Both domestic and foreign terrorist threats could involve NBC agents. These threats include lone individuals, political and special-interest groups, nonaligned groups, doomsday or religious cults, and insurgents. ⁸ Domestic terrorists are those from the United States. They may be individuals such as Ted Kaczynski (i.e., the “Unabomber”); Timothy McVeigh, who was convicted of the Murrah Federal Building bombing; or Eric Rudolph (Olympic Park Bomber). Domestic terrorists may also belong to hate-associated organizations such as the Ku Klux Klan (KKK); ecology “special interest” groups like the Earth Liberation Front (ELF), which was responsible for multiple acts of arson to vehicles and buildings; religious cults such as the Aum Shinrikyo, which was responsible for the sarin gas attacks in Japan; and/or followers of the Bhagwan Shree Rajneesh, who were responsible for sickening hundreds of residents in (the city of) The Dalles, Oregon. Foreign terrorists may belong to organizations such as al Qaeda, Hamas, and/or may be state sponsored. ¹⁰ Terrorists seek to injure, kill, cause destruction, and instill fear for their personal or political agenda. The use or threatened use of WMD agents is a federal crime with the FBI having jurisdictional authority.

NBC agents are practical tools for terrorism. NBC weapons require only small quantities of an agent or pathogen to achieve a high impact. NBC agents are easy to conceal and transport and can be hard to detect. Many of these small, potent agents do not have a characteristic odor or other obvious physical characteristics. NBC components are widely available within the community, are readily made, and are relatively inexpensive. Bioweapons have been cited as “the poor man’s atomic bomb” because of their potentially high impact and relatively low cost. ³⁶ Materials can be found in local factories, hardware stores, industrial settings, school laboratories, universities, and hospitals.

There are differences between the mass casualties arising from a natural disaster and those resulting from terrorism involving NBC components. MCIs occur every day, resulting in injured persons presenting to the emergency department (ED). MCIs may result from manmade events such as a transportation crash or from natural events such as an earthquake, hurricane, tornado, or epidemic. Natural disasters are not premeditated, whereas terrorism is a planned and perpetrated event. Terrorism or threats of terrorism are federal crimes and require collaboration with multiple organizations, which includes following chain of custody when collecting the victim’s personal belongings. Responders need to be aware of possible secondary terrorism devices intended for the rescuers. ⁵ There is a greater potential for death and destruction with NBC agents. Many natural disasters come with some sort of warning beforehand; however, there is usually little to no preparation for an act of terrorism. MCIs involving NBC agents, whether accidental (e.g., Chernobyl, Russia) or intentional (e.g., Tokyo, Japan) will result in reactions of anxiety and increased fear of possible exposure or contamination. Persons with exacerbations of preexisting psychogenic illnesses may also present to the ED. ²⁴ Hospital and emergency medical services (EMS) systems could easily become overwhelmed.

Potential radiologic and nuclear threats include the following:

All of these nuclear threats have the potential to release ionizing radiation in the form of alpha, beta, and gamma rays; neutrons; and x-rays in either a particulate matter or “wavelike” form.

Radiation is energy emitted from a source and is a constant occurrence in our natural environment. We are surrounded by low-level, background radiation coming from the soil, sun, and certain products within our living space and workplace. ²⁶ There are two principal radiation forms, nonionizing and ionizing, and it is the ionizing radiation that poses the potential health risks addressed here. Ionizing radiation has enough energy that it can break chemical bonds of impacted atoms, creating energized, or ionized particles. There are two forms of ionizing radiation: waves (electromagnetic) and particles. Types of ionizing radiation include alpha, beta, gamma, neutron, and x-rays. Under the correct conditions and amounts, the ionized particles can interact with living cells, creating free radicals that cause chemical changes within those cells. Biologic damage can occur to cellular DNA bonds, proteins, and membranes and can be expressed later as tissue alterations, mutations, tumors, or cancers.

The acute illness arising from a significant and penetrating, partial- or whole-body irradiation is referred to as acute radiation syndrome (ARS). Ionizing radiation affects the most radiosensitive cells first, which include those involving hematopoiesis, digestion, and the central nervous system (CNS). ³ ARS is subdivided into three syndromes that are based on the body’s affected system and includes potential cutaneous radiation injury.

Biologic pathogens have been researched, weaponized, and employed by armies against their opponents for hundreds of centuries. Pathogens were used in the Middle Ages, during the French and Indian War, by Germany in World War I, and Japan in World War II. In 1984 The Dalles, Oregon, was the scene for the first known biologic attack in the United States. There the Rajneeshee, a religious cult, attempted to gain control of the local county government by spraying salmonella on salad bars and throughout public venues before a county election. Over 500 persons became ill. ⁴⁶ The September 2001 anthrax attacks on various U.S. news media offices and two U.S. Senate offices resulted in 22 infections including 5 deaths. Today both domestic and foreign terrorists have developed and deployed bioweapons. Countries with offensive biologic weapons programs have included South Africa, United States, Soviet Union, Great Britain, Iraq, Syria, North Korea, and Iran. The signing of the 1972 Biological Weapons Convention Treaty by a majority of nations, including the United States, ended offensive biologic weapons development for the signing countries. Although also signing, the Soviet Union reportedly continued clandestine research, development, and production of genetically altered “super pathogens” well into the 1990s. Production activities were curtailed and facilities closed after defecting Soviet microbiologists revealed ongoing bioweapons activities and facility locations. ²