Physician’s Guide to Terrorist Attack PDF
Preview Physician’s Guide to Terrorist Attack
PHYSICIAN'S GUIDE TO TERRORIST ATTACK PHYSICIAN'S GUIDE TO TERRORIST ATTACK Edited by J. MICHAEL ROY, MD, MPH, FACP Department ofM edicine Uniformed Services University oft he Health Sciences Bethesda, MD ~ HUMANA PRESS ~ TOTOWA, NEW JERSEY © 2004 Humana Press Inc. Softcover reprint of the hardcover 1st edition 2004 999 Riverview Drive, Suite 208 Totowa, NJ 07512 www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the infor mation published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Cover design by Patricia F. Cleary. Cover photo: BrandX Pictures. For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341, E-mail: [email protected]; or visit our Website: www.humanapress.com This publication is printed on acid-free paper. GV ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients is granted by Humana Press, provided that the base fee of US $25.00 per copy is paid directly to the Copyright Clearance Center (CCC), 222 Rosewood Dr., Danvers MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to the Humana Press. The fee code for users of the Transactional Reporting Service is 1-58829-207-X/04 $25.00. Library of Congress Cataloging-in-Publication Data Physician's guide to terrorist attack 1 edited by Michael J. Roy. p.; cm. Includes bibliographical references and index. Additional material to this book can be downloaded from http://extras.springer.com ISBN 978-1-4684-9814-1 ISBN 978-1-59259-663-8 (eBook) DOI 10.1007/978-1- 59259-663-8 I. Terrorism--Health aspects. 2. Disaster medicine. [DNLM: I. Disaster Planning--organization & administration. 2. Emergency Medical Services--organization & administration. 3. Terrorism--prevention & control. 4. Biological Warfare--prevention & control. 5. Chemical Warfare Agents--toxicity. 6. Decontamination--methods. 7. Nuclear Warfare. WX 185 P5785 2004] 1. Roy, Michael J., 1962- RC88.9.T47P482004 362.18--dc21 2003008190 This book is dedicated to the survivors oft he terrorist attacks that occurred on September 11, 2001, and oft he anthrax attacks that followed that fall as well as to the families andf riends who lost loved ones as a result of these horrors. Let us hope and pray that we will be able to prevent such senseless loss ofl ife in the future. PREFACE Terrorists seek to maximize economic, political, and psychological disruption through their actions. To capture media attention for their cause, terrorists often engage in one upmanship, acting in a more horrific and spectacular manner than has been previously seen, from the Olympic Village attack in Munich in 1972, to the airliner crashes into the World Trade Center and the Pentagon in 2001. The use of biological, chemical, or nuclear weapons has been contemplated by many terrorists, and even carried out with some success on occasion, but the medical community justifiably fears that we are likely to see more calamitous use of such agents for terrorist means in the future. Terrorist events in the fall of 200 I-the attacks upon the World Trade Center and the Pentagon on September 11, followed by dissemination of anthrax through the US mail painfully emphasized the need for physicians to be able to diagnose and manage individu als suffering injuries as a result of exposures to biological, chemical, and nuclear, as well as explosives. Physician's Guide to Terrorist Attack is intended to prepare physicians and other health care workers to respond knowledgeably and confidently to a terrorist event. Whether you are a first responder working with emergency personnel amid the chaos of a disaster scene or at a hospital receiving mass casualties, a provider in the community responding to an anxious patient fearful of exposure to a biological agent, or a primary care provider or mental health specialist helping patients and their family members to cope with the psychological aftermath, this book will provide the information you need, in an easy-to-follow, clinically relevant, case-based format. Dr. Smoak, a veteran of the US Embassy bombing in Nairobi, Kenya, reviews lessons learned from previous events with regard to the initial response. Dr. Geiling, who was chief of medical services at the Pentagon on September 11, 2001, details the impact that a terrorist event is likely to have on the medical system, providing valuable guidance on what to expect and how to prepare for a future event. Drs. Yeskey and Morse of the Centers for Disease Control and Prevention outline the approach that a community provider should take, from the initial suspicion of a terrorist event, to the involvement of public health authorities. Dr. Murray reviews the historical use of biological, chemical, and nuclear agents, from ancient times through the present, putting into perspective recent concerns, and providing an introduction to the ensuing chapters, which provide an agent-by-agent review for the clinician. A number of the world's leading infectious diseases experts on potential bio logical agents focus on the key aspects of diagnosis and therapy for the 13 most feared bacteria, viruses, and toxins. A comparable field of experts then reviews the diagnostic and therapeutic approach to various chemical agents. Many of the authors have been involved in various aspects of evaluation and management of biological and chemical threats, in homeland defense efforts to combat terrorism, and in a variety of educational endeavors to help fellow clinicians prepare to diagnose and treat victims promptly should an event come to pass. The subsequent three chapters provide critically important information as well. A chapter on blast injuries, written by leading authorities on this subject, is significant because conventional explosives are still far more likely to be used by terrorists than vii viii Preface anything else. A chapter on nuclear and radiological weapons, written by experts at the Armed Forces Radiobiologic Research Institute, covers the gamut from a "dirty bomb" to the use of a high-powered nuclear device. Last but not least, members of the Depart ment of Psychiatry at Uniformed Services University, internationally recognized for their disaster response experience, review the immediate and late psychological effects of terrorist events. This is particularly salient, since no matter how severe and numerous the physical casualties, it is safe to assume that they will be exceeded by those suffering from psychological traumatization. Although it would be nice to think that physicians need not know the information that is covered here, the reality is that it is critically important for physicians to prepare themselves by acquiring the knowledge and skills necessary to cope effectively with a major terrorist event now, rather than learning through painful experience. Michael J. Roy, MD, MPH, FACP CONTENTS Preface ......................................................................................................................... vii Contributors ................................................................................................................... xi PART I: RESPONDING TO AN INCIDENT 1 Mass Casualty Events: Lessons Learned ......................................... 3 Bonnie L. Smoak and James A. Geiling 2 Hospital Preparation and Response to an Incident ........................ 21 James A. Geiling 3 Physician Recognition of Bioterrorism-Related Diseases ............. 39 Kevin Yeskey and Stephen A. Morse 4 Introduction to Biological, Chemical, Nuclear, and Radiological Weapons: With a Review of Their Historical Use ............................ 47 Clinton K. Murray II: PART BIOLOGICAL AGENTS 5 Anthrax ............................................................................................ 65 Steven J. Durning and Michael J. Roy 6 Plague .............................................................................................. 87 Jennifer C. Thompson 7 Tularemia ...................................................................................... 103 Christian F. Ockenhouse 8 Brucellosis ..................................................................................... 111 David L. Hoover 9 Q Fever .......................................................................................... 123 R. Scott Miller 10 Melioidosis and Glanders ............................................................. 143 Aileen M. Marty 11 Botulinum Toxins ......................................................................... 161 Naomi E. Aronson 12 Ricin Toxin ................................................................................... 175 Glenn Wortmann 13 Staphylococcal Enterotoxin B ...................................................... 181 David L. Blazes ix x Contents 14 Mycotoxins .................................................................................... 189 Duane R. Hospenthal 15 Smallpox ....................................................................................... 197 James V. Lawler and Timothy H. Burgess 16 Viral Hemorrhagic Fevers ............................................................ 221 Thomas W. Geisbert, Aileen M. Marty, and Peter B. Jahrling 17 Viral Encephalitides ...................................................................... 243 Niranjan Kanesa-thasan III: PART CHEMICAL AGENTS 18 Pulmonary Toxic Agents .............................................................. 253 Rafael E. Padilla 19 Cyanide .......................................................................................... 263 Steven I. Baskin, Jonathan S. Kurche, and Beverly I. Maliner 20 Vesicants ....................................................................................... 279 Edward Lucci 21 Nerve Agents ................................................................................. 297 Jonathan Newmark 22 Incapacitating Agents ................................................................... 311 Sage W. Wiener and Lewis S. Nelson 23 Riot Control Agents ...................................................................... 325 Richard J. Thomas and Philip A. Smith PART IV: ADDITIONAL CONSIDERATIONS 24 Radiation Effects ........................................................................... 339 Vijay K. Singh and Thomas M. Seed 25 Explosives ..................................................................................... 363 John M. Wightman and Barry A. Wayne 26 Psychological Impact of Terrorist Incidents ................................ 379 Timothy J. Lacy and David M. Benedek 27 Conclusions ................................................................................... 391 Michael J. Roy Index ........................................................................................................................... 397 CONTRIBUTORS NAOMI E. ARONSON, MD, FACP • Colonel, Medical Corps, US Army; Director, Division of Infectious Diseases, Associate Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD STEVEN I. BASKIN, PharmD, PhD, FCP, FACC, DABT, FATS • Division of Pharmacology, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD DAVID M. BENEDEK, MD· Major, Medical Corps, US Army; Associate Professor of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD DAVID L. BLAZES, MD, MPH· Lieutenant Commander, Medical Corps, US Navy; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Infectious Diseases Service, National Naval Medical Center, Bethesda, MD TIMOTHY H. BURGESS, MD, MPH· Lieutenant Commander, Medical Corps, US Navy; Naval Medical Research Center, Silver Spring, MD STEVEN J. DURNING, MD, FACP • Major, Medical Corps, US Air Force; Director, Clinical Concepts Course, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD JAMES A. GElLING, MD, FACP, FCCp· Colonel, Medical Corps, US Army (Retired); Department of Medicine, VA Medical Center, White River Junction, VT; Assistant Professor of Medicine, Dartmouth Medical School, Hanover, NH THOMAS W. GEISBERT, PhD· US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD DAVID L. HOOVER, MD· Colonel, Medical Corps, US Army; Department of Bacterial Diseases, Walter Reed Army Institute of Research, Silver Spring; Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD DUANE R. HOSPENTHAL, MD, PhD, FACP • Lieutenant Colonel, Medical Corps, US Army; Chief, Infectious Disease Service, Brooke Army Medical Center, San Antonio, TX PETER B. JAHRLING, PhD· US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD NlRANJAN KANESA-THASAN, MD, MTMH • Lieutenant Colonel, Medical Corps, US Army; Medical Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD JONATHAN S. KURCHE, BS· Research Fellow, Division of Pharmacology, Oak Ridge Institute for Science and Education (ORISE); US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD TIMOTHY J. LACY, MD· Lieutenant Colonel, Medical Corps, US Air Force; Assistant Professor of Psychiatry and Family Medicine, Uniformed Services University of the Health Sciences; Program Director, National Capital Consortium Combined Residency in Psychiatry and Family Practice, Uniformed Services University of the Health Sciences, Bethesda, MD xi
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