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Terror and Medicine - Medical Aspects of Biological, Chemical and Nuclear Terrorism

Terror and Medicine - Medical Aspects of Biological, Chemical and Nuclear Terrorism

of: J. Shemer, Y. Shoenfeld (Eds.)

Pabst Science Publishers, 2003

ISBN: 9783899670189 , 563 Pages

Format: PDF, Read online

Copy protection: DRM

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Terror and Medicine - Medical Aspects of Biological, Chemical and Nuclear Terrorism


 

Contents

5

Preface

11

Introduction

13

Diabolical, Haunting Terror - Here and Now

15

Terror and Medicine -The Challenge

17

Epidemiology of Terror

18

Non-conventional warfare - unique epidemiology and medical management

19

Biological MDW management

20

Chemical MDW management

20

Radiation MDW

21

Conclusion

21

References

22

From Geneva to Afghanistan: The Ethical Implications of Terror and its Effect on the Physician

24

Ethics in a World of Terror

25

The role of the physician

26

Terror and civil liberties

28

The Model State Emergency Health Powers Act

29

The Revised Model Act

30

Terror and the allocation of resources

30

And what the future ...

31

References

31

National Preparedness for a Biological Mass Casualty Event: Between the Devil and the Deep Blue Sea

32

Policies and Doctrines of Non-Conventional Warfare

35

Non-Conventional Terrorism: Historical Aspects

37

Chemical Agents

37

Biological Agents

39

Conclusions

41

References

41

The Medical Management of Terrorist Attacks

43

Pre-event medical preparedness for the terrorist attack

43

Planning

44

Resources

45

Instruction and drills

45

Eventmanagement

45

Pre-hospital phase

46

At the hospital: immediate preparation phase

48

Treatment process

48

Post-event procedures

49

Conclusion

49

References

50

Hospital Management of a Bioterror Event

51

Pre-bioterror event preparations

52

Hospital management for bioterror event

53

Conclusion

54

References

54

Medical Guidelines for the Management of Mega-Terror

55

Pathophysiology of injuries related to mega-terror

56

Reaction of the national medical system to mega-terror

57

Pre-hospital setting

57

Guidelines for hospital management of mega-terror

58

Summary

59

References

60

Principles of Contingency Planning for an Unusual Biological Event

61

Objectives of a contingency and response plan

61

Basic assumptions

62

Main implications of the assumptions

62

Detection, identification and response phases

64

Stage I: Detection

64

Stage II: Identification

65

Response Phase

65

Conclusion

68

References

68

Chemical, Biological and Radiological Terror - General Overview

69

The Epidemiologic Pyramid of Bioterrorism

71

The classic epidemologic paradigm

72

Anthrax

73

Plague

74

Smallpox

75

The new epidemiologic paradigm

76

Communication

78

Civil liberties

78

Global reservoirs

79

Conclusion

79

References

79

Sydromic Surveillance for Early Detection and Monitoring of Infectious Disease Outbreaks Associated with Bioterrorism

81

Traditional surveillance system

82

Deficiencies of traditional surveillance systems

83

Syndromic surveillance for bioterrorist-initiated outbreaks

83

Syndromic surveillance systems in the U. S. A.

84

Statistical methods in syndromic surveillance

85

Examples of syndromic surveillance systems

86

Conclusions

94

References

94

Personal Protection against Chemical and Biological Warfare Agents

96

Exposure

96

Personal protection measures

98

Skin protection

100

Sealed rooms

102

Precaution measures and biosafety levels against biological warfare agents

103

Standard precautions

106

Transmission-based precautions

107

Extremely virulent microorganisms

108

Summary

109

References

109

Training Medical Personnel to Treat Casualties of Nuclear, Biological, or Chemical Warfare

111

Why should we improve a standardized approach for training?

112

What should we teach?

112

How should we teach?

113

Who should be taught

114

Who should teach?

115

Summary

115

References

115

Bioterrorism - The New Monster

117

The nature of terror

117

The arsenals

118

The healthcare response

120

Conclusion

121

References

121

Chemical, Biological and Radiological Terror - Chemical Agents

123

Preparedness of Local and National Health Systems for a Chemical Terrorist Attack

125

The detection phase

126

Pre-hospital medical management

127

Hospital preparedness

128

National preparedness

131

Summary

132

References

133

Organophosphates: Nerve Agents, Pesticides and their Use as Chemical Weapons

135

The cholinergic system

136

OP poisoning - pathophysiology

137

Pathophysiology of brain damage following OP poisoning

139

Other properties and characteristics of OP

140

Exposure thresholds

141

Clinical manifestations

141

Laboratory diagnosis of OP poisoning

142

Subacute and late clinical syndromes

143

Triage of OP casualties

145

Medical management

145

Pharmacologic pretreatment

146

Treatment after intoxication

147

Treatment of combined injury casualties

150

Organophosphales and terror

150

References

151

Cyanides

154

Military experience and terror with cyanide

154

Characteristics

155

Clinical presentation

156

Treatment

158

Conclusion

160

References

160

Acute Care and Management of Casualties with Combat Anticholinesterase Poisoning

162

References

165

The Tokyo Subway Sarin Attack

167

20 March 1995, Tokyo

167

Signs and symptoms (Table 1)

168

Treatment

168

Long-term follow-up

169

Conclusions

170

Summary

170

References

171

Mustard Gas - Clinical Implications and Management

172

Clinical effects of mustard

173

Acute effects of mustard

173

Long-term effects of mustard

176

Diagnosis

177

Patient management

177

Skin

178

Eyes

179

Airways

180

Gastrointestinal tract

180

Bone marrow

181

Summary

181

References

181

Simulation-Based Training of Medical Teams to Manage Chemical Warfare Casualties

183

Simulation in medicine

184

Training medical teams to treat chemical warfare casualties: current status

184

Treating the casualties

185

Organizing the scene

186

Simulation training to treat CWC: rationale

186

Pediatric chemical warfare casualties

187

Simulation training to treat CWC: implementation

188

The setting

189

The training concept

190

Adjusting the simulation setting

191

Simulators

192

Modifications of the simulators for the CWC

192

Research and development

193

Conclusion

193

References

194

Chemical, Biological and Radiological Terror - Biological Agents

197

Biological Warfare: Disease Prevention and Post-Exposure Medical Treatment

199

Treatment approaches to disease: biowarfare versus natural causes

199

Causative agents

200

Extent of exposure

200

Route of exposure

200

Timing of treatment

201

Clinical guidelines

201

Antiobiotics

201

Resistance

201

Broad-spectrum antibiotics

203

Intelligence

203

Administration

203

Vaccination

204

Antiviral drugs

206

Summary

207

References

207

Detection and Clinical Identification of a Biological Weapons Attack

209

Possible clues

210

Summary

212

References

212

The Spectrum of Clinical Presentations Associated with Biological Warfare

213

Respiratory syndromes (including pneumonia)

215

Hemorraghic fevers (HF)

216

Encephalities, meningitis, meningoencephalitis

218

Neurologic syndromes with flaccid paralysis

220

Fever syndromes with rash

220

Diarrheal syndromes

221

Summary

223

References

224

Biodefense Strategies against Superantigen Toxins

228

Methods

230

Results

230

Superantigen toxin antagonist

230

Protection and rescue of mice from lethal shock

231

Protected mice rapidly develop immunity to lethal shock

232

The antagonist targets a structurally conserved domain

233

Discussion

234

References

238

Tetracyclines and Ciprofloxacin as Treatment in Children and Pregnant or Lactating Women in the Era of Biologic Terror

241

Tetracyclines

241

Pregnant women

242

Lactating women

242

Children

243

Dosage and indications

244

Ciprofloxacin

244

Pregnant women

245

Lactating women

245

Children

246

Dosage and indications

246

Adverse effects

246

Conclusions

248

References

248

Anthrax - An Overview, 2003

251

Ecology and epidemiology

252

Pathophysiology

253

Clinical symptoms

254

Diagnosis

257

Post-exposure prophylactic treatment

258

Treatment of patients

260

Treating cutaneous anthrax

261

Treating inhalation and systemic anthrax

261

Treatment with antiserum

263

Steroid treatment

264

Experimental drugs

264

Vaccination

265

Summary

266

References

266

Smallpox: A Possible Comeback

269

References

272

Smallpox - Past, Present, and Future

273

The history and use of smallpox as a weapon of biological warfare

273

Epidemiology

274

The virus

275

Pathogenesis

275

Clinical aspects

275

Prognosis and Outcome

277

Diagnosis

277

Treatment

278

Prevention - immunization

278

Steps for disease prevention following exposure

281

Current status of the virus and the fear of renewed spread of the disease

283

The use of smallpox virus for biological warfare

283

Summary

285

References

286

Smallpox Preparedness in Israel: Recommendations and First Steps

288

The Disease

289

Vaccination

290

Vaccine production

291

Immunity of the Israeli population against smallpox, 2003

292

Smallpox containment

293

Resumption of routine smallpox vaccination

297

Summary

298

References

298

Analysis of the Israeli Smallpox Revaccination Program: Strengths, Weaknesses, Threats and Opportunities

300

Strengths

301

Weaknesses

302

Opportunities

305

Threats

306

Conclusion

307

References

308

Hemorraghic Fevers and Bioterror

310

Argentine hemorrhagic fever (1-6)

311

Bolivian hemorrhagic fever (7-11)

311

Brazilian hemorrhagic fever ("Sabia") (12-16)

314

Crimean Congo hemorrhagic fever (17-24)

314

Ebola (25-33)

315

Hantaviruses (34-39)

316

Lassa fever (40-48)

317

Marburg disease (49-53)

318

Omsk hemorrhagic fever (54-55)

318

Rift Valley fever (56-60)

319

Venezuelan hemorrhagic fever (61-64)

320

Yellow fever (65,66)

320

Comment

322

References

322

Ricin - A Potent Plant Toxin

326

History

326

The toxin

327

Structure

328

Mechanism and toxicity

328

Clinical features

329

Diagnosis

330

Treatment

331

Prognosis

332

Ricin in cancer therapy

332

References

332

Chemical, Biological and Radiological Terror - Radiological Terrorism

335

Radiation Terrorism - The Medical Challenge

337

Ionizing radiation

338

Biologic effects of ionizing radiation

338

Clinical radiation injury

339

Radiation incident scenarios

341

The response

342

Non-medical measures

342

Medical measures

343

The Goiania accident

345

Conclusion

347

References

347

Chemical, Biological and Radiological Terror - Trauma

349

Preparedness for Mass Casualty Situations - The Key to Success

351

Main guidelines

351

Standing orders

353

Step-by-step management

354

Problems

357

Conclusions

357

References

358

The Epidemiology of Terror - Data from the Israeli National Trauma Registry

360

Patients and Methods

361

Injury epidemiology

361

Treatment and outcome

364

Patient demographics

366

Discussion

367

Summary and conclusion

368

References

369

Limited Mass Casualties Due to Conventional Weapons - The Daily Level 1 Trauma Center

370

Field management

373

Field medical care for terrorist MCIs

375

Hospital triage

377

Special injury patterns of suicide bombings

380

Summary

384

References

385

Terror Attacks: The Role of Imaging

386

Blast injury

387

Managing the radiology department during a mass victim terrorist attack

389

Imaging of penetrating foreign objects - a multimodality approach

392

Plain film radiology

392

Real-time sonography in the ED

393

Computed tomography

394

Angiography

395

Disaster victim identification

397

Postmortem CT

398

Summary

399

References

399

Suicide Bombings: The General Surgeon's View

401

Mechanisms of injury

401

Specific considerations

402

Triage

404

Approach to management

405

Evaluation

405

Treatment

408

Conclusions

409

References

410

Acute Lung Injuries among Survivors of Suicide Bomb Attacks

412

Incidence/Prevalence

412

Clinical Examples

413

Pathogenesis

417

Diagnosis

419

Management and Treatment

419

Conclusions

423

References

423

Terror and War Burns in Israel

425

Burn treatment in Israel

427

War burns in Israel

428

Skin replacement in wartime

432

Homografts

432

Reconstituted skin

433

Homografts for partial-thickness burns

433

Unique war burns

434

Mustard gas burns

435

Expansion of hospitalization capacity

436

References

436

The Forensic Pathology of Terrorism in Israel - Two Years of Suicide Bombing

438

Identification techniques

442

Discussion

444

References

446

Penetrating Bone Fragments in Suicide Bombings: A Potential New Mode of Infection

448

History

449

Our experience

451

Modes of penetrating wounds during blast injury

451

Bone fragments

451

Metals

454

Glass

455

Unusual transmission of HBV

455

Epidemiology

455

Discussion

458

References

459

Otologic Manifestations of Blast Injury

461

The Blast Wave

461

Mechanism of blast injury

462

Factors affecting blast injury of the ear

462

Effect of the blast wave on the auditory system

463

Patients' complaints and symptoms

463

External ear damage

463

Middle ear damage

463

Inner ear damage

465

The vestibular system

466

Recovery of the damage to the ear after blast injury

467

Summary

468

References

468

Chemical, Biological and Radiological Terror - Rehabilitation of Victims of Terror

471

Unique Aspects of Rehabilitation of Spinal Cord Injuries in Victims of Terror

473

Case Report

473

Spinal cord injuries

475

Discussion

480

References

481

Chemical, Biological and Radiological Terror - Psychological Aspects

483

Conventional, Chemical and Biological Terror of Mass Destruction: Psychological Aspects and Psychiatric Guidelines

485

Clinical syndromes following conventional and non-conventional terror attacks

486

Presumes scenarios of terror attacks

488

Conventional mega-terror attacks

493

Terror attacks with non-conventinal devices

495

Considerations for community deployment during a non-conventional terror attack

500

References

502

Prevention Program against Biological Warfare: The Public must be an Informed and Active Participant

505

The threat

506

Preventive program against biological warfare

507

Expected natural behavior in time of disaster

508

The natural process of coping with an external threat

509

The need to process new information

510

The need for trust in the leadership

511

What deters the leadership from relaying information?

512

How to conduct a dialogue with the public

513

Essence of the communication to the public

513

Conclusions

514

References

515

Clinical Pictures Expected at the Stage of Impact in a Situation of Biological Warfare

516

Reactions to the threat

517

Reactions to trauma among civilians

520

Conclusion

521

Refernces

522

War Stress in a Primatry Care Clinic in Gilo, a Neighborhood of Jerusalem

525

Exposure of the Israeli population to war stressors

526

Measurement of demoralization

527

Gilo under fire

527

Discussion

533

Implementation of community programs to face terrorist attacks

535

References

536

Chemical, Biological and Radiological Terror -- Veterinary Medicine

539

Animal health

542

Public health

543

Agricultural biological warfare/terrorism

545

Conclusion

546

References

546

List of Contributors

548

About the Editors

562