Medical Preparedness for Mass - Casualty Incidents involving CBRN Agents: A Pharmacist’s Perspectives

Sudha Rana, Rakesh Kumar Sharma

Abstract: Terrorism has become synonymous with individuals or groups attempting to destabilise a set up. We are witness to the emergence of new terrorists groups including apocalyptic/religious cults, right-wing extremists and fundamentalist groups, whose aims are neither to bargain with governments, nor to win over public opinion to their point of view, but rather to cause the maximum possible amount of carnage and disruption. In the past, only a few terrorists had the motivation and technical ability to carry out large-scale chemical, biological, radiological or nuclear (CBRN) attacks. The most destructive and high impact terrorist events have thus far been carried out using conventional or military explosives, small arms or means other than dangerous substances such as toxins, chemicals, pathogens or radiological materials. In the aftermath of horrific attacks of 11th September 2001 and 26th November 2008, there is no doubt that today’s ruthless fundamentalist terrorists will attempt to use un-conventional devices in future to inflict maximum casualties. After such incident the governance must quickly assess the scene and assign personnel to coordinate and manage the chaos. Medical preparedness for mass casualty event involving CBRN agents is a formidable task. Pharmacist’ perspective of such critical scenario delineating their precise roles, is presented in this article.

Introduction: Emergency situations by definition are unplanned, unexpected and urgent. Terrorism is an act intended to cause death or serious bodily harm to civilians or non-combatants with the purpose of intimidating a population, or compelling a government or an international organization to do or abstain from doing any act. Terrorism as a tactic is employed in three main contexts: (i) illegal state repression; (ii) propagandistic agitation by non-state actors in times of peace or outside zones of conflict and, (iii) as an illicit tactic of irregular warfare employed by state- and non-state actors. Major high impact terrorist events have thus far been executed using explosives, small arms or means other than dangerous toxic substances such as toxins, chemicals, pathogens or radiological materials.[1] To date there has been no act of Chemical, Biological, Radiological and Nuclear agents (CBRN) terrorism that has caused mass casualties or resulted in catastrophic consequences. However, this fact does not imply that this category of actors has not tried to acquire necessary capabilities in order to perform such attacks (Table- 1), but simply they have not been very successful in their attempts due to certain reasons.



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