Senior Fellow, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA.
Department of Emergency Medicine and EMS, Sundsvall County Hospital, Sundsvall, Sweden.
Prehosp Disaster Med. 2021 Aug;36(4):399-402. doi: 10.1017/S1049023X21000625. Epub 2021 Jun 30.
Terrorist attacks are growing in complexity, increasing concerns around the use of chemical, biological, radiation, and nuclear (CBRN) agents. This has led to increasing interest in Counter-Terrorism Medicine (CTM) as a Disaster Medicine (DM) sub-specialty. This study aims to provide the epidemiology of CBRN use in terrorism, to detail specific agents used, and to develop training programs for responders.
The open-source Global Terrorism Database (GTD) was searched for all CBRN attacks from January 1, 1970 through December 31, 2018. Attacks were included if they fulfilled the terrorism-related criteria as set by the GTD's Codebook. Ambiguous events or those meeting only partial criteria were excluded. The database does not include acts of state terrorism.
There were 390 total CBRN incidents, causing 930 total fatal injuries (FI) and 14,167 total non-fatal injuries (NFI). A total of 347 chemical attacks (88.9% of total) caused 921 FI (99.0%) and 13,361 NFI (94.3%). Thirty-one biological attacks (8.0%) caused nine FI (1.0%) and 806 NFI (5.7%). Twelve radiation attacks (3.1%) caused zero FI and zero NFI. There were no nuclear attacks. The use of CBRN accounted for less than 0.3% of all terrorist attacks and is a high-risk, low-frequency attack methodology.The Taliban was implicated in 40 of the 347 chemical events, utilizing a mixture of agents including unconfirmed chemical gases (grey literature suggests white phosphorous and chlorine), contaminating water sources with pesticides, and the use of corrosive acid. The Sarin gas attack in Tokyo contributed to 5,500 NFI. Biological attacks accounted for 8.0% of CBRN attacks. Anthrax was used or suspected in 20 of the 31 events, followed by salmonella (5), ricin (3), fecal matter (1), botulinum toxin (1), and HIV (1). Radiation attacks accounted for 3.1% of CBRN attacks. Monazite was used in 10 of the 12 events, followed by iodine 131 (1) and undetermined irradiated plates (1).
Currently, CBRN are low-frequency, high-impact attack modalities and remain a concern given the rising rate of terrorist events. Counter-Terrorism Medicine is a developing DM sub-specialty focusing on the mitigation of health care risks from such events. First responders and health care workers should be aware of historic use of CBRN weapons regionally and globally, and should train and prepare to respond appropriately.
恐怖袭击的复杂性不断增加，人们对化学、生物、辐射和核（CBRN）制剂的使用越来越关注。这导致反恐医学（CTM）作为灾害医学（DM）的一个分支越来越受到关注。本研究旨在提供 CBRN 在恐怖主义中的使用情况的流行病学信息，详细说明使用的特定制剂，并为应对人员制定培训计划。
从 1970 年 1 月 1 日至 2018 年 12 月 31 日，从开源的全球恐怖主义数据库（GTD）中搜索所有 CBRN 袭击事件。如果袭击事件符合 GTD 编码手册中规定的与恐怖主义相关的标准，则将其包括在内。有歧义的事件或仅部分符合标准的事件被排除在外。该数据库不包括国家恐怖主义行为。
共有 390 起 CBRN 事件，造成 930 人死亡（FI）和 14167 人非致命伤害（NFI）。共有 347 起化学袭击（占总数的 88.9%）造成 921 人死亡（99.0%）和 13361 人非致命伤害（94.3%）。31 起生物袭击（8.0%）造成 9 人死亡（1.0%）和 806 人非致命伤害（5.7%）。12 起辐射袭击（3.1%）造成零人死亡和零人非致命伤害。没有核袭击。CBRN 的使用占所有恐怖袭击的不到 0.3%，是一种高风险、低频率的袭击方式。塔利班被牵连到 347 起化学事件中的 40 起，使用了包括未确认的化学气体（灰色文献表明是白磷和氯气）、用杀虫剂污染水源以及使用腐蚀性酸在内的混合物。东京的沙林毒气袭击造成 5500 人非致命伤害。生物袭击占 CBRN 袭击的 8.0%。在 31 起事件中，炭疽或被怀疑使用或涉及炭疽，其次是沙门氏菌（5）、蓖麻毒素（3）、粪便（1）、肉毒杆菌毒素（1）和 HIV（1）。辐射袭击占 CBRN 袭击的 3.1%。在 12 起事件中使用了独居石，其次是碘 131（1）和未确定的放射性板（1）。
目前，CBRN 是低频率、高影响的袭击方式，鉴于恐怖事件发生率上升，仍令人担忧。反恐医学是灾害医学的一个新兴分支，专注于减轻此类事件对医疗保健的风险。第一反应者和医疗保健工作者应了解区域和全球范围内 CBRN 武器的历史使用情况，并应进行培训和准备，以适当应对。
