TERRORISM AND WEAPON OF MASS DESTRUCTION: Awareness and Preparedness

By: Ibordor I. Emmanuel

Weapon of mass destruction can conveniently be grouped into three categories, they are; (i) Biological (ii) Chemical and (iii) Radiological.

ORIGIN: The origin of the use of biological and chemical weapon date back to the Biblical times, as recorded in Judges 9:45, on the use of salt to destroy crops. About 300BC, Persians, Greeks, and Romans used animal and human cadavers to contaminate drinking water.

MIDDLE AGE: The Tatar troops threw plague victims on enemies’ territories. Equally, a Polish infantryman suggested creating hollowed bombs filled with rabid dog saliva and other materials that could cause disease.

CONTEMPORARY WORLD: In about 1763, bioterrorism emerged. The British troops supplied smallpox contaminated blankets to Indian tribes during the French and Indian War. During World War I, the use of chlorine, phosgene and mustard gas killed or injured more than a million troops and civilians. The 1925 Geneva Protocol on the Prohibition of the Use in War of Asphyxiating, Poisonous or other Gases and of Bacteriological methods of warfare was borne to check the use and proliferation. 

Shortcoming of the Geneva Protocol are;

It did not prevent countries from asserting their right to respond in kind when attacked with these weapons. It did not ban the production and stockpiling of agents and delivery systems and was not universal.

Consequently, after World War I, Japan began extensive research on biological weapon which exposed over 10,000 prisoners to a wide range of chemical and biological agents. In Europe, the Nazi party recruited physicians, to research and develop the use of biological and chemical agents. The application contributed to the death of well over six (6) million Jews with Zyclon B, Nazi physicians exposed concentrated camp victims to biological agents, like Rickettsia  species, Plasmodia species, and Hepatitis etc.

Mustard agent burns, several weeks after exposure

Radiological terrorism involves the application of radioactive materials to cause human casualties, environmental degradation and maximum disruption, panic, phobia, to citizenry for military, political and economic purpose.

This awesome weapon has the ability to cause immediate devastation, trauma, morbidity and mortality, cancer being inclusive, over years after exposure.

For instance, the Hiroshima bombing in 1945, with casualties of about 150,000 and 75,000 fatalities, is instructive.

POTENTIAL HAZARD IN STORAGE AND HANDLING

Tabulated below are some of the recorded accident/hazards in storage and handling.

S/N	PLACE	PERIOD	INCIDENT	CASUALTY/REMARKS
1	USA	1944-2002	243	1,324
2	Worldwide	1944-2002	403	133,617 with 3,000 effective exposures and 120 death
3	Brazil	1987	200 Contaminated	4 death
4	Chernobyl	1986	116,500 exposed	28 fatalities
5	Fukushima	2011		18,500 due to Tsunami that triggered the incident and 610 died due to exposure. About 10,000 human fatalities from the nuclear incident and a maximum cancer mortality and morbidity of 1,500 and 1,800, respectively.

In Nigeria, the Federal Republic of Nigeria Search and Rescue (SAR) and Epidemic Evacuation plan for Nigeria, involve many of the emergency response organizations.

They Includes;

i.                     Armed Forces.

ii.                   Nigerian Security and Civil Defense Corps.

iii.                  Fire Service.

iv.                 Police.

v.                   Federal Road Safety Commission.

vi.                 Nigerian Railway.

vii.                Nigerian Airspace Management Agency.

viii.              Nigerian Civil Aviation Authority.

ix.                 Nigerian Maritime and Safety Agency.

x.                   Nigerian Port Authority.

xi.                 Nigeria Inland Water Authority.

xii.                Nigerian Meteorological Agency.

xiii.              Accident Investigation Bureau.

xiv.              Nigerian Red Cross.

xv.               National Emergency Management Agency.

These agencies, collaborate and synergize their operations during emergencies but sparingly organizes seminars, workshops and symposia on weapon of mass destruction.

These emergency responders hardly address the following essential areas;

i.                     No or hardly any periodic simulation exercise.

ii.                   Knowledge dissemination during workshops/seminars etc. hardly address the most dangerous aspect of national/international security- that is the use of or accidental emission of Weapon of Mass Destruction (WMD).

NOTE: Distance is no barrier especially on biological and radiological disasters.

THE ROLE OF EMERGENCY RESPONDERS

General Precautions in Responding to Chemical Attacks.

Depending on the chemical and the route of exposure, toxic effects will range from topical injury of the skin and respiratory mucus membranes to systemic injury due to dermal or respiratory absorption (7). Regardless of the agent used, priorities in responding to a chemical attack are the same: preserving life, stabilizing the incident and conserving the environment, including property (8). The response to chemical attacks should follow consistent principles (8):

-          Containing the event.

-          Preventing exposure to others through secondary contamination.

-          Rapid decontamination.

-          Providing supportive care.

-          Administering specific antidotes as indicated.

Anthrax Victim

Anthrax as a biological weapon.

THE PHOBIA IN TERRORIST USE OF WMD

The intentional use or threatened use of biological, chemical and radiological agents has proven effective in coercing and intimidating populations. One review of available literature on biological, chemical and radiological terrorism identified several terrorist aims (1):

-          Create mass anxiety, fear and panic

-          Create mass feelings of helplessness, hopelessness, and demoralization

-          Destroy the public’s assumptions about their own personal security

-          Disrupt the infrastructure

-          Demonstrate how civil authorities are incapable of protecting the public and the Environment (Adapted from Alexander et al. (1), with permission from the Royal College of Physicians.)

Biological, chemical and radiological terrorist attacks are especially terrifying because they may occur unannounced and undetected, because the attacks can occur in places people generally consider safe, and because the injuries they cause may be unusual and prolonged (2). As a result, the use of these weapons is likely to cause mass fear and anxiety, making it likely that mental health casualties will greatly outnumber physical casualties. Risk communication research has identified criteria for exposures associated with prolonged mental health effects. Biological, chemical and radiological attacks fulfill all of these criteria in that they cause exposures that are:

-          Involuntary

-          Man-made

-          Unfamiliar

-          Threatening to children

-          Capable of causing long term effects that threaten future generations

IMPACT

After a biological, chemical or radiological attack, patients may experience a variety of mental health responses, including distress responses, behavioral changes, psychosomatic symptoms, including medically unexplained symptoms, psychological symptoms, including medically unexplained symptoms, psychological symptoms and psychiatric illness, such as PTSD (20). Categories of common mental health responses include (20,21):

-          Physical symptoms and signs, such as fatigue, nausea, fine motor tremors, tics, paresthesias, profuse diaphoresis, dizziness, nausea, diarrhea, tachypnea, tachycardia, and a choking or smothering sensation.

-          Emotional symptoms, such as anxiety, grief irritability, feeling overwhelmed and a sense of vulnerability.

-          Cognitive changes, such as memory loss, anomia, difficulty making decisions, decreased attention span, difficulty concentrating, distractibility, difficulty with math calculation, inability to distinguish trivial problems from major problems.

-          Behavioral changes, such as insomnia, acting out, social withdrawal, crying easily, use of “gallows” humor, hyper-vigilance, ritualistic behavior.

-          Increased use of substances, including increased smoking, increased use of alcohol and other drugs (16); increased substance use may also accompany PTSD and depression (16).

-          Spiritual effects, such as crisis of faith, anger at God, anger displacement toward those in authority, questioning basic religious beliefs.

-          Long-term behavioral effects, including nightmare, intrusive thoughts, uncontrolled affect, difficulties with relationships, difficulties with jobs and/or school, decreased libido and changes in appetite.

A diagnosis of PTSD (Posttraumatic Stress Disorder) in adults and children requires the presence of several conditions (7,23,27):

-          The patient must have been exposed to an extreme stressor or traumatic event to which he/she responded with fear, helplessness and horror.

-          The patient must have three distinct types of symptoms, for at least a month, including:

·         Re-experiencing the event: undesired recall of the incident through distressing images, nightmares or flashbacks.

·         Avoidance of reminders of the event, including avoidance of persons, places or thoughts associated with the incident.

·         Physiological manifestation of hyperarousal symptoms for at least 1 month, such as insomnia, irritability, impaired concentration, hyper-vigilance and increased startle reactions (10,27).

Diagnosis of Mental Health Symptoms Following Terrorist Attacks

Diagnostic criteria for 309.81 posttraumatic stress disorder

a.       The person has been exposed to a traumatic event in which both of the following were present:

1.       The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

2.       The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

b.      The traumatic event is persistently re-experienced in one (or more) of the following ways:

1.       Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

2.       Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

3.       Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

4.       Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

5.       Psychological reactivity on exposure to internal and external cues that symbolize or resemble an aspect of the traumatic event.

c.       Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

1.       Effort to avoid thoughts, feelings, or conversations associated with the trauma.

2.       Efforts to avoid activities, places, or people that arouse recollections of the trauma.  

3.       Inability to recall an important aspect of the trauma.

4.       Markedly diminished interest or participation in significant activities.

5.       Feeling of detachment or estrangement from others.

6.       Restricted range of affect (e.g., unable to have loving feelings).

7.       Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

d.      Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

1.       Difficulty falling or staying asleep

2.       Irritability or outbursts of anger

3.       Difficulty concentrating

4.       Hyper vigilance

5.       Exaggerated startle response

e.      Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

f.        The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The impact of radioactive emission on human

CATEGORIES OF CHEMICAL WEAPON AGENTS TERRORIST MIGHT USE INCLUDE BUT NOT LIMITED TO THE FOLLOWING:

-          Nerve agents: Tabun (ethyl N,N-dimethylphosphoramidocyanidate), sarin (Isopropyl methylphosphanofluoridate), soman (pinacolyl methylphanofluoridate), GF (cyclohexylmethylphosphonofluoridate), VX (o-ethyl-[s]-[2-diisopropylaminoethyl]-methylphosphonothiolate)

-          Vesicant (blister) agents: Lewisite (an aliphatic arsenic compound, 2-chlorovinyldichloroarsine), nitrogen and sulfur mustards, phosgene oxime.

-          Blood agents: hydrogen cyanide, cyanogens chloride

-          Heavy metals: arsenic, lead, mercury

-          Volatile toxins: benzene, chloroform, trihalomethanes

-          Pulmonary agents: phosgene, chlorine, vinyl chloride

-          Incapacitating agents: BZ (3-quinuclidinyl benzilate)

-          Pesticides, persistent, and nonpersistent

-          Dioxins, furans, and polychlorinated biphenls (PCBs)

-          Explosive nitro compounds and oxidizers: ammonium nitrate combined with fuel oil.

-          Flammable industrial gases and liquids: gasoline, propane

-          Poison industrial gases, liquids, and solids: cyanides, nitriles

-          Corrosive industrial acids and bases: nutric acid, sulfuric acid

-          Biotoxins: Ricin

This segment discusses several of these agents based on the Medical Management Guidelines (MMGs) for Acute Chemical Exposures (9). The Agency for Toxic Substances Disease Registry (ATSDR) developed the guidelines to help physicians and other emergency healthcare professionals manage acute chemical exposures.

The guidelines, available at http://www.atsdr.cdc.gov/MHMI/mmg-n.html #bookmark02 (last accessed 5/12/06), include information on how physicians can decontaminate patients effectively, protect themselves and others from contamination, communicate with other involved personnel, transport patients safely and efficiently to a medical facility and provide competent medical evaluation and treatment to exposed persons. The guidelines also include patient information. Additional information on each chemical agent is also available on the CDC with site at http://bt.cdc.gov/agent/agentlistchem.asp.

Fukushima Nuclear Plant Disaster

Treatment of nerve agent intoxication involves four components:

-          Airway and ventilator support.

-          Decontamination

-          Aggressive use of antidotes, especially atropine and pralidoxine.

-          Seizure control.

The general roles of Emergency Responders:

This article has identified key roles for primary care clinicians in protecting the health of their communities:

-          Addressing patient concerns about their risks of terrorist-caused illness.

-          Participation in surveillance to detect an attack, including reporting potential exposures and any unusual cases or clusters of cases to local and state public health officials.

-          Working with public health officials to identify patients at risk of exposure and providing preventive treatment.

-          Working with public health officials to identify patients with terrorist-caused disease and providing effective treatment.

-          Educating patients and the community on the risks of biological, chemical, and radiological terrorism, including how to protect themselves and their families.

-          Detecting symptoms of psychological trauma following terrorist events, and providing compassionate counseling and treatment to address these symptoms.

Security threats are concern to all and sundry. The curiosity is arose when the experts in the response team and the general public are regularly well informed on the presence and danger in WMD. In addition, how to detect and respond before, during and after emergencies. The onus of this information dissemination lies on the health and emergency response agencies. They themselves should be well informed, and update their information regularly. The emergency responders should quarterly simulate emergency situation and update members knowledge on types, characteristics, precaution, adaptation and mitigation of occurrences.

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