Bioterrorism and Weapons of Mass Destruction for Healthcare Providers

About this course

Terrorism is generally considered to be the use of force or violence outside the law to create fear among citizens with the intent to coerce some sort of ideological, financial, religious, or political action. Terror tactics may include biologic, chemical, nuclear, or explosive events. All health professionals need to be prepared for a terrorist attack. Establishing a diagnosis is critical to the public health response to a bioterrorism-related epidemic because the appropriate diagnosis will lead to effective treatments to reduce the morbidity and mortality associated with a terrorist attack. This learning activity will provide an overview of the various weapons of mass destruction, signs, and symptoms that a patient may present with, and the various treatment modalities to reduce morbidity and mortality.

Learning objectives

• Define terrorism and weapons of mass destruction.
• Identify resources for information on public health emergencies.
• Associate the various classifications of weapons of mass destruction to their symptomatology and treatment regimens.
• Consider first responder practices and emergency services preparation.

Course outline

45 sections · finish in any order across devices

1. 1

   Introduction

   Terrorism is generally considered to be the use of force or violence outside the law to create fear among citizens with the intent to coerce an ideological, financial, religious, or political action. Health professionals should be aware that bioterrorism is a perfect vehicle for terrorists to strike

   4 min

2. 2

   Terrorism and Mass Casualty as Defined by Government Agencies

   The Department of Defense:

   4 min

3. 3

   Health Alert Network

   Local health authorities, including emergency services, should examine their preparedness repeatedly for a potential bioterrorist attack and routinely review coordination issues with agencies that take place in response. During a bioterrorist attack, the Center for Disease Control’s Health Alert Net

   4 min

4. 4

   Chemical Weapon

   A chemical weapon is any toxic chemical that can cause injury, sensory irritation, incapacitation, and death. It is usually deployed by a delivery system, such as an artillery shell, ballistic missile, or rocket. Chemical weapons are considered weapons of mass destruction and their use in armed conf

   4 min

5. 5

   Biological Agent

   Bioterrorism is described as the intentional release of biological agents to cause illness or death in humans, animals, or crops. Symptoms of bioterrorism may not appear for days or weeks. Biological agents include bacteria, fungi, toxins, and viruses, and they may be naturally occurring or genetica

   4 min

6. 6

   Toxins

   Toxins are poisonous substances that can be extracted from plants, animals, bacteria, and fungi. Toxic substances that can be used as biological weapons include ricin and venom from snakes and spiders.

   4 min

7. 7

   Radiation Exposure

   Radiation exposure may involve irradiation or contamination². Contamination may be external or internal. External contamination occurs when particles are on the skin or clothing. Some of the particles can fall or be rubbed off, which results in other people and objects being contaminated. Internal c

   4 min

8. 8

   Radiation Syndrome

   Acute radiation syndrome can occur because of internal radiation contamination. Radiation syndrome includes cerebrovascular syndrome, gastrointestinal syndrome, and hematopoietic syndrome.

   4 min

9. 9

   Treatment of Acute Radiation Syndrome

   The following provides overall treatment for acute radiation syndrome: ¹²

   4 min

10. 10

    Nuclear Weapon

    A nuclear weapon is a weapon that uses nuclear fission reactions to create an explosion. ¹ When a nuclear fission reaction occurs, the nucleus of a large atom is broken down into smaller ones, releasing large amounts of energy. This kind of reaction also produces neutrons, and those neutrons can cau

    4 min

11. 11

    Explosives

    The use of explosives has been the preferred terrorist technique in recent years and is often complicated by suicide bombings. Even though the number of injuries and deaths by terrorist suicide bombings is unprecedented in recent history, suicide bombings did occur in World War II during the battle

    4 min

12. 12

    Biological Weapons

    In a biological warfare terror event, healthcare providers must deal with uncommon pathogens that rarely affect humans. Healthcare facilities will be inundated with victims. The arrival of one or more victims with an odd presentation may be the initial indication that an act of terrorism has occurre

    4 min

13. 13

    Classification of Bioweapon Diseases

    The Center for Disease Control has identified 30 organisms that might be weaponized by terrorists. ⁹ The 30 organisms have been grouped into three categories based on ease of dissemination, morbidity and mortality, panic potential, and level of public health requirements.

    4 min

14. 14

    Anthrax

    Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. Although it is rare, people can get sick with anthrax if they contact infected animals or contaminated animal products. Anthrax spores are highly permeable to the porous skin. An anthrax

    4 min

15. 15

    Botulism

    Botulism is a neurologic disorder that causes life-threatening neuro-paralysis because of a neurotoxin produced by Clostridium botulinum. ⁷ The three main clinical presentations of botulism are as follows: Infant botulism, Foodborne botulism, and Wound botulism.

    4 min

16. 16

    Plague: Bubonic

    Bubonic plague is a highly contagious, acute, febrile illness transmitted to humans by the bite of a rat flea. Human-to-human transmission is rare. The disease is caused by a rod-shaped bacterium known as Yersinia pestis. ⁴ Bubonic plague has spread worldwide, but it is more commonly reported in dev

    4 min

17. 17

    Smallpox

    Smallpox is a highly contagious acute disease caused by the variola virus, an Orthopoxvirus in the Poxviridae family. ¹⁴

    4 min

18. 18

    Tularemia or “Rabbit Fever”

    Tularemia or rabbit fever is caused by Francisella tularensis which is a bacteria spread by ticks, deer flies, or contact with infected animals. It may also be spread by breathing contaminated dust or drinking contaminated water. ²

    4 min

19. 19

    Viral Hemorrhagic Fever

    Viral hemorrhagic fevers are caused by a viral infection. They are caused by five families of ribonucleic acid viruses: namely Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae, and Rhabdoviridae. Fever and bleeding disorders characterize all types of viral hemorrhagic fevers and all can progres

    4 min

20. 20

    Abrin Toxin

    Abrin is a toxic toxalbumin that is found in the seeds of the rosary pea Abrus precatorius. ⁹ Abrin is a ribosome inhibiting protein similar to the ricin, however it is more toxic than ricin.

    4 min

21. 21

    Brucellosis

    Brucellosis is a very contagious zoonosis that may be contracted by consumption of undercooked meat, unpasteurized milk, or contact with other secretions. It is also known as Mediterranean fever, Malta fever, or Undulant fever. Brucella is small gram-negative, nonmotile, non-spore-forming, rod-shape

    4 min

22. 22

    Epsilon Toxin

    Epsilon toxin is produced by Clostridium perfringens types B and D and is one of the most potent poisonous substances known. ⁹ Epsilon toxin binds to endothelial cells of brain capillary vessels before passing through the blood-brain barrier.

    4 min

23. 23

    Food Bacterium

    The foodborne disease usually results from food contaminated by pathogenic bacteria, viruses, parasites, or toxins such those found in poisonous mushrooms. The incubation period ranges from hours to days depending on the agent and the amount of consumption.

    4 min

24. 24

    Glanders

    Glanders is an infectious disease that usually affects donkeys, horses, and mules; however, it can also be contracted by cats, dogs, goats, and humans. It is caused by Burkholderia mallei from contaminated feed or water. ⁹

    4 min

25. 25

    Melioidosis

    Melioidosis is an infection caused by gram-negative Burkholderia pseudomallei found in the soil and water. It is phylogenetically related closely to Burkholderia mallei which causes glanders. ⁹

    4 min

26. 26

    Psittacosis

    Psittacosis, parrot fever, or ornithosis is caused by Chlamydia psittaci and contracted from infected parrots. ⁹

    4 min

27. 27

    Q Fever

    Coxiella burnetii causes Q fever. The bacteria are found in cattle, goats, sheep, cats, and dogs. Infection occurs from inhalation from a spore-like variants and contact with feces, milk, semen, and urine of infected animals. The bacterium is an obligate intracellular parasite. ⁹

    4 min

28. 28

    Ricin

    Ricin is a toxic lectin produced by the castor oil plant and found in the seeds. A dose the size of a few grains of table salt can kill a human. Injection or inhalation is more toxic than oral ingestion.

    4 min

29. 29

    Staphylococcus Aureus

    Staphylococcus aureus is a gram-positive bacterium frequently found in the flora of the nose, respiratory tract, and skin. It is a common cause of abscesses, food poisoning, respiratory infections, and sinusitis. Pathogenic strains produce virulence factors such as protein toxins and cell-surface pr

    4 min

30. 30

    Typhus

    Typhus, also known as typhus fever, is caused by Rickettsia prowazekii which is spread by body lice and Orientia tsutsugamushi, chiggers, and Murine typhus, due to Rickettsia typhi spread by fleas.

    4 min

31. 31

    Viral Encephalitis

    Encephalitis is an acute inflammation of the brain caused by either a viral infection or the immune system mistakenly attacking brain tissue. Encephalitis refers to an acute, diffuse, inflammatory process. While meningitis is an infection of the meninges, a combined meningoencephalitis can occur. An

    4 min

32. 32

    H1N1 Influenza

    Influenza A (H1N1) virus is a subtype of influenza A and a common cause of the human flu. It is an orthomyxovirus that contains haemagglutinin and neuraminidase. Haemagglutinin causes red blood cells to clump together. Neuraminidase is a glycoside hydrolase enzyme that moves the virus particles thro

    4 min

33. 33

    Hantavirus

    Hantaviruses or orthohantaviruses are single-stranded, enveloped, negative-sense ribonucleic acid viruses within the Hantaviridae family of the order of Bunyavirales. ⁹ These viruses have the potential to kill humans. Humans become infected from contact with rodent feces, saliva, or urine.

    4 min

34. 34

    HIV/AIDS

    Human immunodeficiency virus and acquired immune deficiency syndrome are conditions caused by infection with human immunodeficiency virus.

    4 min

35. 35

    Nipah Virus

    Nipah virus (NiV) infection is a zoonosis that causes severe disease in humans. The natural host of the virus is the fruit bats of the Pteropodidae family, Pteropus genus. ⁹ Human-to-human transmission has also been documented. NiV infection in humans has a range of clinical presentations, from asym

    4 min

36. 36

    Severe Acute Respiratory Syndrome

    Severe acute respiratory syndrome (SARS) is a zoonotic viral respiratory disease caused by the SARS coronavirus.

    4 min

37. 37

    Emergency Services Preparation

    When a bioterrorism attack is suspected, prehospital and hospital personal should be in communication and prepared for the anticipated surge capacity in patients requiring treatment. The inclusion of all local hospitals is essential in contingency plans as the number of severely injured patients may

    4 min

38. 38

    First Responder Practices

    Triage

    4 min

39. 39

    Catastrophic Hemorrhage

    Direct pressure with bandages to the injury is the initial protocol. Tourniquets should be applied to the extremities when required due to life-threatening arterial bleeding. The emergency services responder can also use hemostatic agents to areas such as the axilla and groin. Elevating and splintin

    4 min

40. 40

    Chemical Terrorism

    The emergency responder must don appropriate protective gear when use of a chemical agent is suspected in terrorism. The personal protective equipment ranges from Level A, which consists of a chemically resistant suit and full-face self-contained breathing apparatus to Level D, which consists of ove

    4 min

41. 41

    Biological Terrorism

    Depending on the type of agent, precautions need to be taken by emergency services personnel. These range from contact and airborne precautions to the need for N95 protective respirators. The patient may have to be isolated from other patients both pre-hospital as well as in the hospital. The emerge

    4 min

42. 42

    Radiological and nuclear terrorism

    Management of a radiological disaster must be with personal protective equipment that includes masks, eye protection, gowns, gloves, and boots. There will also be a hot zone, a warm zone (buffer zone), and cold zone. The victims should be evaluated with a Geiger counter to identify their contaminati

    4 min

43. 43

    Stress Response

    Terrorist attacks can be as emotionally intense as any other major mass casualty event; emergency service providers frequently suffer from at least short-term post-traumatic stress. Counseling for critical incident stress is a recommended strategy. Empathetic care must begin from the time the patien

    4 min

44. 44

    Conclusion

    Local health authorities, including emergency services, should examine their preparedness repeatedly for a potential bioterrorist attack and routinely review coordination issues with agencies that take place in response. Programs aimed to coordinate and direct emergency preparedness and responses of

    6 min

45. 45

    Toxins

    Toxins are poisonous substances that can be extracted from plants, animals, bacteria, and fungi. Toxic substances that can be used as biological weapons include ricin and venom from snakes and spiders.

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

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• Barras, V., & Greub, G. (2014). History of biological warfare and bioterrorism. Clinical Microbiology and Infection, 20(6), 497-502. https://doi.org/10.1111/1469-0691.12706
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• Greaves, I., & Byers, M. (2006). Respiratory protection for health care workers. Journal of the Royal Army Medical Corps, 152(4), 225-230. https://doi.org/10.1136/jramc-152-04-06
• Joseph, B., Brown, C. V., Diven, C., Bui, E., Aziz, H., & Rhee, P. (2013). Current concepts in the management of biologic and chemical warfare causalities. Journal of Trauma and Acute Care Surgery, 75(4), 582-589. https://doi.org/10.1097/ta.0b013e3182a11175
• Kotora, J. G. (2015). An assessment of chemical, biological, radiologic, nuclear, and explosive preparedness among emergency department healthcare providers in an inner city emergency department. Journal of Emergency Management, 13(5), 431. https://doi.org/10.5055/jem.2015.0253
• Moran, G. J. (2002). Threats in bioterrorism II: CDC category B and C agents. Emergency Medicine Clinics of North America, 20(2), 311-330. https://doi.org/10.1016/s0733-8627(01)00003-7
• NVHAN home. (2020, March 3). https://dpbh.nv.gov/Programs/NVHAN/NVHAN_-_Home/
• Public health emergency response Guide|Preparation & planning. (2019, March 21). Emergency Preparedness and Response | CDC. https://emergency.cdc.gov/planning/responseguide.asp
• Radiation exposure and contamination - Injuries; Poisoning - Merck manuals professional edition. (n.d.). Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/injuries-poisoning/radiation-exposure-and-contamination/radiation-exposure-and-contamination
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