreated whenever the Japanese used just smoke, thinking it might be a chemical attack
WWII
President Roosevelt established a “No-First-Use” policy
Germans in fact had manufactured & stored 1/4 million tons of chemical agents
Germans developed Nerve Agents Tabun (GA) & Sarin (GB) production beginning 1939
Korea & Cold War
Continuation of “No-First-Use” Policy
1950 - Full-scale Sarin production complex @ Edgewood Arsenal
Multiple types of Munitions Developed
Honest John Rocket - Chem Warhead & Sarin Bomblet
Vietnam
Extensive use of Chemical agents“Non-lethal” riot control agents
“Defoliants” (Agent Orange)
Re-defined chemical weapons to exclude this category of agents
Yemen Civil War 1962-1970
Yemeni dissidents overthrew monarchyRoyalist forces aided by Saudi Arabia & Jordan engaged in Civil WarEgyptians supported dissidents Egyptian Air Force used chemical weapons
Jan 1967 - Yemeni village of Kitaf95% population & all animals in village died within 10-50 min of attack Agent used was mixed mustard & nerve gas
1967 Arab-Israeli War
Both sides were prepared to use Chemical & Biological agents
Neither side used agents
Probably due to the speed of tactical operations
1973 Arab-Israeli War
No use of agents
But Israeli captured Arab equipment of Soviet design/origin demonstrated sophisticated Chem Defense & Offensive capabilities
Sparked renewed interest in Chem Defense in US Military
Afghanistan War
Extensive use of Chemical weapons by Soviet’s against Afghanistan civilians & mujahedeen (Arabic and or Persian mujhidn, pl. of mujhid, one who fights in a jihad (Holy War))
Iran-Iraq WarIraq trained & influenced by Soviet military advisors used chem agents against Iranian military forcesPrincipally used mustard & Tabun delivered by bomb from aircraft Also delivered agents by artillery shells & chemical rocket systems
Approximately 5% Iranian casualties from chem attack
Immediately after war used Chem agents against Kurds
1st Persian Gulf War
Frequent chemical alert alarms - all originally felt to be false alarms
4 Mar 91 - Kamisiyah arsenal - US Army 37th Engineer Battalion - blew munitions storage bunkers Probably Sarin- & Mustard-agent munitions
Wind shift @ start of battle prevented effective use by Iraqi forces Speed of advance may also have prevented effective deployment of chemical agents Fear of nuclear retaliation
Aum Shinrikyo Attacks
27 June 1994 - Sarin gas used in subway attack - killing 7 & injuring 500
19 March 1995 - Tokyo attack - killing 12 & injuring 3800
Chemical Agent: Definition (FM 8-285)
“A chemical substance…intended for use in military operations to kill, seriously injure, or incapacitate humans (or animals) through its toxicological effects.”
Chemical Agent: Definition (FM 8-285)
“A chemical substance…intended for use in military operations to kill, seriously injure, or incapacitate humans (or animals) through its toxicological effects.”
Excluded by FM 8-285
Riot-control agents (CS, CN, DM)
Chemical herbicides (e.g.. Agent Orange)
Smoke and flame materials
Excluded Agents: Riot-control Agents
Irritant agents (lacrimators) CS (“tear gas”) CN (Mace©) CA CR
Vomiting agents DM (Adamsite) DA DC
Riot-control Agents
Local irritants with high safety ratio
Short onset (seconds to minutes)
Short duration (15-30 minutes)
In low concentrations, cause intense painand lacrimation (tearing) with (Adamsite only)or without vomiting
Excluded Agents: Herbicides (Defoliants)
Agent Blue (cacodylic acid)
Agent Orange (1:1 mixture of 2.4.5-T and 2.4-D)
Contaminant: TCDD (Dioxin)
Agent White (4:1 mixture of 2.4-D and picoram)
Paraquat
Excluded Agents: Smokes
Petroleum oil smokes (fog oil=SGF)
Diesel fuel
HC
RP (RED phosphorus) in butyl rubber
WP (WHITE phosphorus)
FS
FM
Classification of “Official” Chemical Agents
TOXIC AGENTS (producing injury or death)LUNG-DAMAGING AGENTS (choking agents)
Chlorine (CL), phosgene (CG) [smokes] [vesicants]
“BLOOD” AGENTS (cyanogens): AC and CK
BLISTER AGENTS (vesicants) Mustard (H), Lewisite (L), phosgene oxime (CX), [T-2 mycotoxin]
NERVE AGENTS (anticholinesterases) GA,GB,GD,GF,VX
INCAPACITATING AGENTS (producing temporary effects) BZ, Agent 15, [riot-control agents]
Lung-damaging Agents
Chlorine (CL)
Chloropicrin (PS)
Phosgene (CG)
Diphosgene (DP)
[Mustard (HD, H) Lewisite (L)]
[Smokes] [isocyanates] [PFIB] [oxides of nitrogen]
Chemical-agent Damage to Respiratory System
Central effects (in larynx, trachea, and bronchi) predominate
Mustard (H, HD)Lewisite (L)[Chlorine (CL)]
Peripheral effects (in small airways and alveoli) predominate
Phosgene (CG)Perfluoroisobutylene (PFIB)Nitrogen oxides (NOx)HC smoke, isocyanates, many others
“Blood” Agents (Cyanogens)
Hydrogen cyanide (AC)
Cyanogen chloride (CK)
Blister Agents (Vesicants)
Sulfur mustard (H, HD)
Nitrogen mustard (HN1, HN2, HN3)
Lewisite = chlorovinyldichloroarsine (L)
Mustard / Lewisite mixtures (HL, HT, TL)
Phosgene oxime (CX)
[Riot-control agents]
[T-2 mycotoxin]
Nerve Agents (Anticholinesterases)
Tabun (GA)
Sarin (GB)
Soman (GD)
GF
VXAcetylcholineAcetylcholine
receptorreceptor
PPrreessyynnaappttiicc
AchAch
Ach
-est
eras
eA
ch-e
ster
ase
Ach
-est
eras
eA
ch-e
ster
ase
Cholinesterase inhibitorCholinesterase inhibitor
PralidoximePralidoxime
Atr
opin
eA
trop
ine
“Official” Chemical Agents: Incapacitating Agents
Purpose: Temporary incapacitation
CNS stimulants Amphetamines, cocaine, caffeine, nicotine, strychnine, metrazole
CNS depressants Barbiturates, opioids, antipsychotics, benzodiazepines
Psychedelics LSD-25, psilocybin, ibogaine, harmine, MDMA (“ecstasy”), PCP
Deliriants Anticholinergic glycolates (BZ, Agent 15)
Physical Forms of Chemical Agents
Solid
Liquid
Gas
Vapor
Aerosol
Persistence
Dependent on several factorsAgent volatility (determined by chemical structure)
Temperature
Wind
Agent-surface interactions
“Nonpersistent” agents (usually gone within 24 hours)GA, GB, GD, CL, CG, AC, CK
“Persistent” agentsVX, L, HL, “thickened” nerve and blister agents (e.g., TGD, THD)
Exposure and Absorption
Exposure (contact with agent) does not necessarily lead to absorption (penetration of epithelial barriers)
Two types of effects from exposure and absorption:Local
(effects are at the site of contact)
Systemic (absorption and subsequent systemic distribution
produce effects at sites distant from contact site)
Routes of Exposure & Absorption
Absorption through skin (percutaneous absorption)
Absorption through lungs (inhalational absorption)
Absorption through eyes (ocular absorption)
Absorption through the gut (enteral absorption)
Absorption by injection (parenteral absorption)
Intravenous absorption
Intramuscular absorption
Toxicity (Potency) of Liquid Agents
ED50: Effective Dose for 50% of exposed individuals
ID50: Incapacitating Dose for 50% of exposed individuals
LD50: Lethal Dose for 50% of exposed individuals
ID50 for liquid HD(mustard) : 770 mg for a 70-kg man
LD50 for liquid HD: 3000-7000 mg for a 70-kg man
Toxicity of Vapors or Gases
The Ct concept: Concentration x time
1 mg / m3 x 8 min = 8 mg-min / m3
8 mg / m3 x 1 min = 8 mg-min / m3
4 mg / m3 x 2 min = 8 mg-min / m3
2 mg / m3 x 4 min = 8 mg-min / m3
Toxicity of Vapors or Gases
ECt50: Effective Ct for 50% of exposed individuals
ICt50: Incapacitating Ct for 50% of exposed individuals
LCt50: Lethal Ct for 50% of exposed individuals
Ct50 assesses external dose, not internal dose
ICt50 and LCt50 therefore affected by
Route of exposure
Respiratory rate and depth, skin moisture, etc.
Toxicity of HD(Mustard) Vapor
HD vapor in eyes:ICt50: 200 mg-min / m3
Inhaled HD vapor:ICt50: 200 mg-min / m3
HD vapor on skin:ICt50: 1000-2000 mg-min / m3
Toxicity of HD (Mustard) Vapor
HD vapor in eyes:Permanent injury: > 800 mg-min/ m3
Inhaled HD vapor:LCt50: 1000-1500 mg-min / m3
HD vapor on skin:LCt50: 10,000 mg-min / m3
Comparative Toxicity - CW Agents
0
1000
2000
3000
4000
5000
6000
CL CG AC H GB VX BZ CSAGENT
(L) (L)(L)(L)(L) (E)(E)(L)
Ct50
(mg-min/m3)
Precursors to Chemical Weapons - Dual Use Technology & Agents
Ammonium bifluoride 1341-49-7
Civilian Uses CW Agent
Ceramics
Disinfectant for food equipment
Electroplating
Etching glass
Sarin (GB)
Soman (GD)
GF
Precursors to Chemical Weapons - Dual Use Technology & Agents
Diethylphosphite 762-59-2
Civilian Uses CW Agent
Organic synthesis
Paint solvent
Lubricant additive
VG
Sarin (GB)
Soman (GD)
GF
Precursors to Chemical Weapons - Dual Use Technology & Agents
Diethylamine 124-40-3
Civilian Uses CW Agent
Organic synthesis
Pharmaceuticals
Detergents
Pesticides
Gasoline additive
Missile fuels
Vulcanization of rubber
Tabun (GA)
Precursors to Chemical Weapons - Dual Use Technology & Agents
Diethylphosphite 762-59-2
Civilian Uses CW Agent
Organic synthesis
Paint solvent
Lubricant additive
VG
Sarin (GB)
Soman (GD)
GF
Precursors to Chemical Weapons - Dual Use Technology & Agents
Hydrogen Fluoride
Civilian Uses CW Agent
Fluorinating agent chemical reactions
Catalyst - alkylation & polymerization
Additives to liquid rocket fuels
Uranium refining
Sarin (GB)
Soman (GD)
Ethyl sarin (GE)
GF
Precursors to Chemical Weapons - Dual Use Technology & Agents
Methylphosphonous difluoride 753-59-3
Civilian Uses CW Agent
Organic Synthesis VX
VM
Sarin (GB)
Soman (GD)
GF
Precursors to Chemical Weapons - Dual Use Technology & Agents
Phosphorous oxychloride 10025-87-3
Civilian Uses CW Agent
Organic synthesis
Plasticizers
Gasoline additives
Hydraulic fluids
Insecticides
Dopant for semiconductors grade silicon
Flame retardants
Tabun (GA)
Precursors to Chemical Weapons - Dual Use Technology & Agents
Phosphorous trichloride 7719-12-2
Civilian Uses CW Agent
Organic synthesis
Insecticides
Gasoline additives
Plasticizers
Surfactants
Salt process
Dye stuffs
VG
Tabun (GA)
Sarin (GB)
Soman (GD)
GF
Precursors to Chemical Weapons - Dual Use Technology & Agents
Sulfur monochloride 10025-67-9
Civilian Uses CW Agent
Organic synthesis
Pharmaceuticals
Sulfur dyes
Insecticides
Rubber vulcanization
Polymerization catalyst
Hardening of soft woods
Sulfur Mustard (HD)
Precursors to Chemical Weapons - Dual Use Technology & Agents
Thionyl chloride 7719-09-7
Civilian Uses CW AgentOrganic synthesis
Chlorinating agent
Catalyst
Pesticide
Engineering plastics
Sarin (GB)
Soman (GD)
GF
Sulfur mustard (HD)
Sesqui mustard (Q)
Nitrogen mustard (HN-1,HN-2,HN-3)
Chemical Weapons Deployment Principles
Critical Variables in Agent DeploymentVolatility of agent
Persistence of agent
Rate of agent contact with target population
Desired level of geographic coverage
Chemical Weapons Deployment Principles - Volatility
Most CW agents liquids
Transformation of liquid to gas Add heat to cause enhanced vaporization
Explosive force - exploding munitions
Mechanical spray device
Transformation liquid => gas - major operational problem
Non-facilitated (room temperature) vaporization inadequate to develop LCt50 concentrations
Some agents gases under temperate conditions
Phosgene
Cyanogen chloride
Hydrogen cyanide
Chemical Weapons Deployment Principles - Volatility
More volatile = less persistency
Persistency = length of time agent remains liquid
Persistent by definition > 24 hr in liquid form
Nonpersistent < 24hr in liquid form Agent persistency - most to least
Vx - Tabun - Mustard - Lewisite - Sarin - Hydrogen Chloride - Cyanogen Chloride - Phosgene - Chlorine
Chemical Weapons Deployment Principles - Persistency
Sarin - nonpersistent agentEvaporates within 2 hr on sandy soil @ 50°F (10°C)
Evaporates under 1 hr on sandy soil @ 110°F (43°C)
On chemical resistant surface 15 min @ 50°F (10°C)
On chemical resistant surface 12min @ 100°F (43°C)
Vesicant mustard - persistent agentEvaporates 100 hr on sandy soil @ 50°F (10°C)Evaporates 7 hr on sandy soil @ 110°F (43°C)On chemical resistant surface 12 hr @ 50°F (10°C)On chemical resistant surface 1 hr @ 100°F (43°C)
Chemical Weapons Deployment Principles - Persistency
Chemical Weapons Deployment Principles - Rate of Agent
Contact With Target Population
(E)(L) (L)(L)(L)(L) (E)(L)
Ct50
(mg-min/m3)
0
1000
2000
3000
4000
5000
6000
CL CG AC H GB VX BZ CS
ƒ( , )
Chemical Weapons Deployment Principles - Desired level of
Geographic Coverage
(E)(L) (L)(L)(L)(L) (E)(L)
Ct50
(mg-min/m3)0
1000
2000
3000
4000
5000
6000
CL CG AC H GB VX BZ CS
Quantity of Agent & Method of Delivery
Weaponization
Stabilizers -prevent degradation of product Thickeners - increase viscosity & persistence of
liquid agents Transformation of bulk munitions payload of
agent into weaponized form of agent• Microscopic droplets (target - respiratory absorption)• Liquid spray droplets (target - cutaneous absorption)
Weaponization
Military grade munitions generate• Vapors
– Aerosol (1-7 microns)– Micro-climate height (6-10’)
• Liquids– Coarse spray that coats ground
Likely Terrorist delivery systems more primitive
Agricultural sprayersCrop dusting aircraft efficient vehicles
Orchard pesticide sprayer mounted on truck
Atomizers/spray cans
Paint sprayers
Aerosol generators
Fans
Methods Of Target Engagement
Least EfficientEasiest Technically
Highly EfficientDifficult Technically
Meteorological Effects -
Weapon Efficiency Temperature
Liquid mustard @ concentration 30 gm/m2
Persistence several d’s T <50°F (10°C) Persistence 1-2 d @ T 80°F (26°C)
HumidityHigh relative humidity enlarges aerosols
Wind speed & directionAffects @risk target populationHigh winds disperse aerosols Optimal steady wind @ 4 kts/hr
PrecipitationLight rain disperses & spreads chemical agentHeavy rains dilutes & disperses agent
Nature of Buildings & Terrain
Greater turbulence of primary weapons cloud in woodland & hilly terrain
Urban targets may result in enhanced persistence of agent by absorption by porous building materials
Persistence increased 3X by sandy Vs clay soil
Potential Targets
Point source targets - buildings Vulnerability is due to accessibility Entry areas for agent - ventilation & elevator systems Defenses
Surveillance of roof, mechanical rooms, elevator shafts, utility chases
Improved locking & access systems to these resources
Agent Indicator Matrix
A = Nerve agentsB= Blister agentsC= Cyanide D= Choke agentsE= Riot Control
Unchecked boxes = N/A A B C D E
CardiovascularSlow heart rate X X X XFast heart rate X
Digestive SystemDefecation X X XNausea X
Subtotal (this page)
To use the agent indicator matrix: Put a check in each row where the indicator is presentAt the bottom of the matrix -
total all check marks in each column Total all marks from each page - The column with the
highest % of checks is most probable agent
Agent Indicator Matrix
A = Nerve agentsB= Blister agentsC= Cyanide D= Choke agentsE= Riot Control
Unchecked boxes = N/A A B C D E
AppearanceProstration X X XTwitching X X XConvulsions X X XComa X X XBleeding from mouth X X XCoughing XSneezing X XVomiting XFasciculations X X X X
SkinCyanosis X X XGray area of dead skin X X X XPain, irritation XClammy X X XSweating, localized or generalized X X X X
Subtotal (this page)
Agent Indicator Matrix
Unchecked boxes = N/A A B C D E
EyesSmall pupils X X X XNormal, large pupilsInvoluntary closing X X XTearing XBurning, irritation XHeadache, pain around eye X X X XDim vision X X X XBlurred vision X X X XBurning pain in eyes XRedness X X X
RespiratoryCoughing XRunny nose XTight chest (short of breath) XBurning, irritation in nose X
Total (this page)
A = Nerve agentsB= Blister agentsC= Cyanide D= Choke agentsE= Riot Control
Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Nerve Vapor- sec
Liquid-min/hr
Muscle cramps, runny nose,difficulty breathing, eye pains, visual disturbance, sweating, diarrhea, LOC, flaccid paralysis, seizures
Pinpoint pupils (miosis)
Fasciculation's
Sweating
Hyper-salivation
Diarrhea
Seizures
Apnea
Rapid
Disrobing
Water &
Wash with soap
& shampoo
Inhalation &
Dermal
Atropine 2-6 mg IV + 2-PAMCL 600-1800 mg IV or 1gm IV over 20-30 min
Additional Atropine prn & additional 1 gm infusion of 2-PAMCL
Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Cyanide Secs to minutes
Dizziness, nausea, headache, eye irritations, LOC
Nonspecific findings - hyperventilation,
Convulsions, apnea
Rapid
Disrobing
Oxygen,
Amyl nitrate,
Sodium nitrite (300 mg IV) & sodium thiosulfate (12.5 gm IV)
Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Blister Agents
(Sulfur Mustard)
2-48 hr Burning, itching, or red skin, mucosal irritation (tearing, burning, redness of eyes), shortness of breath, N&V
Skin erythema, blistering, conjunctivitis & lid swelling, upper airway sloughing, pulmonary edema, marrow suppression with lymphocytopenia
Rapid
Disrobing, Flush with copious amounts of water
Inhalation, dermal absorption, oral ingestion
Thermal burn Rx
Supportive care
For Lewisite
BAL
Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Pulmonary agents
(phosgene)
1-24 hr Dyspnea, chest tightness, wheezing, mucosal & dermal irritation & redness
ARDS None usually needed
Inhalation
Supportive care
Specific Rx dependent on agent
Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Ricin (Castor bean toxin)
18-24 hr Ingestion - N&V, diarrhea, fever, abdominal pain
Inhalation - chest tightness, coughing, weakness, nausea, fever
ARDS, circulatory collapse, shock
Clothing removal, water rinse
Inhalation & ingestion
Supportive care
For ingestion charcoal lavage
Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
T-2 mycotoxin
2-4 hr Dermal & mucosal irritation; blistering, necrosis, blurred vision, N&V & diarrhea, ataxia, coughing & dyspnea
Mucosal erythema & hemorrhage, red skin, blistering, tearing, salivation, pulmonary edema, seizures, & coma
Clothing removal, water rinse
Inhalation & dermal contact
Supportive care
For ingestion charcoal lavage
Possibly high dose steroids
Biological Warfare - History I
190 BC - Hannibal hurled venomous snakes onto enemy ships of King
Eumenes II of Pergamum @ Eurymedon
400 BC Scythian archers used arrows dipped in blood & manure or
decomposing bodies
Biological Warfare - History II
1340 ADAttackers catapulted dead horses & other animals at the castle of Thun L'Eveque in Hainault (northern France)Defenders
”The stink & the air were so abominable...they could not long endure"
Negotiated a truce
Biological Warfare - History III1346 AD
Tartars siege of Caffa (Port on the Crimean peninsula in the Black Sea)Tartars suffered an outbreak of plagueBefore abandoning their attack, they sent the infected bodies of their comrades by catapult over the walls of the cityFleeing residents carried the disease to ItalySecond major epidemic "Black Death" in Europe
Biological Warfare - History IV
1422 ADAt Karlstein (in Bohemia)
Attacking forces launched the decaying cadavers of men killed in battle over the castle walls
They stockpiled animal manure in hope of spreading illness
The defense held fast, siege was abandoned @ five months
Biological Warfare - History IV
1763 - British Gen Jeffery Amherst
Ft Pitt, Pennsylvania Ordered blankets & handkerchiefs taken from smallpox patients in the fort's infirmary & given to Delaware Indians at a peace-making parley
WWI
1915 - German covert BioWar operations
Glanders - Disease horses/mules - German saboteurs used against military horses/mules
1917- Only real success infection - 4,500 mules Mesopotamia
Biological Warfare - Intra-war & WWII
Japan’s Unit 731 (1932 - 1945)
BW research unit - Ping Fan, Manchuria3000 scientists & techs occupying >150 bldgPossibly 10,000 prisoners died - BW experimentation1,000 autopsies on prisoners infected with anthrax
11 Chinese cities attacked using anthrax, cholera, salmonella, shigella, plague
15 million Plaque infected fleas dropped A/C1940 - Chuhsien in Chekiang province - 1st episode of plaque ever seen in the province
Post WWII - Accusations
British used BioWeapons in Oman - 1957
Brazilian landowners deliberate infection Amazonian tribes - 1960’s
China accused US - Cholera epidemic in Hong Kong 1961
Egyptian accusations against US of BioWar in Middle East, specifically Cholera in Iraq in 1966
Post WWII
Ricin toxin assassinations - 1978Successful attack by Bulgarian Agents
Georgi Markov - Bulgarian dissident in exile
Unsuccessful attack 10 d’s prior Valdimir Kostov - Bulgarian dissident in exile
Post WWII
3 April 1979 - Soviet Institute of Microbiology & Virology
Sverdlovsk - accidental release of Anthrax
66 confirmed deaths
Animal cases seen > 50-km from the site of release
Post WWII
1970's- "Yellow Rain" - T-2 Mycotoxin
Controversial results - government sponsored research's
Possible use of agents Asia & Afghanistan
1st Desert War
7 August 1995 - Defection of Iraqi General Hussein Kamal Iraq had loaded BioWar agents into
166 Bombs (100 botulinum toxin, 50 anthrax, 16 aflatoxin)25 SCUD/A1 Hussein missile warheads (13 botulinum toxin, 10 anthrax, 2 aflatoxin)122-mm rockets filled with anthrax, botulinum, aflatoxinSpray tanks capable of being fitted to fighter/bomber aircraft - 2000 L capacity
US Offensive Bioweapons Program
April 1942 - creation US top-secret BioWar program All offensive programs ended 25 November 1969
Nixon administration Executive order
1972 - US signed Biological Weapons Convention
US Offensive Bio-weapons Program
E-120 BiologicalBomblet
Domestic Bioterrorism
1984 - Rajneesh cult contaminated salad bars with salmonella - 751 cases
of infection
1998 Anthrax spore hoaxes in Cincinnati, Louisville, Indianapolis
Anthrax incidents in US – 1992-1999
Source: Historical Trends Related to Bioterrorism: An Empirical Analysis -Jonathan B. Tucker, Chemical and Biological Weapons Nonproliferation Project, Center for
Nonproliferation Studies, Monterey Institute of International Studies
Aum Shinrikyo Attacks
1993- 1995 conducted up to 10 subway attacks
No casualties Poor manufacturing technique
Avirulent strain
9-11 Anthrax attacks
1 week after 9-11 Tom Brokaw (NBC News) Anthrax tainted letterIdentical letter to office of New York TimesSenator Tom Daschle - Washington DCDecember 2001
18 patients infected 5 deaths Mass disruption
• Not mass destruction
Potential deadly/incapacitating effects susceptible populations
Self-replicating capacity of some bio-agents to continue to proliferate
Relatively low cost of producing bio-weapon
Insidious symptoms can mimic endemic diseases
Difficulty in immediate detection – bio-weapon use
Sparing of property & physical surroundings
Advantages - Biological Weapons
Disadvantages - Biological Weapons
Bio-war weapon could impact health aggressor forcesDependence on prevailing winds & other weather conditions for effective dispersionEffects of temperature, sunlight, & desiccation on survivability of some infectious organisms Environmental persistence of some agents (e.g., anthrax spores) can make region uninhabitable for long periodsPossibility of generation of secondary aerosols generated by troops moving through areaUnpredictability of morbidity secondary to biological attackRelatively long incubation period of many agentsPublic's aversion to use of biological warfare agentsTraceable
Biological Weapons Properties
Toxins
Organisms
Spontaneous regeneration Epidemic organisms
Requirements For Ideal Biological Warfare Agent
Availability or ease of production
Incapacitation and lethality
Appropriate particle size in aerosol
Ease of dissemination
Stability after production
Susceptibility and Non-susceptibility of Target & Attacking Populations
Biological Weapons Deployment Principles
4 Components - Biological Warfare StrikeThe Agent
The Munitions
Delivery System
Meteorological Conditions @ Target Area
Agent
Toxin - short incubation period - limited effectivenessBacterial or viral organism with longer incubation
period - causalities over 100’s of square kilometersAgent may be Incapacitating Vs Lethal
Agent characteristicsInfectivity
Manufacturability (Quantity)Stability after manufactureStability during deployment
Stability post-release
Physical Attributes of Infective Agent
Liquids Simple to produce but difficult to disseminate
Dried FormComplex production but readily disseminated
Physical Appearance of Selected Agents
Liquid agentsDerived from fermentation technology, tissue culture, & embryonated chicken eggs
Liquid agents can include bacteria, bacterial toxins, viruses and rickettsiae
Physical Appearance of Selected Agents
However all have similar physical characteristics Viscosity - 5-15 centipoises Total solid content of the liquid between 5-20%
This MEANS - liquid is significantly thicker than water & less thick than light pancake syrup
Think slightly less viscous than whole milk
Color of liquids vary dramatically Bacterial agents & toxins derived from fermentation -
opaque amber to brown colored Egg-derived liquid agents color of egg yolk (if whole egg
processed) to slightly pink to red (if only embryo has been processed)
Dried Agents
If actor is able to produce agents via tissue culture technology
Then has technology to produce dried agents
Consistency of bath powderIdeal dried agent has free flowing properties
Dried Agents
Color of agent reflects the liquid from which derived Dried bacterial agents tend to be amber to brown Viral agents derived from tissue culture off-whiteViral & rickettesia from embroynated chicken eggs either brown to yellow to pink to redHowever, color of powders can easily be altered with dyes
Physics of Primary Aerosol
Aerosol equilibration - time interval between release & full aerosolization of liquid/powderLarge particles (≥ 15 microns) do not remain in the air but quickly fall to ground Within a minute - aerosol comes to equilibrium with atmosphereAerosol is now composed of particles of 1-5 microns - behaves like a gas - Primary Aerosol Primary Aerosol formation is essential for efficient release of agent
Physics of Primary Aerosol
Primary Aerosol can traverse heavily forested areas without degradation Similarly for a ‘victim’
Aerosol will permeate the atmosphere about the individual
Few if any particles will stick to person’s clothing or objects in aerosol path
Infectivity is high since ‘victim” will exchange 10-20 l/min
Conversely encountering a 15-20 micron particles will not result in high attack rates of illness
Secondary Aerosol
Re-aerosolization of infectious particles Fell to ground from primary aerosolForced onto ground by disseminating deviceDeliberately sprayed or layered onto groundGenerated by people or vehicles stirring up particlesIn fact are difficult to generate & require extremely sophisticated techniques to manufacture into agents physical properties
Biological Decay in Aerosols
Aerosol decay occurs through physical decay (fall out of particles) & biological decay Respiratory virulence & biological decay most important factors determining how far downwind bacterial aerosol will be infective Biological decay is expressed in terms of % death per minute of aerosol age & follows a geometric progression
ie, Biological decay of 20% per minute implies that total viable content of aerosol is halved every 3.5 minutes of age
Munitions
Sophisticated munitions can result in ‘point-source’ or ‘line-source’
Beyond capabilities of even most organized terrorist groups
Terrorists most likely will employ liquid agent
Munitions
Crud bomb could disseminate liquid/dry agent using explosive energy
Explosion will kill a large percentage of agent
Gaseous energy best way to generate high agent concentrations in aerosol but technically challenging
Terrorist deployments
Liquid agentSingle-fluid nozzle efficiency - 600 PSI
Two-fluid nozzle efficiency - 90 PSI
Dried agent - requires high sophistication High agent concentration
Small particle size
Absence of electrostatic charge
Weaponization
However, payoff is equally high - efficient dissemination from any number of devices using little energy
ABC fire extinguisher placed upwind of intended target or air intake of a building can produce large number of infections
Delivery Systems
ANYTHING that can cause aerosol
Truck-mounted sprayer
Crop Dusters
2-gallon garden sprayer or fire extinguisher
Meteorological Conditions Critical For ”Open-air" Targets
Aerosolized weapon maximum effectiveness @ 3-15 ftThermal inversion represents ideal environment
Inversion most likely @ night, daybreak, sundown
Sunlight highly destructive to most BW agentsToxins & spores of Bacillus anthracis & Coxiella burnetii
Wind also important factor for aerosol attackOptimal 5-25 mph< 5-mph limited spread>25-mph aerosol disintegrates
Liquid & Dry agents Can Be Disseminated Over Wide Temps & Environments
Many BW experts expect terrorist use against non-open air targets
Buildings
Subway stations
Interstate tunnels
Alternative Delivery Methods
Oral route - not very efficient - dilution & diffusion factors + chlorination makes public water sources poor targets Contamination of foods & fruits @ point of manufacture & along distribution pathways Dermal exposure not effective means of dissemination Vector transmission - logistically difficult to carry out
Agent Summary ChartAgent Sym onset Syms Signs Rx
Anthrax 2-6 d
Range 1 d to 8 wks
Inhalation
Flu-like syndrome, N&V, abd pain, fever, respiratory distress
Cutaneous
Itching papule, fever
Inhalation
Fever followed by ARDS, confusion, widened mediastinum on CXR, bloody pleural effusions, atypical pneumonia
Cutaneous
Itching papule, 1-3 cm painless ulcer then necrotic center, lymphadenopathy
Mechanical ventilation
Antibiotic therapy
CIPRO 400 mg IV Q 8-12 hr or Doxycycline 200 mg IV initial then 100 mg IV Q 8-12 hr PLUS Rifampin 10/mg/kg/d
Agent Summary ChartAgent Sym onset Syms Signs Rx
Botulism 12-72 hr
Range
2 hrs - 8 ds
Difficulty swallowing or speaking, symmetric descending weakness Respiratory dysfunction
No sensory dysfunction
Dilated or un reactive pupils, drooping eyelids (ptosis), doubled vision, slurred speech (dysarthria), descending flaccid paralysis, intact mental state
Mechanical ventilation
Parental nutrition
Trivalent botulinum antitoxin
Agent Summary ChartAgent Sym onset Syms Signs Rx
Plague 1-3 d’s
by inhalation
Sudden onset fever, chills, headache, myalgia
Pneumonic - cough, chest pain, dyspnea, fever
Bubonic - painful lymph nodes
Pneumonic - Hemoptysis, radiographic pneumonia--patchy, cavities, confluent, consolidation, hemoptysis, cyanosis
Bubonic - painful, enlarged lymph nodes in groin, axilla,& neck
Streptomycin 30mg/kg/d in 2 divided doses X 14 ds
Gentamycin 3-5 mg/kg/d IV/IM Q8hr
TCN 2-4 gm per day,
CIPRO 400 mg IV Q 12 hr
Agent Summary ChartAgent Sym
onsetSyms Signs Rx
Tularemia
“Pneumonic”
2-5 d’s
Range
1-21 d’s
Fever, cough, chest tightness, pleuritic pain, hemoptysis (rarely)
Community-acquired atypical pneumonia,
Radiographic bilateral patchy pneumonia with hilar adenopathy (TB like pleural effusions)
Diffuse, varied skin rash, may be rapidly fatal
Streptomycin 30mg/kg/d in 2 divided doses X 14 ds
Gentamycin 3-5 mg/kg/d IV/IM Q8hr
CIPRO 400 mg IV Q 12 hr (Change to PO after clinical improvement) X 10-14 d’s
Agent Summary ChartAgent Sym
onsetSyms Signs Rx
Smallpox 12-14 d’s
Range
7-17 d’s
High fever & myalgia, itching, abdominal pain, delirium, rash on face, extremities, hands, feet, confused with chickenpox which has less uniform rash
Maculopapular then vesicular rash - 1st on extremities (face, arms, palms, soles, oral mucosa), Rash with hard, firm pustules (intradermal blisters), RASH IS SYNCHRONOUS on various segments of body
Supportive care
Vaccinate care-givers
Experimental
Cidofovir
Initial Discovery Procedures
Put on Personal Protective Equipment Meissner’s 1st Law of Combat Medicine - Don’t Become A Causality Yourself
Stay upwind/stay uphillIf PPE not available maintain distance of 300 feet from scene If PPE is available maintain distance 75 feet
Until Agent & concentration determined
Exercise extreme caution IFBiological attack
Initial Discovery Procedures
Observe & annotate the following Exact location of incident Wind direction & weather conditions Plume direction if visible (generally not visible)Orientation of victimsNumber of victims Suggested safe access routes & staging areas
Gross Decontamination Procedures
If vapor attack Place outside in breeze
May only require removal of outer clothing
Liquid contamination Remove outer clothing
Flush victim with water &/or hypochlorite & water
Site Set-Up Procedures
3 Zones Hot (Exclusion ) Zone
Warm (Contamination reduction ) Zone
Cold (Support) Zone
All zones - upwind & uphill from other zones
Hot Zone
Adjacent to incident scene Rescuer or EOD personnel only in this zone All personnel in protective gearSingle Entry Control Point (ECP) Total accountability for personnel in zone ECP minimum of 25 meters upwind from source Minimal medical treatment
AirwayHemorrhage controlAdminister antidote
Warm Zone
Upwind & uphill from hot zoneRescue, medical, & decontamination personnel in this zone - all in PPEEntry to Warm Zone from Hot Zone via ECPExit is via separate patient transfer pointAll personnel entering/exits & all patient exits must be logged Zone is minimum of 15’ (5 m) wideWarm triage point is where rapid triage of victims takes place
Warm Zone
Immediate category patients go through liter decontaminationAmbulatory victims & warm zone personnel go through ambulatory decontamination Patients exit Warm Zone via patient transfer point No contaminated material enters Cold Zone
Cold Zone
Upwind & uphill from Warm Zone All personnel have protective equipment @ hand (wind shift or improper decontamination)Patients enter via patient transfer point & go through cold triage point
Casualty Decontamination Center
1
2
3
3 4
45
6
1 TRIAGE2 EMT3 CLOTHING REMOVAL4 SKIN DECON5 CLEAN EMT6 DISPOSITION
CONTAMINATEDDUMP 75M
ARRIVAL POINT
30M
PREVAILING WINDS
SHUFFLE PIT
HOT LINE
MTF60M
Casualty Decontamination Center
Arrival Triage / EMT Decon Clean Treatment
Ambulatory Decon
Litter Decon
ArrivalPoint(dirty)
TriageStation
DirtyDisposition
AreaEMT
Station
Clean Treatment
Area
CleanDisposition
Area
Dirty Clean
Evacuate (clean)
Evacuate (dirty) or return to duty
(Dirty dump)
Agent Removal
Two methods of agent removalPhysical & ChemicalPhysical Methods
Simply scraping off visible agent - highly effective
Copious flushing with water - problems containing waste water & thermal protection
Absorbent materials such as earth, dry soap powder, Fuller’s earth, or flour
Water/soap mixture can be highly effective
Agent Removal
Chemical methods 5% chlorine solution for decontamination of
equipment• 48 ounces (1.4 kg) calcium hypochlorite to 5 gallons
(19 liters) H20 • If necessary 5% solution can be used for skin,
however, must rinse off within 10’ of application 0.5% chlorine solution for decontamination of
skin or wounds• 6 ounces (170 gm) calcium hypochlorite to 5 gallons
(19 liters) H20
Decontamination Equipment
Chlorox™ bleach 5.25% hypochlorite solution & can be used directly from the bottle
Calcium hypochlorite available as dry swimming pool/spa chlorine
Plastic garbage can (50-60 gallon (190-230 liter)
Sponges, brushes, & pressurized garden sprayers
Care and Decontamination of Litter Patients
Remove gross contamination
Transfer to decontamination prep litterCut away all clothes & remove personal property
Transfer to decontamination litter
Decontaminate patient with 0.5% hypochlorite (blotted)
Shower with copious amounts of water
Transfer to patient treatment area
Decontamination Pointers
Contaminated clothing dump @ least 240’ downwind of decontamination station
Rub, Scrub, & Flush
Efficient technique is to use small commercial above-ground pools
Careful use of chlorine in enclosed spaces
Threat Analysis
Multiple technical drawbacks to CBW Toxins/pathogens/toxic chemicals need
Sophisticated handling, storage, delivery
Weaponized shelf life is short unless stored in controlled environment Clandestine production is difficult
Basic techniques for production simpleDual use technologies heavily scrutinized Use of missiles expensive per pound of payload/lethalityClimate critical for efficacy
Threat Analysis
Seaport targets Attractive from military standpoint
Classical ‘Choke Points’Majority of combat logistics & troop movements still use
seaborne lanes of communicationDisrupt transportation of goods & foodstuffs
Difficult to control access to seaportTerrorist does not have to physically penetrate the US
immigration proceduresAbility to concentrate large quantities of weaponized
agent Traditionally has poor security
Threat Analysis
Seaport targets Have sophisticated & criminal elements used to subverting custom &
security measures Drug smugglers
Illegal alien transporters
DownsidesMeteorological conditions poor for attack
Usually have significant winds that preclude adequate aerosol production Immersed in the ultimate & universal solvent - H20
Has large workforce available for effective disaster response Has sophisticated machinery available for decontamination procedures
Large storage facilities ideal for decontamination operations