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Disasters and Mass Casualties: II. Explosive, Biologic, Chemical, and Nuclear Agents

Dr. Born is Professor, Orthopaedic Surgery, the Warren Alpert Medical School of Brown University, and Director, Orthopaedic Trauma Service, Rhode Island Hospital, Providence, RI. Dr. Briggs is Associate Professor, Surgery, Harvard Medical School, and Attending General and Trauma Surgeon, Massachusetts General Hospital, Boston, MA. Dr. Ciraulo is Director, Trauma Outreach and Surgical Emergency Preparedness, Maine Medical Center, Portland, ME. Dr. Frykberg is Professor, Surgery, University of Florida College of Medicine, and Chief, General Surgery, University of Florida Health Science Center, Jacksonville, FL. Dr. Hammond is Professor, Surgery, Robert Wood Johnson Medical School, and Director, Surgical Critical Care Service and Trauma Center, New Brunswick, NJ. Dr. Hirshberg is Senior Researcher, ER One Institute, Washington Hospital Center, Washington, DC. Dr. Lhowe is Assistant Professor, Orthopaedic Surgery, Harvard Medical School, and Attending Orthopaedic Surgeon, Massachusetts General Hospital. Dr. O’Neill is Associate Professor, Surgery, and Co-chief, Division of Trauma Surgery and Surgical Critical Care, State University of New York–Downstate Medical Center/Kings County Hospital, Brooklyn, NY. Ms. Mead is Research Assistant, Orthopaedic Trauma, Department of Orthopaedic Surgery, the Warren Alpert Medical School of Brown University.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Born, Dr. Briggs, Dr. Ciraulo, Dr. Frykberg, Dr. Hammond, Dr. Hirshberg, Dr. Lhowe, Dr. O’Neill, and Ms. Mead.

Reprint requests: Dr. Born, University Orthopaedics, Suite 200, 2 Dudley Street, Providence, RI 02905.

Terrorists’ use of explosive, biologic, chemical, and nuclear agents constitutes the potential for catastrophic events. Understanding the unique aspects of these agents can help in preparing for such disasters with the intent of mitigating injury and loss of life. Explosive agents continue to be the most common weapons of terrorists and the most prevalent cause of injuries and fatalities. Knowledge of blast pathomechanics and patterns of injury allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents, their attendant clinical symptoms, and recommended management strategies is an important prerequisite for optimal preparation and response to these less frequently used agents of mass casualty. Orthopaedic surgeons should be aware of the principles of management of catastrophic events. Stress is less an issue when one is adequately prepared. Decontamination is essential both to manage victims and prevent further spread of toxic agents to first responders and medical personnel. It is important to assess the risk of potential threats, thereby allowing disaster planning and preparation to be proportional and aligned with the actual casualty event.

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