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U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE SUBCOURSE MD0534 EDITION 200 DEVELOPMENT This subcourse is approved for resident and correspondence course instruction. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. Development and progress render such doctrine continuously subject to change. ADMINISTRATION Students who desire credit hours for this correspondence subcourse must enroll in the subcourse. Application for enrollment should be made at the Internet website: You can access the course catalog in the upper right corner. Enter School Code 555 for medical correspondence courses. Copy down the course number and title. To apply for enrollment, return to the main ATRRS screen and scroll down the right side for ATRRS Channels. Click on SELF DEVELOPMENT to open the application; then follow the on-screen instructions. For comments or questions regarding enrollment, student records, or examination shipments, contact the Nonresident Instruction Branch at DSN , commercial (210) , toll-free ; fax: or DSN , or write to: NONRESIDENT INSTRUCTION BRANCH AMEDDC&S ATTN: MCCS-HSN TH STREET SUITE 4191 FORT SAM HOUSTON TX Be sure your social security number is on all correspondence sent to the Academy of Health Sciences. CLARIFICATION OF TERMINOLOGY When used in this publication, words such as he, him, his, and men 'are intended to include both the masculine and feminine genders, unless specifically stated otherwise or when obvious in context. USE OF PROPRIETARY NAMES The initial letters of the names of some products may be capitalized in this subcourse. Such names are proprietary names, that is, brand names or trademarks. Proprietary names have been used in this subcourse only to make it a more effective learning aid. The use of any name, proprietary or otherwise, should not be interpreted as endorsement, deprecation, or criticism of a product; nor should such use be considered to interpret the validity of proprietary rights in a name, whether it is registered or not. TABLE OF CONTENTS Lesson Paragraphs INTRODUCTION 1 INTRODUCTION TO CHEMICAL, BIOLOGICAL RADIOLOGICAL, NUCLEAR, EXPLOSIVE Exercises 2 CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE EQUIPMENT Exercises 3 RECOGNIZING AND TREATING NERVE AGENT CASUALTIES Exercises 4 BIOLOGICAL AGENTS OVERVIEW Exercises 5 VESICANT AND CYANIDE AGENTS Section I Vesicants Section II Cyanide Exercises MD0534 i CORRESPONDENCE COURSE OF THE U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL SUBCOURSE MD0534 CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE INTRODUCTION In future conflicts, soldiers must be prepared to function in a field environment contaminated by chemical, biological, radiological, nuclear, and explosive devices. This subcourse is designed to provide instruction in protecting yourself from these agents and in providing care in the field to soldiers who have been exposed to these agents. Chemical agents are fast acting. You must be prepared to quickly perform the necessary triage and treatment procedures in the event of a chemical agent attack. Biological agents usually act at a slower rate. Protection against chemical and biological agents and self-aid procedures for exposure to nerve agents are presented in this subcourse for two reasons. One, you must know the procedures in order to protect yourself and to treat yourself in case of exposure to nerve agents. Also, you must make sure that other soldiers take proper precautions and know how to perform self-aid/buddy-aid procedures. Subcourse Components: The subcourse instructional material consists of five lessons as follows: Lesson 1, Introduction to CBRNE Lesson 2, Chemical, Biological, Radiological, Nuclear, Explosive Equipment. Lesson 3, Recognizing and Treating Nerve Agent Casualties. Lesson 4, Biological Agents Overview Lesson 5, Vesicant and Cyanide Agents. Here are some suggestions that may be helpful to you in completing this subcourse: --Read and study each lesson carefully. --Complete the subcourse lesson by lesson. After completing each lesson, work the exercises at the end of the lesson, marking your answers in this booklet. --After completing each set of lesson exercises, compare your answers with those on the solution sheet that follows the exercises. If you have answered an exercise incorrectly, check the reference cited after the answer on the solution sheet to determine why your response was not the correct one. MD0534 ii Credit Awarded: Upon successful completion of the examination for this subcourse, you will be awarded 8 credit hours. To receive credit hours, you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston, Texas. You can enroll by going to the web site and enrolling under Self Development (School Code 555). A listing of correspondence courses and subcourses available through the Nonresident Instruction Section is found in Chapter 4 of DA Pamphlet , Army Correspondence Course Program Catalog. The DA PAM is available at the following website: MD0534 iii LESSON ASSIGNMENT LESSON 1 Introduction to Chemical, Biological, Radiological, Nuclear, and Explosive TEXT ASSIGNMENT Paragraphs 1-1 through 1-10 LESSON OBJECTIVES Given the potential for a CBRNE attack, 1-1. Identify the different threats that may be used by terrorists Identify agencies who may react to those threats Identify the AMEDD's role in support of CBRNE defense Identify threats, methods of dissemination, and collective defensive agencies that may support and react to an attack. SUGGESTION After completing the assignment, complete the exercises at the end of this lesson. These exercises will help you to achieve the lesson objectives. MD LESSON 1 INTRODUCTION TO CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE 1-1. INTRODUCTION The purpose of this lesson is to familiarize you with recent events involving the potential or actual use of CBRNE materials by terrorists and to familiarize you with all aspects of CBRNE agents; the sources and the hazards associated with CBRNE agents, and the outcomes of such an attack. By the end of this instruction, you should be able to recognize when a terrorist CBRNE event has occurred and know the potential impacts of that event CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE DEFINED a. Chemical agents are natural or manufactured chemicals that can be used as weapons. b. Biological agents are agents that are harvested to be used as weapons to kill or incapacitate soldiers and/or civilians. c. Radiological agents are weapons that can be made from medical radiation waste and other sources of radiation that can be used to make dirty bombs to contaminate an area or population with radiation. d. Nuclear devices are low or high yield devices that can be used by terrorists or larger countries as weapons. e. Explosive devises are any type of manufactured or improvised explosive CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE THREATS AND AVAILABILITY OF AGENTS a. What is the hardest type of CBRNE threat to detect? (1) The lone individual, such as the Unabomber, is by far the most difficult to detect. This type of terrorist is a wild card, striking without a predictable motive or pattern, copying a previous event for the publicity, or just acting on a whim. Fortunately, individual terrorists have been the least successful. Lacking the funding, organization, and sophistication of larger groups, they account for many of the recently failed attempts and hoaxes. MD (2) Local terrorist groups and non-aligned groups form the larger threat of domestic CBRNE terrorism, as they have the funding, organization, and ability to build or purchase CBRNE agents. The primary differences between them are the cause, the home base, and the source of their funding. Local terrorist groups have one distinct advantage over foreign organizations -- the members fit into the local society and are often unnoticed until they strike. b. What do we know about the availability of CBRNE agents? (1) Chemical, biological, radiological, nuclear, explosive agents agents are available and relatively easy to acquire or manufacture. Although not quite high school science, chemical and biological agents can be made from readily available components by individuals with knowledge gained at the college level. (2) Radiological materials are found in many facilities, such as research labs, hospitals, and in industry. In fact, almost every home has radioactive material (in smoke detectors). Toxic chemicals and the materials to make chemical warfare agents are readily available in school laboratories. Such materials are legitimately used in industry and are employed in various research facilities. Libraries contain the recipes required. Biological pathogens may be obtained from nature, hospital labs, university research facilities, and other places. c. What is the impact of Chemical, biological, radiological, nuclear, explosive agents in enclosed spaces? (1) Large amounts are not needed in enclosed spaces. Chemical, biological, radiological, nuclear, explosive agents are extremely toxic at very low doses. If these agents were released into an enclosed space, their lethal effects would be magnified. For comparison purposes, a fragmentation hand grenade has an effective casualty radius of 5 meters. The same quantity of chemical agent (about 1.7 pounds) disseminated in a practical way could fill a 600-foot long subway platform with a concentration that would injure or kill every person who remained on the platform for two minutes. (2) In addition, the facility might have to be shut down until it could be thoroughly decontaminated. A radiological agent, spread in the same location, would likely not cause immediate injury, but would have the potential to shut down the facility until thoroughly removed. (3) One study indicates that the same quantity of the most toxic biological material, disseminated under ideal conditions, could cause deaths or injuries over an area of more than nine square kilometers. d. While knowledge of the capabilities and characteristics of chemical, biological, and radiological agents is useful in the remediation effort after an incident, the ability to recognize both the potential for an event and the tools of a CBRNE terrorist may enable responders to anticipate and prevent or mitigate the effects of the attack. MD (1) In a lot of cases, security is often an issue regarding those that spray insecticide and crop dusting. (2) Unclassified sources show an increase of actual terrorist activity involving CBRNE agents. This increase does not include hoaxes, such as the letter which was alleged to contain anthrax, sent in April 1997 to B nai B rith headquarters in Washington, D.C., and letters claiming to contain anthrax which have been sent to institutions such as clinics and media organizations. (3) Since Sept 11, 2001, we now know that there have been actual letters containing anthrax received in the United States, exposing some and killing a few. The concern over the hoaxes is that they require the same initial response as an actual terrorist attack. e. Some significant incidents are listed below. (1) In 1972, members of a US fascist group called Order of the Rising Sun were found in possession of 30 to 40 kilograms of typhoid bacteria cultures, with which they planned to contaminate water supplies in Chicago, St. Louis, and other large Midwestern cities. (2) In 1984, two members of an Oregon cult cultivated salmonella (food poisoning) bacteria and used it to contaminate restaurant salad bars in an attempt to affect the outcome of a local election. Although some 751 people became ill and 45 were hospitalized, there were no fatalities. f. Terrorist weapons may include nuclear devices, radiological material, and chemical and biological agents. This contrasts the likelihood of the materials being used by terrorists with their potential impact. The conventional wisdom is that a nuclear weapon will be very difficult for a terrorist group to acquire; however, radioactive material, chemical agents, and biological agents are relatively easy to obtain and thus pose a greater threat. g. Note that both the availability and the impact of chemical and biological threat materials are high, with potentially devastating consequences. This subcourse will focus on the most likely terrorist weapons--radioactive material, chemical agents, and biological agents, and will touch on the potential result of terrorist use of nuclear devices as well CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVE DISSEMINATION METHODS a. The method used to disseminate CBRNE will vary greatly on the dispersing device, the downwind hazard and the agent used. Some examples follow. (1) Breaking devices (light bulbs, vacuum bottles)--minimal hazard, used for chemicals. MD (2) Bursting devices--moderate hazard, used for all agents. (3) Exploding devices--moderate hazard, used for radiological (chemical or biological possible). (4) Spraying devices--chemical or biological b. Different methods will be used based on the desired effect of the device and substance used. Breaking and bursting devices may be used for a small attack focused on a specific person or small group. The greater the desired effect, the larger the device needed to spread the agent. (1) Line source (significant downwind hazard)--potential for larger dispersal area and greater effect. (a) Moving vehicles. (b) Airplanes. effect. (2) Point source (moderate/significant downward hazard)- smaller area of (a) Aerosol can (b) Garden hose c. Vectors are used to create unpredictable, biological, or chemical effects. A specific person or group would be hard to target with this method, but the effect of fear or terror would be widespread due to the undiscriminating nature of the attack. (1) Letters/packages. (2) Insects/animals. (3) Contaminated clothing. (4) Contaminated food. (5) Contaminated water. MD 1-5. CHEMICAL AGENTS a. Chemical warfare agents can be persistent, that is, to continue to be a threat for a long period of time after release. Agents can also be non-persistent presenting a hazard for only a short period of time after the release of the agent. (1) Nerve agent summary. (a) Volatile nerve agents, such as Sarin, are non-persistent chemicals that pose primarily an inhalation hazard. (b) Symptoms of exposure develop within seconds, but tend not to worsen if the victim can be evacuated from the area. (c) Individuals who either inhale a toxic dose or are unable to be evacuated from the release site will experience the highest mortality rates. (d) First responders and medical personnel are at risk of becoming secondarily contaminated from agent off-gassing. This occurs if the victim s clothing is not properly handled and responders fail to wear appropriate respiratory protection. (e) Symptomatic individuals require immediate treatment, including airway management and antidote therapy. (f) Persistent nerve agents such as VX continue to present a hazard for a considerable period of time, do not readily vaporize, and pose primarily a liquid threat. (g) Symptoms from such a contamination may be delayed for minutes to hours depending on the concentration, dose, and location of the contaminant on the skin. (2) Mustard--properties. (a) Sulfur mustard is both a vapor inhalation and liquid contact hazard. Mustard causes injury to the eyes, skin, airways, and some internal organs. (b) There is no specific therapy beyond supportive care. Mustard is absorbed and causes chemical cellular damage within 1 to 2 minutes. (c) The onset time for clinical effects ranges from 2 to 48 hours; most commonly between 4 and 8 hours. MD (3) Industrial chemicals. (a) Phosgene. 1 Has the odor of newly mown hay and becomes a gas at 47 degrees Fahrenheit. It primarily damages the lungs and must be inhaled to cause this damage. 2 At high concentrations, the chlorine part of the molecule irritates the eyes, nose, and upper airways, and may cause fatal laryngospasms. 3 Phosgene is a common industrial chemical and was also formerly used as a warfare agent. 4) Dyspnea at exertion worsens to dyspnea at rest after a severe exposure. This is accompanied by a cough productive of frothy, clear sputum. (b) Chlorine. 1 Chlorine was the first chemical used on a large scale in modern warfare. It was used in 1915 in World War I. It is commonly stored at water treatment plants and is also widely used in industry. 2 Chlorine causes irritation to the eyes both as a gas and in solution in swimming pool water. If chlorine gas is inhaled, it causes airway irritation with cough and a feeling of shortness of breath. 3 Chlorine injures cells by reacting with water to produce hydrochloric acid and oxygen free radicals. 4 A high concentration will cause more severe pulmonary damage with both airway and parenchymal damage. 5 After an exposure to a high concentration or a prolonged exposure, chlorine can cause non-cardiac pulmonary edema. b. Recent terrorist use of chemical weapons. (1) Early on the morning of March , the poisonous gas Sarin, which was developed by Nazi Germany during World War II, was used on subway lines in the very heart of Tokyo. Ten people died from poisoning and over 5,000 people were reported injured. The affected subway lines intersected at Kasumigaseki station, the office quarters of the Tokyo government. Poisonous gas was found on five trains heading for the station and the entire city was thrown into terror and confusion. MD (2) This incident demonstrated the potential of a new and insidious form of terrorism, with which few in government, public safety, or medical community were prepared to cope BIOLOGICAL AGENTS A brief discussion of the history and development of biological warfare (BW) agents is given below. a. Biological Agents. Biological agents are the oldest of the nuclear, biological, and chemical triad of weapons of mass destruction. b. Anthrax. Anthrax is caused by the spore-forming bacterium, Bacillus anthracis. Zoonotic disease in herbivores (for example, sheep, goats, and cattle) follows ingestion of spores in soil. Human infection is acquired through contact with anthrax-infected animals or animal products or through intentional exposure. There are three clinical forms--cutaneous, inhalational, and gastrointestinal. c. Smallpox. (a) Smallpox is caused by the Variola virus, an orthopox virus, which caused both a major and minor form of the disease. The smallpox virus only causes overt clinical disease in humans; no animal reservoirs of the virus exist in nature. This was the major reason why the disease was selected for global eradication. (b) Smallpox was declared eradicated in It is the only disease to date that has earned this distinction. The US stopped its civilian vaccination program in Despite eradication, concerns over clandestine stockpiles of smallpox still remain. The issue for destruction of US laboratory stocks of the virus is under review. d. Salmonella. (1) In 1885, pioneering American veterinary scientist, Daniel E. Salmon, discovered the first strain of Salmonella from the intestine of a pig. This strain was called Salmonella choleraesuis, the designation that is still used to describe the genus and species of this common human pathogen. (2) Salmonella is a type of bacteria that causes typhoid fever and many other infections of intestinal origin. MD 1-7. RADIOLOGICAL DEVICES a. Experts say there is enough material and know-how out there for terrorist to mount a lethal radiological attack with a dirty bomb, turning a US downtown into a death zone. b. Potential terrorist attack methods could include explosively dispersing a radioactive source, spreading radioactive material on the ground, dispersing the materials in the air,
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