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 Y2003

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ChemBio Tutorial

  1. 1. Terrorist Use of Chemical & Biological Weapons - A TutorialFrank W Meissner, MD, MS, FACP, FACC, FCCP, CPHIMS
  2. 2. Terrorist - The Official DefinitionFBI Definition - The unlawful use offorce against persons or property tointimidate or coerce a government, thecivilian population, or any segmentthereof, in the furtherance of political orsocial objectives.”
  3. 3. Why Terrorists Might Use"Weapons of Mass Destruction" Classically, terrorism was the act of making Political statement via violencePolitical act designed to influence an audience Levels of violence carefully calculated Draw attention but not so violent as too  Alienate supporters  Trigger overwhelming response
  4. 4. 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)
  5. 5. 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 CA - 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
  6. 6. 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
  7. 7. Why Terrorists Might Use "Weapons of Mass Destruction”Motivational Factors - Economic Damage Attack Crop, Livestock, Pharmaceuticals Attack Corporate interestsPotentially 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?
  8. 8. 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 ofadherence to doctrine or ritual) will survive the end of time and experience paradise Prime motivator for some “ Domestic” Terrorists
  9. 9. Why Terrorists Might Use "Weapons of Mass Destruction”Motivational Factors - Exacting Revenge or Creating ChaosPolitically motivated terrorists desire to change societies rather than destroy them  Thus avoid killing very large numbers of people  Political costs exceed the benefitsSome 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
  10. 10. Why Terrorists Might Use"Weapons of Mass Destruction”Motivational Factors - Mimicking God Create 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
  11. 11. Why Terrorists Might Use "Weapons of Mass Destruction”Motivational Factors - “Copycat” Phenomena Increased 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
  12. 12. Why Terrorists Might Use "Weapons of Mass Destruction”Motivational Factors - Technical Availability Weapons of mass destruction & components are easier to acquire since Fall of Soviet Government Former 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 Russias Future?" New York Times, 28 December 1998, A1. South African biological weapons scientists have offered their expertise to Libya  19James Adams, "Gadaffi Lures South Africas 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.
  13. 13. Why Terrorists Might Use"Weapons of Mass Destruction"In Summary, Postmodern or Super-terrorismMay 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
  14. 14. Questions? Is this terrorism? Or is it asymmetrical warfare?What exactly is a War on Terrorism?
  15. 15. 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?
  16. 16. Hx of Chemical WarfarePre-WWI 1000 BC - Chinese used arsenical smokes 600 BC - Solon of Athens put hellebore roots in the drinking water of Kirrha Thucydides 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
  17. 17. Hx of Chemical WarfarePre-WWI 15th Century Leonardo da Vinci proposed military use of a powder of sulfide of arsenic and verdigris 1618-48 - 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
  18. 18. WWINovember 1914 - Dr. Hans von Tappen -designed 150-mm howitzer shell containing 7lb of xylyl bromide and a burster charge forsplinter effectOperational tests of 18,000 of the shells atRussian positions near Bolimov - op failure2° weather conditionsTested again at Western front at Nieuport -March 1915 - also abysmal failure
  19. 19. WWIYpres, Belgium - 22 April 1915- 1stsuccessful German chemical attack Success of the attack was not capitalized upon by the GermansJuly 1917- Germans introducedmustard agent persistent vesicant that attacked the body in places not protected by gas masks
  20. 20. Intra-war periodItalian-Ethiopian War 3 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
  21. 21. Intra-war periodJapanese Invasion of China - 1937 By 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
  22. 22. WWIIPresident Roosevelt established a “No-First-Use” policyGermans in fact had manufactured & stored1/4 million tons of chemical agentsGermans developed Nerve Agents Tabun(GA) & Sarin (GB) production beginning1939
  23. 23. Korea & Cold WarContinuation of “No-First-Use” Policy1950 - Full-scale Sarin productioncomplex @ Edgewood ArsenalMultiple types of Munitions Developed
  24. 24. Honest John Rocket -Chem Warhead & Sarin Bomblet
  25. 25. VietnamExtensive use of Chemical agents “Non-lethal” riot control agents “Defoliants” (Agent Orange)Re-defined chemical weapons to excludethis category of agents
  26. 26. Yemen Civil War 1962-1970Yemeni dissidents overthrew monarchyRoyalist forces aided by Saudi Arabia &Jordan engaged in Civil WarEgyptians supported dissidentsEgyptian Air Force used chemical weapons Jan 1967 - Yemeni village of Kitaf 95% population & all animals in village died within 10-50 min of attack Agent used was mixed mustard & nerve gas
  27. 27. 1967 Arab-Israeli WarBoth sides were prepared to useChemical & Biological agentsNeither side used agentsProbably due to the speed of tacticaloperations
  28. 28. 1973 Arab-Israeli WarNo use of agentsBut Israeli captured Arab equipment ofSoviet design/origin demonstratedsophisticated Chem Defense & OffensivecapabilitiesSparked renewed interest in Chem Defensein US Military
  29. 29. Afghanistan WarExtensive use of Chemical weapons bySoviet’s against Afghanistan civilians &mujahedeen (Arabic and or Persianmujm hn, pl. of mujm hid hid, one whofights in a jihad (Holy War))
  30. 30. Iran-Iraq WarIraq trained & influenced by Soviet militaryadvisors used chem agents against Iranianmilitary forcesPrincipally used mustard & Tabun deliveredby bomb from aircraftAlso delivered agents by artillery shells &chemical rocket systems Approximately 5% Iranian casualties from chem attackImmediately after war used Chem agentsagainst Kurds
  31. 31. 1st Persian Gulf WarFrequent chemical alert alarms - all originally feltto be false alarms 4 Mar 91 - Kamisiyah arsenal - US Army 37th Engineer Battalion - blew munitions storage bunkers Probably Sarin- & Mustard-agent munitionsWind shift @ start of battle prevented effectiveuse by Iraqi forcesSpeed of advance may also have preventedeffective deployment of chemical agentsFear of nuclear retaliation
  32. 32. Aum Shinrikyo Attacks27 June 1994 - Sarin gas used insubway attack - killing 7 & injuring 50019 March 1995 - Tokyo attack - killing12 & injuring 3800
  33. 33. Chemical Agent: Definition (FM 8-285)“A chemical substance…intended for use inmilitary operations to kill, seriously injure, orincapacitate humans (or animals) through itstoxicological effects.”
  34. 34. Chemical Agent: Definition (FM 8-285)“A chemical substance…intended for use in militaryoperations to kill, seriously injure, or incapacitatehumans (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
  35. 35. Excluded Agents: Riot-control Agents Irritant agents (lacrimators)  CS (“tear gas”)  CN (Mace©)  CA  CR Vomiting agents  DM (Adamsite)  DA  DC
  36. 36. Riot-control AgentsLocal irritants with high safety ratioShort onset (seconds to minutes)Short duration (15-30 minutes)In low concentrations, cause intense painand lacrimation (tearing) with (Adamsite only)or without vomiting
  37. 37. 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
  38. 38. Excluded Agents: SmokesPetroleum oil smokes (fog oil=SGF)Diesel fuelHCRP (RED phosphorus) in butyl rubberWP (WHITE phosphorus)FSFM
  39. 39. Classification of “Official” Chemical AgentsTOXIC 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,VXINCAPACITATING AGENTS (producing temporary effects)  BZ, Agent 15, [riot-control agents]
  40. 40. Lung-damaging AgentsChlorine (CL)Chloropicrin (PS)Phosgene (CG)Diphosgene (DP)[Mustard (HD, H) Lewisite (L)][Smokes] [isocyanates] [PFIB] [oxides ofnitrogen]
  41. 41. Chemical-agent Damage to Respiratory SystemCentral 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
  42. 42. “Blood” Agents (Cyanogens)Hydrogen cyanide (AC)Cyanogen chloride (CK)
  43. 43. 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]
  44. 44. Nerve Agents (Anticholinesterases)Tabun (GA)Sarin (GB)Soman (GD) P Ach-esterase rGF Atropine eVX s y Ach Acetylcholine receptor n a p t Pralidoxime i Cholinesterase inhibitor c
  45. 45. “Official” Chemical Agents: Incapacitating AgentsPurpose: Temporary incapacitationCNS stimulants  Amphetamines, cocaine, caffeine, nicotine, strychnine, metrazoleCNS depressants  Barbiturates, opioids, antipsychotics, benzodiazepinesPsychedelics  LSD-25, psilocybin, ibogaine, harmine, MDMA (“ecstasy”), PCPDeliriants  Anticholinergic glycolates (BZ, Agent 15)
  46. 46. Physical Forms of Chemical Agents Solid Liquid Gas Vapor Aerosol
  47. 47. PersistenceDependent on several factors Agent 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” agents VX, L, HL, “thickened” nerve and blister agents (e.g., TGD, THD)
  48. 48. Exposure and AbsorptionExposure (contact with agent) does not necessarilylead 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)
  49. 49. 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
  50. 50. Toxicity (Potency) of Liquid AgentsED50: Effective Dose for 50% of exposed individualsID50: Incapacitating Dose for 50% of exposed individualsLD50: Lethal Dose for 50% of exposed individualsID50 for liquid HD(mustard) : 770 mg for a 70-kg manLD50 for liquid HD: 3000-7000 mg for a 70-kg man
  51. 51. Toxicity of Vapors or GasesThe 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
  52. 52. Toxicity of Vapors or GasesECt50: Effective Ct for 50% of exposed individualsICt50: Incapacitating Ct for 50% of exposedindividualsLCt50: Lethal Ct for 50% of exposed individualsCt50 assesses external dose, not internal dose ICt50 and LCt50 therefore affected by  Route of exposure  Respiratory rate and depth, skin moisture, etc.
  53. 53. 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
  54. 54. Toxicity of HD (Mustard) VaporHD vapor in eyes: Permanent injury: > 800 mg-min/ m3Inhaled HD vapor: LCt50: 1000-1500 mg-min / m3HD vapor on skin: LCt50: 10,000 mg-min / m3
  55. 55. Comparative Toxicity - CW Agents 6000 5000 4000 Ct50(mg-min/m3) 3000 2000 1000 0 AGENT CL CG AC H GB VX BZ CS (L) (L) (L) (L) (L) (L) (E) (E)
  56. 56. Precursors to Chemical Weapons - Dual Use Technology & Agents Ammonium bifluoride 1341-49-7Civilian Uses CW AgentCeramics Sarin (GB)Disinfectant for food equipment Soman (GD)Electroplating GFEtching glass
  57. 57. Precursors to Chemical Weapons - Dual Use Technology & Agents Diethylphosphite 762-59-2Civilian Uses CW AgentOrganic synthesis VGPaint solvent Sarin (GB)Lubricant additive Soman (GD) GF
  58. 58. Precursors to Chemical Weapons - Dual Use Technology & Agents Diethylamine 124-40-3Civilian Uses CW AgentOrganic synthesis Tabun (GA)PharmaceuticalsDetergentsPesticidesGasoline additiveMissile fuelsVulcanization of rubber
  59. 59. Precursors to Chemical Weapons - Dual Use Technology & Agents Diethylphosphite 762-59-2 Civilian Uses CW Agent Organic synthesis VG Paint solvent Sarin (GB) Lubricant additive Soman (GD) GF
  60. 60. Precursors to Chemical Weapons - Dual Use Technology & Agents Hydrogen FluorideCivilian Uses CW AgentFluorinating agent chemical reactions Sarin (GB)Catalyst - alkylation & polymerization Soman (GD)Additives to liquid rocket fuels Ethyl sarin (GE)Uranium refining GF
  61. 61. Precursors to Chemical Weapons - Dual Use Technology & Agents Methylphosphonous difluoride 753-59-3Civilian Uses CW AgentOrganic Synthesis VX VM Sarin (GB) Soman (GD) GF
  62. 62. Precursors to Chemical Weapons - Dual Use Technology & Agents Phosphorous oxychloride 10025-87-3Civilian Uses CW AgentOrganic synthesis Tabun (GA)PlasticizersGasoline additivesHydraulic fluidsInsecticidesDopant for semiconductors grade siliconFlame retardants
  63. 63. Precursors to Chemical Weapons - Dual Use Technology & Agents Phosphorous trichloride 7719-12-2Civilian Uses CW AgentOrganic synthesis VGInsecticidesGasoline additives Tabun (GA)Plasticizers Sarin (GB)Surfactants Soman (GD)Salt processDye stuffs GF
  64. 64. Precursors to Chemical Weapons - Dual Use Technology & Agents Sulfur monochloride 10025-67-9Civilian Uses CW AgentOrganic synthesis Sulfur MustardPharmaceuticals (HD)Sulfur dyesInsecticidesRubber vulcanizationPolymerization catalystHardening of soft woods
  65. 65. Precursors to Chemical Weapons - Dual Use Technology & Agents Thionyl chloride 7719-09-7Civilian Uses CW AgentOrganic synthesis Sarin (GB)Chlorinating agent Soman (GD)Catalyst GFPesticideEngineering plastics Sulfur mustard (HD) Sesqui mustard (Q) Nitrogen mustard (HN-1,HN-2,HN-3)
  66. 66. Chemical Weapons Deployment PrinciplesCritical Variables in Agent Deployment Volatility of agent Persistence of agent Rate of agent contact with target population Desired level of geographic coverage
  67. 67. Chemical Weapons Deployment Principles - VolatilityMost CW agents liquidsTransformation of liquid to gas Add heat to cause enhanced vaporization Explosive force - exploding munitions Mechanical spray deviceTransformation liquid => gas - majoroperational problem Non-facilitated (room temperature) vaporization inadequate to develop LCt50 concentrations
  68. 68. Chemical Weapons Deployment Principles - VolatilitySome agents gases under temperateconditions Phosgene Cyanogen chloride Hydrogen cyanide
  69. 69. Chemical Weapons Deployment Principles - PersistencyMore volatile = less persistencyPersistency = length of time agent remains liquidPersistent by definition > 24 hr in liquid formNonpersistent < 24hr in liquid formAgent persistency - most to least Vx - Tabun - Mustard - Lewisite - Sarin - Hydrogen Chloride - Cyanogen Chloride - Phosgene - Chlorine
  70. 70. Chemical Weapons Deployment Principles - PersistencySarin - nonpersistent agent Evaporates 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 agent Evaporates 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)
  71. 71. Chemical Weapons Deployment Principles - Rate of Agent Contact With Target Population 6000 5000 4000 Ct50 3000(mg-min/m3) 2000 1000 0 CL CG AC H GB VX BZ CS (L) (L) (L) (L) (L) (L) (E) (E)
  72. 72. Chemical WeaponsDeployment Principles - Desired level of Geographic CoverageQuantity of Agent & Method of Delivery 6000 5000ƒ( , ) 4000 Ct50 3000 2000 (mg-min/m3) 1000 0 CL CG AC H GB VX BZ CS (L) (L)(L)(L)(L) (L)(E) (E)
  73. 73. 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)
  74. 74. Weaponization Military grade munitions generate • Vapors – Aerosol (1-7 microns) – Micro-climate height (6-10’) • Liquids – Coarse spray that coats ground
  75. 75. Likely Terrorist delivery systems more primitiveAgricultural sprayers Crop dusting aircraft efficient vehicles Orchard pesticide sprayer mounted on truckAtomizers/spray cansPaint sprayersAerosol generatorsFans
  76. 76. Methods Of Target Engagement Least Efficient Easiest Technically Highly Efficient Difficult Technically
  77. 77. Meteorological Effects - Weapon EfficiencyTemperature Liquid mustard @ concentration 30 gm/m2  Persistence several d’s T <50° F (10° C)  Persistence 1-2 d @ T 80° F (26° C)Humidity High relative humidity enlarges aerosolsWind speed & direction Affects @risk target population High winds disperse aerosols Optimal steady wind @ 4 kts/hrPrecipitation Light rain disperses & spreads chemical agent Heavy rains dilutes & disperses agent
  78. 78. Nature of Buildings & TerrainGreater turbulence of primary weaponscloud in woodland & hilly terrainUrban targets may result in enhancedpersistence of agent by absorption byporous building materialsPersistence increased 3X by sandy Vsclay soil
  79. 79. Potential TargetsPoint 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
  80. 80. Agent Indicator Matrix To use the agent indicator matrix: Put a check in each row where the indicator is present At 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 agentUnchecked boxes = N/A A B C D E Cardiovascular A = Nerve agentsSlow heart rate X X X X B= Blister agentsFast heart rate X Digestive System C= CyanideDefecation X X X D= Choke agentsNausea X E= Riot ControlSubtotal (this page)
  81. 81. Agent Indicator MatrixUnchecked 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 X A = Nerve agentsCoughing X B= Blister agentsSneezing X XVomiting X C= CyanideFasciculations X X X X D= Choke agents SkinCyanosis X X X E= Riot ControlGray area of dead skin X X X XPain, irritation XClammy X X XSweating, localized or generalized X X X XSubtotal (this page)
  82. 82. Agent Indicator MatrixUnchecked boxes = N/A A B C D E EyesSmall pupils X X X XNormal, large pupilsInvoluntary closing X X X A = Nerve agentsTearing XBurning, irritation X B= Blister agentsHeadache, pain around eye X X X X C= CyanideDim vision X X X XBlurred vision X X X X D= Choke agentsBurning pain in eyes XRedness X X X E= Riot Control RespiratoryCoughing XRunny nose XTight chest (short of breath) XBurning, irritation in nose XTotal (this page)
  83. 83. Agent Summary ChartAgent Sym onset Syms Signs Decon Route & RxNerve Vapor- sec Muscle Pinpoint pupils Rapid Inhalation & Liquid-min/hr cramps, runny (miosis) Disrobing Dermal nose,difficulty Fasciculations Water & Atropine 2-6 breathing, eye Sweating Wash with mg IV + 2- pains, visual Hyper-salivation soap PAMCL disturbance, 600-1800 mg sweating, Diarrhea & shampoo IV or 1gm IV diarrhea, LOC, Seizures over 20-30 flaccid Apnea min paralysis, seizures Additional Atropine prn & additional 1 gm infusion of 2-PAMCL
  84. 84. Agent Summary Chart Agent Sym onset Syms Signs Decon Route & RxCyanide Secs to Dizziness, Nonspecific Rapid Oxygen, minutes nausea, findings - Disrobing Amyl nitrate, headache, eye hyperventilation, Sodium nitrite irritations, LOC Convulsions, (300 mg IV) & apnea sodium thiosulfate (12.5 gm IV)
  85. 85. Agent Summary Chart Agent Sym onset Syms Signs Decon Route & RxBlister 2-48 hr Burning, Skin erythema, Rapid Inhalation,Agents itching, or red blistering, Disrobing, dermal(Sulfur skin, mucosal conjunctivitis & lid Flush with absorption,Mustard) irritation swelling, upper copious oral ingestion (tearing, airway sloughing, amounts burning, pulmonary of water Thermal burn redness of edema, marrow Rx eyes), suppression with shortness of lymphocytopenia Supportive breath, N&V care For Lewisite BAL
  86. 86. Agent Summary Chart Agent Sym onset Syms Signs Decon Route & RxPulmonary 1-24 hr Dyspnea, ARDS None Inhalationagents chest usually(phosgene) tightness, needed Supportive wheezing, care mucosal & dermal Specific Rx irritation & dependent on redness agent
  87. 87. Agent Summary Chart Agent Sym onset Syms Signs Decon Route & RxRicin 18-24 hr Ingestion - ARDS, circulatory Clothing Inhalation &(Castor N&V, diarrhea, collapse, shock removal, ingestionbean toxin) fever, water abdominal pain rinse Supportive care Inhalation - chest For ingestion tightness, charcoal coughing, lavage weakness, nausea, fever
  88. 88. Agent Summary Chart Agent Sym onset Syms Signs Decon Route & RxT-2 2-4 hr Dermal & Mucosal Clothing Inhalation &mycotoxin mucosal erythema & removal, dermal contact irritation; hemorrhage, red water blistering, skin, blistering, rinse Supportive necrosis, tearing, care blurred vision, salivation, N&V & pulmonary For ingestion diarrhea, edema, seizures, charcoal ataxia, & coma lavage coughing & Possibly high dyspnea dose steroids
  89. 89. 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
  90. 90. Biological Warfare - History II1340 AD Attackers catapulted dead horses & other animals at the castle of Thun LEveque in Hainault (northern France) Defenders  ”The stink & the air were so abominable...they could not long endure"  Negotiated a truce
  91. 91. Biological Warfare - History III1346 AD Tartars siege of Caffa (Port on the Crimean peninsula in the Black Sea) Tartars suffered an outbreak of plague Before abandoning their attack, they sent the infected bodies of their comrades by catapult over the walls of the city Fleeing residents carried the disease to Italy Second major epidemic "Black Death" in Europe
  92. 92. Biological Warfare - History IV1422 AD At 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
  93. 93. Biological Warfare - History IV1763 - British Gen Jeffery AmherstFt Pitt, Pennsylvania Ordered blankets & handkerchiefs taken from smallpox patients in the forts infirmary & given to Delaware Indians at a peace-making parley
  94. 94. WWI1915 - German covert BioWar operationsGlanders - Disease horses/mules - Germansaboteurs used against military horses/mules1917- Only real success infection - 4,500 mulesMesopotamia
  95. 95. Biological Warfare - Intra-war & WWII Japan’s Unit 731 (1932 - 1945) BW research unit - Ping Fan, Manchuria 3000 scientists & techs occupying >150 bldg Possibly 10,000 prisoners died - BW experimentation 1,000 autopsies on prisoners infected with anthrax 11 Chinese cities attacked using anthrax, cholera, salmonella, shigella, plague 15 million Plaque infected fleas dropped A/C 1940 - Chuhsien in Chekiang province - 1st episode of plaque ever seen in the province
  96. 96. Post WWII - AccusationsBritish used BioWeapons in Oman - 1957Brazilian landowners deliberate infection Amazoniantribes - 1960’sChina accused US - Cholera epidemic in Hong Kong1961Egyptian accusations against US of BioWar in MiddleEast, specifically Cholera in Iraq in 1966
  97. 97. Post WWIIRicin toxin assassinations - 1978 Successful attack by Bulgarian Agents  Georgi Markov - Bulgarian dissident in exile Unsuccessful attack 10 d’s prior  Valdimir Kostov - Bulgarian dissident in exile
  98. 98. Post WWII3 April 1979 - Soviet Institute ofMicrobiology & Virology Sverdlovsk - accidental release of Anthrax 66 confirmed deaths Animal cases seen > 50-km from the site of release
  99. 99. Post WWII1970s- "Yellow Rain" - T-2 MycotoxinControversial results - governmentsponsored researchsPossible use of agents Asia & Afghanistan
  100. 100. 1st Desert War7 August 1995 - Defection of Iraqi GeneralHussein KamalIraq 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, aflatoxin Spray tanks capable of being fitted to fighter/bomber aircraft - 2000 L capacity
  101. 101. US Offensive Bioweapons ProgramApril 1942 - creation US top-secretBioWar programAll offensive programs ended 25November 1969 Nixon administration Executive order1972 - US signed Biological WeaponsConvention
  102. 102. US OffensiveBio-weapons Program E-120 Biological Bomblet
  103. 103. Domestic Bioterrorism 1984 - Rajneesh cult contaminatedsalad bars with salmonella - 751 cases of infection 1998 Anthrax spore hoaxes in Cincinnati, Louisville, Indianapolis
  104. 104. 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
  105. 105. Aum Shinrikyo Attacks1993- 1995 conducted up to 10subway attacksNo casualties Poor manufacturing technique Avirulent strain
  106. 106. 9-11 Anthrax attacks1 week after 9-11 Tom Brokaw (NBC News) Anthrax tainted letter Identical letter to office of New York Times Senator Tom Daschle - Washington DC December 2001  18 patients infected  5 deaths  Mass disruption • Not mass destruction
  107. 107. Advantages - Biological WeaponsPotential deadly/incapacitating effects susceptiblepopulationsSelf-replicating capacity of some bio-agents tocontinue to proliferateRelatively low cost of producing bio-weaponInsidious symptoms can mimic endemic diseasesDifficulty in immediate detection – bio-weapon useSparing of property & physical surroundings
  108. 108. Disadvantages - Biological Weapons Bio-war weapon could impact health aggressor forces Dependence on prevailing winds & other weather conditions for effective dispersion Effects 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 periods Possibility of generation of secondary aerosols generated by troops moving through area Unpredictability of morbidity secondary to biological attack Relatively long incubation period of many agents Publics aversion to use of biological warfare agents Traceable
  109. 109. Biological Weapons PropertiesToxinsOrganismsSpontaneous regeneration Epidemic organisms
  110. 110. Requirements For Ideal Biological Warfare AgentAvailability or ease of productionIncapacitation and lethalityAppropriate particle size in aerosolEase of disseminationStability after productionSusceptibility and Non-susceptibility ofTarget & Attacking Populations
  111. 111. Biological Weapons Deployment Principles4 Components - Biological Warfare Strike The Agent The Munitions Delivery System Meteorological Conditions @ Target Area
  112. 112. Agent Toxin - short incubation period - limited effectivenessBacterial or viral organism with longer incubation period - causalities over 100’s of square kilometers Agent may be Incapacitating Vs Lethal Agent characteristics Infectivity Manufacturability (Quantity) Stability after manufacture Stability during deployment Stability post-release
  113. 113. Physical Attributes of Infective AgentLiquids Simple to produce but difficult to disseminateDried Form Complex production but readily disseminated
  114. 114. Physical Appearance of Selected AgentsLiquid agents Derived from fermentation technology, tissue culture, & embryonated chicken eggs Liquid agents can include bacteria, bacterial toxins, viruses and rickettsiae
  115. 115. Physical Appearance of Selected AgentsHowever all have similar physical characteristics  Viscosity - 5-15 centipoises  Total solid content of the liquid between 5-20%This MEANS - liquid is significantly thicker thanwater & less thick than light pancake syrup  Think slightly less viscous than whole milkColor 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)
  116. 116. Dried AgentsIf actor is able to produce agents via tissueculture technology Then has technology to produce dried agentsConsistency of bath powder Ideal dried agent has free flowing properties
  117. 117. Dried AgentsColor of agent reflects the liquid from which derivedDried bacterial agents tend to be amber to brownViral agents derived from tissue culture off-whiteViral & rickettesia from embroynated chicken eggs eitherbrown to yellow to pink to redHowever, color of powders can easily be altered with dyes
  118. 118. Physics of Primary AerosolAerosol equilibration - time interval betweenrelease & full aerosolization of liquid/powderLarge particles (≥ 15 microns) do not remain inthe air but quickly fall to groundWithin a minute - aerosol comes to equilibriumwith atmosphereAerosol is now composed of particles of 1-5microns - behaves like a gas - Primary AerosolPrimary Aerosol formation is essential forefficient release of agent
  119. 119. Physics of Primary AerosolPrimary Aerosol can traverse heavily forestedareas without degradationSimilarly for a ‘victim’ Aerosol will permeate the atmosphere about the individualFew if any particles will stick to person’s clothing orobjects in aerosol pathInfectivity is high since ‘victim” will exchange 10-20 l/minConversely encountering a 15-20 micron particles will notresult in high attack rates of illness
  120. 120. Secondary AerosolRe-aerosolization of infectious particles Fell to ground from primary aerosol Forced onto ground by disseminating device Deliberately sprayed or layered onto ground Generated by people or vehicles stirring up particles In fact are difficult to generate & require extremely sophisticated techniques to manufacture into agents physical properties
  121. 121. Biological Decay in AerosolsAerosol decay occurs through physical decay (fall outof particles) & biological decayRespiratory virulence & biological decay mostimportant factors determining how far downwindbacterial aerosol will be infectiveBiological decay is expressed in terms of % death perminute of aerosol age & follows a geometricprogression ie, Biological decay of 20% per minute implies that total viable content of aerosol is halved every 3.5 minutes of age
  122. 122. MunitionsSophisticated munitions can result in ‘point-source’ or ‘line-source’Beyond capabilities of even most organizedterrorist groupsTerrorists most likely will employ liquidagent
  123. 123. MunitionsCrud bomb could disseminate liquid/dry agentusing explosive energy Explosion will kill a large percentage of agent Gaseous energy best way to generate high agent concentrations in aerosol but technically challenging
  124. 124. Terrorist deploymentsLiquid agent Single-fluid nozzle efficiency - 600 PSI Two-fluid nozzle efficiency - 90 PSIDried agent - requires high sophistication High agent concentration Small particle size Absence of electrostatic charge
  125. 125. WeaponizationHowever, payoff is equally high - efficientdissemination from any number of devicesusing little energyABC fire extinguisher placed upwind ofintended target or air intake of a building canproduce large number of infections
  126. 126. Delivery SystemsANYTHING that can cause aerosolTruck-mounted sprayerCrop Dusters2-gallon garden sprayer or fire extinguisher
  127. 127. Meteorological ConditionsCritical For ”Open-air" Targets Aerosolized weapon maximum effectiveness @ 3-15 ft Thermal inversion represents ideal environment Inversion most likely @ night, daybreak, sundown Sunlight highly destructive to most BW agents Toxins & spores of Bacillus anthracis & Coxiella burnetii Wind also important factor for aerosol attack Optimal 5-25 mph < 5-mph limited spread >25-mph aerosol disintegrates
  128. 128. Liquid & Dry agents Can Be Disseminated Over Wide Temps & EnvironmentsMany BW experts expect terrorist useagainst non-open air targets Buildings Subway stations Interstate tunnels
  129. 129. Alternative Delivery MethodsOral route - not very efficient - dilution &diffusion factors + chlorination makes publicwater sources poor targetsContamination of foods & fruits @ point ofmanufacture & along distribution pathwaysDermal exposure not effective means ofdisseminationVector transmission - logistically difficult tocarry out
  130. 130. Agent Summary Chart Agent Sym onset Syms Signs RxAnthrax 2-6 d Inhalation Inhalation Mechanical Flu-like Fever followed by ventilation Range 1 d syndrome, ARDS, confusion, Antibiotic therapy to 8 wks N&V, abd pain, widened CIPRO 400 mg IV Q fever, mediastinum on 8-12 hr or respiratory CXR, bloody pleural Doxycycline 200 mg distress effusions, atypical IV initial then 100 pneumonia mg IV Q 8-12 hr Cutaneous Cutaneous PLUS Rifampin 10/ Itching papule, Itching papule, 1-3 mg/kg/d fever cm painless ulcer then necrotic center, lymphadenopathy
  131. 131. Agent Summary Chart Agent Sym onset Syms Signs RxBotulism 12-72 hr Difficulty Dilated or un Mechanical swallowing or reactive pupils, ventilation speaking, drooping eyelids Range symmetric (ptosis), doubled 2 hrs - 8 Parental nutrition descending vision, slurred ds weakness speech (dysarthria), Respiratory descending flaccid Trivalent botulinum dysfunction paralysis, intact antitoxin No sensory mental state dysfunction
  132. 132. Agent Summary Chart Agent Sym onset Syms Signs RxPlague 1-3 d’s Sudden onset Pneumonic - Streptomycin 30mg/kg/ by fever, chills, Hemoptysis, d in 2 divided doses X inhalation headache, radiographic 14 ds myalgia pneumonia--patchy, Gentamycin 3-5 mg/kg/ cavities, confluent, d IV/IM Q8hr consolidation, Pneumonic - TCN 2-4 gm per day, hemoptysis, cough, chest CIPRO 400 mg IV Q cyanosis pain, dyspnea, 12 hr fever Bubonic - painful, enlarged lymph nodes in groin, Bubonic - axilla,& neck painful lymph nodes
  133. 133. Agent Summary Chart Agent Sym Syms Signs Rx onsetTularemia 2-5 d’s Fever, cough, Community-acquired Streptomycin 30mg/kg/“Pneumonic” Range chest atypical pneumonia, d in 2 divided doses X tightness, Radiographic 14 ds 1-21 d’s pleuritic pain, bilateral patchy Gentamycin 3-5 mg/kg/ hemoptysis pneumonia with hilar d IV/IM Q8hr (rarely) adenopathy (TB like CIPRO 400 mg IV Q pleural effusions) 12 hr (Change to PO Diffuse, varied skin after clinical rash, may be rapidly improvement) X 10-14 fatal d’s
  134. 134. Agent Summary Chart Agent Sym Syms Signs Rx onsetSmallpox 12-14 High fever & Maculopapular then Supportive care d’s myalgia, vesicular rash - 1st Vaccinate care-givers itching, on extremities (face, Experimental abdominal arms, palms, soles, Range Cidofovir pain, delirium, oral mucosa), Rash 7-17 d’s rash on face, with hard, firm extremities, pustules (intradermal hands, feet, blisters), RASH IS confused with SYNCHRONOUS on chickenpox various segments of which has less body uniform rash
  135. 135. Initial Discovery ProceduresPut on Personal Protective Equipment Meissner’s 1st Law of Combat Medicine - Don’t Become A Causality YourselfStay upwind/stay uphillIf PPE not available maintain distance of 300feet from sceneIf PPE is available maintain distance 75 feet Until Agent & concentration determinedExercise extreme caution IF Biological attack
  136. 136. Initial Discovery ProceduresObserve & annotate the following Exact location of incident Wind direction & weather conditions Plume direction if visible (generally not visible) Orientation of victims Number of victims Suggested safe access routes & staging areas
  137. 137. Gross Decontamination ProceduresIf vapor attack Place outside in breeze May only require removal of outer clothingLiquid contamination Remove outer clothing Flush victim with water &/or hypochlorite & water
  138. 138. Site Set-Up Procedures3 Zones Hot (Exclusion ) Zone Warm (Contamination reduction ) Zone Cold (Support) ZoneAll zones - upwind & uphill from other zones
  139. 139. Hot ZoneAdjacent to incident sceneRescuer or EOD personnel only in this zoneAll personnel in protective gearSingle Entry Control Point (ECP)Total accountability for personnel in zoneECP minimum of 25 meters upwind fromsourceMinimal medical treatment Airway Hemorrhage control Administer antidote
  140. 140. Warm ZoneUpwind & uphill from hot zoneRescue, medical, & decontaminationpersonnel 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 exitsmust be logged Zone is minimum of 15’ (5 m) wideWarm triage point is where rapid triage ofvictims takes place
  141. 141. Warm ZoneImmediate category patients go through literdecontaminationAmbulatory victims & warm zone personnel gothrough ambulatory decontaminationPatients exit Warm Zone via patient transfer pointNo contaminated material enters Cold Zone
  142. 142. Cold ZoneUpwind & uphill from Warm ZoneAll personnel have protective equipment @hand (wind shift or improper decontamination)Patients enter via patient transfer point & gothrough cold triage point
  144. 144. Casualty Decontamination Center Arrival Triage / EMT Decon Clean Treatment Triage Ambulatory Decon Arrival Clean Clean Station Disposition Point Treatment (dirty) Area Area Litter Decon (Dirty dump) Dirty Disposition EMT Area Station Evacuate (clean) Evacuate (dirty) Dirty Clean or return to duty
  145. 145. Agent RemovalTwo methods of agent removal Physical & Chemical Physical 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
  146. 146. Agent RemovalChemical 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
  147. 147. 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
  148. 148. Care and Decontamination of Litter Patients Remove gross contamination Transfer to decontamination prep litter Cut away all clothes & remove personal property Transfer to decontamination litterDecontaminate patient with 0.5% hypochlorite (blotted) Shower with copious amounts of water Transfer to patient treatment area
  149. 149. Decontamination PointersContaminated clothing dump @ least 240’downwind of decontamination stationRub, Scrub, & FlushEfficient technique is to use smallcommercial above-ground poolsCareful use of chlorine in enclosed spaces
  150. 150. Threat AnalysisMultiple technical drawbacks to CBWToxins/pathogens/toxic chemicals need Sophisticated handling, storage, deliveryWeaponized shelf life is short unless stored incontrolled environmentClandestine production is difficult Basic techniques for production simple Dual use technologies heavily scrutinized Use of missiles expensive per pound of payload/lethality Climate critical for efficacy
  151. 151. Threat Analysis Seaport targets Attractive from military standpoint Classical ‘Choke Points’ Majority of combat logistics & troop movements still use seaborne lanes of communication Disrupt transportation of goods & foodstuffs Difficult to control access to seaportTerrorist does not have to physically penetrate the US immigration procedures Ability to concentrate large quantities of weaponized agent Traditionally has poor security
  152. 152. Threat Analysis Seaport targetsHave sophisticated & criminal elements used to subverting custom & security measures  Drug smugglers  Illegal alien transporters Downsides Meteorological 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
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