LESSON NOTES WEEK 5:HLSS215 Regulatory Issues in Weapons of Mass Destruction (WMD):CO-5 Explain the process of primary care management for behavioral reactions during a weapon of mass destruction incident in the United States.  This week’s lecture focuses on understanding that as current events show us, applying federal regulatory best practices and sanction do not always work. Therefore, we need to be able to evaluate and appraise emergency management planning and relate to the various operational community action plans and be aware of secondary effects of a WMD incident. In addition, it provides the student four questions to consider preparedness and is designed to spark the student’s interest in learning more about Regulatory Issues in Weapons of Mass Destruction.             When you read World at Risk – pages 82-106 – you should gain an understanding of the Government and culture and who is accountable for preventing WMD proliferation and terrorism. After reading this, stop and think for a moment, make your own determinations on whether or not the world of government has a serious lack of coordination among the various agencies whose job it is to keep us safe.   Next, as you read, Weapons of Terror, Chapter 6 – This reading assignment focus on delivery means, missile defenses, and weapons in space. This reading focuses on three subjects that are not exclusively related to any one of the categories of WMD – the means of delivery of WMD, the dangers of missile defenses, and the risk of weaponization of outer space. With that, let us start our lesson, as current events show us, applying federal regulatory best practices and sanction do not always work. Therefore, we need to be able to evaluate and appraise emergency management planning and relate to the various operational community action plans and be aware of secondary effects of a WMD incident. We need to understand this because one of the gravest threats facing Americans today is a terrorist detonating a nuclear bomb within our borders. The United States wields enormous power of the traditional kind, but traditional power is less effective than it used to be. In today’s world, individuals anywhere on the planet connect instantly with one another and with information. Money is moved, transactions are made, information is shared, instructions are issued, and attacks are unleashed with a keystroke. Weapons of tremendous destructive capability can be developed or acquired by those without access to an industrial base or even an economic base of any kind, and those weapons can be used to kill thousands of people and disrupt vital financial, communications, and transportation systems, which are easy to attack and hard to defend. All these factors have made nation-states less powerful and more vulnerable relative to the terrorists, who have no national base to defend and who therefore cannot be deterred through traditional means. (World at Risk 2008, xxi) Therefore, it is critical, able to ev ...

1. LESSON NOTES WEEK 5:HLSS215 Regulatory Issues in
Weapons of Mass Destruction (WMD):CO-5 Explain the process
of primary care management for behavioral reactions during a
weapon of mass destruction incident in the United States.
This week’s lecture focuses on understanding that as current
events show us, applying federal regulatory best practices and
sanction do not always work. Therefore, we need to be able to
evaluate and appraise emergency management planning and
relate to the various operational community action plans and be
aware of secondary effects of a WMD incident. In addition, it
provides the student four questions to consider preparedness
and is designed to spark the student’s interest in learning more
about Regulatory Issues in Weapons of Mass Destruction.
When you read World at Risk – pages 82-106 – you
should gain an understanding of the Government and culture
and who is accountable for preventing WMD proliferation and
terrorism. After reading this, stop and think for a moment, make
your own determinations on whether or not the world of
government has a serious lack of coordination among the
various agencies whose job it is to keep us safe.
Next, as you read, Weapons of Terror, Chapter 6 – This
reading assignment focus on delivery means, missile defenses,
and weapons in space. This reading focuses on three subjects
that are not exclusively related to any one of the categories of
WMD – the means of delivery of WMD, the dangers of missile
defenses, and the risk of weaponization of outer space.
With that, let us start our lesson, as current events show us,
applying federal regulatory best practices and sanction do not
always work. Therefore, we need to be able to evaluate and
appraise emergency management planning and relate to the
various operational community action plans and be aware of
secondary effects of a WMD incident.

2. We need to understand this because one of the gravest threats
facing Americans today is a terrorist detonating a nuclear bomb
within our borders.
The United States wields enormous power of the traditional
kind, but traditional power is less effective than it used to be. In
today’s world, individuals anywhere on the planet connect
instantly with one another and with information. Money is
moved, transactions are made, information is shared,
instructions are issued, and attacks are unleashed with a
keystroke. Weapons of tremendous destructive capability can be
developed or acquired by those without access to an industrial
base or even an economic base of any kind, and those weapons
can be used to kill thousands of people and disrupt vital
financial, communications, and transportation systems, which
are easy to attack and hard to defend. All these factors have
made nation-states less powerful and more vulnerable relative
to the terrorists, who have no national base to defend and who
therefore cannot be deterred through traditional means. (World
at Risk 2008, xxi)
Therefore, it is critical, able to evaluate and appraise emergency
management planning and relate to the various operational
community action plans and be aware of secondary effects of a
WMD incident. We will discover that any terrorist attack using
WMD will result in substantial psychological trauma and stress
and emergency management planning needs to consider this.
At a conference put on jointly by the Defense Threat
Reduction Agency, the Federal Bureau of Investigation, and the
U.S. Joint Forces Command clear back in 2001 addressing
Human Behavior and WMD Crisis/Risk Communication
Workshop, the presenters highlight some great key points that
are still pertinent today:
A disaster response program includes many factors that will
determine its success in dealing with the effects of a WMD
attack (which includes a Chemical, Biological, Radiological,
Nuclear and Explosive (CBRNE) incident) and restoring public

3. order. In the United States, several agencies at the federal,
state, and local level have been put in place to handle
contingencies such as natural disasters, chemical spills, and
nuclear mishaps. The Federal Response Plan [now referred to as
the National Response Framework], a signed agreement among
27 Federal departments and agencies, including the American
Red Cross, provides a mechanism for coordinating delivery of
Federal assistance and resources to augment state and local
efforts in major disasters or emergencies. (Defense Threat
Reduction Agency [DTRA]/Federal Bureau of Investigation
[FBI] 2001)
Convincing the public to take appropriate action in a WMD
attack will require considerable planning. It will require
developing a significant level of situational awareness of every
aspect of a WMD attack. Situational awareness incorporates
knowledge of plans, procedures, and processes for handling all
aspects of a WMD, no matter what type. One way to address
practically the problem is to concentrate on local communities
and prepare each community on a smaller scale for a WMD
attack. For example, CDC [Center for Disease Control]
maintains an excellent two-way communication program with
local communities that includes regional workshops with public
health officials and medical professionals, a website, and
satellite training. (DTRA/FBI 2001)
If you want to take a look at the guidance the CDC put out back
in 2002, here is the
link: http://wwwnc.cdc.gov/eid/article/8/9/01-0520_article.htm .
Currently, the CDC dedicates a whole entire section of their
website, which is broken down by specific category, that
addresses
preparedness: http://emergency.cdc.gov/?s_cid=cdc_homepage_t
opmenu_004 . And they have even taken a more creative
approach to capture people’s attention and convincing them that
preparedness is important – check out the CDCs graphic novel,

4. "Preparedness 101: Zombie Pandemic"
(http://emergency.cdc.gov/socialmedia/zombies.asp)
Additionally, from the perspective of first responder, getting the
word out and sending the proper message during these types of
events is important.
Message development also requires very careful planning to
determine the effects of messages on industries and private
groups. One statement from CDC can wipe out an entire
industry and put many people out of work. Including a variety
of relevant professionals early in the planning process is also
important. For example, the West Nile virus could have been
identified much earlier if veterinarians were brought in initially.
Veterinarians discovered that birds were dying from some
exotic disease, which was identified as West Nile. Subsequent
testing on humans confirmed that victims who were originally
assumed to be suffering from St. Louis encephalitis were
actually suffering from West Nile disease.
Figure 1 – West Nile Virus
This takes us to a subsequent topic, media coverage.
Building effective media relationships now will help avoid
inappropriate public actions in the event of a WMD attack. The
interests of the media establishment and those of the public, as
exercised by government, are not always the same. It may make
sensational news to skew the events of a WMD attack while the
public would be best served by accurate information designed to
calm the public and avoid inappropriate behavior. In addition,
the news cycle has grown very short, nearly real-time. This
pressure to “get the news out” may also conflict with the time
required to analyze a WMD event and to disseminate accurate
information. (DTRA/FBI 2001)
At the same time, preparation of an effective response is critical
for navigating a WMD event.
Effective response means disseminating large amounts of
information to the public very quickly. As soon as possible,

5. communicators must get accurate information to the public, to
encourage the public to return to normalcy as soon as possible.
The medical community must be a central focus of training
efforts for WMD because they are likely to be the first
responders. In addition, Disaster Response Networks must
include mental health as a part of planning. A clinically trained
psychologist, social worker or other trained individual should
be part of the response team.
For example, in a chemical incident, fire fighters are usually the
first on the scene; however, in a bioterrorist event, the most
likely first responders are hospital/medical personnel. As the
workshop participants indicated, the release of a biological
agent has no centralized locus of destruction. If the agent is
detonated without the knowledge of officials or the media, the
singularity of the event is compromised. (DTRA/FBI 2001)
Seventy percent of hospital personnel are women with family
responsibilities, and twice as likely, than men to experience
post-traumatic stress disorders, anxiety, and depressive
disorders. Dealing with their own families as well as the
families of victims places added pressure on personnel routines;
it also places them in the “line of fire” for ensuing anger. In
addition, rescue and fire personnel are not only at high risk but
also prone to denial when it comes to admitting they need help.
(DTRA/FBI 2001)
Among the general population, women experience twice the
rates of anxiety and depressive disorders as men, and following
disasters, women had nearly twice the rates of post-traumatic
stress disorder (PTSD) as men. Studies also show, however, that
males are more prone to denial when it comes to admitting they
need help, and responders more prone to denial than the general
public.
Since much data is self-reported, a caveat should be used when
analyzing the general population and its response to disaster.
Studies also found that rescue workers and fire fighters have a
preexisting propensity for alcoholism and alcohol intake
increases under extreme stress conditions. (DTRA/FBI 2001)

6. Adult reactions to stress are often manifested in different ways.
For example, the immune system is compromised contributing
to health complications, increased alcohol and cigarette use,
inattention to family responsibilities, depression and anxiety,
all of which can often go untreated in light of triage
prioritization. (Benedek 2003)
The impact of disasters on sociological behavior can be a gray
area. In fact, in the past, studies have shown that victims can
experience symptoms of PTSD as late as 12 years after the
event. Further, I expect, as we see long term studies related to
those that have served in recent wars, we may see PTSD
manifest itself even later.
Historically, resources allotted to the study of sociological
impacts on victims have been minimal and as such, have
prevented mental health professionals from developing clearer
baselines for analysis. The medical community will be greatly
impacted by a WMD attack if one were to occur and must be
prepared. To reduce the impact of WMD attacks, first
responders must include mental health professionals as a
necessary part of the disaster management response cycle –
prepare, respond, recovery and mitigate.
Questions to Consider
1. In the event of a WMD attack, how can public panic/fear be
lessened?
1. How can the public be persuaded to take appropriate action
and to avoid inappropriate actions?
1. Who among responders and the public are at higher risk of
adverse psychological effects and how can such effects be
prevented or mitigated?
1. What are the likely psychosocial impacts of WMD and how
can they be prevented or mitigated?
References/Works Cited:
Defense Threat Reduction Agency, Federal Bureau of
Investigation, & U.S. Joint Forces Command. (2001). Human
Behavior and WMD Crisis/Risk Communication Workshop -

7. Final Report.
Lacy, T.J. & Benedek, D.M. (2003). Terrorism and Weapons of
mass destruction: Managing the behavioral reaction in primary
care. Southern Medical Association, 2003. Bethesda,
MD Southern Medical Association
World at Risk, First Vintage Books Edition: December 2008.
(This book is available on line and provided in the electronic
classroom)
CO-5 Explain the process of primary care management for
behavioral reactions during a weapon of mass destruction
incident in the United States.
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During this discussion, you will explain the process of primary
care management for behavioral reactions during a weapons of
mass destruction in the United States. Read the article titled
"Terrorism and Weapons of mass destruction: Managing the
behavioral reaction in primary care. Southern Medical
Association, 2003. Bethesda, MD Southern Medical
Association” in the Week 5 Lesson Packet.
Based on your understanding of the process of primary care
management for behavioral reactions during a weapons of mass
destruction in the United States, do you believe the United
States is prepared for primary care management during a
weapons of mass destruction incident?