CBRN Jeremy E. Bayer American Military University Professor Christian Kazmierczak October 26, 2014  In today’s world, terrorist attacks are becoming more prevalent then they have in the past. Today’s political and religious movements are getting more violent and more military and citizens all over the world are receiving injuries and death with Chemical, Biological, Radiological, and Nuclear agents. Types of CBRN agents vary but many of the consequences are the same. Chemical, Biological, Radiological, and Nuclear (CBRN) Chemical, Biological, Radiological, and Nuclear (CBRN) have been used as an agent in both International and Domestic Terrorism for years. The Free Dictionary by Farlex defines CBRN as, “A military abbreviation for agents—Chemical, Biological, Radiological, Nuclear—that may be used or to which military personnel may be exposed in non-conventional warfare” (The Free Dictionary by Farlex, n.d.). CBRN agents have also been known to be used on the civilian community around the world. Some of the items used in CBRN attacks are relatively easy to obtain and disperse without warning or detection. This is due in part to so many different agents available to the terrorist organizations. History of CBRN According to the Terrorism Research and Analysis Consortium, “terrorism, itself, has shown a marked trend towards greater incidence and lethality. Between 2005 and 2009 a total of 62,625 attacks took place around the world, killing more than 88,000 people and injuring an additional 175,000. 1,342 of these incidents involved fatality counts above 10 and many exceeded 50. In 2009 (the latest year for which figures are available), 10,999 attacks occurred in 83 countries, leaving 58,000 casualties, including 15,000 deaths” (Terrorism Analysis and Research Consortium, n.d.)According to the Central Intelligence Agency, “Al-Qa'ida and associated extremist groups have a wide variety of potential agents and delivery means to choose from for chemical, biological, radiological, or nuclear (CBRN) attacks. Al-Qa'ida's end goal is the use of CBRN to cause mass casualties; however, most attacks by the group—and especially by associated extremists—probably will be small scale, incorporating relatively crude delivery means and easily produced or obtained chemicals, toxins, or radiological substances. The success of any al-Qa'ida attack and the number of ensuing casualties would depend on many factors, including the technical expertise of those involved, but most scenarios could cause panic and disruption. Several groups of mujahidin associated with al-Qa'ida have attempted to carry out "poison plot" attacks in Europe with easily produced chemicals and toxins best suited to assassination and small-scale scenarios. These agents could cause hundreds of casualties and widespread panic if used in multiple simultaneous attacks. Al-Qa'ida is interested in radiological dispersal devices (RDDs) or "dirty bombs." Construction of an RDD is well within its capabilities as radiological materials are relatively easy to acquire from industrial or medical sources. Osama Bin Ladin's operatives may try to launch conventional attacks against the nuclear industrial infrastructure of the United States in a bid to cause contamination, disruption, and terror. A document recovered from an al-Qa'ida facility in Afghanistan contained a sketch of a crude nuclear device. Spray devices disseminating biological warfare (BW) agents have the highest potential impact. Both 11 September attack leader Mohammad Atta and Zacharias Moussaoui expressed interest in crop dusters, raising our concern that al-Qa'ida has considered using aircraft to disseminate BW agents. Analysis of an al-Qa'ida document recovered in Afghanistan in summer 2002 indicates the group has crude procedures for making mustard agent, sarin, and VX” (Central Intelligence Agency, 2013). Some of the agents that have been used or could be used in an attack include Tabun, Sarin, Soman, mustard gasses, Lewisite, Anthrax, Botulism, Ricin, and VX to name a few. These items can be broken down into Nerve Agents, Nerve Agents, and Biological agents. Some have injuring affects and some have fatal consequenses when deployed. Another item that can cause death and injury are the nuclear devices commonly known as “dirty bombs.” CBRN-Nerve Agents Tabun also known as Ethyl dimethylamidocyanophosphate, “which are the most toxic of the known chemical warfare agents. It has a fruity odor reminiscent of bitter almonds. Exposure to tabun can cause death in minutes. A fraction of an ounce (1 to 10 mL) of tabun on the skin can be fatal. Nerve agents are chemically similar to organophosphate pesticides and exert their effects by interfering with the normal function of the nervous system” (Centers for Disease Control and Prevention, 2014). Tabun is Clear, colorless to pale or dark amber liquid. It can be disseminated by Indoor Air, Water, Food, Outdoor Air, and through Agriculture. Sarin agents also known as Trilone, “Sarin (military designation GB) is a nerve agent that is one of the most toxic of the known chemical warfare agents. It is generally odorless and tasteless. Exposure to sarin can cause death in minutes. A fraction of an ounce (1 to 10 mL) of sarin on the skin can be fatal. Nerve agents are chemically similar to organophosphate pesticides and exert their effects by interfering with the normal function of the nervous system” (Centers for Disease Control and Prevention, 2014). Sarin is a Clear, colorless liquid. It can be disseminated by Indoor Air, Water, Food, Outdoor Air, and through Agriculture. Soman also known as Pinacolyl methylfluorophosphonate, is a “(military designation GD) is one of the nerve agents, which are the most toxic of the known chemical warfare agents. It has an odor like camphor or rotting fruit. Exposure to soman can cause death in minutes. A fraction of an ounce (1 to 10 mL) of soman on the skin can be fatal. Nerve agents are chemically similar to organophosphate pesticides and exert their effects by interfering with the normal function of the nervous system. Soman is a Clear, colorless, liquid. Discolors with aging to dark brown. Gives off colorless vapor. . It can be disseminated by Indoor Air, Water, Food, Outdoor Air, and through Agriculture. VX also known as Methylphosphonothioic acid and O-ethyl S-(2-diisopropylaminoethyl) methylphosphonothiolate, “VX is one of the nerve agents, which are the most toxic of the known chemical warfare agents. It is tasteless and odorless. Exposure to VX can cause death in minutes. As little as one drop of VX on the skin can be fatal. Nerve agents are chemically similar to organophosphate pesticides and exert their effects by interfering with the normal function of the nervous system” (Centers for Disase Control and Prevention, 2014). VX is Clear, amber-colored, oily liquid. It can be disseminated by Indoor Air, Water, Food, Outdoor Air, and through Agriculture. CBRN-Blister Agents Sulfur Mustard also known as HD (distilled sulfur mustard), Mustard, and Mustard gas, “Sulfur mustard (military designation HD or H) is a blister agent (vesicant) that causes severe, delayed burns to the eyes, skin, and respiratory tract. Sulfur mustard damages cells within minutes of contact; however, the onset of pain and other health effects is delayed until hours after exposure. Large exposures to sulfur mustard may be fatal. Sulfur mustard is also an alkylating agent that damages the cells within the bone marrow that are necessary for making blood cells; this affects the body's immune system. Finally, sulfur mustard also affects a part of the nervous system responsible for everyday bodily function, causing "cholinergic toxicity," marked by excessive saliva, tears and urine; gastrointestinal (GI) cramping and diarrhea; vomiting (emesis); and constricted or pinpoint pupils (miosis). Sulfur mustard has been used as a chemical warfare agent to cause delayed casualties. It has an odor of garlic, onion, horseradish, or mustard. However, odor is not a reliable indicator of sulfur mustard and should not be depended on to warn of sulfur mustard exposure” (Centers for Disease Control and Prevention, 2014). It can be disseminated by Indoor Air, Water, Food, Outdoor Air, and through Agriculture. Lewisite also known as Chlorovinylarsine dichloride or Dichloro(2-chlorovinyl)arsine, “is an extremely toxic, arsenic-containing blister agent (vesicant) that affects the lungs and causes whole-body (systemic) effects. It has an odor of geraniums. It was developed as a potential chemical warfare agent (military designation, L), but has not been used on the battlefield. Exposure to large amounts can be fatal. Pain and irritation from exposure to either liquid or vapor lewisite are immediate, and early tissue destruction is more obvious than after exposure to mustard. Lewisite causes burning pain in the respiratory tract at a concentration that cannot be detected by odor” (Centers for Disease Control and Prevention, 2014). Lewisite is an Oily liquid with a range of colors from colorless to violet-black, green, amber, or dark brown. . It can be disseminated by Indoor Air, Water, Food, Outdoor Air, and through Agriculture. CBRN-Biological Anthrax is a “life-threatening infectious disease that normally affects animals, especially ruminants (such as goats, cattle, sheep, and horses). Anthrax can be transmitted to humans by contact with infected animals or their products. In recent years, anthrax has received a great deal of attention as it has become clear that the infection can also be spread by a bioterrorist attack or by biological warfare. Anthrax does not spread from person to person” (Fishbein, n.d.). Anthrax can be disseminated by absorption through the skin, inhalation, and ingestion. Botulism is a “serious illness that causes flaccid paralysis of muscles. It is caused by a neurotoxin, generically called botulinum toxin, produced by the bacterium Clostridium botulinum (and rarely by C. butyricum and C. baratii). There are seven distinct neurotoxins (types A-G) that Clostridium botulinum produces, but types A, B, and E (and rarely F) are the most common that produce the flaccid paralysis in humans. The other types mainly cause disease in animals and birds, which also develop flaccid paralysis. Most Clostridium species produce only one type of neurotoxin; however, the effects of A, B, E, or F on humans are essentially the same. Botulism is not transmitted from person to person. Botulism develops if a person ingests the toxin (or rarely, if it is inhaled or injected) or if the Clostridium spp. organisms grow in the intestines or wounds in the body and toxin is released” (Davis, n.d.). Botulism can be disseminated by food contamination and have been known to affect people who have open wounds thus could be potentially used in an incapacitation but non-fatal dirty bomb attack. Ricin can be one of the most easily made agents for attack but also one of the easiest to get rid of. “Ricin is a poison found naturally in castor beans. If castor beans are chewed and swallowed, the released ricin can cause injury. Ricin can be made from the waste material left over from processing castor beans. It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid. It is a stable substance under normal conditions, but can be inactivated by heat above 80 degrees centigrade (176 degrees Fahrenheit)” (Medicinenet.com, n.d.) . Even though Ricin is a food borne transmission, there was one case that a man was contaminated by injection. CBRN-Blister Agents “A Radiological Dispersal Device (RDD), or "Dirty Bomb", is a conventional explosive device which has been surrounded with or contaminated with some form of radioactive material.  When it explodes, the device spreads the radioactive material over a wide area. The purpose of these devices is to frighten people and make buildings and land unusable during the weeks necessary to perform decontamination. In the most likely scenario, low-level radioactive powder or pellets would be used, and the contamination would be dispersed over a few city blocks. The actual radiation hazard would be dependent on the source material used. It is not likely that enough radiation would be present to cause severe illness in the exposed population” (Occupational Safety and Health Administration, n.d.). Guidance Matrix for RDD Incidents OSHA Occupational Exposure Limits for Ionizing Radiation 29 CFR 1910.1096 Rems per calendar quarter Whole Body; Head and Trunk; Active Blood-Forming Organs; Lens of Eye or Gonads 1 1/4 Hands and Forearms; Feet and Ankles 18 3/4 Skin of Whole Body 7 1/2 Under age 18 workers 10 percent of above limits Over age 18 workers 3 rem may be permitted under conditions specified in 29 CFR 1910.1096(b)(2) (Occupational Safety and Health Administration, n.d.) Response to CBRNE Incidents CBRNE incidents are categorized into 3 response categories by a color system identified as Red, Yellow, and Green. Each category has its main requirements based on the dangers of the CBRNE agent. Below are the response categories: RED ZONE Areas where significant contamination with chemical, biological, radiological, or nuclear (CBRN) agents has been confirmed or is strongly suspected but area has not been characterized. The Area is presumed to be life threatening from both skin contact and inhalation. Level A protection is generally needed when the active release is still occurring, or the release has stopped but there is no information about the duration of the release or the airborne concentrations of CBRN agents. Respirators chosen initially for responders going into a known release area where CBRN are suspected should be a positive pressure self-contained breathing apparatus (SCBA) with a fully encapsulating protective suit until monitoring results allow for other decisions. Level A protection should be consistent with the description in HAZWOPER Appendix B and suits should be appropriate for CBRN agents. e.g. meets the requirements of NFPA 1994-2001, has been tested by a third party such as the U.S. Army and Soldier and Biological Chemical Command (SBCCOM), or has undergone other manufacturer testing. A NIOSH-certified CBRN SCBA respirator should be used, if available. (Occupational Health and Safety Administration, 2005). Other prudent work practices should include minimizing exposure time to that essential for lifesaving or initial monitoring, avoiding any unnecessary contact with surfaces or potentially contaminated material, use of natural ventilation flows to reduce exposure, mandatory decontamination and post exit evaluation for signs and symptoms of exposure. YELLOW ZONE Areas where contamination with chemical, biological, radiological, or nuclear (CBRN) agents is possible but active release has ended and initial monitoring exists. (Occupational Health and Safety Administration, 2005). GREEN ZONE Areas where contamination with chemical, biological, radiological, or nuclear (CBRN) agents is unlikely. This zone covers the area beyond the expected significant dispersal range of the initial event and secondary contamination range caused by traffic and emergency responders. (Occupational Health and Safety Administration, 2005). The threat of CBRN incidents is very real. These agents have dated back to the 1980’s and possibly prior. All Americans need to be aware of the potential hazards these pose. The CBRN agents can cause serious injuries including death. Even though a few agents are noted, there are many more that can be easily obtained and disseminated to unsuspecting government and public.  References Centers for Disase Control and Prevention. (2014, October 7). VX: Nerve Agent. Retrieved October 26, 2014, from The Emergency Response and Safety Database: http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750005.html Centers for Disease Control and Prevention. (2014, October 7). Lewisite (L): Blister Agent. Retrieved October 26, 2014, from The Emergency Response and Safety Database: http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750006.html Centers for Disease Control and Prevention. (2014, October 7). Sarin (GB): Nerve Agent. Retrieved October 26, 2014, from The Emergency Response and Safety Database: http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750001.html Centers for Disease Control and Prevention. (2014, October 7). Sulfar Mustard: Blister Agent. Retrieved October 26, 2014, from The Emergency Response and Safety Database: http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750008.html Centers for Disease Control and Prevention. (2014, October 7). TABUN (GA) : Nerve Agent. Retrieved October 25, 2014, from The Emergency Response Safety and Health Database: http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750004.html Central Intelligence Agency. (2013, June 13). Terrorist CBRN: Materials and Affects. Retrieved October 25, 2014, from Central Intelligence Agency: https://www.cia.gov/library/reports/general-reports-1/terrorist_cbrn/terrorist_CBRN.htm#background Davis, C. P. (n.d.). Botulism. (M. Conrad Stoppler, Editor) Retrieved October 26, 2014, from medicinenet.com: http://www.medicinenet.com/botulism/article.htm#what_is_botulism Fishbein, M. C. (n.d.). Anthrax. (J. Sheil, & W. C, Editors) Retrieved October 26, 2014, from Medicinenet.com: http://www.medicinenet.com/anthrax/article.htm#anthrax_facts Medicinenet.com. (n.d.). Riacin. Retrieved October 26, 2014, from Medicinenet.com: http://www.medicinenet.com/ricin/article.htm#what_ricin_is Occupational Health and Safety Administration. (2005, April). Chemical - Biological - Radiological - Nuclear (CBRN) Personal Protective Equipment Selection Matrix for Emergency Responders. Retrieved October 26, 2014, from US Department of Labor: https://www.osha.gov/SLTC/emergencypreparedness/cbrnmatrix/ Occupational Safety and Health Administration. (n.d.). Radiological Dispersal Devices. Retrieved October 25, 2014, from United States Department of Labor: https://www.osha.gov/SLTC/emergencypreparedness/cbrnmatrix/radiological.html Terrorism Analysis and Research Consortium. (n.d.). Perceived Threat of Terrorism Using CBRN Weapons. Retrieved October 25, 2014, from Biological / Chemical / Agricultural Terrorism: http://www.trackingterrorism.org.ezproxy2.apus.edu/article/biological-agricultural-terrorism/perceived-threat-terrorism-using-cbrn-weapons The Free Dictionary by Farlex. (n.d.). CBRN. Retrieved October 26, 2014, from The Free Dictionary by Farlex: http://medical-dictionary.thefreedictionary.com/CBRN CBRN 12 RUNNING HEAD: CBRN 1