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Disasters and their resultant health implications present medical professionals with challenges outside their normal practice. These events may occur naturally or be man-made. In both instances, the potential for widespread devastation is a real and ever-present danger which demands occupational health care professionals be adequately prepared to respond. Disaster preparedness for all types of emergencies from acts of nature, including pandemics, to acts of terror requires understanding of potential hazards, the ability to forecast emergencies, formulate plans, and train for response. The intent of this chapter is to outline and discuss some of the relevant chemical, biological, radiologic, nuclear, and explosive (CBRNE) events that may cause disasters at local, national, and global levels. This is not intended to be an inclusive list of all CBRNE agents, only those considered most likely to naturally occur or be purposely developed and used as weapons of mass destruction.
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CBRNE release may result from natural disaster, unintentional human error, or by malignant terrorist intent. For example, in 2005 Hurricane Katrina damaged levees in New Orleans which had not been properly designed or constructed to withstand storm surges. The resultant unprecedented flooding had biological and chemical ramifications due to sewage that infected the flood waters and contaminated the local waterways with bacteria. In the 2 weeks following Katrina, Vibrio vulnificus caused 22 human infections and 5 deaths. Weeks later, Escherichia coli found in standing water was still ten times greater than the Environmental Protection Agency (EPA) permissible level for human contact requiring workers to wear protective clothing to decrease the outbreak of skin rashes. Although it took months for water distribution to be brought back on line, interim testing of potable water revealed lead and arsenic levels in excess of EPA drinking water standards. Changes in pipe ecology due to the intrusion of these same contaminants were also a threat. Additionally, homes on well water provided concern for contamination. In Houston, where evacuees were being temporarily housed, Norovirus infections rates were nearly 20%.
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When an earthquake-triggered tsunami struck Japan leading to the Fukashima Daiichi nuclear power plant disaster, nearly 16,000 deaths occurred and 160,000 people lost their homes and livelihoods. Cleanup efforts are still taking much longer than expected. Subsequent radiation exposure continues at unprecedented levels. In 2017, six years after the mishap, the Tokyo Electric Power Company reported radiation levels of 530 Sieverts per hour in the containment vessel of reactor 2, a significant distance from the melted fuel. Both of these CBRNE examples are considered complex emergencies, when a man-made disaster occurs on top of a natural disaster, or vice versa.
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Increased access and exposure to CBRNE agents in the twenty-first century presents a greater threat now than ever before. Technological advances have made it easier today for potential terrorists to obtain or develop novel biological agents or highly infectious “superbugs” to be used as weapons against humanity. Global cooperative efforts have been aimed at ...