Coping With An Attack

Biological Threat Preparedness

• Stockpile three days of nonperishable food.
• Stockpile three days of water (three gallons for each person).
• Develop family contact plan (how to get in touch via phone, Internet, or other method).
• Stockpiling antibiotics is NOT recommended.
• Purchasing a gas mask is NOT recommended.

If an Attack Occurs

• If possible, remain at home.
• You have time — treatment does not have to start immediately.
• Listen to the local news.
• If needed, you will be told where to obtain treatment.
• Do NOT immediately rush to the emergency room.

Smallpox (Viral Infection)

Enters the body by being inhaled.

Immediate Action

• Stay at home; tune to radio or television for instructions.
• DO NOT go to an emergency room unless you are sick.
• Smallpox is contagious; health officials may advise wearing a face mask when you go out.
• Infected persons should be isolated.
• After smallpox exposure, a victim has a few days to get the vaccine.

Symptoms

• Rash appears seven to 17 days after infection.
• Within one to three days after rash appears, the rash becomes raised bumps and pus-filled blisters.
• Blisters crust, scab, and fall off after about three weeks, leaving a pitted scar.
• Victim is infectious until all scabs fall off.

Treatment/Prevention

• Before exposure, smallpox vaccine can prevent the disease.
• After exposure, vaccination within three days will completely prevent or significantly modify effects of the disease in most people.
• Vaccination four to seven days after exposure may modify severity of disease.
• Persons treating smallpox victims should be vaccinated, and wear gloves, gowns, and masks.
• Ensure that clothing, towels, bed sheets, etc., are not used by uninfected persons.
• Bleach will kill the virus on surfaces. Do NOT drink bleach or use on skin.

Contagious? Yes.

Anthrax (Bacterial Infection)

Enters the body through cuts in the skin (cutaneous form), being inhaled, or the mouth (ingested form).

Immediate Action

• Stay at home; tune to radio or television for instructions.
• Do NOT go to an emergency room unless you are sick.
• Antibiotics for anthrax are effective in the first one to six days.
• Antibiotics must be prescribed/administered by medical personnel.

Symptoms

• Symptoms usually occur within seven days.
• Skin anthrax starts with bumps like an insect bite; in one to two days area swells, then becomes painless open sore.
• Anthrax breathed into the body (inhaled) has flu-like symptoms.
• Ingested anthrax has symptoms like food poisoning.

Treatment

• Antibiotics are effective if started within one to six days after infection.
• Vaccination may also be recommended in some cases.
• Bleach can kill the bacteria on surfaces. Do NOT drink bleach or use on skin.

Contagious? No.

Plague (Bacterial Infection)

Enters the body through being inhaled or bites from fleas from infected rodents.

Immediate Action

• Stay at home; tune to radio or television for instructions.
• Do NOT go to an emergency room unless you are sick.
• Begin prescribed antibiotics as soon as possible.
• Infected persons should be isolated.
• Inhalation form of plague is contagious — persons with a cough or sneezing should be considered infectious.
• Health officials may ask you to wear a mask over your nose and mouth when you go out.

Symptoms

• Symptoms occur within one to six days after exposure.
• Symptoms include high fever, painful/swollen lymph nodes (armpits and neck), cough, and difficulty breathing.

Treatment

• Rapid use of antibiotics is effective.
• Heat, sunlight, bleach will kill the plague bacteria on surfaces. Do NOT drink bleach or use directly on skin.
• Masks should be worn at all times when dealing with infected persons.

Contagious? Yes.

Tularemia (Bacterial Infection)

Enters the body through tick bite, being inhaled, or the mouth (ingested via contaminated food).

Symptoms

• Includes fever, chills, headache, weakness occurring in three to five days.
• Eye infections will occur first in most cases.

Treatment

• Antibiotics are very effective and should be started within three to five days of infection.
• Standard disinfectants and mild heat will kill the organism.

Contagious? No.

Botulism (Bacterial Toxin)

The toxin cannot penetrate intact skin. Enters the body through cuts in the skin, being inhaled, or the mouth (ingested via contaminated food).

Symptoms

• Blurred vision and difficulty swallowing or speaking occur within two to three days.

Treatment

• Medical authorities must administer antitoxin.
• Treatment requires hospitalization.
• Soap and water and bleach will inactivate toxin. Do NOT drink bleach or use on skin.

Contagious? No.

Hemorrhagic Fevers (Viral Infection)

Infection spreads through body fluids (blood, urine, stool, saliva) from infected persons.

Symptoms

• Fever, muscle aches, diarrhea begin within three to five days of infection.

Treatment

• Medical personnel will administer antiviral drugs.
• Bleach will kill the organisms on surfaces. Do NOT drink bleach or use on skin.

Contagious? Yes.

Ricin (Poison/Toxin from Castor Beans)

Enters the body through cuts in the skin, being inhaled, or the mouth.

Symptoms

• Fever, tight chest, cough, and respiratory problems occur within a few hours if ricin is inhaled.
• If taken in by mouth, can cause intestinal bleeding and damage to the kidneys and liver.

Treatment

• No vaccine or antitoxin is available; patients given supportive care.
• The toxin is inactivated by bleach or soap and water. Do NOT drink bleach or use on skin.

Contagious? No.

Chemical Threat Preparedness

• Stockpile three days of nonperishable food.
• Stockpile three days of water (three gallons for each person).
• Develop family contact plan.
• Purchasing a gas mask is NOT recommended.

If a Chemical Attack Occurs

• IMMEDIATELY leave the chemical attack area.
• IMMEDIATELY remove contaminated clothing and shower or flush with water if you were exposed.
• Avoid puddles of liquid.
• Chemical clouds blow away quickly.
• Do NOT immediately rush to the emergency room unless you have inhaled chemical fumes or have contamination on your skin.

Nerve Agents (VX, Sarin, Tabun)

Can be liquid or gas. Enters body through skin and eyes, being inhaled, or the mouth.

Immediate Action

• If you are exposed, the effects will be fairly rapid.
• IMMEDIATELY leave the area. Avoid puddles of liquid.
• If the attack was outside, get inside a building or a car. If inside, get to the outside.
• If directly exposed, remove clothing (place in plastic bags if possible). Do not remove contaminated clothing over your head; cut or tear it off.
• Thoroughly flush all areas where agent contacted your skin using nearest water available.

Symptoms

• First, pupils of the eyes shrink to pinpoints and victim begins sweating and twitching.
• Then, victim experiences runny nose, watery eyes, drooling, excessive sweating, difficulty breathing, dimness of vision, nausea, vomiting.

Treatment

• Remove clothing and flush eyes and skin with plenty of water.
• Seek medical attention immediately; there are antidotes for specific chemical agents.
• Atropine is an effective nerve gas antidote, but should be administered only by qualified personnel.

Contagious? No.

Sulfur Mustards

Generally thick liquid, yellow or brown in color, with a slight garlic or mustard odor. Enters the body through skin and eyes, being inhaled, or the mouth.

Symptoms

• Mustard gas is a blistering agent, burning eyes and skin exposed to it, and lungs, mouth, and throat if inhaled.
• Symptoms are not usually noticed until one to six hours after exposure.

Treatment

• Remove clothing and flush the eyes and skin with plenty of water.
• Seek medical attention immediately.

Contagious? No.

Hydrogen Cyanide

Extremely flammable, colorless gas or liquid. Enters the body through skin and eyes, being inhaled, or the mouth.

Symptoms

• Burning and redness of the skin and eyes.
• Inhaling causes confusion, drowsiness, and shortness of breath; leads to collapse.

Treatment

• Get fresh air immediately.
• Flush skin or eyes with plenty of water.
• Seek medical attention immediately; there are antidotes for specific chemical agents.

Contagious? No.

Chlorine

Chlorine is a greenish-yellow gas with stinging odor. It is heavier than air, so it will settle in low spots.

Symptoms

• Very harmful to the eyes and skin, and can cause tearing, blurred vision, difficulty breathing, and burns.

Treatment

• Get fresh air immediately.
• Flush skin or eyes with plenty of water.
• Seek medical attention immediately.

Radiological Threat (“Dirty Bomb”) Preparedness

• Stockpile three days of nonperishable food.
• Stockpile three days of water (three gallons for each person).
• Develop family contact plan.
• Purchasing potassium iodide tablets, a Geiger counter, or a gas mask is NOT recommended.

If a Dirty Bomb Attack Occurs

• You have time — the amount of radiation from a “dirty bomb” is unlikely to give you radiation sickness or cancer.
• Follow instructions of emergency personnel.
• Leave the area by foot; do NOT use public transportation to avoid contaminating buses, subways, railcars, etc.
• Do NOT immediately rush to the emergency room.

At the Blast Site

• Stay calm — you have time — decontamination does not need to begin immediately.
• Cover your mouth and nose with a handkerchief.
• REMAIN in the area until released by emergency personnel.

Near the Blast Site

• Cover your mouth and nose with a handkerchief or other material.
• Proceed on foot away from the area. Do not take public transport.
• If you drive your car or truck, do not use the air conditioning or heater.
• At home, remove clothing OUTSIDE and place in plastic bag.
• Shower twice; wash hair thoroughly.

Radiation Exposure Symptoms & Treatment

Radiation doses are referred to as the number of rem. A chest X-ray is about 1/100th rem. The average person gets about 1/3 of a rem from natural exposure during a year.

• 5 to 75 rem: Few observable symptoms.
• 75 to 200 rem: Causes vomiting, fatigue, and appetite loss — recovery takes a few weeks.
• More than 300 rem: Causes bleeding and changes in blood cells.
• More than 600 rem: Causes hair loss and an inability to fight infections — usually fatal.

Treatment

• Treatments are available for some types of radiation exposure.
• Wash any open wound several times with soap and water.
• Anti-nausea drugs and painkillers can relieve some symptoms.
• Antibiotics can fight secondary infections.
• Blood transfusions may be needed.

Contagious? No.

Biological Attack: Frequently Asked Questions

What should I do to protect my family if a biological agent were released? Emergency management teams will let you know if you need to evacuate. Self-isolation will protect you and your family from contagious diseases. Most agents are destroyed by bleach, or in some cases soap and water.

What should I do if I’m in a building during a biological attack? Stay in your area so you do not kick up dust. Cover your mouth with a handkerchief or clothing. If a letter or package is the source, close the doors and windows of that room and turn off air conditioning, heating, and fans.

How can I distinguish between anthrax and a cold or flu? A runny nose is a rare symptom of anthrax. Flu-like symptoms outside of the “flu season” should trigger medical attention.

Is smallpox contagious before symptoms show? A person with smallpox is sometimes contagious with onset of fever, but becomes most contagious with the onset of rash. Infected persons are contagious until the last smallpox scab falls off.

Should I keep a stockpile of antibiotics? No. There is no single pill that can protect against all types of biological agents, and antibiotics have a limited “shelf life.”

Is it safe to drink water from the tap? It would be extremely difficult for a terrorist to contaminate drinking water supplies. Water treatment facilities routinely filter and add chlorine to kill harmful germs. Citizens can protect themselves by boiling their drinking water.

Should I purchase disposable masks? Having disposable masks is not a bad idea, but not absolutely necessary. In an emergency, you can get the same amount of protection by placing an article of clothing over your mouth and nose.

Chemical Attack: Frequently Asked Questions

Should I purchase a gas mask? No. A mask would only protect you if you were wearing it when an attack occurs, and attacks are most likely done without anyone knowing ahead of time. Masks that are not properly fitted will NOT give adequate protection.

Should I keep a stockpile of water? Yes. One gallon of safe water per person per day is the bare minimum for survival. Properly chlorinated tap water can be safely stored for up to three months. Water purification tablets are also readily available.

What are the signs of a chemical attack? Many chemical agents cannot be seen or smelled. If several people are down, coughing, vomiting, or seizing, they could be reacting to a toxic substance. Leave the area immediately and call 9-1-1.

If the attack occurs indoors: Exit the building immediately. Avoid puddles of liquid. Taking off your outer clothing can remove roughly 80 percent of the contamination hazard. Look for a nearby source of water to rinse any exposed skin.

If the attack occurs outdoors: Get indoors quickly — into a building or a car. Shut all windows and doors, turn off air conditioner or heater. The wind will carry the toxic hazard away within a relatively short period of time.

Dirty Bomb: Frequently Asked Questions

What is a “dirty bomb”? A conventional explosive, such as dynamite, packaged with radioactive material that scatters when the bomb goes off. It is not the same as an atomic bomb. Most dirty bomb casualties will be from the initial blast. The TNT may still be more dangerous than the radioactive material.

Will a “dirty bomb” make me sick? Although a dirty bomb could cause serious injuries from the explosion, it most likely would not have enough radioactive material to cause serious radiation sickness among large numbers of people. Radioactive material is much more dangerous if it gets inside your body. Do not eat, drink, or smoke, and do not touch your hand to your face until you have been properly decontaminated.

How fast do I have to leave the area? Anyone who survives the explosion will actually have hours to evacuate. There is no need for panic.

Can I decontaminate my home? Yes. Decontamination is difficult, but possible. With reasonable effort and care you should be able to return to a normal, safe life in your home.

Should I buy a radiation detector? No. Unless you have been trained you won’t be able to interpret the readings.

Should I purchase potassium iodide tablets? No. Potassium iodide (KI) protects against radioactive iodine, which is released in nuclear explosions, not dirty bombs.

Credits

The information in this brochure was prepared by Patricia Coomber, PhD (Lt. Col., USAF) and Robert Armstrong, PhD (Col., USAR) at the Center for Technology and National Security Policy, National Defense University, Fort McNair, Washington, D.C. Reproduced with permission.

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