Weapons of Mass Destruction

Besides managing the injuries and illnesses from common disasters such as earthquakes and airplane crashes, emergency clinicians should also have competence in treating victims generated by terrorist attacks with chemical, nuclear, biologic, or high-energy explosive weapons. Chemical weapons can be divided into categories according to their pathologic function (nerve agents, vesicants, cyanides, and pulmonary intoxicants). Early identification based on symptoms and potential exposure allows for lifesaving antidote therapy. Medical stabilization should be a priority; however, decontamination and personal protective equipment (PPE) are important to protect staff and bystanders. There are multiple biologic weapons. CDC has identified 6 agents of highest risk, called category A agents: anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers. Symptoms are commonly vague and initially appear like an influenza-like illness (ILI). Rapid identification, population protection, prophylactic therapy and vaccines, and targeted therapies are lifesaving. Radiation or nuclear events are rare high injury events. A basic emergency department radiation protocol should address decontamination, triage, staff safety, personal protective equipment (PPE), and diagnostic procedures that emphasize radiation monitoring. There are three types of radiation syndrome (hematologic, gastrointestinal, and neurologic). Cutaneous burns can also occur. Explosive weapons are the most likely to be used by terrorists due to their relative ease of production and potential for mass injury. There are four types of blast injury (primary, secondary, tertiary, and quaternary). Basic trauma evaluation and care will suffice for most injuries; however, it is important to understand blast injuries are caused by pressure waves which can cause internal organ damage without significant external appearing pathology.