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Weapons of mass destruction
- 2. “Weapons of mass destruction” (WMD) is a wide terminology. The military uses the acronym CBRNE refers to chemical, biological, radiological, nuclear and explosive disasters. The results of an attack with WMD are potentially catastrophic. Children are particularly vulnerable to these weapons. Disasters strike without warning, so it is essential for emergency services to have foundation.
- 3. CHEMICAL • NERVE AGENTS Sarin,Soman,Tabun,VX MUSTARD AGENTS BIOLOGIC anthrax, plague,smallpox RADIOLOGIC/ RADIATION simple devices dispersal devices
- 4. Divided into 3 groups:- • Bacteria • Viruses • Toxins ROUTES:- • Aerosal • Dermal contact • Ingestion
- 5. SYNDROME Pulmonary symptoms,pneumonia Rashes Sepsis syndrome Influenza symptoms EPIDEMIOLOGY Multiple, simultaneous events Dead animals Large patients numbers with high toxicity and death rate
- 6. Causative agent- bacillus anthracis, a gram positive spore forming bacterium. Usually disease of sheep, cattle & horses Caused by SPORES NOT THE BACILLI ROUTES-inhalation, ingestion & dermal contact 2 countries- Russia & USA- developed anthrax into biological weapons.
- 7. Cutaneous Pneumonic gastrointestinal
- 8. CUTANEOUS ( 95 % ) GERMS ENTER THROUGH SKIN – CURABLE AN OCCUPATIONAL DISEASE ( WOOL SORTERS DISEASE)
- 12. PNEUMONIC BY INHALATION OF SPORES (90- 100 % FATAL) PERSON TO PERSON SPREAD DOES NOT OCCUR Begins with flu like illness. Within 24-48 hrs sudden deterioration occurs with overwhelming sepsis, shock, hemorrhagic mediastinitis. GASTROINTESTINAL BY INGESTION ( 25 – 75 % FATAL) Begins with nausea, vomiting and fever assoc. with mesenteric lymphadenitis. Later –severe abd. Pain, hematemesis, ascites &bloody diarrhea.
- 13. DIAGNOSIS CLINICAL CULTURE & ANTIBIOTIC TESTS GRAM STAIN PCR
- 14. TAB CIPROFLOXACIN 500 MG BD x 60 DAYS OR TAB DOXYCYCLINE 100 MG BD x 60 DAYS ACTIVE DISEASE— CIPROFLOXACIN 400 MG IV BD 12 HRLY OR DOXYCYCLINE 100 MG 12 HRLY + CLINDAMYCIN 900 mg 8 HRLY RIFAMPICIN 300 MG 12 HRLY x 60 DAYS ANTHRAX ANTITOXIN UNDER STUDY PROPHYLAXIS – ADSORBED ANTHRAX VACCINE IS AVALABLE NEEDS 6 DOSES WITH ANNUAL BOOSTERS
- 15. ZOONOTIC DISEASE SEEN IN RODENTS( RATS) CAN SPREAD TO MAN AETIOLOGY : YERSINA pestis (BACTERIA) SPREAD – BY BITE OF INFECTED RAT FLEA & BY HANDLING OF INFECTED MATERIAL & FROM PATIENTS TO ATTENDANTS( BY COUGH DROPLETS)
- 16. IN 1940 JAPAN MILITARY AIRCRAFT BOMBED NINGBO (A CHINESE TOWN) WITH CERAMIC BOMBS FULL OF FLEAS SPREADING BUBONIC PLAGUE.
- 17. IN MIDDLE AGES : MERCHANT CARAVANS BROUGHT PLAGUE FROM CENTRAL ASIA TO EUROPE THE BLACK DEATH (14th CENTURY ) EPIDEMIC IN EUROPE KILLED ½ - 1/3 OF POPULATION INDIA – ENDEMIC FOCI EXIST IN TAMILNADU & MAHARASHTRA
- 18. BUBONIC PLAGUE FEVER WITH PAINFUL SWOLLEN LYMPH NODES (BUBOS ) PLAGUE SEPTICAEMIA FOLLOWS
- 19. PNEUMONIC PLAGUE HIGHLY INFECTIOUS SPREADS FROM PATIENT TO ATTENDANT START AS FLULIKE ILLNESS, FOLLOWED BY FULMINANT PNEUMONIA WITHIN 24HRS ASSOC. WITH HEMOPTYSIS, RS FAILURE,COLLAPSE & DEATH COAGULATION OCCURS CHARACTERISED BY ECCHYMOSES, DIC & ACRAL GANGRENE (black death)
- 20. DIAGNOSIS CULTURE GRAM STAIN DIRECT FLUORESCENT ANTIBODY PCR
- 21. INJ GENTAMYCIN 2mg /kg IV LOADING FOLLOWED BY 1.7 mg /kg 8 HRLY & INJ STREPTOMYCIN 1 gm 12 HRLY IM/IV (OR) DOXYCYCLINE 100 mg BD ORAL /IV CHLORAMPHENICOL 500 mg QID ORAL /IV PROPHYLAXIS CAP DOXYCYCLINE 100 mg BD x 7 DAYS FOR ATTENDENTS HAS NO VACCINE
- 22. AETIOLOGY: VARIOLA VIRUS EXTREMELY INFECTIOUS HIGH ATTACK RATES SPREAD BY COUGH ,SNEEZE OR SKIN FRAGMENTS A DISEASE OF HUMANS ONLY
- 23. FEVER , PROSTATION CHARACTERISTIC RASH AFTER 2 – 3 DAYS ON FACE, ARMS & LEGS 30 % MORTALITY ROUTINE SMALL POX VACCINATION WAS DISCONTINUED IN 1972 TODAY PUBLIC IMMUNITY ( HERD IMMUNITY ) IS LOW
- 24. VERY SUITABLE BW AGENT - SPECIALLY A THREAT TO URBAN POPULATIONS USA / RUSSIA HAVE LARGE VIRUS STOCKS A POSSIBLE AEROSOL RELEASE WOULD BE DEVASTATING.
- 25. DIAGNOSIS CULTURE PCR ELECTRON MICROSCOPY
- 26. TREATMENT SUPPORTIVE CIDAOFOVIR - ANTI VIRAL DRUG ANTI VACCINIA IMMUNOGLOBULIN PROPHYLAXIS VACCINA IMMUNIZATION
- 27. A NERVE TOXIN HAS BEEN EXTENSIVELY WEAPONISED. AETIOLOGY: FROM CLOSTRIDIUM botulinum A GRAM POSITIVE BACILLUS. CLINICALLY: CAUSES GRADUAL SYMMETRICAL CRANIAL NERVE PALSIES, PARALYSIS AND RESPIRATORY FAILURE. PUPILS GET DILATED. LESIONS ARE SYMMETRICAL
- 28. TREATMENT: SUPPORTIVE CARE PASSIVE IMMUNIZATION WITH EQUINE (HORSE) ANTITOXIN NEUTRALISING ANTIBODIES AFTER CLINICAL DIAGNOSIS. MECHANICAL VENTILATION PARENTERAL NUTRITION RECOMBINANT VACCINES ARE UNDER TRIALS. BOTULINUM TOXIN IS A MAJOR BW THREAT WHICH IS HIGHLY POTENT AND LETHAL.
- 29. A SINGLE GRAM OF CRYSTALLINE TOXIN EVENLY DISPERSED AND INHALED WOULD KILL OVER ONE MILLION PEOPLE. LETHAL DOSE 1 ugm. BOTOX (BOTULINUM TOXIN) INJECTIONS ARE USED IN SOME NERVE DISORDERS.
- 30. ONE OF THE MOST VIRULENT VIRAL DISEASES KNOWN TO MANKIND 50 TO 90 % CASE FATALITY CAUSED BY A RNA VIRUS OF FILOVIRUS FAMILY FORMER USSR HAD AEROSOLIZED THE EBOLA VIRUS FOR DISSEMINATION AS A WEAPON OF MASS DESTRUCTION
- 31. POSSIBLY A MAN MADE CREATION BY VIROLOGISTS IN THE USA. THEY ENGINEERED THE AIDS VIRUS IN 1977 POSSIBLY AT FORT DETRICK BY SPLICING TOGETHER TWO VIRUSES - ( VISNA AND HTLV 1)
- 32. NERVE AGENTS Nerve agents are organophosphates. MOA; Inhibit the enzyme acetylcholinesterase SYMPTOMS MUSCARINIC RECEPTORS Miosis, Salivation, Rhinorrhea, Lacrimation, bronchorrhea, Bronchospasm, vomiting and defecation. NICOTINIC RECEPTORS Muscle fasciculations, flaccid paralysis, tachycardia, hypertension.
- 33. Direct cns toxicity manifest as seizures, coma and apnea. Imp features include- muscle fasciculation and miosis Diagnosis is confirmed by RBC cholinesterase level TREATMENT 1. Atropin for muscarinic, 2. 2-PAM for nicotinic 3. Diazepam for seizures
- 34. NAZI GERMANY LABORATORIES PRODUCED THE FIRST NERVE GAS AGENT TABUN IN POTSDAM.
- 35. They are chemical warfare agents that induce blister formation when contacting skin. Has both liquid and vapour toxicity Injury occurs in 1-2 mins but symptoms develop for 4 to 8 hrs Local effects occurs from direct exposure to skin, eyes &airways. Systemic toxicity is caused by bone marrow suppression Rx- decontamination & airway maintenance
- 36. Simple radiological device are used in hospital for radiation therapy Ionizing radiation causes injury at cellular levels by damaging dna. Signs and symptoms- • Dermal burns, • Bone marrow failure • G.I dysfunction
- 37. 2 TYPES OF RADIATION- • NON IONNIZING-it does not produce charged ions when passing via matter eg;-UV rays, visible light rays, IR rays,micro waves & radio waves • Used in lasers, USG, MRI • IONIZING RADIATION- alpha, beta, gamma & x rays
- 39. LOCAL INJURY- Depands on the amt of dosage. Within 1st week- transient erythema,hyperasthesia & itching 2nd week-true erythema appears with progressive epilation 3rd-skin becomes warm,painful, swollen & puritic 4th week-dry or wet desquamation or ulcer may form
- 40. WHOLE BODY RADIATION/ ACUTE RADIATION SYNDROME
- 41. • PREHOSPITAL EMERGENCY MEDICAL MANAGEMENT INCIDENT INFO- Circumstances of the incident/ event No. of victims Type & extent of radiologic insult Identification of radioactive material, if known PATIENT INFO- Medical condition & physical injuries of the victim Extent of field survey & decontamination
- 43. SEPT 1994 LASTED 2 WEEKS SURAT IS THE 2ND LARGEST GUJARAT METRO 52 DEATHS 1200 CASES LARGE SCALE CHAOTIC INTERNAL MIGRATION OF 3-5 LAKHS OF PEOPLE TOOK PLACE
- 44. IT WAS AN ECONOMIC DISASTER TOURISM INDUSTRY GROUNDED TO HALT EVEN PAKISTAN CANCELLED INDIAN PAAN (BETEL LEAVES) IMPORTS. THIS IS WHAT TERRORISTS WOULD WANT AND CAN BE SUCCESSFUL IN CROWDED INDIAN CITIES.
- 45. FEB 2006 BIRD FLU HIT NANDURBAR DIST NORTH MAHARASTRA 40,000 CHICKEN DIED IN 48-72 HOURS GOVT. WAS ALERTED BY THE HIGH SECURITY ANIMAL DISEASES LABORATORY BHOPAL
- 46. LAB CONFIRMED DEADLY H5N1 BIRD FLU VIRUS IN BLOOD SAMPLES OF DEAD BIRDS HEALTH MINISTRY DESPATCHED PROTECTIVE GEAR FOR CULLING AND TAMIFLU (ROCHE) TABLETS
- 47. 8422 CASES OF SARS WITH 916 DEATHS OCCURRED WORLDWIDE (10.9 % FATALITY) MAN MADE GENETICALLY MUTATED VIRUS.
- 48. SUDDEN DISEASE, ESPECIALLY IN A DISCRETE POPULATION eg. ON A WARSHIP MORE SEVERE DISEASE THAN EXPECTED AND FAILURE TO RESPOND TO THERAPY.
- 49. RAPID INCREASE (IN HOURS TO DAYS) IN NUMBER OF HEALTHY MEN FALLING ILL SIMILARLY UNUSUAL CLINICAL PRESENTATIONS. REPORTS OF DEAD ANIMALS EVEN RATS.
- 50. A DISEASE UNUSUAL IN THAT GEOGRAPHICAL AREA OR SEASON. A DISEASE EPIDEMIC BY AN UNCOMMON AGENT eg. SMALL POX & VHF
- 51. IDENTIFY / DIAGNOSE TREATMENT IN ISOLATION BARRIER NURSING EVACUATION DECONTAMINATION WITH NBCD SUITS WITH WATER SUNLIGHT, PHENOL ANTISEPTICS
- 52. DRDE HAS ALSO DEVELOPED CHEMICAL / BIOLOGICAL PROTECTIVE GEAR INCLUDING MASKS, SUITS, DETECTORS AND SUITABLE DRUGS DEFENCE MATERIALS & STORES RESEARCH AND DEVELOPMENT ESTABLISHMENT (DMSRDE) KANPUR HAS SUCCESSFULLY DESIGNED AND MANUFACTURED PROTECTIVE CLOTHING AND EQUIPMENT AGAINST BW
- 53. Terrorism related bombings using conventional explosives comprise the vast majority of blast injuries It results in high injury score for victims as well as higher hospital resource use than for victims of other trauma Increase immediate mortality , greater inhospital mortality rate, more frequent need for surgical intervention, longer hospital stays & greater use of critical care
- 54. 4 types of blast effects- 1. Spalling- from lung parenchyma toalveolar space causing tissue surface to explode geyser like 2. Shearing-ruptured vascular & broncial pedicles 3. Implosion of flexible air spaces which rebound to greater than original size resembling miniexplosions
- 57. Details about explosions should be obtained from patient The nature & location of blast (size & type of charge, location in open or closed space, structural collapse, associated fire/ smokes, toxic agent release etc.) will be helpful in making informed clinical decisions IV fluids & blood products should be administered judiciously. Preventing fluid overload in brain & lung injury
- 58. Tranexamic acid or activated facter VII administration should be considered in selected cases of uncontrolled bleeding Coupious irrigation & disinfection of wounds should be performed urgently Investigation
- 62. PREPAREDNESS before any destruction / disaster is very important When disaster strikes we should be ready to handle the situation and face the challenge & save as much life as possible
- 63. 7th edition Rosen’s emergency medicine (vol 2) 7th edition tintinalli’s emergency medicine