Although there is no one single accepted definition for terrorism, the Code of Federal Regulations defines terrorism as the unlawful use of force or violence against persons or property to intimidate or coerce the government, the civilian population, or any segment thereof, in furtherance of political or social objectives. The key elements of terrorism are that it is: 1) premeditated; 2) it is political; 3) it is aimed at civilians (or noncombatants); and 4) it is carried out by sub national groups. Terrorism is usually associated with community disruption, injuries, and death. Bioterrorism, a specific category of terrorism, is defined as the intentional use of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants.
The threat of biological agents in military operations and civilian terrorist attacks continues to increase. The asymmetry in world super-power structure has provided impetus for smaller aggressive nations to develop and acquire biological weapons to level the playing field against the superiority of the U.S. and its allies. Proliferation of the technology needed by rogue nations and terrorist groups to develop biological weapons has also occurred in recent years. Further, advancements in biotechnology have generated new capability to disguise or modify existing genetically biological agents and to create new ones. This increases the biological agent variety and availability to terrorists. In civilian scenarios a number of factors mitigate against preventing a successful biological attack. The small quantity needed for a successful attack increases the probability that terrorists can acquire and conceal sufficient quantities. For example, the Aum Shinrikyo cult in Japan experimented with biological weapons before using chemical agents in the infamous subway attack of 1995 in Tokyo. It is also difficult to control access to public areas, so preventing a terrorist attack is problematic.
The approach to defending against a terrorist attack must focus on managing the consequences. In contrast, the approach to defense in military scenarios is focused on destroying offensive capabilities before an attack is launched and ensuring early detection or medical pre-treatment.
Focusing on consequence management in civilian scenarios versus hazard avoidance in the military equivalent has great effect on the probability of achieving the elements of an integrated approach to defense. Planning and preparation to avoid exposure to biological agents characterize the military approach. The greatest importance is placed on hazard assessment, medical pre-treatments, and early detection and warning so minimum numbers of soldiers become casualties. The scale of a military attack limits the types of agent that can be used, means of dissemination of the agents, and the conditions under which they are released. These factors limit the ability to conceal an offensive capability and allow a more accurate prediction of the threat and hazard. Because military operations are highly organized, detection systems can provide advanced warning of an attack to avoid exposure or to don protective equipment. Early detection and reconnaissance also enhance control of contamination spread and decontamination operations. Finally, early detection allows treatment before onset of symptoms, greatly enhancing its effectiveness.
The focus of civilian scenarios is consequence management after an attack, versus planning and avoiding exposure in military scenarios. Rapid diagnosis and medical treatment is key in civilian scenarios, versus vaccination and other medical pre-treatments in military scenarios. Avoiding contamination is most important in civilian scenarios while prevention of contamination through active defense is feasible in military scenarios. A variety of detection systems, including hand-held sensors, small remote point systems, and vehicle-mounted systems are all necessary in civilian scenarios. Detection systems should be used to monitor the hazards to ensure effectiveness of decontamination and to avoid secondary contamination.
Decontaminating casualties and treating physical injuries are also priorities. Equally important, but not as time-dependent, is treatment of infection or intoxication through the use of antibiotics.
The overriding consequence of an effective large-scale unannounced bioterrorism attack will be the rapid emergence of large numbers of casualties. Response systems need to anticipate and be robust enough to deal with this possibility. As much as possible, a response system should be able to detect and identify the medical problem at the earliest moment, administer appropriate medical prophylaxis to avoid disease in exposed victims, and then be able to keep up with the onset of casualties so that all are dealt with in a supportive and non-chaotic manner. Due to high-dose effects, the ability to save many of the casualties exposed to lethal diseases, even with immediate medical treatment, will be diminished. Therefore, the response systems should have the capability to deal with high numbers of fatalities. Casualties from an attack on a building could be dispersed over wide metropolitan, multi-state, or multi-national areas. Conversely, an outside release against a residential area could result in severe incapacitation of entire apartment complexes within one geographic location.
In short, an effective large-scale bioterrorism attack would result in a catastrophic medical emergency. Without prior planning, such an emergency would quickly saturate local emergency response and medical assets.
In response to the bioterrorism threat, the District 1 Regional Medical Response Coalition was formed. The District 1 Regional Medical Response Coalition (D1RMRC) is a regional organization of a broad-spectrum of groups who have a requirement and/or interest in preparing for and responding to a large-scale disaster, specifically a Weapons of Mass Destruction (WMD) event. The D1RMRC was formed as part of a federal grant issued by the U.S. Department of Health and Human Services' (DHHS) Health Resources and Services Administration (HRSA). The grant identified several focus areas to be addressed in a regional bioterrorism response plan. The focus areas under the HRSA grant are being coordinated with other grants (e.g., CDC grants, DOJ grants) to ensure the most efficient use of resources. (See History of the Coalition for further details.)
By addressing the challenges that a WMD event may present, the planning effort can strengthen the ability of the health system (e.g., first responders, hospitals, public health) to perform routine tasks that affect daily medical care and public health activities. The planning efforts are essential in developing a more robust public health infrastructure and providing necessary resources to manage a dramatic increase in requirements: providing surveillance, engaging in epidemiological-criminal investigations, distributing medical and public health recommendations, distributing scarce resources, and communicating with hospitals, the public, and other local, state, and federal agencies. Strengthening the region's health system provides the best civil defense against a WMD event, especially a Biological Weapons Incident (BWI).