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Day 4-Antidecapitation Training

We were trained how to enter and depart a helicopter without getting our heads or extremities chopped off. We were told in no uncertain terms never to leave by the rear of the helicopter, as the tail rotor is invisible when rotating and many people have been decapitated by leaving a burning helicopter in haste by that lethal route. We also learned how to evacuate the helicopter in case of an engine failure or fire. One of the MSU team members demonstrated a six-man tent supposedly easy to raise and lower. In the lowering process about 20 of the thin aluminum struts (like umbrella supports) snapped. He was very embarrassed, after having told us how fool-proof it was.

What became increasingly obvious as each of the lectures progressed was the fact that despite a one-sentence acknowledgment of psychiatric casualties being associated with an exposure to chemical, biological or nuclear weapons, nothing more was said about how to handle them. Being the only psychiatrist there and the only mental health representative, I often questioned how we would be doing a rapid assessment of casualties in a situation where a few people were actually exposed to the toxic agent, and 50 times more people were afraid they had been, or believed they had been.

Such was the case in the recent Tokyo subway gas attacks, where there were 150 actual casualties commingled with 5,000 panicked people who believed they had inhaled the poisonous gas. Clearly, in an Olympics venue, which can hold 60,000 people with 60,000 more waiting to enter, there could be many people crushed as panic developed and people became traumatized by fears of exposure.

The instructor then discussed the fact that both biological and chemical agents are already being used world-wide. Ricin, of which 130 grams can kill thousands of people, was used by the Aryan Nation, a U.S.-based right-wing group, to kill four men recently. As a deterrent to would-be terrorists, our instructor (a world authority on biological warfare) told us that he had once published an incorrect formula for sarin gas on the Internet. Within 30 minutes, there were over 25 e-mail postings correcting the formula!

If a terrorist wants a delayed reaction, giving him time to escape, he could use botulism spores, which take two days to germinate. They can easily be dispersed by aerosols. He described viruses like small pox and pneumonic plague and other toxic agents that can easily be sprayed on unsuspecting large numbers of people. He told how easily botulism could be spread via contaminated mustard in dispensers for hot dogs in an arena. The tragic conclusion is that biological weapons are easily obtained, easily disseminated and can produce a wide-spread catastrophe.

He then showed a slide demonstrating the comparative costs of killing a population with a biological agent-$1 per 3 square kilometers versus $2,000 per square kilometer for other agents-about one-third the cost of any other destructive weapon to produce and deliver. He showed a slide describing the more than 300 toxins (poisons of natural origin), all of which are tasteless, odorless and lethal. Botulism is 10,000 times more toxic than ricin which is next on the list. Botulism is lethal at less than 5 micrograms per kilogram. The symptoms occur 18 to 36 hours after exposure, giving [a perpetrator] plenty of time to get away.

The instructor then went on to scare us with the information that in the United States we have 30,000 tons of chemical weapons sitting in rusting, deteriorating tanks, situated in more than 10 different states.

Students Teaching the Teachers

Several of the team leaders approached the administrative staff to set up instructional courses, since there was so much down time. The staff eagerly agreed and my session on handling stressed and panicky victims was first on the agenda.

I set up role-playing situations based on the actual experiences of those who had participated in disasters. One member of my team portrayed dramatically a victim of a hurricane who was exposed to and contaminated by a toxic gas, and she effectively contaminated the entire class one by one. Eventually, her story of having been near a tanker truck that overturned and released a yellow gas, much to the chagrin of all those eager helpers who had reached out to comfort her. The people who attended applauded at the end-I felt very pleased, since that was the only class that received such recognition. I was asked to repeat it the next day with several other academy-award performances, including one young man who portrayed a pregnant woman injured in an earthquake.

Apparently, the administrative staff liked the format of my instruction, as I was asked by the medical director to be on the DMAT advisory board. Hopefully, I will be able to emphasize the need for instruction in handling the psychological and emotional aspects of disasters.

We then had another chemical agent class in which different scenarios were acted out and we were expected to respond with the appropriate medications and triage. In the same triage class we learned that CPR is not always a good idea, especially if someone shows the symptoms of cyanide poisoning. Mouth-to-mouth resuscitation or even forcing oxygen by mask can release enough cyanide gas from the lungs to kill everyone nearby. A firefighter/paramedic recently gave mouth-to-nose resuscitation to his dog and died of cyanide poisoning.

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