Chemical, biological, radiological or nuclear (CBRN) weapons in the hands of a terrorist or a rogue state is one of the greatest threats to the security of the United States. These weapons of mass destruction (WMDs) can cause catastrophic loss of life and innumerable injuries and challenge the US health system beyond its capacity to provide care. Most hospitals do not have the beds, equipment, staff, or facilities to adequately respond to a WMD event.Compounding this problem is that many people who have minimal or no exposure to a CBRN agent will seek medical care and slow down medical treatment of genuinely affected patients. These "worried well" patients may comprise as many as 20 times the number of "legitimate" patients and may become one of the most difficult aspects in dealing with WMD events. This paper is an examination of the worried well phenomenon. It looks at three CBRN events that are often noted for unaffected masses seeking medical care--the Goiania Radiation Incident, the Aum Shinrikyo Attack, and the Anthrax Letters Incident.The purpose of this paper is twofold. First, this paper provides a better understanding of the worried well response. The literature often contains bold proclamations of the problem without a substantial analysis, and researchers cite cases but fail to provide any in-depth study of them. This paper provides a closer examination of the cases and shows that the worried well response is neither irrational nor characterized by panic. Instead when examined from informational, medical, and psychological perspectives, the worried well response is largely a rational reaction.The second purpose of this paper is to provide a strategy to mitigate the worried well response in CBRN events. Admittedly, it is beyond the scope of this paper to provide a detailed worried well response plan for every possible CBRN event. This paper, however, does provide the basic elements to reduce the response and still provide proper health care for everyone affected by a CBRN event.CASE STUDIES * The Goiania Incident * The Aum Attack * Anthrax Letters Incident * UNDERSTANDING THE WORRIED WELL * Information Explanations for the Worried Well * Government Directions * Media Reports * Medical Explanations for the Worried Well * Group 1. People who were exposed and had minor symptoms requiring minimal or no medical care * Group 2. People who may have been exposed but had no clear physical symptoms related to the event or an organic etiology * Group 3. People who could not possibly have been exposed but came to the hospital seeking care for imagined illnesses or prevention * Group 4. Those hoping to profit either financially or emotionally * Group 5. Those experiencing stress disorders * Psychological Explanations for the Worried Well * Looking for Answers * RESPONDING TO THE LOW RISK PATIENT RESPONSE * Re-Thinking the Worried Well * Pre-CBRN Event Preparation * Community Involvement * Partner with the Media * Develop Trusted Agents * Prepare alternate communication channels * Post-CBRN Event: Preventing LRPs from Seeking Immediate Care * Tier 1: Prevent LRPs from Seeking Care * Tier 2: Stop LRPs at the Door * Tier 3: Comprehensive Medical Care * Other Considerations: Security and Liability coverage * LRP Response Plan Summary * CONCLUSIONS * APPENDIX: PROBLEMS ESTIMATING THE WORRIED WELL RESPONSE * APPENDIX: THE CRITICAL ROLE OF THE DEPARTMENT OF DEFENSE * BIBLIOGRAPHY

Chemical, Biological, Radiological, Nuclear, and high-yield Explosive (CBRNE) events have the potential to destabilize governments, create conditions that exacerbate violence or promote terrorism. This can trigger global repercussions. These events can quickly overwhelm the infrastructure and capability of the responders, especially in countries that do not have the specialized resources for response like those available in the United States. When a CBRNE incident occurs in a partner nation or other foreign country, the U.S. is often called upon to provide assistance. Interoperability - the ability to work together - among U.S. agencies, foreign governments, and responders involved in the effort is key to an efficient response. The effectiveness of the U.S. response and approach to CBRNE events in partner nations depends on the capability of the U.S. government to provide timely and appropriate assistance and the resilience of the partner nation to a CBRNE event. An All-of-Government Approach to Increase Resilience for International Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Events is the summary of a workshop convened in June 2013 by the National Institute of Standards and Technology and the National Research Council to discuss ways to strengthen the U.S. ability to prepare for and respond to CBRNE events that occur in U.S. partner nations. The workshop brought together diverse experts and stakeholders to identify capabilities that are necessary for responding to an international CBRNE event; discuss best practices and resources needed for improved interoperability of the U.S. and partner nation during response to a CBRNE event; and identify key questions that need to be addressed in follow up activities focused on improving U.S. CBRNE response in partner nations.

Originating in the armed forces of the early 20th century, weapons based on chemical, biological or nuclear agents have become an everpresent threat that has not vanished after the end of the cold war. Since the technology to produce these agents is nowadays available to many countries and organizations, including those with terrorist aims, civil authorities across the world need to prepare against incidents involving these agents and train their personnel accordingly. As an introductory text on NBC CBRN weapons and agents, this book leads the reader from the scientific basics to the current threats and strategies to prepare against them. After an introductory part on the history of NBC CBRN weapons and their international control, the three classes of nuclear/radiological, biological, and chemical weapons are introduced, focusing on agents and delivery vehicles. Current methods for the rapid detection of NBC CBRN agents are introduced, and the principles of physical protection of humans and structures are explained. The final parts addresses more general issues of risk management, preparedness and response management, as the set of tools that authorities and civil services will be needed in a future CBRN scenario as well as the likely future scenarios that authorities and civil services will be faced with in the coming years. This book is a must-have for Health Officers, Public Health Agencies, and Military Authorities.

At 2:00am on October 2, 2001, Robert Stevens entered a hospital emergency room. Feverish, nauseated, and barely conscious, no one knew what was making him sick. Three days later he was dead. Stevens was the first fatal victim of bioterrorism in America. Bioterrorism expert Leonard Cole has written the definitive account of the Anthrax attacks. Cole is the only person outside law enforcement to have interviewed every one of the surviving inhalation-anthrax victims, along with the relatives, friends, and associates of those who died, as well as the public health officials, scientists, researchers, hospital workers, and treating physicians. Fast paced and riveting, this minute-by-minute chronicle of the anthrax attacks recounts more than a history of recent current events, it uncovers the untold and perhaps even more important story of how scientists, doctors, and researchers perform life-saving work under intense pressure and public scrutiny. Updated with new information about Ivins and a series of upcoming Congressional hearings into the FBI’s conduct in this case, The Anthrax Letters amply demonstrates how vulnerable America was in 2001 and whether we are better prepared now for a bioterror attack.

The author maintains that without full govenment cooperation on an international basis, terrorism will not be kept at bay. And to achieve this, one of the first steps is full understanding of the entire subject.

In the twentieth century, disasters caused by human beings have become more and more common. Unlike earthquakes and other natural catastrophes, this 'new species of trouble' afflicts person and groups in particularly disruptive ways.