and Jasdeep Kaur1
Earth and Life Sciences Vrije Universiteit Amsterdam and ILEWG, Amsterdam, The Netherlands
15.2 Bioterrorism Attack
Bioterrorism situations can arise unexpectedly anywhere, anytime, as evidenced by terrorist activity around the globe. Although conventional emergency medical services center around medically trained personnel paramedics, dentists and forensic odontologists have many skills and attributes that are of vital importance in responding to this mass casualty situation. This chapter highlights areas forensic odontologists should be aware of, excluding the identification process, and serves to encourage further training and professional development to increase skills in the event of a terrorist event.
The threat of bioterrorism, long ignored and denied, has increased over the past few years. Bioterrorism involves the purposeful release of viruses, bacteria, or other agents used to cause illness or death in people, animals, or plants (Hamburg 1999). These agents classically are found in nature, but it is possible that they could be changed to increase their ability to cause disease, to be resistant to current medicines, or to be spread into the environment. Biological agents can be spread through the air, through water, or in food (Hamburg 1999; Miller 2001). Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, such as the smallpox virus, can be spread from person to person, while others, such as anthrax, cannot.
15.2 Bioterrorism Attack
A bioterrorism attack is the deliberate release of viruses, bacteria, toxins, or other harmful agents used to cause illness or death in people, animals, or plants. These agents are typically found in nature, but it is possible that they could be mutated or altered to increase their ability to cause disease, make them resistant to current medicines, or increase their ability to be spread into the environment. Biological agents can be spread through the air, water, or food. Terrorists tend to use biological agents because they are extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, like the smallpox virus, can be spread from person to person, and some, like anthrax, cannot (CDC 2001, 2011).
15.3 Bioterrorism Agents (Miller 2001)
Bioterrorism agents comprise bacteria, viruses, fungi, and other microorganisms as well as biotoxins formed by microorganisms, plants, and animals that can kill or debilitate. Because they can reproduce, biological agents have the sole potential to make an environment more dangerous over time. If used for aggressive purposes, any disease-causing microorganism could become a weapon. For the reasons of warfare, the specific uniqueness of certain agents makes them more likely to be used than others. Some potential warfare agents can make their victims very sick without necessarily killing them. Examples include the microorganisms that cause tularemia, Q fever, and yellow fever. After suffering debilitating illness, victims of these diseases often recover, though not always. Other agents are more likely to be lethal. The bacteria that cause bubonic plague and the virus that causes smallpox can kill large numbers of untreated people. Early management regularly cures plague victims, and smallpox vaccinations before exposure to the virus can prevent the disease.
15.4 Classification of Bioterrorism Agents
The Centers for Disease Control (CDC 2001; Rotz et al. 2002) separates bioterrorism agents into three categories, depending on how easily they can be spread and the severity of illness or death they cause:
Category A agents are organisms or biotoxins and are considered the highest risk to the public and national security because they can easily be spread or transmitted from person to person, they result in high death rates and have the potential for major public health impact, they might cause public panic and social disruption, and they require special action for public health preparedness. Diseases caused by such agents include anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers (Table 15.1