Bioterrorism and Weapons of Mass Destruction - 4 Nursing CEs

Author: Kristi Hudson RN MSN CCRN

Written: December 12, 2006

Updated: October 14, 2009

Course Description

This course is designed to give an overview of bioterrorism and weapons of mass destruction. Focus will be placed on the high priority types of bioterrorism agents as well as the reservoir, incubation and transmission of these agents. Personal protective equipment required and common symptoms and methods of treatment associated with exposure or injury associated with category “A” agents, chemical, biological, radioactive and nuclear agents will also be presented. Surveillance and reporting procedures for acts of terrorism as well as the use of the “Health Alert Network” will also be presented. The debriefing process will be the final focus of this course.

Course Objectives

Upon completion of this course the student will be able to:

• Define terrorism and bioterrorism.
• State commonly used weapons of mass destruction.
• Differentiate between Category A, B and C bioterrorism agents.
• Discuss the incubation and method of transmission of bioterrorism agents.
• Explain the proper use of personal protective equipment.
• List the common symptoms associated with chemical, biological, radioactive and nuclear exposure.
• State methods of treatment for chemical, biological, radioactive and nuclear exposure.
• Describe surveillance and reporting procedures for acts of bioterrorism or weapons of mass destruction.
• Have a better understanding of the function of the “Health Alert Network”.
• Discuss the debriefing process.

What is Terrorism?

The Department of Justice defines terrorism as any act that is of violent or dangerous in nature, that is intended to intimidate or coerce a government, civilian population or any segment thereof in furtherance of ones own political or social objectives.

 What is Bioterrorism?

Bioterrorism is a deliberate release of virus, bacteria and/or other germs (microorganisms) with the intention of causing harm or death to people, animals or plants. Although most of the agents can be found in nature, they are often altered in order to increase their resistance to medication. These biological agents can be spread through the air, water or be placed in food. Some agents such as small pox can be spread from person to person while others such as Anthrax are not considered to be contagious.

What are Weapons of Mass Destruction (WMD)?

Weapons of mass destruction can be any type of weapon that can cause harm or damage on a large scale. The acronym “B-NICE” describes the most commonly used WMD’s:

B – Biological Weapons

N – Nuclear Weapons

I – Incendiary Weapons

C – Chemical Weapons

E - Explosives

Bioterrorism Agent Categories

Bioterrorism agents can be divided into three categories, depending on the ease of spreading them and the range of illness, disability or degree of threat that they can cause.

Category A – These are the highest priority agents and include organisms or toxins that are considered to be of the highest threat to the public because they are:

• Easy to spread
• Cause a high death rate
• Require special healthcare attention
• Can cause panic

Category B – These agents are a second highest priority because they are:

• Moderately easy to spread
• Cause moderate illness
• Require enhanced healthcare attention

Category C – These third highest priority agents include emerging pathogens that could be engineered for mass distribution because they are:

• Easily available
• Easy to produce
• They have potential high mortality and morbidity rates

Biological Characteristics of Category “A” Agents

Signs/Symptoms of Bioterrorism Exposure to Category “A” Agents

Anthrax:

Cutaneous Anthrax – Approximately 95% of anthrax infections occur when bacterium enters a cut or abrasion on the skin (handling of contaminated wool, hides, leathers or hair products of infected animals for example). Signs of infection include:

• Rash (raised, bumpy, itchy)
• Resembles insect bite (develops into a vesicle and then painless ulcer)
• Usually 1-3 cm in diameter
• Develops a black necrotic area in the center of the vesicle
• Lymph glands and adjacent area may swell
• Approximately 20% of the untreated cases result in death (rare with antimicrobial therapy)

Inhalation Anthrax -  

Early Symptoms:

• Initial symptoms resemble a common cold
• Sore throat
• Mild fever
• Muscle aches
• Malaise

Late Symptoms:

• Severe breathing difficulty
• Shock that usually progresses to a fatal situation

Gastrointestinal Anthrax- Occurs after consumption of contaminated meat with the following symptoms:

• Acute inflammation of the intestinal tract
• Nausea/Vomiting
• Loss of appetite
• Fever
• Abdominal pain
• Vomiting of blood
• Severe diarrhea
• Death occurs in 25% to 60% of intestinal anthrax

Plague:

Signs and symptoms associated with plague include the following:

• Swollen and tender lymph glands (painful)
• Swollen glands are called “bubo” (hence the term bubonic plague)
• Fever/chills
• Headache
• Extreme exhaustion
• History of possible exposure to rodents, rabbits and or fleas

Small Pox:

First symptoms usually occur between days 12 and 14 (after exposure) and include:

• Fever
• Malaise
• Headache
• Severe fatigue
• Severe back pain

After initial flu like symptoms (a few days later) the following symptoms present:

• Rash that resembles flat red spots (lesions)
• These lesions then turn to blisters with clear fluid (vesicles)
• These lesion then fill with pus (pustules)
• The rash presents first on the face, hands and forearms and later the trunk
• The rash is most notable on the “palms of the hands”
• Lesions later develop in the mucous membranes of the nose and mouth
• The manner that the lesions display are the hallmark of diagnosing small pox

Botulism:

Signs and symptoms of Botulism include the following:

• Symmetrical cranial neuropathies
• Difficulty swallowing and speaking (dry mouth)
• Diplopia (double vision)
• Blurred vision
• Ptosis (droopy eyelids)
• Dilated or non-reactive pupils
• Symmetrical descending weakness
• Respiratory dysfunction
• Descending flaccid paralysis
• Intact mental state
• NO fever

Tularemia:

Signs and symptoms of tularemia include:

• Sudden fever
• Chills
• Headache
• Muscle aches
• Joint pain
• Diarrhea
• Dry cough
• Progressive weakness
• Chest pain
• Bloody sputum
• Respiratory difficulty and/or respiratory arrest
• Ulcers of the skin and mouth
• Swollen/painful lymph glands

Hemorrhagic Fever (Ebola):

Signs and symptoms of Hemorrhagic fever or Ebola vary from patient to patient but can include:

Most Ebola infected patients:

• High fever
• Headache
• Muscle aches
• Stomach pain
• Fatigue
• Diarrhea
• Chest pain
• Shock
• Death

Some Ebola infected patients:

• Sore throat
• Hiccoughs
• Rash (red and itchy)
• Red and itchy eyes
• Vomiting blood
• Bloody diarrhea
• Blindness

Signs and Symptoms of Chemical Agent Exposure

Nerve Agents – (Sarin, Tabun, Soman Cyclohexyl Sarin):

• Pinpoint pupils
• Bronchoconstriction
• Respiratory arrest
• Increased secretions
• Hypersalivation
• Diarrhea
• Decreased memory/concentration
• Loss of consciousness
• Seizures/Tremors
• Diffuse muscle cramping
• Runny nose
• Dimming vision
• Sweating

Cyanides – (hydrogen cyanide (HCN), Cyanogen chloride):

• Metabolic acidosis
• Elevated venous blood O2
• Hypotension
• “Pink” skin tone
• Coma
• Convulsions
• Respiratory/Cardiac arrest (can be immediate with high exposure)

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