Urban Survival Secrets for Terrorist Attacks

Urban Survival Guide

Discover How You Can Easily Have A Survival Plan Staying Right Where You Currently Live That's Better Than Having. A Fully Stocked Rural Retreat That You Can't Get To! Finally Revealed: Urban Survival Secrets For Surviving Terrorist Attacks, Natural Disasters And Pandemics! In The Real World, Most People Don't Have A Fully Stocked Retreat They Can Escape To. Even If You've Planned Ahead And You Do, There's No Guarantee That You'll Leave In Time Or That You'll Be Able To Make It There. Your First Plan Must Be To Survive In Place. Read more here...

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Threat assessment bioterrorism in the overall terrorism context

Biologic agents are considered to be weapons of mass destruction (WMD) because, as with nuclear and chemical weapons, their use may result in potential mortality on a massive scale. Bioterrorism occupies a unique niche among WMD (Table 12.2) exposure to biologic agents entails a clinical incubation period of days to weeks during which time recognition of an attack is problematic (assuming a covert attack), detection of a specific agent is difficult, and infection may disseminate widely among a population. This is in contradistinction to other forms of WMD, where recognition of an actual event occurs with the deployment, allowing mitigation strategies to begin nearly immediately. The difference is important, as specific therapeutic or prophylactic measures may be available in bioterrorism, as opposed to simply general decontamination and supportive measures used in other arenas of terrorism response. Multiple factors likely contribute to the attractiveness of biological agents as tools...

Bioterrorism and the public health response problem areas

The response to bioterrorism is unique among weapons of mass destruction, because it necessitates the consequence management that is common to all disasters as well as the application of basic principles of infectious disease disease surveillance, infection control, antimicrobial therapy and prophylaxis, and vaccine prevention. For these reasons, and factors related to the epidemiology of bioterrorism (see above), physicians and other clinicians are the likely first responders to bioterrorism and are expected to be reliable sources of information for their patients, colleagues, and public health authorities (Artenstein etal., 2002b). There remain a number of potential pitfalls regarding bioterrorism that must be identified and managed to optimize the public health. As discussed above, emergencies involving conventional threats, natural disasters, or even chemical attacks, have immediate consequences assessments of casualties can begin as can containment and mitigation strategies. In...

Bioterrorism in special populations

The public health approach to bioterrorism must be broadened to include special populations, including not only children, pregnant women, and immunocompromised persons, but also other at-risk vulnerable populations - disabled persons, non-English speakers, the homeless, substance abusers, mentally ill persons, and those that are geographically or culturally isolated. A general approach to the management of biothreat infections requires an assessment of the risk of certain drugs or products in select populations versus the potential risk of the infection in question, accounting for extent of exposure and the agent involved. While specific recommendations for treatment and prophylaxis have been recently reviewed (Inglesby et al., 1999, 2000 Dennis et al., 2001), these only address the biological part of the issue. A larger and more complex problem is ensuring that risk communication regarding bioterrorism and other emergencies is appropriately formulated and delivered in a fashion that...

Epidemiologic principles as applied to bioterrorism

By definition, bioterrorism is insidious absent of advance warning or specific intelligence information, clinical illness will be manifest before the circumstances of a release event are known. For this reason, health-care providers are likely to be the first responders to this form of terrorism, as symptomatic individuals present for medical attention. This contrasts with the more familiar scenarios in which police, firefighters, paramedics, and other emergency services personnel -traditional first responders - are deployed to the scene of a conventional attack or natural disaster. Physicians and other health-care workers must therefore maintain a high index of suspicion of bioterrorism and recognize suggestive epidemi-ologic clues and clinical features in order to enhance early recognition, optimize the initial management of casualties, and minimize the amplifying effect on the population (Artenstein etal., 2002a). Table 12.3 Agents of concern for use in bioterrorism Table 12.3...

Social determinants of bioterrorism the concept of risk

Any discussion of bioterrorism, and certainly one that involves mitigation strategies, hinges on the concept of risk. Risk refers to the likelihood that exposure to a hazard will lead to a negative consequence therefore, it is essential to understand both the threat and the potential range of consequences associated with bioterrorism in order to accurately assess risk in this regard (Ropeik and Gray, 2002). When applied to cause-specific mortality, risk can be viewed in a purely statistical sense the risk of dying from cardiovascular disease in the US in the year 2000 was approximately 1 in 400, while the risk of succumbing in a lightning strike was approximately 1 in 4.5 million (Table 12.1). In the arenas of human biology and medicine, however, risk assessment is based on the complex interplay of genetics, environmental factors, and chance. Risk as it relates to bioterrorism is difficult to quantify while the probability of exposure to a biologic attack is statistically low, it is...

The Scope of the Problem

During the Cold War (1945-1991), issues of public health (with the exception of biological weaponry) were typically consigned to the realm of low politics. With the end of US-Soviet rivalry in the early 1990s, environmental change, terrorism, migration, and public health began to ascend on the international agenda. Public health victories against microbes reached a zenith in the mid 1970s with the development of powerful anti-microbial drugs. However, the pace and intensity of pathogen emergence has increased since that time with the proliferation of novel agents of contagion. In the late 1990s, the recognition that the HIV AIDS pandemic represented a significant threat to the economy, the governance, and perhaps the security of developing countries spurred the academic and policy communities into action against this emerging foe. In recent years, the BSE epizootic, the SARS contagion of 2003, and our increasing understanding of the influenza pandemic of 1918-19 have generated great...

Health and National Security

The definition of national security has changed over the years to include terrorism, resource scarcity, migration, and now threats to population health. During the first session of the United Nations Security Council of July 17, 2000, the UN adopted Resolution 1308 (2000) and declared the HIV AIDS pandemic a threat to global security. This represents the first time in history that an issue of public health has been elevated to such status, and it illustrates the recent transformation in thinking about new threats to security in the post-Cold War era.

Responding to the challenges ahead

Maintaining a safe blood supply will require constant vigilance on the part of blood-banking and public health officials. No one could have predicted the enormous challenges created by the AIDS pandemic, and no doubt new challenges will arise in the years ahead. One such relatively new concern is terrorism (see Chapter 12). Officials in the United States are concerned about the possibility that terrorists could obtain access to the smallpox virus and use it against the public. Before 1972, vaccinia, the live virus used in smallpox vaccinations, was routinely administered to Americans. Smallpox can be highly infectious - for example, a scab at the inoculation site can contain infectious virus, so it is possible for a scab that spontaneously separates from the skin to inadvertently infect close contacts that touch the vaccination site or dressing. Another area of concern is blood-banking. In response to this potential threat, the United States Department of Health and Human Services...

Andrew W Artenstein and Troy Martin

Bioterrorism, broadly defined as the deliberate and malicious deployment of microbial agents or their toxins as weapons in a non-combat setting, represents perhaps the most overt example of human behavior impacting epidemic infectious diseases (Artenstein, 2004a). While most of the microbial threat agents of potential use in bioterrorism occur naturally in various ecological niches throughout the world, they are rare and sporadic causes of human disease in developed countries and urban environments. It is human behavior within the context of the extant geopolitical milieu that transforms these naturally-occurring organisms into potential weapons of mass terror. Other more recent examples of bioterrorism, though not necessarily resulting in attacks causing morbidity or mortality, may serve as harbingers of future events. Saddam Hussein's regime in Iraq developed and deployed anthrax- and botulinum-laden warheads in the years leading up to the Gulf War (Zilinskas, 1997) the reasons that...

Geopolitics and the psyche of terrorists

The opening act of the modern era of terrorism dates from 1972, when the Palestinian terrorist group Black September murdered 11 members of the Israeli Olympic team and a German police officer in Munich (Post, 2005). As the event played out, the enormous amplifying effect of international media coverage was recognized and serves as a legacy for today's terrorists. Three types of terror organizations have since been recognized social-revolutionary groups, nationalist-separatist groups, and, more recently, religious fundamentalists. Social-revolutionary groups, as exemplified by the Red Brigades in Italy and the Red Army Faction in Germany, are leftist groups with strong ties to Communist parties seeking to overthrow the extant capitalist economic and social order. With the collapse of Communism in Europe and the end of the Cold War, their activity has dramatically declined. Nationalist-separatist terrorism organizations are one of the two types seen commonly today. These groups are...

Viral hemorrhagic fevers

Hemorrhagic fever viruses have been viewed as emerging infections in nature due to their sporadic occurrence in focal outbreaks throughout the world they are thought to be the results of human intrusion into a viral ecologic niche. They are, however, potential weapons of bioterrorism because they are highly infectious in aerosol form, are transmissible in health-care settings, cause high morbidity and mortality, and are purported to have been successfully weaponized (Alibek, 1999). Additionally, VHF frequently produce dramatic clinical pictures that have received worldwide attention, thus fulfilling another terrorist goal - to induce maximum fear and panic in the civilian population.

Genetically modified weapons

While modern-day terrorists may be constrained by the physics of aerosols, dispersion clouds and pulmonary alveolar dimensions, advances in molecular genetics and biotechnology have afforded them the possibility of manipulating the genetic composition of biologic organisms in order to enhance their threat potential. Theoretically, at least, such science could result in a Cold War-style arms race between bioterrorist states and biodefense organizations, since the molecular technology would serve dual purposes (Fraser, 2004). The application of genomic science to bioterrorism may include the insertion of select genes for heightened infectivity, virulence, enhanced aerosol stability or antibiotic resistance into the agent's genome it may also involve modification of the sequences recognized by detection devices or the host immune response (Petro et al., 2003). One example is the concept of a multi-drug resistant anthrax strain created by the insertion of plasmids carrying multiple...

Public health response as informed by recent events anthrax attacks 2001

During October and November of 2001, beginning just weeks after the events of 11 September, the US experienced a series of biological attacks using weap-onized anthrax spores deployed in mailed letters. In total there were 22 confirmed or suspected cases, 11 of inhalational anthrax and 11 of the cutaneous form (Jernigan et al., 2001) five of the inhalational cases were fatal. Although these attacks were small scale and employed a low-technology approach to anthrax delivery, their impact was substantial two branches of the Federal Government were temporarily closed, postal operations were severely disrupted, thousands of potentially exposed persons received post-exposure prophylaxis, total mitigation costs approached US 3 billion, and scarce public health resources were diverted away from other concerns to manage the inordinate volume of false alarms that accompanied the actual exposures (Heyman, 2002). Not unexpectedly, a host of after-action reports and analyses have subsequently...

Smallpox vaccination program 2003

The terrorist attacks on the World Trade Center and the Pentagon on 9 11, and the anthrax attacks that followed shortly thereafter, served to focus attention on the threat of bioterror. Smallpox, for reasons delineated above, is widely considered to be a high priority threat agent, and one for which an effective vaccine exists, although not in sufficient quantity for broad application. In late 2002 the Federal Government authorized the implementation of a smallpox vaccination program for over half-a-million operational military personnel, and a second program, presided over by the states, to vaccinate civilian smallpox response teams comprising health-care workers and other emergency response personnel (Faden et al., 2003). Because of the questions concerning risk outweighing benefit in the pre-event setting, the vaccine program was subjected to more rigorous scrutiny than historical smallpox mass vaccination. As may be seen with such large, well-studied datasets, novel and...

Challenges to global public health

The threat of bioterrorism will likely persist and continue to present challenges to global public health. Adding to the concern is the possibility that advances in biomedical research may be used for malicious purposes - a possibility that has recently resulted in the creation of the National Science Advisory Board for Biosecurity by the US Department of Health and Human Services, to counsel government agencies regarding the dissemination of results from controversial experiments (Steinbrook, 2005). While the overall risk of bioterrorism is probably low from a practical standpoint, the consequences are potentially quite high thus it is essential that we continue to develop countermeasures and response plans. There is otherwise a tendency to move on in our thinking to the next big thing and to leave these threats incompletely addressed. This concept of bio-terrorism fatigue can be quantified (Figure 12.1). Bioterrorism represents the ecological niche that lies at the confluence of...

Epidemiologic settings

The epidemiologic settings in which network descriptions have the longest history of use involve sexually transmitted infections (STIs), such as gonorrhea or the human immunodeficiency virus (HIV).8-14 Here there are natural, well-defined, network structures (sexual partnership networks) which have long been exploited by public health bodies in their attempts to track and control outbreaks of STIs. Network models have more recently been employed to describe the spread of a wider range of infections such as measles, SARS or foot and mouth disease (FMD).15-18 Increased interest in bioterrorism has also spurred much research, with the spread of smallpox coming under particular scrutiny.19'20

The US Centers for Disease Control and Prevention

In 2003, the CDC launched a 22-month-long, large-scale strategic planning effort to improve its ability to achieve its mission. The ensuing restructuring effort, approved by Congress in April 2005, sought to streamline management and operations, reduce management levels, and increase coordination. It organized the CDC into coordinating centers and offices - the Coordinating Center for Environmental Health and Injury Prevention the Coordinating Center for Health Information and Services the Coordinating Center for Health Promotion the Coordinating Office for Global Health the Coordinating Center for Infectious Diseases, which includes the Coordinating Office for Terrorism Preparedness and Emergency Response the National Center for HIV, STD, and TB Prevention and the National Institute for Occupational Safety and Health (NIOSH). In addition, the CDC provides administrative support for the Agency for Toxic Substances and Disease Registry (ATSDR), a sister agency of CDC, and the Director...

Notes on Contributors

Bartlett MD is Professor of Medicine in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine, Baltimore, Maryland. He served as Chief of the Infectious Disease Division at the School for 26 years, stepping down in June of 2006. Dr Bartlett received his undergraduate degree at Dartmouth College, Hanover, New Hampshire, and his medical degree at Upstate Medical Center, Syracuse, New York. He trained in internal medicine at the Peter Bent Brigham Hospital, Boston, Massachusetts, and the University of Alabama, Birmingham, and he completed his fellowship training in Infectious Diseases at the University of California, Los Angeles (UCLA). Before accepting his position at the Johns Hopkins University, Dr Bartlett served as a faculty member at UCLA and Tufts University School of Medicine in Boston, Massachusetts, and was Associate Chief of Staff for research at the Boston VA Hospital. Dr Bartlett has worked in several areas of research, all related to...

Conclusions

Not very long ago, a list of health challenges for the twenty-first century included sanitation and hygiene, vaccination, antibiotics and other antimicrobials, technological advances in detecting and monitoring diseases, serologic testing, viral isolation and tissue culture, and molecular techniques that can help diagnose and track the transmission of new threats (CDC, 1999). The paper went on to discuss the value of molecular genetics and how the US public health system must prepare to address diverse challenges including emergence of new infectious diseases, the re-emergence of old diseases, large food-borne outbreaks, and acts of bio-terrorism. Not until the last sentence was the need for research into environmental factors that facilitate disease emergence mentioned. A mere seven years later, with a growing understanding of the threats that climate change and habitat destruction pose to ecosystems and public health, it is unlikely that such an oversight would be made. The fact is...

Bacterial Diseases

Plague, caused by Yersinia pestis, is the most important reemergent bacterial vector-borne disease. The current global increase in case reports of plague is primarily due to outbreaks in Africa. However, it is the potential of plague to cause explosive epidemics of pneumonic disease, transmitted person-to-person and with high mortality that makes it important as a reemergent infectious disease and as a potential bioterrorist threat. This was illustrated in 1994 when an outbreak of plague occurred in Surat, Gujarat, India (WHO 1994). Although this was a small outbreak (most likely less than 50 cases) that should have been a relatively unimportant local public health event, it became a global public health emergency. The reasons for this are complicated and beyond the scope of this article, but it is a

Metal Mobilization

Metal mobilization from rocks, minerals, soil, and other substrates can be achieved by protonolysis, respiratory carbon dioxide resulting in carbonic acid formation, chelation by excreted metabolites and Fe(iii)-binding siderophores, and methylation which can result in volatilization. In addition, other excreted metabolites with metal-complexing properties, for example, amino acids, phenolic compounds, and organic acids, may also be involved. Fungal-derived car-boxylic acids can play an integral role in chemical attack of mineral surfaces and these provide a source ofprotons as well as a metal-chelating anion. Oxalic acid can act as a leaching agent for those metals that form soluble oxalate complexes, including Al and Fe. Solubilization phenomena can also have consequences for mobilization of metals from toxic metal containing minerals, for example, pyromorphite (Pb5(PO4)3Cl), contaminated soil, and other solid wastes. Fungi can also mobilize metals and attack mineral surfaces by...

Background

Literature on the political dimensions of the epidemic remains exceedingly sparse. The microbiologist Elizabeth Prescott argued that the SARS epidemic illustrates the increasingly acute nature of complex interdependence among countries in the domain of public health, and provides us with lessons that may help countries in their efforts to prevent bioterrorist attacks. She observed that the emergence of the contagion illuminated significant and vital weaknesses in global and local preparedness for surprise outbreaks.6 The political scientists Melissa Curley and Nicholas Thomas argued that infectious diseases (the SARS outbreak in particular) represented a significant and growing threat to human security in Southeast Asia. The legal scholar David Fidler has also conceptualized SARS as a threat to the material interests of the state, which aligns with the republican Realist model presented in this work.7 The emergence of the SARS pathogen in China and later in Canada demonstrates that...

Threat agents

CDC category agents are those biologic threat agents thought to be of major public health concern. Extensive coverage of these and other pathogens of concern in bioterrorism can be found elsewhere (Sidell et al., 1997). Data concerning clinical incubation periods, transmission characteristics, and infection control procedures for selected agents of bioterrorism are provided in Table 12.4. Syndromic differential diagnoses for select clinical presentations are detailed in Table 12.5. Table 12.4 Infection control issues for selected agents of bioterrorism Table 12.4 Infection control issues for selected agents of bioterrorism Table 12.5 Syndromic differential diagnoses of selected bioterrorism agents

Anthrax

It is ironic that, as American policies and regulations alleviated the risk of industrial outbreaks of anthrax, latter-day governmental policies may have shifted that risk to bioterror-related outbreaks. What was once an occupational disease of slaughterhouse workers, ranchers, and mill workers has now become an occupational hazard of politicians, journalists, postal workers, and the public at large (Witkowski and Parish, 2002). Prevailing wisdom had previously held that a large-scale bioterrorism attack with anthrax would employ aerosolized endospores and result in outbreaks of inhalational disease. The attacks in the US in 2001 illustrate the difficulties in predicting modes and outcomes in bioterrorism the attacks were on a relatively small scale, and while endospores were used, the delivery method -envelopes - resulted in a significant proportion of cutaneous cases (Inglesby et al., 2002). However, as with the Sverdlovsk outbreak in 1979, the serious morbidity and mortality in the...

Smallpox

The suspicion of a single smallpox case should prompt immediate notification of local public health authorities and infection-control specialists. Containment of smallpox is predicated on the ring vaccination strategy, which was successfully deployed in the WHO global eradication campaign and mandates the identification and vaccination of all directly exposed persons, including close contacts, health-care workers, and laboratory personnel. Vaccination, if deployed within four days of infection during the early incubation period, can significantly attenuate or prevent disease and may reduce secondary transmission (Henderson et al., 1999). Because variola virus does not exist in nature, and legitimate stocks were confined to the two sites in the US and Russia, the occurrence of even a single case of smallpox outside of an accidental laboratory exposure would be tantamount to bioterrorism. An epidemiologic investigation would be necessary to ascertain the perimeter of the initial...

Botulism

Botulism, an acute neurologic disease resulting from intoxication with Clostridium botulinum, occurs sporadically and in focal outbreaks throughout the world, related to wound contamination by the bacterium or ingestion of food-borne toxin (Bleck, 2005). Aerosol forms of the toxin, while a rare mode of acquisition in nature, have been weaponized for use in bioterrorism (Zilinskas, 1997). Botulinum toxin is considered to be the most toxic molecule known it is lethal to humans in minute quantities. It acts by blocking the release of the neurotransmit-ter acetylcholine from presynaptic vesicles, thereby inhibiting muscle contraction (Arnon et al., 2001). Botulism therefore possesses a number of attributes of concern it is lethal in small quantities it has been successfully weaponized in the past and its deployment by terrorists could paralyze a health-care system. bioterrorism attack. A large number of epidemiologically unrelated, multifocal cases should be clues to an intentional...

Plague

The allure of plague as an agent of bioterrorism is related to a number of factors it can be mass produced and disseminated as an aerosol, as successfully accomplished experimentally by both the US (Christopher et al., 1997) and the Soviet (Alibek, 1999) bioweapons programs in the past the pneumonic form of the disease is communicable from person-to-person and associated with a high mortality rate if untreated drug-resistant mutants occur in nature (Galimand et al., 1997) and an effective vaccine is not widely available. Perhaps the greatest appeal to terrorists is the stigma attached to plague, largely based on its historical track record of social and economic devastation. While the outbreak in Surat, India, in 1994 resulted in only 52 deaths, hundreds of thousands fled the city and mass chaos followed in its wake (Ramalingaswami, 2001). Aerosolized preparations of the agent, the expected vehicle in bioterrorism, would be predicted to result in cases of primary pneumonic plague...

Tularemia

Francisella tularensis, the causative agent of tularemia, is another small Gramnegative coccobacillus that would likely cause a primary pneumonic presentation if delivered as an aerosol agent of bioterrorism. The agent is associated with a high attack rate due to its virulence as few as 10 organisms can cause a pneumonic infection (Dennis et al., 2001). Inhalational tularemia presents with the abrupt onset of a febrile, systemic illness with prominent upper respiratory symptoms, pleuritic chest pain, and the variable development of pneumonia, hilar adenopathy, and progression to respiratory failure and death in excess of 30 percent of those who do not receive appropriate therapy (Dennis et al.,

Vaccines

Perhaps the most effective approach towards mitigation of the bioterrorist threat is the development of an effective, scaleable, technologically advanced vaccine platform that can not only respond to likely threat agents, but also has the flexibility to respond to novel and re-emergent pathogens. Vaccines will need to be designed for imminent threats and post-exposure settings products targeted against the likeliest threats will need to be stockpiled for rapid, practical deployment. A brief review of the current state of vaccines for select Category A agents follows smallpox vaccine is discussed on p. 342. More comprehensive reviews of biodefense vaccines can be found elsewhere (Cieslak et al., 2000 Ales and Katial, 2004). Whereas anthrax and tularemia efforts demonstrate models for bacterial vaccines, Clostridium botulinum is an example of a vaccine effort directed against an important toxin agent of bioterrorism. Antitoxin remains a scarce resource, and is only useful in certain...

Psychosocial issues

An often overlooked but vitally important issue in bioterrorism is that of psychosocial sequelae. These often take the form of acute anxiety reactions and exacerbations of chronic psychiatric illness during the stress of the event, or posttraumatic stress disorder (PTSD) in its aftermath. Nearly half of the emergency department visits during the Gulf War missile attacks on Israel in 1991 were related to acute psychological illness or exacerbations of underlying psy-chopathology (Karsenty et al., 1991). Data from recent acts of terrorism in the US suggest that PTSD may develop in as many as 35 percent of those affected by the events (Yehuda, 2002). In the early period after the 11 September 2001 attacks in New York, PTSD and depression were nearly twice as prevalent as in historical control subjects (Galea et al., 2002). Although close proximity to the events and personal loss were directly correlated with PTSD and depression, respectively, there was a substantial burden of morbidity...

Mental health

Traumatic events, such as tsunami, produce substantial psychological trauma to individuals and communities (Ursano et al., 1995, 2006 Lopez-Ibor, 2006 CDC, 2007). This applies to a variety of events, including not only earthquakes and tsunami, but also hurricanes, tornadoes, pandemics, and bioterrorism. In general, there are several features in common when these sudden and often unexpected events afflict a community (CDC, 2007)

Timelines

The warning of threat ranges from no advance notice (as in tsunami) to days to weeks for hurricanes. The actual onset and tempo is variable. The 2004 tsunami struck with enormous impact, resulting in 230,000 deaths in a few days with 1 million persons displaced, but three months later there were an additional 1300 deaths from one aftershock. The events of bioterrorism may linger over days and months, as they did with anthrax in the US in 2001.

Recommendations

Counter Threat Myopia The terrorist attacks of 2001, and the subsequent wars in Afghanistan and Iraq have deflected the security community's attention away from those infectious disease threats which had been on the radar at the United Nations Security Council in the spring of 2001. The prevailing obsession with anthropocentric threats (i.e., terrorism) leaves little cognitive space for scholars or policy makers to be concerned about subtle and attenuated threats, and makes it difficult to observe health and environmental challenges to security.

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