As in all hazmat topical areas, the WMD arena is rife with acronyms. One such acronym — NBC — describes three of the major categories of WMD agents (nuclear, biological and chemical). Although we are familiar with other similar acronyms (CBRNE, BNICE, etc.), in this discussion we will key in on the three major categories referenced in the NBC acronym.
How Will We Know that a WMD Incident Has Occurred?
Apart from any collateral explosion or evident dispersion of a WMD agent, we will have to play the role of epidemiologist and rely on the clues presented to us in the form of patterns of mass casualties and the signs and symptoms presented by victims of the incident.
In any type of WMD incident with a readily apparent initiation, there will normally be a state of chaos as the commonly accepted ratio of unaffected persons to affected persons is five or six to one — meaning that for every person actually exposed to the WMD agent and exhibiting exposure symptoms, five or six persons will be unaffected.
On the psychological level, however, those five or six persons that are unaffected for every affected person will be exiting the area and self-referring to local hospitals as quickly as possible when the signs and symptoms of those affected are noticed. As can be seen, scene control and incident management practices are of paramount importance.
Although there is no doubt that a dispatch to a possible WMD incident will raise the pulse rate of any responder, such incidents should not be addressed as a type of “black ops” involving mystery and speculation, as sound standard hazardous materials response techniques such as setting up initial isolation and protective action distances; delineating hot, warm and cold zones; determining the product or products involved; setting up proper decontamination measures, and resolving the exposure problems arising from the product or products apply to WMD incidents. In addition, there are many resources that we can rely on to guide us in our response to WMD incidents.
The “DOT Emergency Response Guidebook” can be a valuable aid that assists us in making educated response choices during the initial phases of an incident. Certain electronic versions of the ERG even include a dedicated section referencing WMD agents. Another valuable resource is the “WMD Response Guidebook” produced by the National Center for Biomedical Research and Training (NCBRT), which provides the typical signs and symptoms exhibited with exposure to various WMD agents.
While there are a myriad of detection devices that allow us to determine the exact WMD agents that we are dealing with, the signs and symptoms exhibited by exposed persons (and any other initial information such persons and/or other witnesses may give) often is the best method of at least narrowing down the possibilities of the agent or agents we are encountering during the initial phases of an incident.
While it is still possible for a major nuclear attack to occur, the likelihood of such an attack occurring is not as great as during the days of the Cold War in which school children were taught to “duck and cover” in the event of an attack utilizing nuclear devices. The same theory applies to portable nuclear devices designed to kill or injure by the force of their blast alone, as such devices would emit radioactivity that is easily detected and would normally be excessively heavy to transport. Responders are far more likely to encounter a “dirty bomb” or radiological dispersion device (RDD) in which radioactive sources are wrapped around an explosive that is designed to propagate or disperse radiological contamination over an area; or a simple conventional dispersion of radioactive sources.
In an incident involving a radiological source, the protection tenets of time, distance, and shielding should always be remembered. In addition, we have the element of monitoring and detection on our side, as we should know as Hazmat Technicians are able to effectively perform radiological monitoring.
In terms of the signs and symptoms of persons exposed to radiological sources, such victims may present with symptoms varying according to the level of exposure ranging from nausea and vomiting to bleeding and rapid death. Such symptoms may not, however, manifest themselves for a long period of time. Victims close to the initial blast of an RDD may also display wounds from shrapnel and the initial explosion itself. Sound decontamination practices utilizing water and detergent are of paramount importance to reduce secondary or cross contamination in such an incident.
Biological agents are divided into three sub-categories, consisting of bacteria, viruses and toxins. Bacteria are microorganisms that are present in most environments on earth. Viruses are small infectious agents that only replicate inside the living cells of organisms, while toxins are poisonous substances produced in living cells or organisms. As the inhalation route of exposure is normally the easiest and most effective route of exposure for humans, biological agents in the size range of one to five microns present the greatest threat due to the fact that such particles can migrate into the alveoli within the lungs, whereas the travel of larger particles is usually restricted to the upper respiratory system.
Examples of bacteriological biological agents include anthrax and plague. Anthrax exhibits an incubation period (the time between exposure and the presentation of symptoms) of one to six days, while plague has an incubation period of two to three days. While anthrax and bubonic plague are not contagious, pneumonic plague is. The signs and symptoms of anthrax include chills, fever, nausea and swollen lymph glands; while those for plague include chills, high fever, headache, spitting up blood and shortness of breath. Standard precautions should be utilized for anthrax, while standard and droplet precautions should be utilized for plague.
Viral biological agents include smallpox and viral hemorrhagic fever. The incubation period for smallpox is seven to 17 days, while that for viral hemorrhagic fever is four to 21 days. Both viruses are contagious, and the symptoms range from fever, rigor, vomiting, headache, and pustules for smallpox to fever, vomiting, diarrhea, and blotchy skin for viral hemorrhagic fever. The precautions to be utilized for smallpox include standard, airborne and contact; while viral hemorrhagic fever necessitates standard, airborne, droplet and contact precautions.
The final sub-category of biological agents — toxins — is exemplified by botulinum and ricin. Both toxins are not contagious, and botulinum exhibits an incubation period of one to three days while that of ricin is one to seven days. Ricin is one of the easiest biological agents to produce, as it is processed from the readily accessible castor bean. The signs and symptoms of botulinum exposure include weakness, dizziness, dry mouth and throat; blurred vision, and paralysis; while the signs and symptoms of ricin exposure include nausea, vomiting, bloody diarrhea, gastrointestinal cramps, and shortness of breath. Standard precautions should be utilized for both. In terms of the choice of decontamination agent for biological agents, a bleach/water solution is generally used, with concentrations ranging from as low as 0.5 percent bleach to as high as 50 percent bleach dependant on the incident itself and whether the decontamination involves persons or objects.
Chemical agents can be sub-categorized into toxic industrial chemicals and warfare agents. Toxic industrial chemicals utilized as WMD agents can be further subdivided into the categories of choking and blood agents. Choking agents include chlorine and phosgene, which induce symptoms of coughing, choking, and tightness in the chest. Chlorine exhibits an odor of bleach, while phosgene smells like mown hay. Both chemicals require the use of respiratory and skin protection. Blood agents include hydrogen cyanide and cyanogen chloride, which exhibit an odor of bitter almonds. The signs and symptoms of both include gasping for air and red eyes, lips and skin. Respiratory and skin protection is needed, and a cyanide antidote such as amyl nitrite can be administered. Toxic industrial chemicals utilized as WMD agents usually have vapor pressures in excess of one atmosphere.
Chemical warfare agents can be further subdivided into blister and nerve agents. Blister agents include sulfur mustard (coded H), nitrogen mustard (HN), lewisite (L), and phosgene oxime (CX). The vapor pressures of blister agents range from 0.072 mmHg for sulfur mustard to 13 mmHg for phosgene oxime, meaning that such agents are persistent in the liquid state but give off relatively low amounts of vapor.
The vapor densities for blister agents are greater than one, meaning the vapors emanating therein are heavier than air. As an example indicative of other blister agents, sulfur mustard is an oily liquid that freezes at 57 degrees Fahrenheit and exhibits a garlic or mustard odor. Symptoms associated with blister agents include burning, gritty eyes; delayed blisters, raspy cough, and severe respiratory damage. Respiratory and skin protection is needed, and decontamination is paramount.
Nerve agents include G-agents such as tabun (GA), sarin (GB), and soman (GD); and V-agents such as VX. Nerve agents normally have low vapor pressures (0.0007 mmHg for VX and 2.9 mmHg for GB) and vapor densities greater than one. Nerve agents exhibit a fruity or sulfur odor, and the symptoms presented include the pinpointing of pupils, vomiting, diarrhea, difficulty breathing, salivation, twitching and convulsions. Respiratory and skin protection is needed, as well as decontamination and the administration of an antidote such as 2 PAM chloride. As a memory aid for the symptoms exhibited from exposure to chemical agents in general (and nerve agents in particular), we can use the acronym SLUDGE, which stands for salivation, lacrimation (tearing), urination, defecation, gastrointestinal distress, and emesis (vomiting).
In summation, we should approach a possible WMD incident utilizing sound hazmat response principles and the knowledge we have of WMD agents themselves. The greatest “tool” we can use in the initial stages of an incident to determine the type of WMD agent we are encountering is the signs and symptoms presented by those persons exposed to the agent. We should not be inordinately concerned about the response to such incidents, but in the same vain we should respond armed with the knowledge of the characteristics of and hazards presented by WMD agents.
As always, be safe out there and be sure to visit the North Carolina Association of Hazardous Materials Responders website at www.nchazmat.com.
Glenn Clapp is President of the North Carolina Association of Hazardous Materials Responders and is a Fire Training Commander (Special Operations) for the High Point Fire Department. He is a Technician-Level Hazmat Instructor, a Law Enforcement Hazmat Instructor, and is a Certifi ed Hazardous Materials Manager and Certifi ed Fire Protection Specialist.