Tutorial on Chemical and Biological Warfare - Presented at The 1st Annual Symposium On Seaport Security given in Houston Texas Y2003

1. Terrorist Use of Chemical
& Biological Weapons -
A Tutorial
Frank W Meissner, MD, MS, FACP, FACC, FCCP, CPHIMS
fmmd@mac.com

2. Terrorist - The Official Definition
FBI Definition - The unlawful use of
force against persons or property to
intimidate or coerce a government, the
civilian population, or any segment
thereof, in the furtherance of political or
social objectives.”

3. Why Terrorists Might Use
"Weapons of Mass Destruction"
Classically, terrorism was the act of making
Political statement via violence
Political act designed to influence an audience
Levels of violence carefully calculated
Draw attention but not so violent as too
 Alienate supporters
 Trigger overwhelming response

4. Why Terrorists Might Use
"Weapons of Mass Destruction”
Classical Terrorists have had substantively
rational goals, e.g.,
Attaining national autonomy (Morocco)
Establish representative government (Palestinians)
Protest government policies & actions
(Weatherman)

5. Why Terrorists Might Use
"Weapons of Mass Destruction”
Candidates for use of Chem/Bio weapons
represent the intersection of three sets of Groups
A B
C
A - Groups that want to use the agents despite the political risks
B - Groups that can acquire the agent & dissemination technology
C - Groups whose organizational structure allows for covert delivery

6. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - Gaining Attention
Bio-weapons ARE
Mysterious
Unfamiliar
Indiscriminate
Uncontrollable
Inequitable
Invisible
Factors that heighten FEAR, the Terrorists Goal State

7. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - Economic Damage
Attack Crop, Livestock, Pharmaceuticals
Attack Corporate interests
Potentially massive costs of clean up of a Bio-war attack
Recall that the Soviets lost the Cold War because we
outspent them!
Could non-state Terrorists causes us to outspend our
resources?

8. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - Millenarianism
The Millenarian idea- The present age is corrupt & a
new age will dawn after a cleansing apocalypse
Only a Chosen few (usually selected on the basis of
adherence to doctrine or ritual) will survive the end
of time and experience paradise
Prime motivator for some “ Domestic” Terrorists

9. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - Exacting Revenge or
Creating Chaos
Politically motivated terrorists desire to change societies rather
than destroy them
 Thus avoid killing very large numbers of people
 Political costs exceed the benefits
Some terrorists wish to annihilate enemies or demolish societal
order
 Ramzi Yousef, organizer of World Trade Center bombing, claimed he was exacting
revenge against the United States
 William Pierce, leader of neo-Nazi organization National Alliance, aims to initiate a
worldwide race war & establish an Aryan state
 Leon Czolgosz, assassin who shot President William McKinley was an anarchist, i.e.,
espoused a political philosophy that believes all forms of governments are oppressive

10. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - Mimicking God
Create an aura of divine retribution
 Gods 5th plague on the Pharaoh in Exodus was murrain,
a group of cattle diseases that includes anthrax
 5th chapter of Samuel I, God turned against the
Philistines and "smote them with emerods"
• Emerods=Bubo’s a symptom of bubonic plague

11. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - “Copycat” Phenomena
Increased interest in Chem/Bio-weapons among
domestic extremists after Aum Shinrikyo incident
Surge in Anthrax hoaxes after both Aum Shinrikyo &
Anthrax letters post-9/11

12. Why Terrorists Might Use
"Weapons of Mass Destruction”
Motivational Factors - Technical Availability
Weapons of mass destruction & components are easier to acquire
since Fall of Soviet Government
Former Soviet weapons experts may be providing biological
weapons & expertise to Iran
 Judith Miller and William J. Broad, "Bio-Weapons in Mind, Iranians Lure
Needy Ex-Soviet Scientists," New York Times, 8 November 1998, A1;
Miller and Broad, "Germ Weapons: In Soviet Past or in the New Russia's
Future?" New York Times, 28 December 1998, A1.
South African biological weapons scientists have offered their
expertise to Libya
 19James Adams, "Gadaffi Lures South Africa's Top Germ Warfare
Scientists," Sunday Times, 26 February 1995; Paul Taylor, "Toxic S.
African Arms Raise Concern; US Wants Assurance `80s Program is
Dead," Washington Post, 28 February 1995.

13. Why Terrorists Might Use
"Weapons of Mass Destruction"
In Summary, Postmodern or Super-terrorism
May aim to maximize number of casualties
Levels of violence carefully calculated
Reflects a shift in the goal of terrorists
Maximizing damage to the target
This can become the end itself

14. Questions?
Is this terrorism?
Or is it asymmetrical warfare?
What exactly is a War on Terrorism?

15. Carl Von Clausewitz
Vom Kriege (On War) - 1832
“War is Merely The Continuation of
Policy By Other Means”
Can a state be at war with a non-state
actor?
Or are we talking about Police actions?
Can a War on Terrorism lead to a
Police State?

16. Hx of Chemical Warfare
Pre-WWI
1000 BC - Chinese used arsenical smokes
600 BC - Solon of Athens put hellebore roots in
the drinking water of Kirrha
Thucydide's History of Peloponnesian War
 429 & 424 BC, Spartans & Allies used noxious smoke
and flame against Athenian-allied cities
660 AD Kalinkos invented "Greek Fire”
 Technical innovation extensively used by the Naval Fleet
of the Byzantine Empire for over 200 years
 Destroyed the naval fleet of Igor, Prince of Keiv, 941 AD

17. Hx of Chemical Warfare
Pre-WWI
15th Century Leonardo da Vinci proposed military
use of a powder of sulfide of arsenic and verdigris
1618-48 - Thirty Years War - Toxic smoke
projectiles designed & used
1899-1902 - Boer War - British troops fired picric
acid-filled shells - munitions had little effect on the
outcome of combat
1904-1905 - Russo-Japanese War - Japanese
soldiers threw arsenal rag torches into Russian
trenches

18. WWI
November 1914 - Dr. Hans von Tappen -
designed 150-mm howitzer shell containing 7
lb of xylyl bromide and a burster charge for
splinter effect
Operational tests of 18,000 of the shells at
Russian positions near Bolimov - op failure
2° weather conditions
Tested again at Western front at Nieuport -
March 1915 - also abysmal failure

19. WWI
Ypres, Belgium - 22 April 1915- 1st
successful German chemical attack
Success of the attack was not capitalized upon by
the Germans
July 1917- Germans introduced
mustard agent
persistent vesicant that attacked the body
in places not protected by gas masks

20. Intra-war period
Italian-Ethiopian War
3 October 1935 - Benito Mussolini
-invasion of Ethiopia from Eritrea, an Italian
colony, and Italian Somaliland
Italians dropped mustard bombs and
occasionally sprayed it from airplane tanks

21. Intra-war period
Japanese Invasion of China - 1937
By 1939 Japanese were using mustard
agent & Lewisite
Very effective against the untrained &
unequipped Chinese troops
Chinese reported that their troops retreated
whenever the Japanese used just smoke,
thinking it might be a chemical attack

22. WWII
President Roosevelt established a “No-
First-Use” policy
Germans in fact had manufactured & stored
1/4 million tons of chemical agents
Germans developed Nerve Agents Tabun
(GA) & Sarin (GB) production beginning
1939

23. Korea & Cold War
Continuation of “No-First-Use” Policy
1950 - Full-scale Sarin production
complex @ Edgewood Arsenal
Multiple types of Munitions Developed

24. Honest John Rocket -
Chem Warhead & Sarin Bomblet

25. Vietnam
Extensive use of Chemical agents
“Non-lethal” riot control agents
“Defoliants” (Agent Orange)
Re-defined chemical weapons to exclude
this category of agents

26. Yemen Civil War 1962-1970
Yemeni dissidents overthrew monarchy
Royalist forces aided by Saudi Arabia &
Jordan engaged in Civil War
Egyptians supported dissidents
Egyptian Air Force used chemical weapons
Jan 1967 - Yemeni village of Kitaf
95% population & all animals in village died within
10-50 min of attack
Agent used was mixed mustard & nerve gas

27. 1967 Arab-Israeli War
Both sides were prepared to use
Chemical & Biological agents
Neither side used agents
Probably due to the speed of tactical
operations

28. 1973 Arab-Israeli War
No use of agents
But Israeli captured Arab equipment of
Soviet design/origin demonstrated
sophisticated Chem Defense & Offensive
capabilities
Sparked renewed interest in Chem Defense
in US Military

29. Afghanistan War
Extensive use of Chemical weapons by
Soviet’s against Afghanistan civilians &
mujahedeen (Arabic and or Persian
mujm hn, pl. of mujm
hid hid, one who
fights in a jihad (Holy War))

30. Iran-Iraq War
Iraq trained & influenced by Soviet military
advisors used chem agents against Iranian
military forces
Principally used mustard & Tabun delivered
by bomb from aircraft
Also delivered agents by artillery shells &
chemical rocket systems
Approximately 5% Iranian casualties from chem
attack
Immediately after war used Chem agents
against Kurds

31. 1st Persian Gulf War
Frequent chemical alert alarms - all originally felt
to be false alarms
4 Mar 91 - Kamisiyah arsenal - US Army 37th
Engineer Battalion - blew munitions storage bunkers
Probably Sarin- & Mustard-agent munitions
Wind shift @ start of battle prevented effective
use by Iraqi forces
Speed of advance may also have prevented
effective deployment of chemical agents
Fear of nuclear retaliation

32. Aum Shinrikyo Attacks
27 June 1994 - Sarin gas used in
subway attack - killing 7 & injuring 500
19 March 1995 - Tokyo attack - killing
12 & injuring 3800

33. Chemical Agent:
Definition (FM 8-285)
“A chemical substance…intended for use in
military operations to kill, seriously injure, or
incapacitate humans (or animals) through its
toxicological effects.”

34. Chemical Agent:
Definition (FM 8-285)
“A chemical substance…intended for use in military
operations to kill, seriously injure, or incapacitate
humans (or animals) through its toxicological effects.”
Excluded by FM 8-285
Riot-control agents (CS, CN, DM)
Chemical herbicides (e.g.. Agent Orange)
Smoke and flame materials

35. Excluded Agents: Riot-control Agents
Irritant agents (lacrimators)
 CS (“tear gas”)
 CN (Mace©)
 CA
 CR
Vomiting agents
 DM (Adamsite)
 DA
 DC

36. Riot-control Agents
Local irritants with high safety ratio
Short onset (seconds to minutes)
Short duration (15-30 minutes)
In low concentrations, cause intense pain
and lacrimation (tearing) with (Adamsite only)
or without vomiting

37. Excluded Agents: Herbicides (Defoliants)
Agent Blue (cacodylic acid)
Agent Orange (1:1 mixture of 2.4.5-T and 2.4-D)
 Contaminant: TCDD (Dioxin)
Agent White (4:1 mixture of 2.4-D and picoram)
Paraquat

38. Excluded Agents: Smokes
Petroleum oil smokes (fog oil=SGF)
Diesel fuel
HC
RP (RED phosphorus) in butyl rubber
WP (WHITE phosphorus)
FS
FM

39. Classification of “Official” Chemical Agents
TOXIC AGENTS (producing injury or death)
LUNG-DAMAGING AGENTS (choking agents)
 Chlorine (CL), phosgene (CG) [smokes] [vesicants]
“ BLOOD” AGENTS (cyanogens):
 AC and CK
BLISTER AGENTS (vesicants)
 Mustard (H), Lewisite (L), phosgene oxime (CX), [T-2 mycotoxin]
NERVE AGENTS (anticholinesterases)
 GA,GB,GD,GF,VX
INCAPACITATING AGENTS (producing temporary effects)
 BZ, Agent 15, [riot-control agents]

40. Lung-damaging Agents
Chlorine (CL)
Chloropicrin (PS)
Phosgene (CG)
Diphosgene (DP)
[Mustard (HD, H) Lewisite (L)]
[Smokes] [isocyanates] [PFIB] [oxides of
nitrogen]

41. Chemical-agent Damage to Respiratory System
Central effects (in larynx, trachea, and bronchi)
predominate
Mustard (H, HD)
Lewisite (L)
[Chlorine (CL)]
Peripheral effects (in small airways and alveoli)
predominate
Phosgene (CG)
Perfluoroisobutylene (PFIB)
Nitrogen oxides (NOx)
HC smoke, isocyanates, many others

42. “Blood” Agents (Cyanogens)
Hydrogen cyanide (AC)
Cyanogen chloride (CK)

43. Blister Agents (Vesicants)
Sulfur mustard (H, HD)
Nitrogen mustard (HN1, HN2, HN3)
Lewisite = chlorovinyldichloroarsine (L)
Mustard / Lewisite mixtures (HL, HT, TL)
Phosgene oxime (CX)
[Riot-control agents]
[T-2 mycotoxin]

44. Nerve Agents (Anticholinesterases)
Tabun (GA)
Sarin (GB)
Soman (GD) P
Ach-esterase
r
GF
Atropine
e
VX s
y Ach Acetylcholine
receptor
n
a
p
t Pralidoxime
i
Cholinesterase inhibitor
c

45. “Official” Chemical Agents: Incapacitating Agents
Purpose: Temporary incapacitation
CNS stimulants
 Amphetamines, cocaine, caffeine, nicotine, strychnine, metrazole
CNS depressants
 Barbiturates, opioids, antipsychotics, benzodiazepines
Psychedelics
 LSD-25, psilocybin, ibogaine, harmine, MDMA (“ecstasy”), PCP
Deliriants
 Anticholinergic glycolates (BZ, Agent 15)

46. Physical Forms of Chemical Agents
Solid
Liquid
Gas
Vapor
Aerosol

47. Persistence
Dependent on several factors
Agent volatility (determined by chemical structure)
Temperature
Wind
Agent-surface interactions
“Nonpersistent” agents (usually gone within 24 hours)
GA, GB, GD, CL, CG, AC, CK
“Persistent” agents
VX, L, HL, “thickened” nerve and blister agents (e.g., TGD, THD)

48. Exposure and Absorption
Exposure (contact with agent) does not necessarily
lead to absorption (penetration of epithelial barriers)
Two types of effects from exposure and absorption:
Local
 (effects are at the site of contact)
Systemic
 (absorption and subsequent systemic distribution
produce effects at sites distant from contact site)

49. Routes of Exposure & Absorption
Absorption through skin (percutaneous absorption)
Absorption through lungs (inhalational absorption)
Absorption through eyes (ocular absorption)
Absorption through the gut (enteral absorption)
Absorption by injection (parenteral absorption)
 Intravenous absorption
 Intramuscular absorption

50. Toxicity (Potency) of Liquid Agents
ED50: Effective Dose for 50% of exposed individuals
ID50: Incapacitating Dose for 50% of exposed individuals
LD50: Lethal Dose for 50% of exposed individuals
ID50 for liquid HD(mustard) : 770 mg for a 70-kg man
LD50 for liquid HD: 3000-7000 mg for a 70-kg man

51. Toxicity of Vapors or Gases
The Ct concept: Concentration x time
1 mg / m3 x 8 min = 8 mg-min / m3
8 mg / m3 x 1 min = 8 mg-min / m3
4 mg / m3 x 2 min = 8 mg-min / m3
2 mg / m3 x 4 min = 8 mg-min / m3

52. Toxicity of Vapors or Gases
ECt50: Effective Ct for 50% of exposed individuals
ICt50: Incapacitating Ct for 50% of exposed
individuals
LCt50: Lethal Ct for 50% of exposed individuals
Ct50 assesses external dose, not internal dose
ICt50 and LCt50 therefore affected by
 Route of exposure
 Respiratory rate and depth, skin moisture, etc.

53. Toxicity of HD(Mustard) Vapor
HD vapor in eyes:
ICt50: 200 mg-min / m3
Inhaled HD vapor:
ICt50: 200 mg-min / m3
HD vapor on skin:
ICt50: 1000-2000 mg-min / m3

54. Toxicity of HD (Mustard) Vapor
HD vapor in eyes:
Permanent injury: > 800 mg-min/ m3
Inhaled HD vapor:
LCt50: 1000-1500 mg-min / m3
HD vapor on skin:
LCt50: 10,000 mg-min / m3

55. Comparative Toxicity -
CW Agents
6000
5000
4000
Ct50
(mg-min/m3) 3000
2000
1000
0
AGENT CL CG AC H GB VX BZ CS
(L) (L) (L) (L) (L) (L) (E) (E)

56. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Ammonium bifluoride 1341-49-7
Civilian Uses CW Agent
Ceramics Sarin (GB)
Disinfectant for food equipment Soman (GD)
Electroplating
GF
Etching glass

57. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Diethylphosphite 762-59-2
Civilian Uses CW Agent
Organic synthesis VG
Paint solvent Sarin (GB)
Lubricant additive
Soman (GD)
GF

58. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Diethylamine 124-40-3
Civilian Uses CW Agent
Organic synthesis Tabun (GA)
Pharmaceuticals
Detergents
Pesticides
Gasoline additive
Missile fuels
Vulcanization of rubber

59. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Diethylphosphite 762-59-2
Civilian Uses CW Agent
Organic synthesis VG
Paint solvent Sarin (GB)
Lubricant additive Soman (GD)
GF

60. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Hydrogen Fluoride
Civilian Uses CW Agent
Fluorinating agent chemical reactions Sarin (GB)
Catalyst - alkylation & polymerization Soman (GD)
Additives to liquid rocket fuels
Ethyl sarin (GE)
Uranium refining
GF

61. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Methylphosphonous difluoride 753-59-3
Civilian Uses CW Agent
Organic Synthesis VX
VM
Sarin (GB)
Soman (GD)
GF

62. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Phosphorous oxychloride 10025-87-3
Civilian Uses CW Agent
Organic synthesis Tabun (GA)
Plasticizers
Gasoline additives
Hydraulic fluids
Insecticides
Dopant for semiconductors grade silicon
Flame retardants

63. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Phosphorous trichloride 7719-12-2
Civilian Uses CW Agent
Organic synthesis VG
Insecticides
Gasoline additives Tabun (GA)
Plasticizers Sarin (GB)
Surfactants
Soman (GD)
Salt process
Dye stuffs GF

64. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Sulfur monochloride 10025-67-9
Civilian Uses CW Agent
Organic synthesis Sulfur Mustard
Pharmaceuticals
(HD)
Sulfur dyes
Insecticides
Rubber vulcanization
Polymerization catalyst
Hardening of soft woods

65. Precursors to Chemical Weapons -
Dual Use Technology & Agents
Thionyl chloride 7719-09-7
Civilian Uses CW Agent
Organic synthesis Sarin (GB)
Chlorinating agent Soman (GD)
Catalyst
GF
Pesticide
Engineering plastics Sulfur mustard (HD)
Sesqui mustard (Q)
Nitrogen mustard
(HN-1,HN-2,HN-3)

66. Chemical Weapons
Deployment Principles
Critical Variables in Agent Deployment
Volatility of agent
Persistence of agent
Rate of agent contact with target population
Desired level of geographic coverage

67. Chemical Weapons
Deployment Principles - Volatility
Most CW agents liquids
Transformation of liquid to gas
Add heat to cause enhanced vaporization
Explosive force - exploding munitions
Mechanical spray device
Transformation liquid => gas - major
operational problem
Non-facilitated (room temperature) vaporization
inadequate to develop LCt50 concentrations

68. Chemical Weapons
Deployment Principles - Volatility
Some agents gases under temperate
conditions
Phosgene
Cyanogen chloride
Hydrogen cyanide

69. Chemical Weapons
Deployment Principles - Persistency
More volatile = less persistency
Persistency = length of time agent remains liquid
Persistent by definition > 24 hr in liquid form
Nonpersistent < 24hr in liquid form
Agent persistency - most to least
Vx - Tabun - Mustard - Lewisite - Sarin - Hydrogen
Chloride - Cyanogen Chloride - Phosgene - Chlorine

70. Chemical Weapons
Deployment Principles - Persistency
Sarin - nonpersistent agent
Evaporates within 2 hr on sandy soil @ 50° F (10° C)
Evaporates under 1 hr on sandy soil @ 110° F (43° C)
On chemical resistant surface 15 min @ 50° F (10° C)
On chemical resistant surface 12min @ 100° F (43° C)
Vesicant mustard - persistent agent
Evaporates 100 hr on sandy soil @ 50° F (10° C)
Evaporates 7 hr on sandy soil @ 110° F (43° C)
On chemical resistant surface 12 hr @ 50° F (10° C)
On chemical resistant surface 1 hr @ 100° F (43° C)

71. Chemical Weapons
Deployment Principles - Rate of Agent
Contact With Target Population
6000
5000
4000
Ct50 3000
(mg-min/m3) 2000
1000
0
CL CG AC H GB VX BZ CS
(L) (L) (L) (L) (L) (L) (E) (E)

72. Chemical Weapons
Deployment Principles - Desired level of
Geographic Coverage
Quantity of Agent & Method of Delivery
6000
5000
ƒ( , )
4000
Ct50 3000
2000
(mg-min/m3)
1000
0
CL CG AC H GB VX BZ CS
(L) (L)(L)(L)(L) (L)(E) (E)

73. Weaponization
 Stabilizers -prevent degradation of product
 Thickeners - increase viscosity & persistence of
liquid agents
 Transformation of bulk munitions payload of
agent into weaponized form of agent
• Microscopic droplets (target - respiratory absorption)
• Liquid spray droplets (target - cutaneous absorption)

74. Weaponization
 Military grade munitions generate
• Vapors
– Aerosol (1-7 microns)
– Micro-climate height (6-10’)
• Liquids
– Coarse spray that coats ground

75. Likely Terrorist delivery
systems more primitive
Agricultural sprayers
Crop dusting aircraft efficient vehicles
Orchard pesticide sprayer mounted on truck
Atomizers/spray cans
Paint sprayers
Aerosol generators
Fans

76. Methods Of Target Engagement
Least Efficient
Easiest Technically
Highly Efficient
Difficult Technically

77. Meteorological Effects -
Weapon Efficiency
Temperature
Liquid mustard @ concentration 30 gm/m2
 Persistence several d’s T <50° F (10° C)
 Persistence 1-2 d @ T 80° F (26° C)
Humidity
High relative humidity enlarges aerosols
Wind speed & direction
Affects @risk target population
High winds disperse aerosols
Optimal steady wind @ 4 kts/hr
Precipitation
Light rain disperses & spreads chemical agent
Heavy rains dilutes & disperses agent

78. Nature of Buildings & Terrain
Greater turbulence of primary weapons
cloud in woodland & hilly terrain
Urban targets may result in enhanced
persistence of agent by absorption by
porous building materials
Persistence increased 3X by sandy Vs
clay soil

79. Potential Targets
Point source targets - buildings
Vulnerability is due to accessibility
Entry areas for agent - ventilation &
elevator systems
Defenses
 Surveillance of roof, mechanical rooms,
elevator shafts, utility chases
 Improved locking & access systems to these
resources

80. Agent Indicator Matrix
To use the agent indicator matrix:
Put a check in each row where the indicator is present
At the bottom of the matrix -
total all check marks in each column
Total all marks from each page - The column with the
highest % of checks is most probable agent
Unchecked boxes = N/A A B C D E
Cardiovascular A = Nerve agents
Slow heart rate X X X X B= Blister agents
Fast heart rate X
Digestive System C= Cyanide
Defecation X X X D= Choke agents
Nausea X
E= Riot Control
Subtotal (this page)

81. Agent Indicator Matrix
Unchecked boxes = N/A A B C D E
Appearance
Prostration X X X
Twitching X X X
Convulsions X X X
Coma X X X
Bleeding from mouth X X X
A = Nerve agents
Coughing X B= Blister agents
Sneezing X X
Vomiting X C= Cyanide
Fasciculations X X X X D= Choke agents
Skin
Cyanosis X X X
E= Riot Control
Gray area of dead skin X X X X
Pain, irritation X
Clammy X X X
Sweating, localized or generalized X X X X
Subtotal (this page)

82. Agent Indicator Matrix
Unchecked boxes = N/A A B C D E
Eyes
Small pupils X X X X
Normal, large pupils
Involuntary closing X X X A = Nerve agents
Tearing X
Burning, irritation X
B= Blister agents
Headache, pain around eye X X X X C= Cyanide
Dim vision X X X X
Blurred vision X X X X D= Choke agents
Burning pain in eyes X
Redness X X X
E= Riot Control
Respiratory
Coughing X
Runny nose X
Tight chest (short of breath) X
Burning, irritation in nose X
Total (this page)

83. Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Nerve Vapor- sec Muscle Pinpoint pupils Rapid Inhalation &
Liquid-min/hr cramps, runny (miosis) Disrobing Dermal
nose,difficulty Fasciculation's Water & Atropine 2-6
breathing, eye Sweating Wash with mg IV + 2-
pains, visual
Hyper-salivation soap PAMCL
disturbance, 600-1800 mg
sweating, Diarrhea & shampoo
IV or 1gm IV
diarrhea, LOC, Seizures over 20-30
flaccid Apnea min
paralysis,
seizures Additional
Atropine prn &
additional 1
gm infusion of
2-PAMCL

84. Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Cyanide Secs to Dizziness, Nonspecific Rapid Oxygen,
minutes nausea, findings - Disrobing Amyl nitrate,
headache, eye hyperventilation, Sodium nitrite
irritations, LOC Convulsions, (300 mg IV) &
apnea sodium
thiosulfate
(12.5 gm IV)

85. Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Blister 2-48 hr Burning, Skin erythema, Rapid Inhalation,
Agents itching, or red blistering, Disrobing, dermal
(Sulfur skin, mucosal conjunctivitis & lid Flush with absorption,
Mustard) irritation swelling, upper copious oral ingestion
(tearing, airway sloughing, amounts
burning, pulmonary of water Thermal burn
redness of edema, marrow Rx
eyes), suppression with
shortness of lymphocytopenia Supportive
breath, N&V care
For Lewisite
BAL

86. Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Pulmonary 1-24 hr Dyspnea, ARDS None Inhalation
agents chest usually
(phosgene) tightness, needed Supportive
wheezing, care
mucosal &
dermal Specific Rx
irritation & dependent on
redness agent

87. Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
Ricin 18-24 hr Ingestion - ARDS, circulatory Clothing Inhalation &
(Castor N&V, diarrhea, collapse, shock removal, ingestion
bean toxin) fever, water
abdominal pain rinse Supportive
care
Inhalation -
chest For ingestion
tightness, charcoal
coughing, lavage
weakness,
nausea, fever

88. Agent Summary Chart
Agent Sym onset Syms Signs Decon Route & Rx
T-2 2-4 hr Dermal & Mucosal Clothing Inhalation &
mycotoxin mucosal erythema & removal, dermal contact
irritation; hemorrhage, red water
blistering, skin, blistering, rinse Supportive
necrosis, tearing, care
blurred vision, salivation,
N&V & pulmonary For ingestion
diarrhea, edema, seizures, charcoal
ataxia, & coma lavage
coughing & Possibly high
dyspnea dose steroids

89. Biological Warfare - History I
190 BC - Hannibal hurled venomous
snakes onto enemy ships of King
Eumenes II of Pergamum @
Eurymedon
400 BC Scythian archers used arrows
dipped in blood & manure or
decomposing bodies

90. Biological Warfare - History II
1340 AD
Attackers catapulted dead horses & other
animals at the castle of Thun L'Eveque in
Hainault (northern France)
Defenders
 ”The stink & the air were so abominable...they
could not long endure"
 Negotiated a truce

91. Biological Warfare - History III
1346 AD
Tartars siege of Caffa (Port on the Crimean peninsula in the
Black Sea)
Tartars suffered an outbreak of plague
Before abandoning their attack, they sent the infected bodies
of their comrades by catapult over the walls of the city
Fleeing residents carried the disease to Italy
Second major epidemic "Black Death" in Europe

92. Biological Warfare - History IV
1422 AD
At Karlstein (in Bohemia)
Attacking forces launched the decaying cadavers of men
killed in battle over the castle walls
They stockpiled animal manure in hope of spreading illness
The defense held fast, siege was abandoned @ five months

93. Biological Warfare - History IV
1763 - British Gen Jeffery Amherst
Ft Pitt, Pennsylvania
Ordered blankets & handkerchiefs
taken from smallpox patients in the
fort's infirmary & given to Delaware
Indians at a peace-making parley

94. WWI
1915 - German covert BioWar operations
Glanders - Disease horses/mules - German
saboteurs used against military horses/mules
1917- Only real success infection - 4,500 mules
Mesopotamia

95. Biological Warfare -
Intra-war & WWII
Japan’s Unit 731 (1932 - 1945)
BW research unit - Ping Fan, Manchuria
3000 scientists & techs occupying >150 bldg
Possibly 10,000 prisoners died - BW experimentation
1,000 autopsies on prisoners infected with anthrax
11 Chinese cities attacked using anthrax,
cholera, salmonella, shigella, plague
15 million Plaque infected fleas dropped A/C
1940 - Chuhsien in Chekiang province - 1st episode of
plaque ever seen in the province

96. Post WWII - Accusations
British used BioWeapons in Oman - 1957
Brazilian landowners deliberate infection Amazonian
tribes - 1960’s
China accused US - Cholera epidemic in Hong Kong
1961
Egyptian accusations against US of BioWar in Middle
East, specifically Cholera in Iraq in 1966

97. Post WWII
Ricin toxin assassinations - 1978
Successful attack by Bulgarian Agents
 Georgi Markov - Bulgarian dissident in exile
Unsuccessful attack 10 d’s prior
 Valdimir Kostov - Bulgarian dissident in exile

98. Post WWII
3 April 1979 - Soviet Institute of
Microbiology & Virology
Sverdlovsk - accidental release of Anthrax
66 confirmed deaths
Animal cases seen > 50-km from the site of
release

99. Post WWII
1970's- "Yellow Rain" - T-2 Mycotoxin
Controversial results - government
sponsored research's
Possible use of agents Asia & Afghanistan

100. 1st Desert War
7 August 1995 - Defection of Iraqi General
Hussein Kamal
Iraq had loaded BioWar agents into
166 Bombs (100 botulinum toxin, 50 anthrax, 16
aflatoxin)
25 SCUD/A1 Hussein missile warheads (13
botulinum toxin, 10 anthrax, 2 aflatoxin)
122-mm rockets filled with anthrax, botulinum,
aflatoxin
Spray tanks capable of being fitted to
fighter/bomber aircraft - 2000 L capacity

101. US Offensive
Bioweapons Program
April 1942 - creation US top-secret
BioWar program
All offensive programs ended 25
November 1969
Nixon administration
Executive order
1972 - US signed Biological Weapons
Convention

102. US Offensive
Bio-weapons Program
E-120
Biological
Bomblet

103. Domestic Bioterrorism
1984 - Rajneesh cult contaminated
salad bars with salmonella - 751 cases
of infection
1998 Anthrax spore hoaxes in
Cincinnati, Louisville, Indianapolis

104. Anthrax incidents in US – 1992-1999
Source: Historical Trends Related to Bioterrorism: An Empirical Analysis -Jonathan B.
Tucker, Chemical and Biological Weapons Nonproliferation Project, Center for
Nonproliferation Studies, Monterey Institute of International Studies

105. Aum Shinrikyo Attacks
1993- 1995 conducted up to 10
subway attacks
No casualties
Poor manufacturing technique
Avirulent strain

106. 9-11 Anthrax attacks
1 week after 9-11
Tom Brokaw (NBC News) Anthrax tainted letter
Identical letter to office of New York Times
Senator Tom Daschle - Washington DC
December 2001
 18 patients infected
 5 deaths
 Mass disruption
• Not mass destruction

107. Advantages - Biological Weapons
Potential deadly/incapacitating effects susceptible
populations
Self-replicating capacity of some bio-agents to
continue to proliferate
Relatively low cost of producing bio-weapon
Insidious symptoms can mimic endemic diseases
Difficulty in immediate detection – bio-weapon use
Sparing of property & physical surroundings

108. Disadvantages - Biological Weapons
Bio-war weapon could impact health aggressor forces
Dependence on prevailing winds & other weather
conditions for effective dispersion
Effects of temperature, sunlight, & desiccation on
survivability of some infectious organisms
Environmental persistence of some agents (e.g., anthrax
spores) can make region uninhabitable for long periods
Possibility of generation of secondary aerosols generated
by troops moving through area
Unpredictability of morbidity secondary to biological attack
Relatively long incubation period of many agents
Public's aversion to use of biological warfare agents
Traceable

109. Biological Weapons
Properties
Toxins
Organisms
Spontaneous regeneration
Epidemic organisms

110. Requirements For Ideal
Biological Warfare Agent
Availability or ease of production
Incapacitation and lethality
Appropriate particle size in aerosol
Ease of dissemination
Stability after production
Susceptibility and Non-susceptibility of
Target & Attacking Populations

111. Biological Weapons
Deployment Principles
4 Components - Biological Warfare Strike
The Agent
The Munitions
Delivery System
Meteorological Conditions @ Target Area

112. Agent
Toxin - short incubation period - limited
effectiveness
Bacterial or viral organism with longer incubation
period - causalities over 100’s of square
kilometers
Agent may be Incapacitating Vs Lethal
Agent characteristics
Infectivity
Manufacturability (Quantity)
Stability after manufacture
Stability during deployment
Stability post-release

113. Physical Attributes of
Infective Agent
Liquids
Simple to produce but difficult to disseminate
Dried Form
Complex production but readily disseminated

114. Physical Appearance of
Selected Agents
Liquid agents
Derived from fermentation technology,
tissue culture, & embryonated chicken
eggs
Liquid agents can include bacteria,
bacterial toxins, viruses and rickettsiae

115. Physical Appearance of
Selected Agents
However all have similar physical characteristics
 Viscosity - 5-15 centipoises
 Total solid content of the liquid between 5-20%
This MEANS - liquid is significantly thicker than
water & less thick than light pancake syrup
 Think slightly less viscous than whole milk
Color of liquids vary dramatically
 Bacterial agents & toxins derived from fermentation -
opaque amber to brown colored
 Egg-derived liquid agents color of egg yolk (if whole egg
processed) to slightly pink to red (if only embryo has
been processed)

116. Dried Agents
If actor is able to produce agents via tissue
culture technology
Then has technology to produce dried agents
Consistency of bath powder
Ideal dried agent has free flowing properties

117. Dried Agents
Color of agent reflects the liquid from which derived
Dried bacterial agents tend to be amber to brown
Viral agents derived from tissue culture off-white
Viral & rickettesia from embroynated chicken eggs either
brown to yellow to pink to red
However, color of powders can easily be altered with dyes

118. Physics of Primary Aerosol
Aerosol equilibration - time interval between
release & full aerosolization of liquid/powder
Large particles (≥ 15 microns) do not remain in
the air but quickly fall to ground
Within a minute - aerosol comes to equilibrium
with atmosphere
Aerosol is now composed of particles of 1-5
microns - behaves like a gas - Primary Aerosol
Primary Aerosol formation is essential for
efficient release of agent

119. Physics of Primary Aerosol
Primary Aerosol can traverse heavily forested
areas without degradation
Similarly for a ‘victim’
Aerosol will permeate the atmosphere about the individual
Few if any particles will stick to person’s clothing or
objects in aerosol path
Infectivity is high since ‘victim” will exchange 10-20 l/min
Conversely encountering a 15-20 micron particles will not
result in high attack rates of illness

120. Secondary Aerosol
Re-aerosolization of infectious particles
Fell to ground from primary aerosol
Forced onto ground by disseminating device
Deliberately sprayed or layered onto ground
Generated by people or vehicles stirring up
particles
In fact are difficult to generate & require extremely
sophisticated techniques to manufacture into
agents physical properties

121. Biological Decay in Aerosols
Aerosol decay occurs through physical decay (fall out
of particles) & biological decay
Respiratory virulence & biological decay most
important factors determining how far downwind
bacterial aerosol will be infective
Biological decay is expressed in terms of % death per
minute of aerosol age & follows a geometric
progression
ie, Biological decay of 20% per minute implies that total
viable content of aerosol is halved every 3.5 minutes of age

122. Munitions
Sophisticated munitions can result in ‘point-
source’ or ‘line-source’
Beyond capabilities of even most organized
terrorist groups
Terrorists most likely will employ liquid
agent

123. Munitions
Crud bomb could disseminate liquid/dry agent
using explosive energy
Explosion will kill a large percentage of agent
Gaseous energy best way to generate high agent
concentrations in aerosol but technically
challenging

124. Terrorist deployments
Liquid agent
Single-fluid nozzle efficiency - 600 PSI
Two-fluid nozzle efficiency - 90 PSI
Dried agent - requires high sophistication
High agent concentration
Small particle size
Absence of electrostatic charge

125. Weaponization
However, payoff is equally high - efficient
dissemination from any number of devices
using little energy
ABC fire extinguisher placed upwind of
intended target or air intake of a building can
produce large number of infections

126. Delivery Systems
ANYTHING that can cause aerosol
Truck-mounted sprayer
Crop Dusters
2-gallon garden sprayer or fire extinguisher

127. Meteorological Conditions
Critical For ”Open-air" Targets
Aerosolized weapon maximum effectiveness @ 3-15 ft
Thermal inversion represents ideal environment
Inversion most likely @ night, daybreak, sundown
Sunlight highly destructive to most BW agents
Toxins & spores of Bacillus anthracis & Coxiella burnetii
Wind also important factor for aerosol attack
Optimal 5-25 mph
< 5-mph limited spread
>25-mph aerosol disintegrates

128. Liquid & Dry agents Can Be Disseminated
Over Wide Temps & Environments
Many BW experts expect terrorist use
against non-open air targets
Buildings
Subway stations
Interstate tunnels

129. Alternative Delivery Methods
Oral route - not very efficient - dilution &
diffusion factors + chlorination makes public
water sources poor targets
Contamination of foods & fruits @ point of
manufacture & along distribution pathways
Dermal exposure not effective means of
dissemination
Vector transmission - logistically difficult to
carry out

130. Agent Summary Chart
Agent Sym onset Syms Signs Rx
Anthrax 2-6 d Inhalation Inhalation Mechanical
Flu-like Fever followed by ventilation
Range 1 d syndrome, ARDS, confusion, Antibiotic therapy
to 8 wks N&V, abd pain, widened CIPRO 400 mg IV Q
fever, mediastinum on 8-12 hr or
respiratory CXR, bloody pleural Doxycycline 200 mg
distress effusions, atypical IV initial then 100
pneumonia mg IV Q 8-12 hr
Cutaneous Cutaneous PLUS Rifampin 10/
Itching papule, Itching papule, 1-3 mg/kg/d
fever cm painless ulcer
then necrotic center,
lymphadenopathy

131. Agent Summary Chart
Agent Sym onset Syms Signs Rx
Botulism 12-72 hr Difficulty Dilated or un Mechanical
swallowing or reactive pupils, ventilation
speaking, drooping eyelids
Range
symmetric (ptosis), doubled
2 hrs - 8 Parental nutrition
descending vision, slurred
ds weakness speech (dysarthria),
Respiratory descending flaccid Trivalent botulinum
dysfunction paralysis, intact antitoxin
No sensory mental state
dysfunction

132. Agent Summary Chart
Agent Sym onset Syms Signs Rx
Plague 1-3 d’s Sudden onset Pneumonic - Streptomycin 30mg/kg/
by fever, chills, Hemoptysis, d in 2 divided doses X
inhalation headache, radiographic 14 ds
myalgia pneumonia--patchy, Gentamycin 3-5 mg/kg/
cavities, confluent, d IV/IM Q8hr
consolidation,
Pneumonic - TCN 2-4 gm per day,
hemoptysis,
cough, chest CIPRO 400 mg IV Q
cyanosis
pain, dyspnea, 12 hr
fever Bubonic - painful,
enlarged lymph
nodes in groin,
Bubonic - axilla,& neck
painful lymph
nodes

133. Agent Summary Chart
Agent Sym Syms Signs Rx
onset
Tularemia 2-5 d’s Fever, cough, Community-acquired Streptomycin 30mg/kg/
“Pneumonic” Range chest atypical pneumonia, d in 2 divided doses X
tightness, Radiographic 14 ds
1-21 d’s
pleuritic pain, bilateral patchy Gentamycin 3-5 mg/kg/
hemoptysis pneumonia with hilar d IV/IM Q8hr
(rarely) adenopathy (TB like CIPRO 400 mg IV Q
pleural effusions) 12 hr (Change to PO
Diffuse, varied skin after clinical
rash, may be rapidly improvement) X 10-14
fatal d’s

134. Agent Summary Chart
Agent Sym Syms Signs Rx
onset
Smallpox 12-14 High fever & Maculopapular then Supportive care
d’s myalgia, vesicular rash - 1st Vaccinate care-givers
itching, on extremities (face, Experimental
abdominal arms, palms, soles,
Range Cidofovir
pain, delirium, oral mucosa), Rash
7-17 d’s rash on face, with hard, firm
extremities, pustules (intradermal
hands, feet, blisters), RASH IS
confused with SYNCHRONOUS on
chickenpox various segments of
which has less body
uniform rash

135. Initial Discovery Procedures
Put on Personal Protective Equipment
Meissner’s 1st Law of Combat Medicine - Don’t
Become A Causality Yourself
Stay upwind/stay uphill
If PPE not available maintain distance of 300
feet from scene
If PPE is available maintain distance 75 feet
Until Agent & concentration determined
Exercise extreme caution IF
Biological attack

136. Initial Discovery Procedures
Observe & annotate the following
Exact location of incident
Wind direction & weather conditions
Plume direction if visible (generally not visible)
Orientation of victims
Number of victims
Suggested safe access routes & staging areas

137. Gross Decontamination Procedures
If vapor attack
Place outside in breeze
May only require removal of outer clothing
Liquid contamination
Remove outer clothing
Flush victim with water &/or hypochlorite &
water

138. Site Set-Up Procedures
3 Zones
Hot (Exclusion ) Zone
Warm (Contamination reduction ) Zone
Cold (Support) Zone
All zones - upwind & uphill from other zones

139. Hot Zone
Adjacent to incident scene
Rescuer or EOD personnel only in this zone
All personnel in protective gear
Single Entry Control Point (ECP)
Total accountability for personnel in zone
ECP minimum of 25 meters upwind from
source
Minimal medical treatment
Airway
Hemorrhage control
Administer antidote

140. Warm Zone
Upwind & uphill from hot zone
Rescue, medical, & decontamination
personnel in this zone - all in PPE
Entry to Warm Zone from Hot Zone via ECP
Exit is via separate patient transfer point
All personnel entering/exits & all patient exits
must be logged
Zone is minimum of 15’ (5 m) wide
Warm triage point is where rapid triage of
victims takes place

141. Warm Zone
Immediate category patients go through liter
decontamination
Ambulatory victims & warm zone personnel go
through ambulatory decontamination
Patients exit Warm Zone via patient transfer point
No contaminated material enters Cold Zone

142. Cold Zone
Upwind & uphill from Warm Zone
All personnel have protective equipment @
hand (wind shift or improper decontamination)
Patients enter via patient transfer point & go
through cold triage point

143. Casualty Decontamination Center
CONTAMINATED SHUFFLE PIT
DUMP 75M
2 3 4 6
ARRIVAL
POINT 60M
30M
MTF
1 3 4
1 TRIAGE 5
2 EMT
3 CLOTHING REMOVAL
4 SKIN DECON HOT LINE
5 CLEAN EMT
6 DISPOSITION
PREVAILING WINDS

144. Casualty Decontamination Center
Arrival Triage / EMT Decon Clean Treatment
Triage Ambulatory Decon
Arrival Clean Clean
Station Disposition
Point Treatment
(dirty) Area
Area
Litter Decon
(Dirty dump)
Dirty
Disposition EMT
Area Station
Evacuate (clean)
Evacuate (dirty) Dirty Clean
or return to duty

145. Agent Removal
Two methods of agent removal
Physical & Chemical
Physical Methods
 Simply scraping off visible agent - highly
effective
 Copious flushing with water - problems
containing waste water & thermal protection
 Absorbent materials such as earth, dry soap
powder, Fuller’s earth, or flour
 Water/soap mixture can be highly effective

146. Agent Removal
Chemical methods
 5% chlorine solution for decontamination of
equipment
• 48 ounces (1.4 kg) calcium hypochlorite to 5 gallons
(19 liters) H20
• If necessary 5% solution can be used for skin,
however, must rinse off within 10’ of application
 0.5% chlorine solution for decontamination of
skin or wounds
• 6 ounces (170 gm) calcium hypochlorite to 5 gallons
(19 liters) H20

147. Decontamination Equipment
 Chlorox™ bleach 5.25% hypochlorite solution &
can be used directly from the bottle
 Calcium hypochlorite available as dry
swimming pool/spa chlorine
 Plastic garbage can (50-60 gallon (190-230 liter)
 Sponges, brushes, & pressurized garden
sprayers

148. Care and Decontamination
of Litter Patients
Remove gross contamination
Transfer to decontamination prep litter
Cut away all clothes & remove personal property
Transfer to decontamination litter
Decontaminate patient with 0.5% hypochlorite
(blotted)
Shower with copious amounts of water
Transfer to patient treatment area

149. Decontamination Pointers
Contaminated clothing dump @ least 240’
downwind of decontamination station
Rub, Scrub, & Flush
Efficient technique is to use small
commercial above-ground pools
Careful use of chlorine in enclosed spaces

150. Threat Analysis
Multiple technical drawbacks to CBW
Toxins/pathogens/toxic chemicals need
Sophisticated handling, storage, delivery
Weaponized shelf life is short unless stored in
controlled environment
Clandestine production is difficult
Basic techniques for production simple
Dual use technologies heavily scrutinized
Use of missiles expensive per pound of
payload/lethality
Climate critical for efficacy

151. Threat Analysis
Seaport targets
Attractive from military standpoint
Classical ‘Choke Points’
Majority of combat logistics & troop movements
still use seaborne lanes of communication
Disrupt transportation of goods & foodstuffs
Difficult to control access to seaport
Terrorist does not have to physically penetrate the
US immigration procedures
Ability to concentrate large quantities of
weaponized agent
Traditionally has poor security

152. Threat Analysis
Seaport targets
Have sophisticated & criminal elements used to subverting custom &
security measures
 Drug smugglers
 Illegal alien transporters
Downsides
Meteorological conditions poor for attack
 Usually have significant winds that preclude adequate aerosol production
 Immersed in the ultimate & universal solvent - H20
 Has large workforce available for effective disaster response
 Has sophisticated machinery available for decontamination procedures
 Large storage facilities ideal for decontamination operations