Urban Survival Secrets for Terrorist Attacks

Urban Survival Guide

Discover How You Can Easily Have A Survival Plan Staying Right Where You Currently Live That's Better Than Having. A Fully Stocked Rural Retreat That You Can't Get To! Finally Revealed: Urban Survival Secrets For Surviving Terrorist Attacks, Natural Disasters And Pandemics! In The Real World, Most People Don't Have A Fully Stocked Retreat They Can Escape To. Even If You've Planned Ahead And You Do, There's No Guarantee That You'll Leave In Time Or That You'll Be Able To Make It There. Your First Plan Must Be To Survive In Place. More here...

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Like war, terrorism, the use of violence and threats to intimidate or coerce, is a political act. The term dates back to the Reign of Terror (1793 1794) during the French Revolution, but hostage-taking and other acts of terrorism preceded that period. Among the most prominent terrorist groups in early times were the Jewish Zealots of Roman Judea, the Moslem Assassins of the Ottoman Empire, and the Indian Thugs. Terrorists on the right and the left of the political spectrum have seldom been successful in their expressed aim of overthrowing the government. For example, despite the fact that they caused a popular uprising, the activities of the Jewish Zealots of the A.D. first century led to the mass suicide at Masada, the destruction of the Second Temple, and the Diaspora, or scattering of the Jews outside Palestine (Shurkin, 1988). During the twentieth century, terrorism has been practiced by Russian revolutionaries, European anarchists, Irish nationalists, members of the Indian...

Migration To The Cities The Process Of Immigration

For many, the process of gaining legal admission is not an easy one. In recent years, the process has been rendered increasingly difficult as a result of visa quotas that result in extended delays to obtain a permanent resident status, income requirements excluding from the U.S. persons earning below a certain income level, health-related criteria barring individuals with certain conditions, such as HIV infection, sexually transmitted diseases, tuberculosis, and certain mental illnesses, among others from entering, and fears of terrorism, resulting in the exclusion of those who may have any connection to groups viewed suspiciously.

Water Supply Organization

Before its distribution to the public retail system. Although there have been documented quality-control issues with distributed bottled water found to have high bacterial counts (Illinois Department of Public Health, 1996 Pennsylvania Department of Environmental Protection, 2000), the FDA stipulates that bottled water must meet specific safety and labeling requirements, according to standards similar to those proposed by the EPA for public water systems (FDA, 2002). State and local authorities also regulate bottled water. Overall, the FDA cites a good safety record, and bottled water suppliers are given a lower inspection priority than are municipal systems (FDA, 2002). However, bottled water is not immune to contamination in November 2003, a terrorist or terrorists (the Aquabomber ) injected bleach, acetone, and ammonia into plastic bottles of water in 20 Italian cities, causing a number of consumers to be hospitalized (Reuters, 2003), and it is clear water bottling plants could...

Diagnostic Expert Systems For Biosurveillance

In addition to the diagnostic expert systems for hospital infection control just outlined, there are two other projects developing systems in the domain of biosurveillance. Shannon and colleagues at the Children's Hospital in Boston are developing a web-based diagnostic expert system to assist emergency room clinicians with diagnosis of approximately 20 diseases caused by biological agents known to have been weaponized or that are otherwise of concern as potential bioterrorist threats. The system has developed and evaluated on-line educational modules about the biological agents (Chung et al., 2004), and is intended to support the reporting of cases to local, state, and federal agencies (Shannon et al., 2002). Similar to stand-alone

Special Considerations

For any suspected nerve agent intoxication, an act of terrorism must be ruled out. It is imperative that precautions to prevent contamination of the facility and staff be undertaken as soon as possible. The appropriate emergency management and law enforcement officials should be alerted immediately. Once measures to protect the staff and treat the patient are undertaken, every effort should be made to facilitate public health personnel in the investigation and containment of the event. It is worth noting that the first patients are likely to present to the nearest emergency rooms within minutes, prior to any alert of the medical community. This quickly leads to the nearest facility being overwhelmed despite efforts to evenly distribute patients.

Prehospital Considerations

From a pre-hospital perspective, the unique considerations that involve aircraft accidents must be addressed. The first consideration is access to the scene. In aviation crashes over open sea, response efforts are centered at the nearest land areas. Such crashes present unique challenges to emergency medical services (EMS), search and rescue, and primarily recovery efforts since there are unfortunately few survivors. Air crashes occurring in and around an airport will often occur within the confines of the flight line. Larger and busier airports may either suspend or continue active flight operations near the crash site. EMS units should receive prior training on responding to these situations and have established communication links with the airport control tower and fire rescue units. A triage area should be established, and all victims should be directed to the triage area. This is important, as it improves the process of identifying and assessing all survivors. Responders need to...

Initial Assessment And Stabilization

Assessing the patient with a potential toxic exposure follows the basic tenets of Emergency Medicine secure the airway, breathing, and circulation. Patient decontamination may also be necessary in cases of toxin-induced disasters or chemical terrorism. Decontamination is a crucial intervention in the initial assessment and stabilization of a patient who is poisoned as part of a terrorist attack. In such cases, dermal decontamination is usually the focus as agents of biological and chemical terror are likely to be aerosolized. Gastrointestinal decontamination (gastric emptying and or administration of activated charcoal), while an important intervention in the hospital-based treatment of poisoned patients, is unlikely to be helpful in the treatment of disaster-related toxic exposures, as mass exposures are unlikely to occur during the oral route. Incidents such as staphylococcal enterotoxin B poisoning, where gastrointestinal decontamination may actually be indicated, are the exception...

Robert E Antosia md mph

Security is an essential component of logistics. It may require the appointment of an incident manager and involvement of police, fire, or military personnel. The key role of the security unit is to provide protection to medical personnel and first respon-ders. In addition to controlling civil order, the security unit is responsible for traffic control, treatment area security, and security against secondary terrorist attacks.

National Retail Data Monitor

The National Retail Data Monitor (NRDM) is a public health surveillance tool that collects daily sales data for selected over-the-counter (OTC) products from retailers nationwide Tor the purpose of detecting outbreaks of disease, either naturally occurring or as a result of bto terrorism. Hie potential benefits to a retail coqioration that participates in the NRDM are listed here. Mitigate the impact of a bioterrorism attack. The worldwide economic impact of a successful bioterrorism attack would be enormous and would likely affect your business by causing economic recession in Ibe same way that SARS produced recession in Asia. That impact can only be mitigated through earlier detection and thereby earlier control.

Other Laboratory Networks

As well as conducts laboratory-based surveillance and early warning systems for emerging pathogens and bioterrorism threats. The National Animal Health Laboratory Network (NAHLN) is part of a national strategy in the United States to coordinate the nation's federal, state, and academic animal health laboratories. The USDA has taken the lead in the development of this network, which includes agriculture and animal health laboratories operated by state agricultural agencies and those associated with veterinary teaching facilities. The facilities and professional expertise of NAHLN members allows authorities to better respond to animal health emergencies that might include a bioterrorist event, the emergence of a new domestic animal disease, or the appearance of a foreign animal disease that could threaten the nation's food supply and public health. Because many of the biologic agents that cause the greatest concern as terrorist agents infect both humans and animals, the role of...

The Laboratory Response Network

Laboratory Response Network

The CDC's LRN was established in 1999 in compliance with a presidential directive that outlined federal agencies' countert-errorism goals and responsibilities. The mission of the LRN is to maintain an integrated national and international network of laboratories that can respond quickly to acts of chemical or biological terrorism, emerging infectious diseases and other public health threats and emergencies.'' The LRN was first tasked to address state and local public health laboratory preparedness and response for bioterrorism. Since its inception, its mission has expanded to include chemical terrorism. The scope of laboratories in the LRN has expanded beyond state and local public health laboratories in order to meet national security needs (http www.bt.cdc.gov lrn ). The LRN and its partners maintain a network of laboratories that can respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, or other public health threats and emergencies. The network...

Betweenmethod Replication

Researchers have various ways of categorizing methods of manipulating independent variables, but one broad distinction that is especially relevant for social psychologists, and that often translates into using different operationalizations, is between-field studies and laboratory studies. Social psychologists are most likely to use lab experiments to test their theories largely because of the high degree of control that lab experiment can more easily provide and the yield in terms of clear causal inferences. However, for all the virtues of the highly controlled lab experiment, there are also well-known ethical and practical drawbacks, especially for studying certain phenomena (e.g., reactions to terrorist attacks or natural disasters), that often make lab experiments unfeasible and make field studies desirable.

The Gaussian Plume Model

(3) the released material behaves as a gas (that has the same density as air), (4) the material does not settle out of the air or otherwise decay (such as might occur due to chemical reactions with air or sunlight), and (5) the terrain is flat. Of the five assumptions, the ones least likely to hold in a bioterrorism scenario are (1), (2), and (5), but these assumptions did not affect the conclusions of Meselson and colleagues. Assumptions (3) and (4) are reasonable. The size of particles that most effectively enter the lung to cause infection is 1 to 5 microns, a particle size that behaves like a gas with respect to atmospheric dispersion (Office of Technology Assessment, 1993). For B. anthracis spores, ultraviolet light has an insignificant effect on the infectivity of spores as they travel through the atmosphere (World Health Organization, 1970).

Department Of Defense

Protection against biological warfare has long been a part of force protection for the military. As the threat has evolved, protection against biological terrorism on domestic and overseas installations has also improved. As diseases do not respect installation boundaries, and the well-being of military retirees and family members is also of importance to the military, the DoD has greatly increased its surveillance efforts to identify natural or deliberate disease outbreaks at the earliest possible point in time. Presidential Decision Directive NSTC-7 (June 1996) stated that the United States will strengthen domestic infectious disease surveillance and response. It expanded the mission of the DoD to include support of global surveillance, training, research, and response to emerging infectious disease threats (White House, 2005). In response to this directive, DoD established the Global Emerging Infections Surveillance and Response System (DoD-GEIS). The DoD-GEIS is designed to...

Examples Of Economic Analyses In Biosurveillance

As is often said, time is money, especially in biosurveillance, in which delays in response can have significant consequences. Early action can lead to effective containment of a threat, and prompt measures can minimize disruptions in government and business operations. Many treatment options are only effective very early in an outbreak. Because biological agents used by terrorists would be expected to kill quickly, a tardy response can result in substantial morbidity and mortality. A predictive CBA, such as Kaufmann, Meltzer and Schmid's simulation of three types of bioterrorist attacks (with Bacillus anthracis, Brucella melitensis, and Francisella tularensis) over a major city suburb of 100,000 people, can help quantify the cost of such delays.

Clinical Laboratories

Professional laboratorians provide services that include simple, rapid screening tests more advanced diagnostic tests and complex confirmatory analyses. Clinicians use the information provided by laboratories to establish diagnoses and to make treatment decisions on virtually every patient. The demand for testing is increasing as the population ages and requires more health care, including analytical services. New tests are frequently introduced that improve diagnosis and care. The emergence of new diseases, the threat of bioterrorism, and the need for better biosurveillance systems have increased the demand for qualified laboratory professional in all fields, especially infectious disease testing. Although the demand for more laboratory professionals is increasing, the number of established laboratory professional training programs is decreasing.

Making Use Of Data Utilities

National Bioterrorism Syndromic Surveillance Demonstration Project Although the National Bioterrorism Syndromic Surveillance Demonstration Project is not functioning as a data utility, it collects data from large health maintenance organizations (HMOs) and health plans, some of which span many public health jurisdictions. It may be possible to negotiate data use agreements with this organization (https btsurveillance.org btpublic ). We are not aware of the technical transmission methods that might be employed.

Potential Strategies For Improving The Health Of People In Cities Of Nepal

Urban health is also affected by the growing terrorism nationally and -internationally. Peace and counseling centers should be established. Relief programs for victims should be launched. Rehabilitation and resettlement programs for the insurgency affected families should be launched. Moral, spiritual, emotional and confidence building programs also are essential in the towns and cities of Nepal too.

Depersonalization disorder

The symptom of depersonalization can also occur in normal individuals under such circumstances as sleep deprivation, the use of certain anesthetics, experimental conditions in a laboratory (experiments involving weightlessness, for example), and emotionally stressful situations (such as taking an important academic examination or being in a traffic accident). One such example involves some of the rescue personnel from the September 11, 2001 terrorist attacks on the World Trade Center and the Pentagon. These individuals experienced episodes of depersonalization after a day and a half without sleep. A more commonplace example is the use of nitrous oxide, or laughing gas as an anesthetic during oral surgery. Many dental patients report a sense of unreality or feeling of being outside their bodies during nitrous oxide administration.

Water Monitoring Tests

Downstream of the reservoir, at which intentional contamination could be introduced, such as back-siphoning through a local service line. If monitoring is meant to serve as an early warning system for terrorist activities, then the safeguarding of these access points must be addressed. Authorities often base organism-specific tests on the prevalent threats to the local service area, such as the inherent differences between rural supplies and larger metropolitan water sources. Often, the local supplier's tests identify a natural contamination problem and correct it before any illness is reported in a network. Any problem, but particularly those related to bioterrorism, must be reported quickly if the networks are to function properly. Rapid turnaround in reporting to the network allows identification of larger issues, such as contamination of multiple supplies. Otherwise, the local or state health department would generally issue the initial alert based on patient presentation. The...

Testimony on the Anabolic Steroid Control Act of 2004

Before the House Subcommittee on Crime, Terrorism and Homeland Security of SOURCE Hale, R. W. 2004. U. S. Anti-Doping Agency. Testimony before the House Subcommittee on Crime, Terrorism and Homeland Security of the House Judiciary Hearing on Anabolic Steroid Control Act of 2004. March 16. Online information retrieved 6 17 05. http Reprinted with permission of the United States Anti-Doping Agency.

Case Study of a School Surveillance System

Project SHARE (School Health and Absenteeism Reporting Exchange) began as an idea to link schools and public health for early event detection for bioterrorism events, as well as identification and management of both large- and small-scale outbreaks. The vision was to create an electronic surveillance system that had minimal workload impact on the school staff, provided regular updated data to public health agencies for analysis, and built an informal network of collaboration between front-line school nurses and public health.The project is a collaboration between the County of San Diego, the state's local county Office of Education, and school districts throughout San Diego County. Funding was made available from the Centers for Disease Control and Prevention through bioter-rorism preparedness funds.

Limitations of Current Monitoring

The food supply system is sufficiently large that direct monitoring for biological contaminants, as is being contemplated for the water system, is not feasible. Security of the food chain against accidental contamination is achieved through a combination of supplier initiatives designed to protect their businesses as well as federal and state regulations and inspections. Although the food industry's procedures work well to contain the impact of most food-related outbreaks, their limitations currently preclude the early detection advocated by the government for bioterrorism incidents. In essence, despite the potential represented by data sources we discussed earlier, current efforts to protect the population from contaminated food are limited to trace-back methods. More proactive measures are not in use because of prohibitive cost and lack of appropriate tools. In June 2002, Congress passed the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (Bioterrorism...

Food Emergency Response Network

FERN's communication backbone is the Electronic Laboratory Exchange Network (eLEXNET), the first Internet-based food safety data network in the United States (Counter Terrorism Food Emergency Response Network, 2003). When launched in 2002, eLEXNET held data on Escherichia coli O157 H7, Listeria monocytogenes, Campylobacter jejuni, and Salmonella species (Levitt, 2003), but it has expanded to include thousands of analytes. eLEXNET's database of food sample and laboratory data is available online, and offers data mining and analysis tools such as On-Line Analytical Processing as well as a geographical information system. eLexNet communicates with LRN.

Current Limitations And Future Directions

It remains to be seen whether the traditional cost and reward measures (such as dollars, life years, and QALYs) in their present forms are appropriate or if researchers need to modify current measures or develop new ones to match the unique aspects of bioterrorist attacks and epidemics. After all, many of these current measures originally arose in the context of more well circumscribed medical events, such as individual acute and chronic diseases. Such measures may not capture the complex scientific, economic, and social interactions that occur when the ambient environment is threatened and changed. For example, how does surrounding panic or loss of faith in daily business operations affect quality of life Will existing measures adequately represent psychological distress What is the cost of losing or damaging the life of a person, such as a healthcare worker, who is essential to mounting an adequate response to the outbreak Do potential future earnings fully represent costs from a...

Crush Injurycrush Syndrome

Earthquakes and manmade disasters are the leading causes of crush injuries and an increased incidence of crush syndrome. The estimated incidence are 20 and 2-5 , respectively. However, given the global climate of war and acts of terrorism, we should anticipate a rise in manmade disasters in the future. Bywaters and Beall offered the first classic description of crush syndrome in Londoners treated during the German Blitz in 1940-41. Zhi-Yong described its devastation in one of history's worst natural catastrophes, the 1973 Tangshan earthquake in China, where the death toll was 242,769 and the additional injured 164,851. The mechanism of injury is entrapment of victims under collapsed structures for periods of 4 hours or longer. In crush-injured victims, deaths within the first hours are caused by shock and hyperkalemia, while deaths days later are from myoglobinuric acute renal failure.

Liudvikas Jagminas md Robert E Antosia md mph

The twentieth century witnessed the creation and development of Weapons of Mass Destruction (WMDs) nuclear, chemical, and biological. While such weapons have been used in major wars, regional conflicts, and terrorism, this chapter will focus on the latter. WMDs all have the potential to create mass casualties, public panic, and enormous property destruction. They represent an existing and growing security and safety risk for all the citizens of the world. Terrorists now have an improved ability to collect information, raise money, and disseminate rhetoric. Advanced information technology available through the Internet allows extremists to communicate widely and efficiently. Additionally, publicly available databases serve as repositories for technical information relating to weapons production. Another important factor is that WMDs, together with the materials and technology used to make them, are increasingly available. Many of these materials are widely available for legitimate...

System Example New York City

Since November 2001, the NYC Department of Health and Mental Hygiene has operated a syndromic surveillance system using ED visit data supplied in an electronic format. All ED visits from 40 hospitals in the city are logged for date and time of visit, age, sex, home zip code, and free-text chief complaint. An algorithm scans chief complaints for character strings and places these complaints into a single syndrome category. The two syndromes of interest for bioterrorism are acute respiratory and fever syndromes in persons greater than 13 years of age. Citywide daily temporal analysis and spatial clustering analysis are both used to identify significant signals. A signal is investigated by reviewing the data provided by the ED. This is followed by a phone call to the ED to alert them to the unusual disease pattern and ask if they have

The Logic Of Classification

Much has been written on the logic underlying the Misuse of Drugs Act 1971. The illegality which surrounds the sale and use of certain specified substances is based on assumptions about their dangerousness to the health of the user, particularly the likelihood that the user will become 'addicted', and the desire to protect society as a whole from these effects. Fears that drugs threaten to undermine Western society have been voiced, and serve as the justification for 'the war on drugs' on both sides of the Atlantic, and on a broader world scale. Such is the national and international concern about drugs that the involvement of the Taliban in the drug (opiate) trade has recently been used as an argument in support of the anti-terrorist bombing raids in Afghanistan. The assumption is that 'addiction' is, to varying and specifiable degrees, a property of the drugs and that consequently all steps have to be taken to eliminate the drug menace from our midst.

The Complexity Of Biosurveillance System Design

A designer of a comprehensive biosurveillance system for a city or a country would have to elucidate functional requirements for detection of hundreds of biological agents that can cause disease in animals and humans (and, through mutation, the number continues to expand). As in the case of anthrax, many of these agents can infect humans or animals through diverse pathways (amplified by the ingeniousness of terrorists), resulting in an almost infinite variety of outbreaks that a biosurveillance system must be capable of recognizing in a timely manner. This section provides but a sample of these biological agents, those identified by international and national organizations as being of the greatest concern. Our purpose in this section is to indicate the magnitude and complexity of the design problem. Table 4.2 is a list of biological agents that we created by consolidating lists developed by internationally recognized organizations and experts. Five of the primary sources listed...

Health Care And Governmental Public Health

It may be instructive to examine just the integration that should exist between laboratory information management systems and governmental public health. As we discuss in Chapter 8, laboratory test orders and results are highly automated in most hospitals. There are many firms that are in the business of creating interfaces between laboratory information systems and other information systems in hospitals. Although it is true that significant effort is required to create an interface, the effort is finite and the cost is in the neighborhood of 100,000 (Overhage et al., 2001) for a comprehensive interface (one that covers all laboratory tests). The cost would likely be lower for an interface that covered only results of interest to biosurveillance. Even were the cost to be as high as 100,000, the total cost for 10,000 interfaces (more than the number of hospitals in the United States) would be 1 billion dollars. One of the authors in fact presented this option to President Bush in...

Definitions And Basic Concepts

One of the most important attributes of an economic study is its perspective, which is the person or organization whose point of view or interests determine the costs and benefits considered in the study. For example, a publicly traded company may be primarily interested in protecting shareholder value, and therefore, an economic study commissioned by the company about the impact of a bioterrorist event might include only elements directly relevant to shareholder value and exclude costs of treating sick individuals other than those employed by the company. The perspective of an economic study is important because available choices, costs, and benefits vary significantly depending on whom and where you are. For example, people in densely populated areas that are vulnerable to bioterrorist attacks may benefit more from biosurveillance than would people in remote rural areas who are less likely to experience such attacks. If the residents in both areas have to pay the same When...

PTPs and Human Disease

The current environment of fear regarding the potential for acts of bioterrorism has also drawn attention to the PTP family of enzymes. The prototypic DSP, encoded by the VH1 open reading frame of Vaccinia, is essential for normal virion infectivity 16,17 , and homologs of this enzyme are also known to be essential for the viability of other poxviruses 71 . Variola virus, the cause of small pox, is closely related to Vaccinia, suggesting that its VH1-like DSP is an essential element of small pox infections. PTPs have also been implicated in bacterial infections, and, in this context, the function of the PTP Yop of Yersinia, the causative agent of bubonic plague, is of interest. Progress has been made in defining the function of this enzyme, which has been shown to target p130cas at focal adhesions in infected host cells 84 . The importance of these PTPs in infection suggests that development of inhibitors of the enzymes may offer strategies to counter the threat posed by these...

Poststabilization Patient Assessment

A more detailed physical examination may also reveal the presence of a toxic syndrome, or toxidrome, which provides a diagnosis in the absence of historical information or laboratory data. The toxidrome examination consists of assessing vital signs, mental status, pupil size, oral mucous membranes, lung sounds, bowel sounds, and the skin. Several agents that may be employed in terrorist-related disasters might be expected to produce classic toxidromes (see Table 1). One test that is unlikely to be of benefit in evaluating potential victims of toxin-related disasters is the toxicology screen. Such screens typically test for drugs of abuse (cocaine, amphetamines, LSD, PCP, marijuana), which are unlikely to be used in terrorist attacks. Even a positive result would be unhelpful, as it would likely be an incidental finding. The toxicology screen, therefore, really has no role in the routine management of poisoned patients in the disaster setting.

Reliability And Utility

Offices of Medical Examiner or Coroner are public agencies charged with investigating unexpected or suspicious deaths and those where the victim was not attended by a physician. These departments have a public health reporting obligation similar to other healthcare providers. They use information systems that are similar in many respects to point-of-care systems used by physicians. Thus, we can expect reliability and data accuracy to be high. Virtually all large jurisdictions use these systems, so availability should also be high and they constitute a potentially useful source of information for biosurveillance. Post-mortem medical examinations, however, are rare and inherently late in the timeline of disease. Mass casualty incidents can cause significant delays in data entry. The utility of medical examiner data in the context of an outbreak, whether naturally occurring or a product of bioterrorism, also depends on the degree to which the information systems are integrated and linked...

Attractive Features of Prenylation Inhibition Based Antiviral Therapy

It is worth emphasizing that prenylation inhibition-based antiviral therapy has implications for other viruses besides HDV which are found to have similarly prenylated proteins. Indeed a CXXX box motif is present in proteins of numerous other medically important viruses, as well as in agents with a potential for bioterrorism (Elazar and Glenn 2005). The precise role played by prenylation, however, may differ in each case and need not be restricted to mediating assembly as in HDV. For example, the polymerase proteins of hepatitis A virus and foot and mouth disease virus have a conserved CXXX box. Because the replication of these positive single-strand RNA viruses is thought to occur in intimate association with intracellular membranes, prenylation of these proteins may provide a membrane anchoring function for the catalytic subunit of the respective replication complexes. On the other hand, the UL32 gene product of herpes simplex virus (HSV), which is thought to be involved in virus...

The Need For An Investigative Psychology

In contrast, the results of empirical research move any insights or understanding into the public domain of scientific knowledge. This knowledge can be utilised by anyone with the skill to understand it. Science deals with actual people and the criminal actions that the police must examine and it focuses on knowledge that can be applied. It is thus able to feed into many aspects of police training and become integrated into the procedures that police use. Such a set of considerations really is the basis of a new discipline that grows out of applied psychology. Canter (1995b) has called this discipline Investigative Psychology. It is much more than the production of 'offender profiles' on serial killers. Rather, Investigative Psychology provides a framework for the integration of many diverse aspects of psychology into all areas of police and related investigations. It is concerned with all the forms of criminality that may be examined by the police. The discipline extends further to...

The Hospital Addresses Emergency Management Ec

The plan needs to address the four phases on an emergency mitigation, preparedness, response and recovery, and hazard vulnerability analysis. The plan must be flexible and allow response to different situations involving both internal (institution-based) and external (community-based) disasters. The plan must also be scalable it must have the ability to respond to emergencies as diverse as a heat wave or a terrorist attack. Plans must clearly describe areas of responsibility, circumstances under which the plan is to be activated, who is in charge, and who is authorized to activate the plan. It is required that the organization have an incident command structure for emergency management that is consistent with that used by the local community. JCAHO advocates taking an all-hazards approach to emergency preparedness. Hazard Vulnerability Analysis (HVA) is an essential first step in the planning process. HVA is defined as the identification of potential emergencies and the direct and...

David Riley md and John D Cahill md

In the past, blast injuries were usually associated with conventional warfare or unintentional accidents occurring in the workplace or at home. Over the last several decades, terrorism and landmines have increasingly contributed to the amount of injuries seen. Currently, worldwide there are over 120 million active landmines, with 25,000 serious injuries or death occurring annually. Proximity to an explosion and where it occurs (inside versus outside) both impact the extent of injury that occurs. The physical effects of blast injuries may be divided into primary, secondary, tertiary, or miscellaneous injuries.

Poison Information Centers

Currently, participating poison control centers submit data to the American Association of Poison Control Centers Toxic Exposure Surveillance System (AAPCC TESS) on a monthly, quarterly, or semiannual basis. Sixty-four poison centers submitted data in 2003 and these data reflect all 50 states and the Commonwealth of Puerto Rico (Watson et al., 2003). Participation in AAPCC TESS and submission of all data is mandatory for certified regional poison information centers and voluntary for noncertified centers. Data are reviewed and published on an annual basis approximately nine months after the end of the calendar year. Since data submission is intermittent and partially voluntary, there is no real-time surveillance of national poison center data for toxidromes that are consistent with exposure to biological and chemical terrorism agents. Furthermore, most individual centers do not conduct real-time toxico-surveillance. Figure 25.3 shows the type of surveillance that is feasible using...

Obtaining Surveillance Data for Evaluation

To have the greatest validity, an evaluator tests an algorithm using surveillance data collected from real outbreaks. However, with the exception of influenza, rotavirus, adenovirus, and some foodborne illnesses, obtaining surveillance data for even 10 outbreaks is difficult, at best. For some diseases of great concern as bioterrorist threats, outbreaks are non-existent. For outbreaks to be useful to the evaluator, they must have occurred in regions that collected biosurveillance data. Although the availability of suitable data is rapidly improving, the present lack of surveillance data is a significant barrier to research using real data. Indeed, there are few published evaluations of outbreak detection algorithms using real data that also have had sufficient sample size to compute confidence intervals on their measures of sensitivity and timeliness. At the time of this writing, we are aware only of studies by Hogan et al. (2003), Ivanov et al. (2003), and Campbell et al. (2004).

Overview Of Spatial Cluster Detection

At present, health departments are using automatic spatial cluster detection primarily on syndromic data with a goal of detecting regions in a city or even a country with abnormally high case counts of some syndrome (e.g., respiratory), based on observed quantities such as the number of emergency department visits or sales of over-the-counter cough and cold medication. The detected clusters of disease may be indicative of a naturally occurring outbreak, a bioterrorist attack (e.g., anthrax release) or an environmental hazard.

Commercial Assistance Call Centers

Other items of interest to a bioterrorist, the companies' tracking systems and call centers are important sources of data to consider. Since these modern systems use relational databases, they will generally be technically amenable to modifications for purposes of biosurveillance. Access to these databases is as valuable to public health authorities as access to CAD databases, described earlier (JB Hunt Transport Services Inc., 2001, Schneider National Inc, 2005, Werner Enterprises, 2001, CRST International, 2005, CSX Corporation, 2005, Norfolk Southern, 2001).

Interoperating With Other Organizations

The Metropolitan Medical Response System and the CDC Cities Readiness Project focuses on communication at the metropolitan level. Their goals are similar to develop or enhance existing emergency communication systems to better handle a public health crisis, such as an act of bioterrorism. In particular, they focus on improving the communication and coordination among local law enforcement, fire, hazardous materials (hazmat), emergency medical services (EMS), hospital, public health, and other first responders'' (Metropolitan Medical Response System, n.d.). We include In the case of a bioterrorist or criminal act using a biological agent, criminal and epidemiological investigations occur concurrently. The steps necessary to identify a potential covert bioterrorism attack include a close coordination between those who collect and analyze medical and syndromic surveillance information and law-enforcement intelligence and case-related information. The best method for timely detection of a...

Laboratory Infrastructure

Because the release of a biological agent is intended to have devastating effects on the population, laboratory networks have been established to standardize the issues associated with bioanalysis, including sampling, testing, reporting, and sample disposal. These networks provide a hierarchical approach to identification and confirmation of biological agents, allowing water suppliers to become involved in the testing process and obviating the need for trained responders to take action in every incident on the local level. Even though local level analytical laboratories are not likely to have comprehensive biological agent monitoring systems in place, they provide initial, basic analyses. At later stages, better equipped laboratories in the networks, such as select government and academic laboratories, can perform more sophisticated analyses. In this sense, the system is set up so that laboratories are available to provide support and confirmation. Many hospital or clinic laboratories...

Definitive and Confirmatory Tests

Found in the structure of single strands of DNA and RNA. The unique pattern of bases is specific for a single organism or closely related organisms. The nucleic-acid-based assays involve the use of probes, which are strands of DNA or RNA that match distinctive DNA or RNA patterns of the organism being tested and will bind with that DNA or RNA if it is in the clinical specimen. Once the binding occurs, the binding can be detected by using electrochemical, colorimetric, and optical systems (Committee on Research and Development Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents, 1999). This binding provides extreme selectivity between the known probes and the material found in clinical specimens. The use of a technique known as polymerase chain reaction (PCR) makes it is possible to amplify trace quantities of DNA or RNA in a clinical specimen to enable the detection of as few as 1,000 bacteria or viruses. The high specificity and sensitivity of...

Other Organizations That Conduct Biosurveillance

The DHS was established in March 2003 as a result of the terrorism events of 2001. According to Homeland Security Presidential Directive 10, the Secretary of Homeland Security is the principal federal official for domestic incident management and is responsible for coordinating domestic federal operations to prepare for, respond to, and recover from biological weapons attacks (White House, 2004). The Secretary of Homeland Security coordinates with the heads of other federal departments and agencies to accomplish this mission. DHS plays a principal role in the monitoring of air for pathogens and has broad responsibilities for situational awareness (of which biosurveillance is but one dimension) for terrorism threats and events. A system that is expected to integrate data from environmental monitoring and health surveillance systems with incident characterization toolsa in order to provide timely warning of a biological attack and to help guide an effective response. BWICS is also...

The Scope Of Biosurveillance

2 In fact, the current edition of the Oxford English Dictionary (OED) does not define the word biosurveillance. although it is in widespread usage, as evinced by Google search results (13,000 hits on May 8, 2005) as well as its routine use by government agencies, politicians, journalists, and academics. There is no doubt that biosurveillance has been inducted into the common vernacular. Even those without technical expertise or training in the field understand the term intuitively, just as they understand the meaning of bioterrorism, another word currently left undefined in the OED. The absence of a standard definition reflects the need to synthesize the multidisciplinary work being done in the field. Indeed, this book is our effort to present a unified approach to and understanding of biosurveillance.

Governmental Oversight

In addition, Congress passed a plethora of amendments, including the Total Coliform Rule, the Surface Water Treatment Rule, and the Bioterrorism Act of 2002, each addressing specific drinking water contaminants. These statutes required the EPA to establish specific rules and regulations to ensure that drinking water supplies do not pose a health risk, either acute or chronic. The EPA has established maximum contaminant levels (MCLs) for 83 contaminants known to pose a public health risk. The EPA also has acted to raise public awareness, designated laboratories that are permitted to culture for selected agents, and developed vulnerability assessments for water systems (EPA, n.d.).The combined objectives of governmental legislation are to set safety standards, develop monitoring procedures, and collect data into a national database.

Avoiding the Menace of Toxins in the Real World Outside the Laboratory

Perhaps more challenging than the science, though, are issues of communication and politics. In contrast to the rapid enactment of legislation to prevent malevolent use of microcystin by terrorists, several nations are currently moving toward the development of health guidance levels for microcystins in drinking water. Maybe the new reputation of microcystin as a potential danger to national security will motivate systematic action to ensure that no one ever has to imbibe this toxin in drinking water from natural sources.

Departments of Health

Urban departments of health are a primary consumer of the products of health educational programs, i.e., health professionals, and they are also the bodies accountable for the health of urban populations. Thus, they are key stakeholders in the development of the urban health workforce. To date, however, municipal health departments have not had a defined role or a strong voice in professional education. More often, their role has been limited to providing internships, sponsoring continuing education for their employees (Potter, et al., 2003), or helping to coordinate the educational responses to emerging needs, e.g., the HIV epidemic or bioterrorism.

Past Role Of Laboratory Animals

In 1798, English physician Edward Jenner conducted experimental vaccination for the prevention of smallpox by inoculating the closely related vaccinia, or cowpox virus.3 Persons inoculated with cowpox virus showed complete resistance to a challenge with the deadly smallpox virus. A century and a half later, Jenner's smallpox vaccine formed the basis for the World Health Organization's 1958 program of global eradication of smallpox. The freeze-dried vaccine, the simple application with the bifurcated needle, and the concept of mass vaccination, combined with surveillance and containment, resulted in the eradication of smallpox in 1979. The subject remains timely, however, given the potential use of this virus in biowarfare and bioterrorism.

Prevention and Control Measures 91 Vaccine

A number of strategies have been used for the development of both Lassa and Ebola virus vaccines (Baize et al., 2001 Fisher-Hoch and McCormick, 2004 Sullivan et al., 2000). One novel approach involving immunisation with a DNA priming vaccine followed by a booster immunisation containing recombinant adeno-virus expressing glycoprotein was associated with the development of both humoral and cellular immunity against Ebola virus in Cynomolgus monkeys (Sullivan et al., 2000). Recently, the threat of bioterrorism using VHF agents has underpinned renewed impetus and enthusiasm for the development of effective vaccines (Baize, 2005 Jones et al., 2005 Peters, 2005).


Before an outbreak is detected, researchers and system builders use dispersion models to simulate outbreaks to understand the most likely tactics of a terrorist or military opponent. They also generate simulated outbreak data for use in measuring the outbreak detection performance of algorithms and systems. Terrorists or military adversaries who wish to create an outbreak with maximal impact are likely to release a biological agent from locations or under weather conditions that maximize the lethality of the attack. Simulating releases from various

Initial Assessment

Important aspects of the history include where the patient was in relation to the explosion was it indoors, outdoors, or underwater and was the explosion industrial related, accidental, or from a terrorist event One should also get an idea of the number injured, so an appropriate disaster plan can be activated if needed. If necessary, proper decontamination measures should be taken by the staff, before a patient potentially exposes others or contaminates an area of the hospital. Physical exam should start with checking the vital signs and the ABCs. Aside from obvious physical exam findings, careful attention should be placed on the pulmonary and abdominal exam. The tympanic membranes should always be examined, for perforation indicates the presence of a high-pressure wave (greater than 40 kilopascals, 6 psi) and may correlate with other significant organ injury. Any individual with suspicion of significant injury or abnormal vital signs should have venous access established with a...

Stephen J Traub md

Disaster medicine must concern itself with toxicology because many weapons of mass destruction and terror are toxins. A working knowledge of the principles of toxicology, therefore, is crucial for anyone who might deal with mass casualty incidents or terrorist attacks. This chapter will focus on those areas of medical toxicology that are pertinent to disaster medicine and the response to chemical or biological terrorism identifying an incident as a toxin-mediated event, initial assessment and stabilization, post-stabilization assessment, and treatment.

Spice Regulations

The U.S. government plays a prominent role in the import and supply of spices. They regulate spice sanitation, pesticides, and sterilizers used, labeling, tariffs, and now, bioterrorism. FDA and ASTA set guidelines and quality specifications for There are other regulatory issues facing the U.S. spice industry today that would affect the global spice trade, including policies regarding FDA's bioterrorism regulations, allergy labeling, possible phasing out of methyl bromide fumigation, new treatment studies for ethylene oxide as a fumigant, irradiation safety concerns, flavor regulation labeling differences for active principles that are naturally derived (e.g., by fermentation) and chemically synthesized, and the use of genetically modified spices such as mustard seed and black pepper.


From 15 to 25 countries are currently suspected of possessing biologic weapons where political and economic instability threatens control of stockpiles. Terrorist groups have included these weapons in their armamentarium. These agents are more deadly on a compound-per-weight basis than chemical agents. They can be produced at relatively low cost and delivered surreptitiously via a building's ventilation system, aerosolized via an aircraft or rooftop dispenser, or placed into the food or water system. Biologic agent attacks have a slower course than other WMD attacks, but have the greatest potential impact for casualties by weapon size and cost.

Natural Disasters

More evidence for the long-term effects of trauma comes from a study by Desivilya, Gal, and Ayalon (1996), who investigated the effects of early trauma in adolescence for victims* mental health and adaptation in later life. The critical incident took place in 1974 in a small town close to the border of Israel and Lebanon, when hundreds of hostages were taken during a terrorist attack, most of them adolescents. Participants in the study displayed signi cantly more health problems 17 years later than the nontraumatized individuals in the control group. Also, survivors of the early traumatic event later showed greater vulnerability to psychological dif culties when Israel was attacked by Iraqi Scud missiles in 1991 (see also Ben-Zur & Zeidner, 1991 Zeidner & Hammer, 1992). As the authors conclude, the scars of the event remained for a lifetime.

Federal Laboratories

The DOE oversees the operation of 25 DOE national laboratories, many of which were established to support the production, use, and response to nuclear materials. After the end of the Cold War, the focus of some of the DOE laboratories shifted to other projects, including the Human Genome Project and the development of technologies and assays to support homeland security initiatives. The DOE national laboratories develop new technologies for countering biologic and chemical threats, including systems for the detection, modeling, and response to terrorist attacks (see www-ed.fnal.gov doe doc_labs.html).


Older adults have a great fear of street crime, although young people are victimized more often. Fear of violence or intimidation has been reported to limit physical activity and promote social isolation. Factors such as loneliness are associated with fear of crime in the neighborhood as well as in the home (Bazargan, 1994). Older adults living in cities are also frequent targets for fraud, from telemar-keters and others. Twenty-seven percent of 200 Houston senior center participants reported being victimized by fraud (Otiniano, et al., 2002). Such victimization increases feelings of fear, guilt, and self-doubt. Finally, the terrorist attack of September 11, 2001 traumatized the nation's populace, including older adults, and reminds us of a new threat to urban communities. The different ways that older adults, and children, are particularly vulnerable to threats of bioterrorism and as well as targeted methods to safeguard these groups, remain to be addressed.

Biologic Isolation

Communicable diseases, which occur naturally, such as SARS, and potential bioterrorism agents, such as smallpox and pneumonic plague, make it essential that hospitals rapidly identify and isolate these patients. All medical staff should be educated in the recognition and immediate isolation and treatment of these patients. Triage should have appropriate signage instructing patients to identify themselves if they have a fever and a rash or if they have a fever and a cough and have traveled to area of the world known to be endemic for SARS. Once a patient has been identified they should be placed in an isolation room. Healthcare workers should use appropriate precautions and don an N-95 respirator (employees should be fit tested), gown, gloves, and eye protection. Procedures should be in place for safely moving the patient from triage to the treatment area, quarantining the waiting room, notifying public health officials, and providing educational materials to quarantined patients,...


Epidemics of arthropod-borne encephalitis can occur during natural disasters if heavy rainfall and flooding lead to increased numbers of mosquitoes, or if insect control measures are disrupted. There have been recent epidemics of West Nile virus in the United States. In addition, the CDC lists Venezuelan, eastern, and western encephalitis as potential biological weapons. An unexplained large number of cases should raise suspicion for a potential act of bioterrorism.

Data Collection

The Department of Defense's ESSENCE program has developed broad syndrome groups using ICD-9 codes that approximate natural infectious disease outbreaks or bioterrorism. Syndrome groups were created using all possible codes. These syndrome groups are now being used for routine surveillance at all military medical treatment facilities. These syndrome definitions and associated ICD-9 coded syndrome groups can be used in syndromic surveillance systems to allow for comparability and evaluation among programs. A challenge for all systems is to establish the correct balance between sensitivity and specificity. Systems that are too sensitive will result in frequent false alarms. This will tax the resources of public health officials as well as EDs and other clinicians. Frequent expenditures of resources investigating false alarms could potentially erode the confidence of the medical professionals utilizing the system. From a practical point of view, no public health system will be able to...

Cutaneous Anthrax

This is the most common form of anthrax seen in the natural setting. Initial infection occurs when an individual comes into contact with an infected animal or an animal product, or is involved in a bioterrorism event. The incubation period is 3 to 7 days, and lesions develop on exposed skin surfaces (hands, face, neck). The lesion initially forms as a papule, progresses through a vesicular stage, and evolves into a black depressed necrotic ulcer (eschar), which is painless. Edema, redness, and or necrosis without ulceration may occur. Regional lymphadenopathy may be appreciated. The lesions resolve slowly over a 2- to 6-week period of time. If untreated, infection may become systemic. Untreated, mortality approaches 25 treated, this decreases to 1 . The differential diagnosis includes ulceroglandular tularemia, scrub typhus, orf, plague, and strep or staph infections of the skin.


Unlike traditional systems, syndromic surveillance is a system of data collection and analysis in which a clinical syndrome (signs and symptoms) or incident disease clusters are the focus of investigation rather than a specific disease. Systems are designed to collect data during the earliest manifestations of a disease, before a diagnosis is made. By identifying abnormally high visit rates for a specific syndrome, an early signal of BT attack may be detected. For example, in an anthrax attack the initial clinical presentation of patients with respiratory complaints would proceed a laboratory diagnosis by a few days. Early identification would allow public health officials to limit the scope of the outbreak. Ideally, these systems would not only identify disease outbreaks early but would do so with 100 sensitivity and a high degree of specificity. Systems may be designed for one or more of the following purposes (1) to identify early cases of disease caused by terrorism, (2) to find...

Nuclear Agents

There are two types of radiological weapons that may be used by a terrorist. The first would be the use of a thermonuclear device. Development of such weapons requires such technical sophistication and effort that only national military programs have constructed such weapons, meaning the terrorist would have to steal such a weapon from a national arsenal. Significantly more easy to obtain are radioactive isotopes, which are used in industrial and medical sites and are occasionally lost or mishandled. Terrorists could also cause accidents involving nuclear power plants or vehicles used in the transportation of nuclear waste. A Radiation Dispersal Device is more commonly known as the dirty bomb. A dirty bomb combines a conventional explosive, such as dynamite, with radioactive material. The conventional explosive itself would cause more casualties than the radioactive material. At the levels created by most probable sources, not enough radiation would be present in a dirty bomb to kill...

Data Analysis

The statistical methodology utilized needs to be able to identify both temporal and geographic clusters of events that may merit additional investigation. The ability to examine small geographic areas is important, as disease outbreaks in a BT event may be confined. Analysis that includes that area in a larger region may be unable to detect the outbreak. Most of the statistical techniques being utilized for syndromic surveillance have been adapted from analytical methods designed for other purposes. The application of advanced space-time analytic methods may detect aberrations in bioterrorism surveillance data with greater sensitivity, specificity, and timeliness.

Risk Factors

STD epidemiology is not significantly impacted by acute terrorist attacks. However, STD infections thrive in disaster situations that lead to prolonged population dislocations and social disruption, such as within refugee camps. Social instability, poverty, and disintegration of stable relationships all contribute to increased STD risk by weakening sociocultural constraints that ordinarily govern sexual behavior. The break in social norms compounded by easy access to and perforation of commercial sex activity also increases STD risk. Women and children are at special risk of being victims of sexual coercion to obtain their most basic needs. Sexual violence is a


Security is essential to the successful implementation of an EMP. In any disaster there is a significant potential for disruption of ongoing care and interference with implementation of the EMP. Security needs to have and implement plans for crowd control, communication with local police, and locking down of the emergency department and facility. Issues of biological and chemical terrorism pose unique problems of quarantine and decontamination.

Emerging Issues

International law is a dynamic field that's undergoing rapid change. Several notable examples of other, newly emerging issues that may impact the work of healthcare professionals include the international law of terrorism and international disaster response law. Several legal problems contribute to the ongoing debate on terrorism and state response (1) no treaty provides a comprehensive definition of terrorism, and (2) it is sometimes unclear whether threats posed by terrorism are more military or criminal in their characteristics. This can make it difficult to determine whether IHL (military response) or human rights law (police response) applies. This problem will not be fully resolved any time soon.


Clinically, the diagnosis can be suggested, but laboratory confirmation is of utmost importance, particularly in the context of a bioterrorism event. Body fluids (blood and CSF) and skin lesions can be Gram stained, looking for encapsulated, broad, Gram-positive bacilli. It may also be cultured on sheep's blood agar cultures.


Melioidosis is on the Category B list of potential bioterrorism agents issued by the United States Centers for Disease Control and Prevention. It is a tropical disease caused by Burkholderia pseudomallei, a motile, aerobic, non-spore-forming Gram-negative bacterium found in soil and water. It is transmitted through direct contact of penetrating wounds or skin lesions with contaminated soil and water. Evidence for person-to-person transmission, inhalation of organisms, laboratory acquired infection, and vector transmission have also been documented. The clinical manifestations are widely varied, from asymptomatic to septicemia.

State Laboratories

The capabilities, responsibilities, and practices of the state public health laboratories vary. During recent years, many of these laboratories have received substantial federal funding to increase staff, equipment, and capabilities to respond to biologic and chemical threats, as part of the DHHS' Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism. A large percentage of the state public health laboratories have used some of the federal funding to build, remodel, and upgrade facilities. Funding for state laboratories is generally a mix of state and federal funds. Many states rely on fees, reimbursements, and service contracts to carry out their mission. Some states have regional or district laboratories to provide the necessary services throughout an entire state. State public health laboratories partner with public health laboratories operated by counties or cities to meet the needs of their communities. State public health laboratories are generally...

Laboratory Networks

The EPA has established the eLRN from a network of environmental laboratories to provide laboratory assistance during a natural disaster or a chemical, biological, radiological, or nuclear incident. The network focuses on all aspects of the protection of the nation's drinking water supply, including safety guidelines, sampling regulations, and transport documentation. This network is designed to provide laboratory support during an incident in the event that the initial jurisdic-tional laboratory cannot respond or requires additional assistance. An incident involving a select agent has much stricter guidelines than does one involving a natural water-borne pathogen. A laboratory, when responding to an incident may request aid and can receive assistance through either a federal EPA laboratory or state public health laboratory. In the event of an act of biological terrorism, the eLRN laboratories respond and analyze specimens by using validated protocols available through the LRN....

Water Surveillance

The principal roles of water supply biosurveillance are to communicate with utility regulators and governmental public health (as well as law enforcement, as appropriate), organize emergency preparedness, and coordinate crisis management. Surveillance is crucial during situations likely to cause water contamination, such as pipe ruptures (water main ruptures reduce distribution water pressure, increasing vulnerability to contamination), shortages, and threats to the water system, in particular bioterrorism threats. Several organizations are involved in defining surveillance policy, specifically in the areas of protocol development, identification of emerging threats, protection, security, and emergency planning. These include the water utilities, the government regulators overseeing them, and law enforcement and governmental public health organizations.


For noncontagious diseases that may cause outbreaks, Assumptions 1 and 2 are reasonable when I contains all of the factors that significantly influence the status of an outbreak disease in individuals in the population. In the case of bioterrorist-released bioagents, for example, such information includes the time and place of release of the agent. Key characteristics of nodes in I are that they have arcs to the nodes in one or more person models, and they induce the conditional independence relationships described in Assumptions 1 and 2. Often the variables in I will be unmeasured. It is legitimate, however, to have measured variables in I. For example, the regional smog level (not shown in Figure 18.2) might be a measured variable that influences the disease status of people in the population, and thus it would be located in I.


The biggest limitation, bar none, to the effective use of satellite data is twofold an astronomical amount of data flows to us from the skies, and trained analysts available to sift through it are few. Moreover, the number of analysts with domain knowledge to perform biosurveillance constitutes a subset of these analysts. Currently, the probability that space-based surveillance would miss the early signs of an epidemic or bioterrorism incident are high if only because a small hillock of relevant images would be buried in mountain ranges of other pictures. Aircraft and satellites are affected by weather. Heavy cloud cover hides scenes of interest from cameras storm activity can prevent aircraft or drones from flying their assigned missions. This is a factor in manmade epidemics. If bioterrorists understand that satellites are being used for surveillance, they are likely to attempt to strike when weather conditions most favor them, or to try as much as possible to conceal their attacks...

Political Ideas

Center-periphery has wide play in international political economy. Center emerges as the key term in this dyad, appearing 37 times compared with periphery's three. Center evokes a very clear circular spatial grid. Indeed, as Sen. Steven Symms (R-Idaho) used center, he conjured up an image of a spider - Saddam Hussein - sitting at the center of a web of domestic power The Iraqi dictator sits at the center of a web of state, party, military, and secret police organizations (CR, S-380). When the web spreads outward beyond the national boundaries of Iraq, it entangles an ever-growing number of participants including the international world of terrorism. However, as in a real web, control always remains at the center. Indeed, as Sen. Orrin Hatch (R-Utah) suggested We all know that the world's most vicious terrorists have taken up residence in


Early, reliable detection of outbreaks of disease, whether natural (e.g., West Nile virus and SARS) or bioterrorist induced (e.g., anthrax and smallpox), is a critically important problem today. We need to detect outbreaks as early as possible in order to provide the best response and treatment, as well as improve the chances of identifying the source.


Given an average workload, significant delays are the exception rather than the rule. Whether a medical examiner can maintain efficient operation in the face of an epidemic, or bioterrorist attack, depends on the incident's effect on the medical examiner's workload and the medical examiner's ability to quickly deploy additional staff. The utility of medical examiner data in the context of an epidemic, whether organic or a case of bioterrorism, also depends on the degree to which the medical examiner has integrated the department's information systems and linked them to a biosurveillance system, and the degree to which the medical examiner's personnel can continue functioning efficiently. Thus, medical examiner data seems most helpful in outbreaks that have a long window of opportunity for intervention, are fatal, and are distinctive enough or large enough to come to postmortem examination. There are many pathogens and outbreaks, for example, which have this characteristic, including...


In the event of a mass casualty incident (MCI) that results in HazMat contamination and poses a threat to life or health, performing emergency decontamination is necessary. Patients should be directed outside the ED near the entrance to await evaluation and decontamination. In addition, the hospital HazMat response plan should be activated. Fortunately, the vast number of exposures involve only one or two victims. However, terrorists have shown the willingness and capacity to use hazardous chemicals when attacking civilians. As such, hospitals need the assessment skills, decontamination equipment, and other appropriate resources to offer care for such patients.

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