homeland security forum post (215)

LESSON NOTES WEEK 5: HLSS215 Regulatory Issues in Weapons of Mass Destruction (WMD): CO-5 Explain the process of primary care management for behavioral reactions during a weapon of mass destruction incident in the United States.  

This week’s lecture focuses on understanding that as current events show us, applying federal regulatory best practices and sanction do not always work. Therefore, we need to be able to evaluate and appraise emergency management planning and relate to the various operational community action plans and be aware of secondary effects of a WMD incident. In addition, it provides the student four questions to consider preparedness and is designed to spark the student’s interest in learning more about Regulatory Issues in Weapons of Mass Destruction.

            When you read World at Risk – pages 82-106 – you should gain an understanding of the Government and culture and who is accountable for preventing WMD proliferation and terrorism. After reading this, stop and think for a moment, make your own determinations on whether or not the world of government has a serious lack of coordination among the various agencies whose job it is to keep us safe.

  Next, as you read, Weapons of Terror, Chapter 6 – This reading assignment focus on delivery means, missile defenses, and weapons in space. This reading focuses on three subjects that are not exclusively related to any one of the categories of WMD – the means of delivery of WMD, the dangers of missile defenses, and the risk of weaponization of outer space.

With that, let us start our lesson, as current events show us, applying federal regulatory best practices and sanction do not always work. Therefore, we need to be able to evaluate and appraise emergency management planning and relate to the various operational community action plans and be aware of secondary effects of a WMD incident.

We need to understand this because one of the gravest threats facing Americans today is a terrorist detonating a nuclear bomb within our borders.

The United States wields enormous power of the traditional kind, but traditional power is less effective than it used to be. In today’s world, individuals anywhere on the planet connect instantly with one another and with information. Money is moved, transactions are made, information is shared, instructions are issued, and attacks are unleashed with a keystroke. Weapons of tremendous destructive capability can be developed or acquired by those without access to an industrial base or even an economic base of any kind, and those weapons can be used to kill thousands of people and disrupt vital financial, communications, and transportation systems, which are easy to attack and hard to defend. All these factors have made nation-states less powerful and more vulnerable relative to the terrorists, who have no national base to defend and who therefore cannot be deterred through traditional means. (World at Risk 2008, xxi)

Therefore, it is critical, able to evaluate and appraise emergency management planning and relate to the various operational community action plans and be aware of secondary effects of a WMD incident. We will discover that any terrorist attack using WMD will result in substantial psychological trauma and stress and emergency management planning needs to consider this.

        At a conference put on jointly by the Defense Threat Reduction Agency, the Federal Bureau of Investigation, and the U.S. Joint Forces Command clear back in 2001 addressing Human Behavior and WMD Crisis/Risk Communication Workshop, the presenters highlight some great key points that are still pertinent today:

A disaster response program includes many factors that will determine its success in dealing with the effects of a WMD attack (which includes a Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) incident) and restoring public order. In the United States, several agencies at the federal, state, and local level have been put in place to handle contingencies such as natural disasters, chemical spills, and nuclear mishaps. The Federal Response Plan [now referred to as the National Response Framework], a signed agreement among 27 Federal departments and agencies, including the American Red Cross, provides a mechanism for coordinating delivery of Federal assistance and resources to augment state and local efforts in major disasters or emergencies. (Defense Threat Reduction Agency [DTRA]/Federal Bureau of Investigation [FBI] 2001)

Convincing the public to take appropriate action in a WMD attack will require considerable planning. It will require developing a significant level of situational awareness of every aspect of a WMD attack. Situational awareness incorporates knowledge of plans, procedures, and processes for handling all aspects of a WMD, no matter what type. One way to address practically the problem is to concentrate on local communities and prepare each community on a smaller scale for a WMD attack. For example, CDC [Center for Disease Control] maintains an excellent two-way communication program with local communities that includes regional workshops with public health officials and medical professionals, a website, and satellite training. (DTRA/FBI 2001)

If you want to take a look at the guidance the CDC put out back in 2002, here is the link:  http://wwwnc.cdc.gov/eid/article/8/9/01-0520_article.htm  . Currently, the CDC dedicates a whole entire section of their website, which is broken down by specific category, that addresses preparedness:  http://emergency.cdc.gov/?s_cid=cdc_homepage_topmenu_004  . And they have even taken a more creative approach to capture people’s attention and convincing them that preparedness is important – check out the CDCs graphic novel, "Preparedness 101: Zombie Pandemic" ( http://emergency.cdc.gov/socialmedia/zombies.asp )

Additionally, from the perspective of first responder, getting the word out and sending the proper message during these types of events is important.

Message development also requires very careful planning to determine the effects of messages on industries and private groups. One statement from CDC can wipe out an entire industry and put many people out of work. Including a variety of relevant professionals early in the planning process is also important. For example, the West Nile virus could have been identified much earlier if veterinarians were brought in initially. Veterinarians discovered that birds were dying from some exotic disease, which was identified as West Nile. Subsequent testing on humans confirmed that victims who were originally assumed to be suffering from St. Louis encephalitis were actually suffering from West Nile disease.

Figure 1 – West Nile Virus

This takes us to a subsequent topic, media coverage.

Building effective media relationships now will help avoid inappropriate public actions in the event of a WMD attack. The interests of the media establishment and those of the public, as exercised by government, are not always the same. It may make sensational news to skew the events of a WMD attack while the public would be best served by accurate information designed to calm the public and avoid inappropriate behavior. In addition, the news cycle has grown very short, nearly real-time. This pressure to “get the news out” may also conflict with the time required to analyze a WMD event and to disseminate accurate information. (DTRA/FBI 2001)

At the same time, preparation of an effective response is critical for navigating a WMD event.

Effective response means disseminating large amounts of information to the public very quickly. As soon as possible, communicators must get accurate information to the public, to encourage the public to return to normalcy as soon as possible. The medical community must be a central focus of training efforts for WMD because they are likely to be the first responders. In addition, Disaster Response Networks must include mental health as a part of planning. A clinically trained psychologist, social worker or other trained individual should be part of the response team.

For example, in a chemical incident, fire fighters are usually the first on the scene; however, in a bioterrorist event, the most likely first responders are hospital/medical personnel. As the workshop participants indicated, the release of a biological agent has no centralized locus of destruction. If the agent is detonated without the knowledge of officials or the media, the singularity of the event is compromised. (DTRA/FBI 2001)

Seventy percent of hospital personnel are women with family responsibilities, and twice as likely, than men to experience post-traumatic stress disorders, anxiety, and depressive disorders. Dealing with their own families as well as the families of victims places added pressure on personnel routines; it also places them in the “line of fire” for ensuing anger. In addition, rescue and fire personnel are not only at high risk but also prone to denial when it comes to admitting they need help. (DTRA/FBI 2001)

Among the general population, women experience twice the rates of anxiety and depressive disorders as men, and following disasters, women had nearly twice the rates of post-traumatic stress disorder (PTSD) as men. Studies also show, however, that males are more prone to denial when it comes to admitting they need help, and responders more prone to denial than the general public.

Since much data is self-reported, a caveat should be used when analyzing the general population and its response to disaster. Studies also found that rescue workers and fire fighters have a preexisting propensity for alcoholism and alcohol intake increases under extreme stress conditions. (DTRA/FBI 2001)

Adult reactions to stress are often manifested in different ways. For example, the immune system is compromised contributing to health complications, increased alcohol and cigarette use, inattention to family responsibilities, depression and anxiety, all of which can often go untreated in light of triage prioritization. (Benedek 2003)

The impact of disasters on sociological behavior can be a gray area. In fact, in the past, studies have shown that victims can experience symptoms of PTSD as late as 12 years after the event.  Further, I expect, as we see long term studies related to those that have served in recent wars, we may see PTSD manifest itself even later.  

Historically, resources allotted to the study of sociological impacts on victims have been minimal and as such, have prevented mental health professionals from developing clearer baselines for analysis. The medical community will be greatly impacted by a WMD attack if one were to occur and must be prepared. To reduce the impact of WMD attacks, first responders must include mental health professionals as a necessary part of the disaster management response cycle – prepare, respond, recovery and mitigate.

Questions to Consider

1. In the event of a WMD attack, how can public panic/fear be lessened?

1. How can the public be persuaded to take appropriate action and to avoid inappropriate actions?

1. Who among responders and the public are at higher risk of adverse psychological effects and how can such effects be prevented or mitigated?

1. What are the likely psychosocial impacts of WMD and how can they be prevented or mitigated?

References/Works Cited:

Defense Threat Reduction Agency, Federal Bureau of Investigation, & U.S. Joint Forces Command. (2001). Human Behavior and WMD Crisis/Risk Communication Workshop - Final Report.

Lacy, T.J. & Benedek, D.M. (2003). Terrorism and Weapons of mass destruction: Managing the behavioral reaction in primary care. Southern Medical Association, 2003. Bethesda, MD Southern Medical Association

World at Risk, First Vintage Books Edition: December 2008. (This book is available on line and provided in the electronic classroom)