Introduction to Biological and Chemical Terrorism

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Introduction to Biological and Chemical Terrorism

• CPT Bradley N. Younggren M.D.
• Madigan Army Medical Center
• Ft. Lewis, Washington

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The opinions and assertions herein are the
private views of the author. They are not to be
construed as official or as reflecting the views
of the Departments of the Army or Navy, Madigan
Army Medical Center, the Department of Defense,
or the U.S. government.
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Overview
Biological Agents
Chemical Agents

• Epidemiology
• Clinical Presentations
• Pulmonary
• Neurologic
• Dermatologic
• Treatment Options
• Chemotherapy/Prophylaxis
• Vaccines

• Pulmonary Agents
• Cyanide
• Vesicants
• Nerve Agents
• Incapacitating Agents
• Riot Control Agents

ED Control Plan
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Why Biological Agents?

• Low Visibility
• Accessibility
• High Potency
• Relative Ease of Delivery

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Epidemiology

• Epidemic Curve
• Number of Cases, Incubation Period
• Clinical Presentation
• Virulence
• Geography

• Resources Affected
• Seasonal Distribution
• Evidence of Attack
• Dispersal Method
• Residual Toxicity

Weiner SL. Strategies of biowarfare defense.
Military Medicine. 198715225-28.
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Pulmonary Signs and Sx.

• Bacillus anthracis (Anthrax)
• Yersinia pestis (Plague)
• Francesella tularensis (Tularemia)

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Neurological Presentations

• Botulinum Toxin
• Clostridium botulinum

• Viral Encephalitides
• Venezuelan Equine Encephalitis
• Eastern Equine Encephalitis
• Western Equine Encephalitis

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Dermatologic Presentations
Tularemia
Plague

• SmallPox

Anthrax
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Treatment Options
Chemoprophylaxis
Chemotherapy
Anthrax Plague(Pneumonic) Tularemia Botulinum
Toxin Viral Encephalitides Smallpox
Ciprofloxacin 500 mg po BID Doxycycline 100 mg
po BID
Ciprofloxacin 400 mg IV q8-12 hrs Doxycycline 100
mg po BID x4 weeks
Streptomycin 1g PO bid Gentamicin 5 mg/kg IM/IV qd
Doxycycline 100 mg PO bid
None
No aminoglycosides or clindamycin
None
None
VIG (0.6 mL/kg IM)_
None
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Vaccines/Antitoxins

• Botulism Antitoxin
• ADE(10 ml vial diluted 110 in 0.9 saline)
• ABCDEFG
• Anthrax
• Plague
• Smallpox
• Yellow Fever
• Cholera

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Pulmonary Agents

• Phosgene (CG)
• Also consider PFIB and NO derivatives
• Cyanide (HCN, NaCN)
• Hydrocyanic acid(AC), cyanogen chloride (CK)
• Chlorine

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Vesicants

• Mustard (H)
• Distilled mustard (HD)
• Lewisite (L)
• Phosgene Oxime (CX)

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Nerve Agents

• Sarin (GB)
• Tabun (GA)
• Soman (GD)
• VX
• TreatmentAtropine,2PamCL,Diazepam

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Other Agents

• Incapacitating Agents
• BZ,Agent 15
• Riot-Control Agents
• CS
• CN

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Medical Control Plan

• Institution Specific Plan
• Medical Community/Law Enforcement
• Infection Control / FBI
• Universal Precautions
• Special Cases
• Pneumonic Plague
• SmallPox

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ConclusionsBiological Agents

• Cheap and Effective Agents
• Medical, Political, and Social effects
• Antibiotic Resistance and side effects
• Current Events
• Research What lies ahead

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ConclusionsChemical Weapons

• Historically Ignored
• Very potent Agents
• Varied Effects Varied Goals
• Fairly Obvious Signs/Symptoms

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Questions??