The management of nuclear, biological and chemical (NBC) terrorism events is critical to reducing morbidity and mortality in the next decade; however, initial patient care considerations and protective actions for staff are unfamiliar to most front-line clinicians. High explosive events (bomb and blast) remain the most common type of terrorism and are easy to detect. Conversely, some types of terrorist attacks are more likely to be unsuspected or covert. This paper explains the current threat of terrorism and describes clues for detection that an event has occurred. Specific criteria that should lead to a high suspicion for terrorism are illustrated. The manuscript outlines initial actions and clinical priorities for management and treatment of patients exposed to nuclear/radiological, biological, chemical and combined agents (for example an explosion involving a chemical agent). Examples of terrorist events include: a nuclear explosion, an aerosolised release of anthrax (biological), dissemination of sarin in a subway (chemical), and the detonation of a radiologic dispersion device or "dirty bomb" (combined explosive and radiological). Basic principles of decontamination include potential risks to healthcare providers from secondary exposure and contamination. Unique issues may hinder clinical actions. These include coordination with law enforcement for a crime scene, public health entities for surveillance and monitoring, hazardous materials teams for decontamination, and the media for risk communications. Finally, the importance of personal preparedness is discussed.
Biological Warfare Agents ; Chemical Warfare Agents ; Civil Defense ; Nuclear Weapons ; Terrorism

Animals ; Biological Warfare ; Burns ; pathology ; Burns, Chemical ; pathology ; Chemical Warfare ; China ; Humans ; Military Medicine ; Radiation Injuries ; pathology ; Wounds, Gunshot ; pathology

The recent cases of anthrax due to bioterrorism in the United States have reminded us that our society is also vulnerable to biological attacks. Illnesses due to bioterrorism are not naturally occurring diseases, and therefore may show presentations not familiar to many doctors. The last case of smallpox was reported in 1960, and doctors aged less than 60 years have no experience of smallpox. Anthrax is a rare zoonosis, and no case of inhalation anthrax has been reported in Korea. American doctors might be on high alert to bioterrorism after September 11, 2001. However, it took more than 2 weeks from the symptom onset of the index case to the recognition that anthrax outbreak had occurred due to bioterrorism. This delay shows how difficult it is to recognize bioterrorism. This article describes clinical recognition and management of patients exposed to biological warfare agents, especially agents causing anthrax, smallpox, plague, and botulism.
Anthrax ; Biological Warfare Agents* ; Biological Warfare* ; Bioterrorism ; Botulism* ; Humans ; Inhalation ; Korea ; Plague* ; Smallpox ; United States

This paper introduced the detailed strategy to manage the impact of chemicowar in Vietnam including the detoxication in the environment, development of forest, plant for fruits and industry, prevention from forest destroy and management of long-term bad outcomes in human.
Chemical Warfare ; therapeutics

The Laboratories engaging with microorganisms have some potential risks, depending on handling of pathogens. The safety management system to extend recognition of biosafety and biosecurity needs to be established and practiced in order to prevent hazard possibility and secure safety of researchers who deal with pathogen. As the importance and regulation of global biosafety and biosecurity tended to be intensified, various laws and institutions for the security of biosafety were established when the Act on implementation of Living Modified Organisms, an implantation act of Cartagena was enforced in Korea in 2008. In particular, the system of permission report for Living Modified Organism (LMO), Highly Dangerous Pathogens (HDPs) and Biological Weapons Convention (BWC), in order to prevent intended or non-intended leakage and occurrence of biohazard derived from pathogen and infectious substance and safely use them. The bioterrorism can be controlled and autonomous management of biosafety by agencies that handle pathogens can be also secured by practicing the various laws and institutions.
Biological Warfare Agents ; Bioterrorism ; Jurisprudence ; Korea ; Safety Management

OBJECTIVESTo review the calendar, mortality and morbidity of Iraq-Iran chemical war among Iranians based on researchers'reports.

METHODSWe used national and international databanks such as PubMed, ISI, Scopus, Irandoc and Iranmedex and studied 350 articles related to chemical agents and their effects on different organs. The main criteria for qualification of articles were relevancy orientation and being published in approved medical journals.

RESULTSThe Iraqi army invaded to west and southwest Iran using chemical weapons such as nerve agents (NAs) and sulfur mustard (SM). Most victims were civilians including women and children. These attacks had imposed more than 150 types of diseases and complications on Iranians and the frequency of death was 2%-3%. Most reports were about respiratory problems and a few were in the domain of socio-economic damages.

CONCLUSIONAt present, 25 years after the end of war, the victims are faced with different complications induced by chemical agents and it is estimated that they will be continuously troubled by these problems in future.

Phosgene is not only a dangerous asphyxiating chemical warfare agent, but also an important chemical raw material, which is widely used in chemical production. According to statistics, there are more than 1 000 phosgene production enterprises in China, with an annual production volume of more than 3 million tons and hundreds of thousands of employees. Therefore, once the leakage accident occurs during production, storage and transportation, it often causes a large number of casualties. In the past 20 years, phosgene poisoning accidents in China have occurred from time to time, and due to the weak irritation, high density, and high concentration of phosgene at the scene of the accident, it often results in acute high-concentration inhalation of the exposed, triggering acute lung injury (ALI), and is very likely to progress to acute respiratory distress syndrome (ARDS), with a mortality rate up to 40%-50%. In view of the characteristics of sudden, mass, concealed, rapid and highly fatal phosgene, and the mechanism of its toxicity and pathogenicity is still not clear, there is no effective treatment and standardized guidance for the sudden group phosgene poisoning. In order to improve the efficiency of clinical treatment and reduce the mortality, this paper has summarized the pathophysiological mechanism of phosgene poisoning, clinical manifestations, on-site treatment, research progress, and innovative clinical therapies by combining the extensive basic research on phosgene over the years with the abundant experience in the on-site treatment of sudden mass phosgene poisoning. This consensus aims to provide guidance for the clinical rescue and treatment of patients with sudden mass phosgene poisoning, and to improve the level of treatment.
Humans ; Phosgene ; Chemical Warfare Agents ; Acute Lung Injury/drug therapy* ; Respiratory Distress Syndrome/therapy* ; Treatment Outcome

In 1945, many Koreans, in addition to Japanese, were killed or injured by the atomic bombs dropped on Hiroshima and Nagasaki, Japan. This study compared the biological profiles of Korean atomic bomb survivors in residence at Daegu and Kyungbuk, Republic of Korea with those of a representative sample of Koreans obtained during a similar period. We evaluated anthropometric measurements, blood pressure, blood cell counts, blood chemistry, and urinalysis of survivors (n=414) and age- and sex-matched controls (n=414) recruited from the third Korea National Health and Nutrition Examination Survey conducted in 2005. Univariate analyses revealed significantly higher systolic blood pressure, white blood cell count, and serum total cholesterol, triglycerides, high-density lipoprotein-cholesterol, and aspartate aminotransferase levels (p<0.01) in the survivors. Conversely, hemoglobin concentration, hematocrit, red blood cell count, and the proportion of positive urine occult blood (p<0.01) were lower in the survivors. Our findings suggest that biological profiles of Korean atomic bomb survivors were adversely affected by radiation exposure.
Abnormalities, Radiation-Induced ; Aged ; Biological Markers/analysis ; Female ; Humans ; Japan ; Korea ; Male ; *Nuclear Warfare ; Radiation Injuries/diagnosis/*metabolism ; Radioactive Fallout ; Survivors

Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.
Animals ; Animals, Domestic ; Anthrax* ; Bacillus anthracis ; Biological Warfare Agents ; Bioterrorism ; Ciprofloxacin ; Diagnostic Tests, Routine ; Disinfectants ; Doxycycline ; Droughts ; Early Diagnosis ; Eating ; Herbivory ; Hot Temperature ; Humans ; Immunization ; Incidence ; Inhalation ; Korea ; Polymerase Chain Reaction ; Spores ; Zoonoses

To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion.The main pathogenic factors are free radical mediators. Prevalence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmonary disease, bronchiectasis, and asthma. Spirometry results can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mustard lung. The effective treatment regimens consist of oxygen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, therapeutic bronchoscopy, laser therapy, placement of respiratory stents, early tracheostomy in laryngospasm, and ultimately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable.
Adult ; Chemical Warfare ; Chemical Warfare Agents ; pharmacology ; Humans ; Iran ; Lung ; diagnostic imaging ; Lung Injury ; chemically induced ; epidemiology ; Male ; Middle Aged ; Mustard Gas ; pharmacology ; Respiratory System ; drug effects ; Survivors ; Tomography, X-Ray Computed ; Veterans ; statistics & numerical data