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At least 199 records · Page 11Linked to original sources
PubMed2001

Botulinum toxin as a biological weapon: medical and public health management.

OBJECTIVE: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if botulinum toxin is used as a biological weapon against a civilian population. PARTICIPANTS: The working group included 23 representatives from academic, government, and private institutions with expertise in public health, emergency management, and clinical medicine. EVIDENCE: The primary authors (S.S.A. and R.S.) searched OLDMEDLINE and MEDLINE (1960-March 1999) and their professional collections for literature concerning use of botulinum toxin as a bioweapon. The literature was reviewed, and opinions were sought from the working group and other experts on diagnosis and management of botulism. Additional MEDLINE searches were conducted through April 2000 during the review and revisions of the consensus statement. CONSENSUS PROCESS: The first draft of the working group's consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group convened to review the first draft in May 1999. Working group members reviewed subsequent drafts and suggested additional revisions. The final statement incorporates all relevant evidence obtained in the literature search in conjunction with final consensus recommendations supported by all working group members. CONCLUSIONS: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours after exposure. Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation. Persons potentially exposed to botulinum toxin should be closely observed, and those with signs of botulism require prompt treatment with antitoxin and supportive care that may include assisted ventilation for weeks or months. Treatment with antitoxin should not be delayed for microbiological testing.

Antitoxins↗
PubMed2002

Hemorrhagic fever viruses as biological weapons: medical and public health management.

OBJECTIVE: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. PARTICIPANTS: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. EVIDENCE: MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. CONSENSUS PROCESS: Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. CONCLUSIONS: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.

Aerosols↗
PubMed1976

[Differentation and timeinterval for detection of tissue cells on a weapon used in a crime (author's transl)].

There are numerous methods of examining the weapon used in a crime to detect evidence of blood or of blood-group properties. Forensic literature also contains references to the tracing of organic tissue. In the case against Jaccoud the two medical experts called upon, UNDRITZ and HEGG, found evidence of cells from internal organs on a knife which had possibly been used to commit the crime and which had been stored away for some considerable time. Practical experience has shown that the likelihood of finding cells on the weapon used is small; however, it is greater in the case of abdominal injuries than in the case of stab wounds in the chest. Tests carried out on corpses have revealed evidence that cells from the liver can adhere to a blade plunged into the organ. This happens mostly when a knife with a serrated or wavy edge is used. The abdominal wall has a greater cleaning effect on a blade than clothing does. It is of crucial importance to clarify the environmental conditions to which an object bearing certain traces has been exposed. Over a long period of time it is much easier to detect parts of organs if they have been subjected to swift dehydration (by the wind, for example). A location which is either warm or damp and humid makes identification, even after a few hours, no longer possible. The presence of a single tissue cell, especially if it should have managed to retain its structure after several months' dessication, can never suffice for an organic diagnosis. How many determining characteristics then must be traceable? And how great is the certainty of identification with regard to cells from other organs or to nun-human cell structures - all of which are also subject to environmental and time factors? How many single tissue cells must be identified to determine conclusively that the cells in question came, for example from the liver?

Autolysis↗
PubMed2006

Medical strategies to handle mass casualties from the use of biological weapons.

This article reviews the definitions of biological weapons and mass casualties. In addition, it discusses the main operational and logistical issues of import in the medical management of mass casualties from the use of biological weapons. Strategies for medical management of specific biologic agents also are highlighted.

Biological Warfare↗
PubMed2004

A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities.

STUDY OBJECTIVE: To reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information. SETTINGS: Two environments simulated simultaneously: one a major trauma center emergency room (ER) with two patient simulators and several human actors; the other an Emergency Operations Command Center (EOC). TARGET AUDIENCE: Students for this course included: clinicians, scientists, military and intelligence officers, lawyers, administrators, and logistic personnel whose jobs involve planning and executing emergency response plans to WMD/T. SIMULATION SCRIPT: A WMD/T attack in Washington, D.C., has occurred. Clinical students performed in their real life roles in the simulated ER, while nonclinical students did the same in the simulated EOC. Six ER casualties with combined WMD/T injuries were presented and treated over 40 minutes. In the EOC, each person was given his or her role title with identification tag. The EOC scenario took cues from the action in the ER via two television (TV) news feeds and telephone calls from other Emergency Operations Assets. PERFORMANCE EXPECTATIONS: Students were expected to actively engage in their roles. Student performances were self-evaluated during the debriefing. DEBRIEFING: The two groups were reunited and debriefed utilizing disaster crisis resource management tools. ASSESSMENT OF EFFECTIVENESS: Students answered an 18-point questionnaire to help evaluate the usefulness and acceptance of multimodality patient simulation. LESSONS LEARNED: Large-scale multimodality patient simulation can be used to train both clinicians and nonclinicians for future events of WMD/T. Students accepted the simulation experience and thought that scenario was appropriately realistic, complex, and overwhelming. Difficulties include the extensive man-hours involved in designing and presenting the live simulations. EOC-only sessions could be staged with only a few video cassette recorders, TVs, telephones, and callers.

Disasters↗
PubMed2006

Fungi and fungal toxins as weapons.

Recent aggressive attacks on innocent citizens have resulted in governments increasing security. However, there is a good case for prevention rather than reaction. Bioweapons, mycotoxins, fungal biocontrol agents (FBCA), and even pharmaceuticals contain, or are, toxins and need to be considered in the context of the new paradigm. Is it desirable to discuss such issues? None of the fungi are (a) as toxic as botulinum toxin from Clostridium botulinum, and (b) as dangerous as nuclear weapons. One toxin may be defined as a pharmaceutical and vice versa simply by a small change in concentration or a moiety. Mycotoxins are defined as naturally occurring toxic compounds obtained from fungi. They are the biggest chronic health risk when incorporated into the diet. The current list of fungal toxins as biochemical weapons is small, although awareness is growing of the threats they may pose. T-2 toxin is perhaps the biggest concern. A clear distinction is required between the biological (fungus) and chemical (toxin) aspects of the issue. There is an obvious requirement to be able to trace these fungi and compounds in the environment and to know when concentrations are abnormal. Many FBCA, produce toxins. This paper indicates how to treat mycotoxicosis and decontaminate mycotoxins. There is considerable confusion and inconsistency surrounding this topic which requires assessment in an impartial and scientific manner.

Biological Warfare↗
PubMed2006

Transfer of 137Cs from Chernobyl debris and nuclear weapons fallout to different Swedish population groups.

Data from measurements on the body burden of (134)Cs, (137)Cs and (40)K in various Swedish populations between 1959 and 2001 has been compiled into a national database. The compilation is a co-operation between the Departments of Radiation Physics in Malmö and Göteborg, the National Radiation Protection Authority (SSI) and the Swedish Defense Research Agency (FOI). In a previous study the effective ecological half time and the associated effective dose to various Swedish populations due to internal contamination of (134)Cs and (137)Cs have been assessed using the database. In this study values of human body burden have been combined with data on the local and regional ground deposition of fallout from nuclear weapons tests (only (137)Cs) and Chernobyl debris (both (134)Cs and (137)Cs), which have enabled estimates of the radioecological transfer in the studied populations. The assessment of the database shows that the transfer of radiocesium from Chernobyl fallout to humans varies considerably between various populations in Sweden. In terms of committed effective dose over a 70 y period from internal contamination per unit activity deposition, the general (predominantly urban) Swedish population obtains 20-30 microSv/kBq m(-2). Four categories of populations exhibit higher radioecological transfer than the general population; i.) reindeer herders ( approximately 700 microSv/kBq m(-2)), ii.) hunters in the counties dominated by forest vegetation ( approximately 100 microSv/kBq m(-2)), iii.) rural non-farming populations living in sub-arctic areas (40-150 microSv/kBq m(-2)), and iv.) farmers ( approximately 50 microSv/kBq m(-2)). Two important factors determine the aggregate transfer from ground deposition to man; i.) dietary habits (intakes of foodstuff originating from natural and semi-natural ecosystems), and ii.) inclination to follow the recommended food restriction by the authorities. The transfer to the general population is considerably lower ( approximately a factor of 3) for the Chernobyl fallout than during the 1960s and 70s, which is partly explained by a higher awareness of the pathways of radiocaesium to man both by the public and by the regulating authorities, and by the time-pattern of the nuclear weapons fallout during the growth season in Sweden.

Body Burden↗
PubMed2006

Biological weapons: an introduction for surgeons.

Although the risk of an intentional biological weapon release is small for any one location, the chance that there will be an attack somewhere is real. Because surgeons will certainly be called on should this happen, they need to know the basics about the potential agents. This review covers the history of biological weapons,the major agents, and the possible specific roles for surgeons.

Biological Warfare↗
PubMed2006

Civilian preparedness and counter-terrorism: conventional weapons.

Most terrorist attacks involve conventional weapons. These explosive devices produce injury patterns that are sometimes predict-able. The chaos produced from these weapons can be greatly reduced with prior planning, response practice, and realization by the entire medical community of the need to participate in preparation for these devastating events.

Blast Injuries↗
PubMed2000

Deadly weapon-related open-globe injuries: outcome assessment by the ocular trauma classification system.

PURPOSE: To describe mechanisms and injury characteristics influencing visual outcomes in eyes with open-globe injuries caused by deadly weapons and to apply the classification system introduced by the Ocular Trauma Classification Group. METHODS: Two-hundred-twenty-eight eyes of 212 consecutive patients, who were mostly injured in military confrontation, were analyzed. Mechanism and injury characteristics were evaluated for predicting visual outcome according to the recently studied classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities were defined as favorable (5/200 or better) or unfavorable (less than 5/200, including enucleation). RESULTS: The mean age of patients was 23 years, and the mean follow-up was 5.7 months. The predictors for favorable visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect-negative injuries. The predictors for unfavorable outcome were type A, grade 5, zone III, and relative afferent pupillary defect-positive injuries. Land mine and hand grenade injuries had the worst outcome among causative agents. Proliferative vitreoretinopathy, comprising 30.4% of postoperative failures, was the most common complication. CONCLUSION: Deadly weapon-related open-globe injuries, especially those associated with land mines and hand grenades, have devastating visual results. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict visual outcomes in this series of severe open-globe injuries.

Adult↗
PubMed2002

[Availability of antidotes in the event of accidents or attacks with chemical weapons].

BACKGROUND: In this report, we aimed to determine the availability of six antidotes for victims of accidents or attacks with chemical weapons. MATERIAL AND METHOD: Telephone interviews with 6 Catalan hospitals and 8 hospitals from the community of Castilla y León. We evaluated the availability of antidotes in the hypothetical event of a massive intoxication with 600 affected people. RESULTS: Only 3 out of the 14 hospitals had all 6 antidotes. Only atropine and, in Catalan hospitals, sodium thiosulfate were available in enough quantities to treat all victims. With regard to the remaining antidotes, the percentage of treated patients would have been fewer than 50%. The less available antidote was hydroxocobalamine. CONCLUSIONS: We have found both qualitative and quantitative deficiencies of antidotes for the treatment of people intoxicated by chemical weapons.

Accidents↗
PubMed2002

Long-term effects of chemical weapons on respiratory tract in Iraq-Iran war victims living in Babol (North of Iran).

In the Iraq-Iran war (1981-1989), extensive use of chemical weapons such as mustard gas caused high mortality, morbidity, injuries, and chronic side effects in vital organs, especially the respiratory tract. This study was performed to evaluate the long-term effects on respiratory tract of victims. Two hundred and twenty victims were referred from the Mostazafan and Janbazan Foundation of Babol from 1994 to 1998. Complete histories, physical examinations, chest X-rays, and PFTs were performed. Nearly all the victims complained of cough, dyspnea, and suffocation. Hemoptysis was found in 6 victims. In 4 patients, respiratory distress with use of accessory muscles was observed. Two-thirds of the subjects had wheezing and coarse rale. For the other third, physical examination revealed no abnormal finding. Radiographic findings were mostly normal. Spirometry revealed an obstructive pattern in all patients and PFT revealed mostly normal and restrictive patterns. The shortlist time from exposure to study was 7 years and the longest was 13 years. Most patients reported mustard gas exposure and a few of them did not know what type of gas exposure they had. The clinical evaluations, radiography, and PFTs revealed that the most prevalent effects of chemical weapons on respiratory tract were chronic obstructive lung disease, presenting as many types of obstructive involvement.

Adult↗
PubMed1995

Medical devices made into weapons by prisoners: an unrecognized risk.

STUDY OBJECTIVE: The alteration of a knee immobilizer into a sharp weapon by a prisoner prompted us to survey neighboring penal institutions to determine the frequency of such events. DESIGN: We mailed a nine-item survey to all detention facilities in Tennessee, Arkansas, and Mississippi. A second survey was sent to nonresponding institutions 6 weeks after the initial mailing. SETTING: The Regional Medical Center at Memphis, the designated facility for evaluation and treatment of prisoners from the county jail and state penitentiary. PARTICIPANTS: Survey respondents included 25 state penitentiaries, 31 county jails, 1 state minimum-security facility, 1 state maximum-security facility, 1 work-release center, 1 county detention center for drunken-driving offenders, and 1 federal penitentiary. RESULTS: Of the 81 institutions surveyed, 77% responded to one of the two mailings. Forty percent responded in the affirmative when asked whether stolen or unauthorized medical equipment from outside their institutions had been discovered among inmates. When respondents were questioned as to whether medical equipment, prescribed or not, had been used or altered in a criminal manner, 34% responded "yes." Medications and medical appliances were listed in the responses. CONCLUSION: A survey of 81 local and neighboring penal institutions in a three-state area revealed that the illicit use of medicine and medical devices by prisoners is a legitimate safety concern of prison personnel and health care workers when medical care for inmates must be sought outside the security of their institutions. The modification of medical equipment into weapons by incarcerated patients, although clearly recognized as a security and safety problem by police authorities, appears to be unappreciated by health care workers providing episodic care to inmates.

Adult↗
PubMed2003

Injury patterns related to use of less-lethal weapons during a period of civil unrest.

This case series documents injury patterns related to beanbag and other less-lethal (LL) weapons during a period of civil unrest in a major U.S. city. A retrospective review of injuries related to LL weapons usage presenting to an urban Emergency Department (ED) from April 10, 2001 to April 18, 2001 was performed. Patients under 18 years of age and those without signed consent to treat were excluded. Twenty-seven patients were identified. Two were excluded due to lack of signed consent for treatment. Mean age was 28.4 +/- 11.7 years; 76% of patients were male. Significant morbidity was found in 7 (28%) cases with no fatalities. Three (12%) individuals, with the diagnoses of pulmonary contusion, liver laceration, and Achilles tendon rupture, required admission. Two (8%) individuals had delayed complications of pneumonia and post-concussive syndrome. Reports of injury patterns associated with beanbag munitions in the medical literature are limited. Physicians should be aware of the injuries and delayed sequelae associated with their use.

Adult↗
PubMedDate not supplied

The Flexible Baton TM-12: a case report involving a new police weapon.

The purpose of this case report is to describe a new type of police weapon and the injuries sustained by an individual after being shot with it. The Flexible Baton is a type of ammunition that consists of a fabric bag, filled with lead shot pellets, that is shot from a shotgun. It is predicted that this bag may cause bruising, abrasions, and blunt trauma. In our patient, the fabric bag burst and the pellets penetrated the skin of the elbow, resulting in cortical violation of the distal humerus. As more guns with this ammunition have been introduced throughout the United States, we conclude that injuries from this weapon will be seen with greater frequency.

Adult↗
PubMedDate not supplied

A method to determine the time since last purification of weapons grade plutonium.

A non-destructive technique to determine the time since last purification of weapons grade plutonium based on the 241Pu decay series has been developed and demonstrated to provide results that are consistent with our historical and process knowledge. This method is based on the use of the Bateman equations and the decay chain 241Pu-->237U & 241Am-->237Np-->233Pa. Secular equilibrium is assumed between the (2.1 x 10(6) year) 237Np and the (27 day) 233Pa. The proposed method is dependent upon the efficiency of the plutonium separation process but makes no assumption about the relative abundance of 241Pu in 239Pu. Even though the technique was developed for weapons grade plutonium, it is expected to apply to almost any material that contains plutonium.

Algorithms↗
PubMed1995

Hearing loss associated with weapons noise exposure: when to investigate an asymmetrical loss.

The air conduction thresholds in the right and left ears, and the interaural asymmetry of thresholds at 0.5, 1, 2, 3, 4 and 6 kHz were measured in a group of 225 soldiers exposed to a variety of weapon noise who were referred for assessment because of a deterioration in hearing on routine testing. At 0.5 and 1 kHz the threshold levels rarely exceeded 25 dB and the interaural asymmetry was 10 dB or less in 90 per cent of cases. The degree of hearing loss and interaural asymmetry increased as the frequency increased, with the average loss being significantly greater in the left ear at 2, 3, 4 and 6 kHz. Recommendations are made for the selection of cases of asymmetrical hearing loss exposed to weapon noise which require further investigation to exclude a retrocochlear cause or to define spurious hearing threshold levels.

Adolescent↗
PubMed1997

Further follow-up of New Zealand participants in United Kingdom atmospheric nuclear weapons tests in the Pacific.

We previously reported a study of deaths and cancer incidence in Royal New Zealand (RNZ) Navy personnel who participated in atmospheric nuclear weapons tests conducted by the United Kingdom in the Pacific in 1957-58. The study involved 528 men known to have participated in the tests, and a control group of 1,504 men who were in the RNZ Navy during the same period but were not involved in the tests. The original follow-up was carried out for the period 1957-87 with an observed increase in risk of leukemia and other hematologic cancers, but little or no increase of non-hematologic cancers or non-cancer deaths in test participants. Follow-up now has been extended for the period 1988-92. For the total follow-up period, there were 97 deaths in test participants and 256 deaths in controls, a relative risk (RR) of 1.1 (90 percent confidence interval [CI] = 0.9-1.3). The RR of death from causes other than cancer was 1.0 (CI = 0.8-1.3), whereas the RR of cancer death was 1.2 (CI = 0.8-1.7) and that of cancer incidence was 1.0 (CI = 0.8-1.4). For cancers other than hematologic malignancies, the RR was 1.0 (CI = 0.7-1.5) for mortality, and 1.0 (CI = 0.7-1.3) for incidence. However, there were eight deaths from hematologic cancers in test participants (RR = 3.8, CI = 1.4-10.8), including four leukemias (RR = 5.6, CI = 1.0-41.7). The RR for incidence of hematologic cancers was 1.9 (CI = 0.8-4.3), and that for leukemia was 5.6 (CI = 1.0-41.6). We concluded that the evidence is still consistent with the hypothesis that some leukemias and other hematologic cancers may have resulted from participation in the nuclear weapons test program, but the further follow-up strengthens the evidence that there is no increased risk for non-hematologic cancers or for causes of death other than cancer in the test participants.

Confidence Intervals↗