TERRORISM

- is the systematic use of terror, especially as a means of coercion.

SIX CATEGORIES:
1. Civil disorder A form of collective violence interfering with the peace, security, and normal functioning of the community. 2. Political terrorism Violent criminal behaviour designed primarily to generate fear in the community, or substantial segment of it, for political purposes. 3. Non-Political terrorism Terrorism that is not aimed at political purposes but which exhibits conscious design to create and maintain a high degree of fear for coercive purposes, but the end is individual or collective gain rather than the achievement of a political objective. 4. Quasi-terrorism The activities incidental to the commission of crimes of violence that are similar in form and method to genuine terrorism but which nevertheless lack its essential ingredient. It is not the main purpose of the quasi-terrorists to induce terror in the immediate victim as in the case of genuine terrorism, but the quasi-terrorist uses the modalities and techniques of the genuine terrorist and produces similar consequences and reaction. 5. Limited political terrorism Genuine political terrorism is characterized by a revolutionary approach; limited political terrorism refers to acts of terrorism which are committed for ideological or political motives but which are not part of a concerted campaign to capture control of the state. 6. Official or state terrorism "referring to nations whose rule is based upon fear and oppression that reach similar to terrorism or such proportions. It may also be referred to as Structural Terrorism defined broadly as terrorist acts carried out by governments in pursuit of political objectives, often as part of their foreign policy.

BIOLOGICAL WEAPONS
These are weapons that spread disease among the general population or the military. These are toxic materials produced from pathogenic organisms (usually microbes) or artificially manufactured toxic substances that are used to intentionally interfere with the biological processes of a host. These substances work to kill or incapacitate the host. Biological weapons may be used to target living organisms such as humans, animals or vegetation. They may also be used to contaminate nonliving substances such as air, water and soil These are easily obtained and easily disseminated and can result in significant mortality and morbidity.

EFFECTS OF BIOLOGIC WEAPONS

BIOLOGIC WARFARE - a covert method of effecting terrorist objectives.

BIOLOGIC AGENTS - delivered in either a liquid or dry state, applied to foods or water, or vaporized for inhalation or direct contact. Vaporization may be accomplished through spray or explosives loaded with the agent. The vector can be an insect, animal, or person, or there may be direct contact with the agent itself.

TYPES OF BIOLOGIC AGENTS

ANTHRAX (bacillus anthracis) - recognized as the most likely weaponized biologic agent available. - a naturally occurring gram-positive, encapsulated rod that lives in the soil in the spore state throughout the world. - The bacterium sporulates when exposed to air and is infective only in the spore form. - Contact with animal products (raw meat) or inhalation of the spores result in infection. - It is believed that approximately 8000 to 50,000 spores must be inhaled to put a person at risk. - As an aerosol, anthrax is odorless and invisible and can travel a great distance before disseminating; hence, the site of release and the site of infection can be miles apart. - Caused by replicating bacteria that release toxin, resulting in hemorrhage, edema and necrosis. The incubation period is 1-6 days

Initial signs and sx: cough, headache, fever, vomiting, chills, weakness, mild chest discomfort, dyspnea and syncope. Recommended tx: penicillin, erythromycin, gentamicin. If antibiotic tx begins within 24 hrs. after exposure, death can be prevented. In a mass casualty situation, tx with ciprofloxacin (cipro) or doxycycline (vibramycin) is used for prophylaxis for 60 days.

MANAGEMENT:
Standard precautions are the only precautions necessary to protect the caregiver exposed to a pt. infected with anthrax. The pt. is not contagious, and the disease cannot spread from person to person. Equipment should be cleaned using standard hospital disinfectant. After death, cremation is recommended because the spores can survive for decades and represent a threat to morticians and forensic medicine personnel. 1. SMALLPOX (VARIOLA) Caused by poxvirus variola.

 It is classified as a DNA virus. It has an incubation period of approximately 12 days. It is extremely contagious and is spread by direct contact, by contact with clothing or linens, or by droplets from person to person after the fever has decreased and the rash phase has begun. But it is only contagious after the appearance of the rash. It can survive in cool temperatures and low humidity for up to 24 hrs.

THREE MAJOR FORMS:

1) Variola major - (classic smallpox), which carried a high mortality; 2) Variola minor - a mild form that occurred in nonvaccinated persons and resulted from a less virulent strain; 3) Varioloid - a mild variant of smallpox that occurred in previously vaccinated persons who had only partial immunity.

Signs and sx:

Chills High fever Headache Backache Severe malaise Vomiting Marked prostration Possible convulsive seizures, violent delirium, stupor, or coma

MANAGEMENT:
Treatment includes supportive care with antibiotics for any additional infection. The patient must be isolated with the use of transmission precautions. Laundry and biologic wastes should be autoclaved before being washed with hot water and bleach. Standard decontamination of the room is effective. All people who have household or face-to-face contact with the pt. after the fever begins should be vaccinated within 4 days to prevent infection and death. Cremation is preferred for all deaths, because the virus can survive in scabs for up to 13 years.

OTHER BIOLOGIC AGENTS:

Microbe Natural Environment Target Host Mode of Contraction Diseases/Symptoms

AnthraxBacillus anthracis

Soil

Humans, Domestic Animals

Open Wounds, Inhalation, Gastrointestinal ingestion

Pulmonary Anthrax Septicemia, Flu-like symptoms

Clostridium botulinum

Soil

Humans

Contaminated Food or Water,

Inhalation

Clostridium perfringens

Intestines of humans and other animals, Soil

Humans, Domestic Animals

Open Wounds

Gas gangrene, Severe Abdominal Cramps, Diarrhea

RICINProtein Toxin

Extracted from Castor Bean Plants

Humans

Contaminated Food or Water, Inhalation, Injection

Severe Abdominal Pain, Watery and Bloody Diarrhea, Vomiting, Weakness, Fever, Cough, and Pulmonary Edema

Smallpox

Eradicated from Nature, Now Obtained from Laboratory Stockpiles

Humans

Direct Contact with Bodily Fluids or Contaminated Objects, Inhalation

Persistent Fever, Vomiting, Rash on Tongue and in Mouth, Rash and Bumps on Skin

CHEMICAL WEAPONS

 A device that uses chemicals formulated to inflict death or harm to human beings. They are classified as weapons of mass destruction, and have been "condemned by the civilized world". COMMON CHEMICAL AGENTS: Sarin, soman - affect nerves Cyanide - affect blood Lewisite, nitrogen and sulfur mustard, phosgene - vesicants Arsenic, lead - heavy meals Benzene, chloroform - volatile toxins Chlorine - pulmonary agents Nitric acid, sulfuric acid - corrosive acids Chlorine, phosgene, and cyanide (including hydrogen cyanide and cyanogen chloride) - are widely used in industry and therefore are readily available.

AGENT NERVE AGENTS (sarin, soman organophosphates)

ACTION Inhibition of cholinesterase

SIGNS & Sx Increased secretions, gastrointestinal motility, diarrhea, bronchospasm

BLOOD AGENT ( cyanide)

Inhibition of aerobic metabolism

VESICANT AGENTS (lewisite, sulfur mustard, nitrogen mustard, phosgene) PULMONARY AGENTS (phosgene, chlorine)

Blistering agents

Inhalation tachypnea, tachycardia, coma, seizures. Can progress into respiratory arrest, respiratory failure, cardiac arrest, and death. Superficial to partial Soap & water thickness burn with Blot; do not rub dry vesicles that coalesce

DECONTAMINATION & Tx Soap and water Supportive care Benzodiazepine Pralidoxime Atropine Sodium nitrate Sodium thiocyanate Amyl nitrate Hydroxocobalamin

Separation of alveoli from capillary bed

Pulmonary edema, bronchospasm

Airway management Ventilatory support Bronchoscopy

CHARACTERISTICS OF CHEMICALS:
1) VOLATILITY- the tendency for a chemical to become a vapor. - Most volatile agents are phosgene and cyanide. 2) PERSISTENCE - the chemical is less likely to vaporize and disperse. 3) TOXICITY - the potential of an agent to cause injury to the body. 4) LATENCY - the time from absorption to the appearance of symptoms. - Sulfur mustards and pulmonary agents have the longest latency, whereas vesicants, nerve agents, and cyanide produce symptoms within seconds.

TYPES OF CHEMICALS: 1) VESICANTS

chemicals that cause blistering and result in burning, conjunctivitis, bronchitis, pneumonia, hematopoietic suppression, and death. The initial presentation after exposure to a vesicant is similar to that of a large superficial to partial thickness burn in the warm and moist areas of the body (perineum, axillae, antecubital spaces).

TREATMENT:
Appropriate decontamination includes soap and water. Scrubbing and the use of hypochlorite solutions (bleach) should be avoided, because they increase penetration. Once the substance penetrated, it cannot be removed. Eye exposure requires copious irrigation. For respiratory exposure, intubation and bronchoscopy to remove necrotic tissue are essential.

2) NERVE AGENTS
The most toxic agents in existence (sarin,soman, tabun , VX, and organophosphates[pesticides]). In the liquid form, nerve agents evaporate into a colorless, odorless vapor. It can be inhaled or absorbed percutaneously or subcutaneously. Signs and sx are those of cholinergic crisis: visual disturbances, increased gastrointestinal motility, nausea and vomiting, diarrhea, indigestion, bradycardia, and atrioventricular block, bronchoconstriction,weakness and incontinence. Neurologic responses include insomnia, impaired judgement, depression, and irritability. A lethal dose results in loss of consciousness, seizures, copious secretions, flaccid muscles, and apnea.

TREATMENT:
Decontamination with copious amounts of soap and water or saline solution for 8-20 minutes is essential. Fresh 0.5 % Hypochlorite solution (bleach) can also be used. The airway maintained, and suctioning is frequently required. Plastic airway equipment will absorb sarin gas, which may result in continued exposure to the agent. Atropine 2 to 4 mg is administered IV, followed by 2 mg every 3 to 8 mins. for up to 24 hours of treatment. Alternatively, IV atropine 1 2mg/hr may be administered until clear signs of anticholinergic activity have returned (decreased secretions, tachycardia, and decreased gastrointestinal motility).

3) BLOOD AGENTS
Have a direct effect on cellular metabolism, resulting in asphyxiation through alterations in hemoglobin such as hydrogen cyanide and cyanogen chloride. Cyanide can be ingested, inhaled, or absorbed through the skin and mucous membranes. Inhalation of cyanide results in flushing, tachypnea, tachycardia, nonspecific neurologic symptoms, stupor, coma, and seizure preceding respiratory arrest.

TREATMENT:
Rapid administration of amyl nitrate, sodium nitrate, and sodium thiosulfate is essential to the successful management of cyanide exposure. First, the pt. is intubated and placed on a ventilator. Next, amyl nitrate pearls are crushed and placed in the ventilator reservoir to induced methemoglobinemia. Cyanide has a 20%- 25% higher affinity for methemoglobin than it does for hemoglobin; it binds methemoglobin to form either cyanomethemoglobin or sulfmethemoglobin. The cyanomethemoglobin is then detoxified in the liver by the enzyme rhodanase.

4) PULMONARY AGENTS
Destroy the pulmonary membrane that separates the alveolus from the capillary bed, disrupting alveolar-capillary oxygen transport mechanisms such as phosgene and chlorine. Capillary leakage results in fluid-filled alveoli. Phosgene and chlorine both vaporize, rapidly causing this pulmonary injury.

SIGNS AND SYMPTOMS:

Pulmonary edema with shortness of breath, especially during exertion. An initial hacking cough is followed by frothy sputum production. A mask is the only protection required to protect health care personnel. Phosgene does not injure the eyes.

SUBMITTED BY: VINCE, MAEVIN JABE YBANEZ, MABELLE SUBMITTED TO: MR. DANILO SALAVARIA