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Terrorism-Related Chemical, Biological, Radiation, and Nuclear Attacks: A Historical Global Comparison Influencing the Emergence of Counter-Terrorism Medicine

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  30 June 2021

Derrick Tin Open the ORCID record for Derrick Tin [Opens in a new window] ,
Fredrik Granholm ,
Alexander Hart  and
Gregory R. Ciottone
Derrick Tin*
Affiliation:
Senior Fellow, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA
Fredrik Granholm
Affiliation:
Department of Emergency Medicine and EMS, Sundsvall County Hospital, Sundsvall, Sweden
Alexander Hart
Affiliation:
Director of Research, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Instructor, Harvard Medical School, Boston, MassachusettsUSA
Gregory R. Ciottone
Affiliation:
Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA
*
Correspondence: Derrick Tin, MBBS, Senior Fellow, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts02215-5491USA, E-mail: derrick@alphazodiac.com
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Abstract

Background:

Terrorist attacks are growing in complexity, increasing concerns around the use of chemical, biological, radiation, and nuclear (CBRN) agents. This has led to increasing interest in Counter-Terrorism Medicine (CTM) as a Disaster Medicine (DM) sub-specialty. This study aims to provide the epidemiology of CBRN use in terrorism, to detail specific agents used, and to develop training programs for responders.

Methods:

The open-source Global Terrorism Database (GTD) was searched for all CBRN attacks from January 1, 1970 through December 31, 2018. Attacks were included if they fulfilled the terrorism-related criteria as set by the GTD’s Codebook. Ambiguous events or those meeting only partial criteria were excluded. The database does not include acts of state terrorism.

Results:

There were 390 total CBRN incidents, causing 930 total fatal injuries (FI) and 14,167 total non-fatal injuries (NFI). A total of 347 chemical attacks (88.9% of total) caused 921 FI (99.0%) and 13,361 NFI (94.3%). Thirty-one biological attacks (8.0%) caused nine FI (1.0%) and 806 NFI (5.7%). Twelve radiation attacks (3.1%) caused zero FI and zero NFI. There were no nuclear attacks. The use of CBRN accounted for less than 0.3% of all terrorist attacks and is a high-risk, low-frequency attack methodology.

The Taliban was implicated in 40 of the 347 chemical events, utilizing a mixture of agents including unconfirmed chemical gases (grey literature suggests white phosphorous and chlorine), contaminating water sources with pesticides, and the use of corrosive acid. The Sarin gas attack in Tokyo contributed to 5,500 NFI. Biological attacks accounted for 8.0% of CBRN attacks. Anthrax was used or suspected in 20 of the 31 events, followed by salmonella (5), ricin (3), fecal matter (1), botulinum toxin (1), and HIV (1). Radiation attacks accounted for 3.1% of CBRN attacks. Monazite was used in 10 of the 12 events, followed by iodine 131 (1) and undetermined irradiated plates (1).

Conclusion:

Currently, CBRN are low-frequency, high-impact attack modalities and remain a concern given the rising rate of terrorist events. Counter-Terrorism Medicine is a developing DM sub-specialty focusing on the mitigation of health care risks from such events. First responders and health care workers should be aware of historic use of CBRN weapons regionally and globally, and should train and prepare to respond appropriately.

Keywords

biowarfareCBRNchemical weaponscounter-terrorism medicinedisaster medicinenuclearradiationterrorism
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 4 , August 2021 , pp. 399 - 402
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Barton, G. In COVID’s shadow, global terrorism goes quiet. But we have seen this before, and should be wary. The Conversation. Published August 14, 2020. https://theconversation.com/in-covids-shadow-global-terrorism-goes-quiet-but-we-have-seen-this-before-and-should-be-wary-144286. Accessed December 22, 2020.Google Scholar
Kruglanski, AW, Gunaratna, R, Ellenberg, M, Speckhard, A. Terrorism in time of the pandemic: exploiting mayhem. Glob Secur Heal Sci Policy. 2020;5(1):121–132.CrossRefGoogle Scholar
Court, M, Edwards, B, Issa, F, Voskanyan, A, Ciottone, G. Counter-Terrorism Medicine: creating a medical initiative mandated by escalating asymmetric attacks. Prehosp Disaster Med. 2020;35(6):595–598.CrossRefGoogle ScholarPubMed
Tin, D, Hart, A, Ciottone, GR. Rethinking disaster vulnerabilities. Am J Emerg Med. 2020;S0735-6757(20):30973–30976.Google Scholar
National Consortium for the Study of Terrorism and Responses to Terrorism (START). Codebook: Inclusion Criteria and Variables. College Park, Maryland USA: START; 2019.Google Scholar
Memorandum to Convention on Conventional Weapons Delegates the Human Suffering Caused by Incendiary Munitions. http://www.hrw.org/en/news/2010/11/22/memorandum-ccw-delegates. Accessed December 9, 2020.Google Scholar
Background of the Cult - A Case Study on the Aum Shinrikyo. Global Proliferation of Weapons of Mass Destruction. Published 1995. https://fas.org/irp/congress/1995_rpt/aum/part03.htm. Accessed November 23, 2020.Google Scholar
Danzig, R, Sageman, M, Leighton, T, et al. Aum Shinrikyo: insights into how terrorists develop biological and chemical weapons. https://www.cnas.org/publications/reports/aum-shinrikyo-insights-into-how-terrorists-develop-biological-and-chemical-weapons. Accessed November 23, 2020.Google Scholar
Clarke, SA, Weir, AGA. UK resilience to a chemical incident. BMJ Mil Health. 2019;166(2)95–98.CrossRefGoogle ScholarPubMed
Riches, JR, Read, RW, Black, RM, Cooper, NJ, Timperley, CM. Analysis of clothing and urine from Moscow Theatre siege casualties reveals carfentanil and remifentanil use. J Anal Toxicol. 2012;36(9):647–656.CrossRefGoogle ScholarPubMed
TEMS Position Statement. National Tactical Officers Association. https://www.ntoa.org/sections/tems/tems-position-statement/. Accessed January 19, 2021.Google Scholar
Vayer, JS, Schwartz, RB. Developing a Tactical Emergency Medical Support Program. Top Emerg Med. 2003;25(4):282–298.Google Scholar
Hartle, M. Seven Components of a Successful TEMS Program | EMS World. Published 2015. https://www.emsworld.com/article/12056563/seven-components-of-a-successful-tems-program. Accessed January 19, 2021.Google Scholar
Heiskell, L. “Tactical Medicine and Combat Casualty Care.” In: Auerback, P, Cushing, T, Harris, NS. Auerbach’s Wilderness Medicine. 7 th ed. Amsterdam, Netherlands: Elsevier; 2016.Google Scholar
Schwartz, R, Lerner, B, Llwewllyn, C, et al. Development of a national consensus for Tactical Emergency Medical Support (TEMS) training programs--operators and medical providers. J Spec Oper Med. 2014;14(2):122–138.Google ScholarPubMed
Counter Narcotics and Terrorism Operational Medical Support (CONTOMS) - United States Park Police (US National Park Service). https://www.nps.gov/subjects/uspp/contoms.htm. Accessed January 12, 2021.Google Scholar
Certified Tactical Paramedic Handbook. Snellville, Georgia USA: International Board of Specialty Certification; 2019.Google Scholar
Byers, M. Deliberate chemical attack: revisiting the lessons of the Tokyo subway attack. Scand J Trauma Resusc Emerg Med. 2014;22(S1):10–13.CrossRefGoogle Scholar
Ciottone, GR. Toxidrome recognition in chemical-weapons attacks. N Engl J Med. 2018;378(17):1611–1620.CrossRefGoogle ScholarPubMed
Lockey, DJ. The shootings in Oslo and Utøya island July 22, 2011: lessons for the international EMS community. Scand J Trauma Resusc Emerg Med. 2012;20(1):4.CrossRefGoogle ScholarPubMed
Hunt, P. Lessons identified from the 2017 Manchester and London terrorism incidents. Part 1: introduction and the prehospital phase. JR Army Med Corps. 2018;166(2):111–114.Google ScholarPubMed
Hallikainen, J, Lund, V. A national model for Tactical Emergency Medical Support in Finland. Prehosp Disaster Med. 2019;34(s1):s13.CrossRefGoogle Scholar
Corcostegui, SP, Galant, J, Pasquier, P, et al. Military medical response of the French gendarmerie to terrorist events. BMJ. 2020;368.Google ScholarPubMed
American College of Emergency Physicians. What is Tactical Medicine? Published 2020. https://www.acep.org/how-we-serve/sections/tactical-emergency-medicine/what-is-tactical-medicine/. Accessed January 19, 2021.Google Scholar
Park, CL, Langlois, M, Smith, ER, et al. How to stop the dying, as well as the killing, in a terrorist attack. BMJ. 2020;368.Google ScholarPubMed
Miletta, S. Into the warm zone: essential elements and considerations for developing warm zone capabilities. JHTAM. 2021;3(1).CrossRefGoogle Scholar
Martaindale, MH, Blair, JP. The evolution of active shooter response training protocols since Columbine: lessons from the advanced law enforcement rapid response training center. J Contemp Crim Justice. 2019;35(3):342–356.CrossRefGoogle Scholar
Chilcott, RP, Larner, J, Matar, H. UK’s initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals. Emerg Med J. 2019;36(2):117–123.CrossRefGoogle ScholarPubMed
Calamai, F, Derkenne, C, Jost, D, et al. The chemical, biological, radiological and nuclear (CBRN) chain of survival: a new pragmatic and didactic tool used by Paris Fire Brigade. Crit Care. 2019;23(1).CrossRefGoogle ScholarPubMed
DeFeo, DR, Givens, ML. Integrating chemical, biological, radiologic, and nuclear (CBRN) protocols into TCCC introduction of a conceptual model - TCCC + CBRN = (MARCHE)2. J Spec Oper Med. 2018;18(1):118–123.Google ScholarPubMed
Tin, D, Hart, A, Ciottone, GR. Hardening hospital defenses as a counter-terrorism medicine measure. Am J Emerg Med. 2020;S0735-6757(20):30947–30955.Google Scholar