A Summary:
CBMTS-INDUSTRY IV
Third World Congress CBR and Terrorism
Dubrovnik, Croatia; 17-23 September 2005.
The CBMTS - Industry IV was without doubt the science and medical professionals’ meeting of the year. Our CBMTS professionals with their very important and timely presentations, provided us an insight into the most forward edge of requirements and technology across CBR&T science and medicine. Added to this was Dubrovnik, the most charming and beautiful of all the diamonds on the Adriatic.
From the Opening and Welcome by Assistant Minister of Defense and Director CBMTS-Industry IV, the Honorable Igor Pokaz, to the erudite and very important presentation of Ambassador Rogelio Pfirter, the Director General Organization for the Prohibition of Chemical Weapons (OPCW) and to Major General David Poythress, The Adjudant General, State of Georgia Department of Defense and his presentation on where have we been and where we are going with the CBMTS series.
During this meeting, several new arenas were opened for CBMTS consideration including Agroterrorism and its many ramifications, Dr. Lee Myers, principal; Radiological/Nuclear Preparedness to include those actions required following a radiological event, Dr. Terry Pellmar, principal; Nonproliferation R&D, Dr. Jan Cerveny, principal; and a look at those areas of most intense consideration by the US NIH which also serve as a barometer of what the world's professionals in medicine are considering, Dr. Maria Giovanni, principal; and many more areas.
For the record we had 210 individuals for the Symposium and Workshop, both participants and accompanied persons, from 39 countries - and all with their grace, charm and intelligence made this meeting the meeting of the year. They are the CBMTS. And our thanks to the Government of Croatia, our host and sponsor, and the Croatian Ministry of Defense and all of the Croatian Ministries for their time and resources which made all of this seem effortless.
Our thanks to the 12 Sector Chairs and Co-Chairs and to the 30 Session Chairs and Co-Chairs for their extra efforts at ensuring the success of the CBMTS-Industry IV. The Summary below will provide the reader an overview of CBMTS-Industry IV and will begin with a speech by General David Poythress, a senior CBMTS Executive Board Member, which serves as an introduction to the CBMTS. This will be followed by summary reports from each of the four Sectors.
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The Summary
Speech Delivered by:
Major General David B. Poythress
The Adjutant General
Georgia Department of Defense
to the CBMTS-Industry IV, Dubrovnik, Croatia
Minister Igor Pokaz
Ambassador Rogelio Pfirter
Ambassador Ana George
Ambassador Kirnich
Col. Zvorno Orehovec
Col Richard Price
Dr. Barbara Price
Friends and Colleagues:
It’s a wonderful occasion for us to be together again in Croatia for this CBMTS-Industry IV-Conference, 2005, which is a unique forum in the world for the kind of dialogue reflected in this year’s very challenging scientific agenda.
Since its inception in 1994 at Spietz Laboratory, Switzerland, the CBMTS series has matured into the premier forum of its kind in the world — in terms of both the scientific and professional credentials of the participants, as well as the relevance and timeliness of the scientific presentations. Over the past several years, I have enjoyed watching as Dr. Barbara Price has coached and cajoled, pushed and prodded new participants as they achieved ever more polished, professional presentations. The result has been that even a non-technical person such as myself can appreciate, even though I may not completely understand, the various authors’ messages. At the same time, our scientific colleagues who do understand have been better prepared — every year — to return home and make practical application in their home countries of the things they have learned in the CBMTS series.
The first CBMTS-Industry meeting was on chemical and biological warfare, and was the world’s very first meeting which recognized the critical role that industry could play in public health and safety at the local and regional level through technical and operational safeguards.
The next meeting, Industry II, was the first World Congress on Chemical, Biological and Radiological Terrorism, and it focused extensively on appropriate scientific and operational responses at all levels of government in the event of a catastrophic terrorist attack. That meeting — which was held some four and one-half months prior of 9/11/01 — surfaced and discussed some of the very kinds of events that actually occurred in that attack — specifically, the use of a commercial aircraft as a fuel bomb.
Industry III was yet another successful meeting that was ahead of its time in surfacing and examining previously undefined problems. And now CBMTS-Industry IV will again be at the leading edge of both policy and technology with this outstanding group of professionals.
The catalogue of topics for this meeting is the best yet. Bio Policy — and the threat of agro-terrorism — will be addressed by Dr. Lee Myers, State Veterinarian of my home State of Georgia in the U.S. Bio Agents-viruses-will be addressed by several of our distinguished colleagues. Chemical Agents — Mustard and the ongoing tragedy of Saddam’s use of mustard against civilians — most specifically the Iraqi-Kurdish population — will again be addressed. And CBMTS will continue in its tradition of providing a platform for worldwide dissemination of the important scientific research being done in this area by the CBMTS young medical and science professionals in Iran. And we will begin a deeper look into radiological issues, with Drs. Cerveny and Pellmar, and Capt Boris Ilijas who has been with the CBMTS series since its inception. We will look at chemical and biological medical treatment and detection and decontamination, and a myriad of other issues that will be addressed.
Finally, all 210 of us, representing 39 countries around the world, will have plenty of opportunities for informal interaction and networking that build the professional relationships and personal trust that are so central to progress in our increasing globablized scientific community. Indeed, that is one of the most important dividends for our collective participation in the CBMTS series.
And once again, our Croatian hosts — especially the Croatian Ministry of Defense — and the organizing committee have graced us with their most generous hospitality in this truly magical city of Dubrovnik. As we all know, Dubrovnik is a permanent site of the series, and we always look forward to renewing friendships with our wonderful Croatian hosts.
So, in conclusion:
I thank each of you for your presence at this very important meeting,
I congratulate you upon being selected by your government and by your scientific colleagues to participate in it,
And finally, I challenge each of you
• first, to build at least one new scientific and personal friendship during this meeting, and
• second, to take the lessons learned here and made practical application of them wherever possible.
Thank you again, to our Croatian hosts and to the organizing committee.
I know we will have a most successful CBMTS IV conference.
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Sector I Report: Workshop and Special Demonstrations/Exercise
Workshop Sessions: 1, 2, 3, 4, 5 and Congress Session 8
Summary
Chair: Col. Zvonko Orehovec (Croatia)
Co-Chair: Col. Richard Price (US)
Co-Chair: Col. Richard Price (US)
Under the Workshop “WMD and Non-Proliferation Policy”, we had 8 presentations. These presentations were followed by some lively discussions, which centered, inter alia, around issues such as:
• Discrepancies in interpretation of treaties and associated definitions;
• Tactics, form and methods of terrorism,
• International policy towards NBC terrorism,
• WMD Non-proliferation policy and security,
• Tactical level of the WMD non-proliferation policy.
It was concluded that one good way to counter terrorism would be to remove one reason for its existence, poverty; and, the scientific community, such as CBMTS, should actively strive to influence policy-making by establishing a link between policy and technology. This can inter alia be achieved by creating an awareness and appreciation of the proceedings and findings of international conferences, such as CBMTS, among government officials. On the poverty issue it was also pointed out that not one of the well known 9/11 terrorists could be said to have been impoverished.
Workshop “Emergency response and crisis management” were managed by Dr. Lionel Lee and Mr. Richard Nolan. Five presentations took a floor during that workshop. The workshop presentations were followed by some lively discussions too, which centered, inter alia, around issues such as:
• Lack of cooperation and support from privately owned hospitals during a catastrophic event;
• Striking a balance between confidentiality and openness;
• Ongoing conflict between commercial interests and what is good for the public;
• Need for international control over LPG's (Liquid Petroleum Gases).
Workshop ”The Congress technical demonstration and related exhibition” were managed by Maj. Tomica Sabolic and Maj. Jefrey Allan. It was shown that cooperation between antiterrorist police units, police border units, NBC military units and international units, teams and professionals, such 4th WMD Civil Support Team from Atlanta Georgia is very useful and welcome to learn more about different tactics, methods and forms in combat against terrorism and proliferation of the WMD.
Zvonko Orehovec
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Sector II Report: Chemical
Sessions: 3, 4, 5, 9a, 9b, 11
Summary
Chair: Dr. David H. Moore (US)
Co-Chair: Dr. Milos Stojiljkovic (Denmark)
Co-Chair: Dr. Zrinka Kovaric (Croatia)
The Chemical Sector of CBMTS Industry IV consisted of 29 oral presentations and 10 poster presentations delivered by scientists from 11 counties. The emphasis was primarily in one of two areas; 1.The medical aspects of traditional chemical warfare agents and toxic industrial chemicals and 2. Issues related to detection, decontamination, planning and response.
The theme of CBMTS Industry I “chemical warfare without the use of chemical warfare agents” re-emerged in this sector as participants were provided with new details on the hazards and consequences of exposure to toxic industrial chemicals. Industrial chemical health hazards are increasingly important concerns for military and civilian emergency response planners because large stores of highly toxic compounds are common in urban environments, are often poorly secured or controlled, and terrorist use of non-weaponized chemicals is becoming more common. Interesting advancements in emergency response and preparedness to industrial chemical incidents were presented. These include new approaches to evaluate what chemicals and industries are of highest concern for potential terrorist use or targeting, novel methods for prospectively modeling the geographic extent of the hazard areas that may result from a large scale release, and new tools that may be used to quickly model the consequences of chemical terrorism. Examples of locations and types of hazardous substances in various regions were discussed. Clearly, while the threat from industrial chemicals is increasing, progress is being made in our ability to prepare for possible events through enhanced knowledge of where hazards exist, advanced forecasting and modeling capabilities, and improved medical treatment possibilities for some of the most toxic compounds.
Once chemicals have been employed by terrorists, detection, treatment and decontamination are three pillars of an effective response. The importance of rapid and accurate detection systems and comprehensive response processes were emphasized in this sector. Examples of how advanced detection technologies have been adapted to mobile laboratories are clear evidence of how far we have come in our preparation for a chemical event. The capabilities and training of field medical teams and the doctrine for treatment and decontamination of casualties have also significantly improved.
Improvements on existing methods of treating nerve agent exposure were presented and the debate regarding the selection of the most appropriate oxime reactivator for nerve agent-induced AChE inhibition continued in this sector. However, the controversy was not at the center of the sessions as it has been in the past. It was made clear in a number of the presentations that there are many factors to consider in addition to the reactivation efficacy of HI-6 against soman inhibited enzyme when considering a replacement for approved and fielded oximes.
Rapid and appropriate therapy of cyanide poisoning continues to be a major problem when considering a mass-casualty incident. Recent advances in pre-hospital medical treatment options for cyanide intoxication may soon be available to many personnel in the emergency medical services. Additionally, new delivery methods and technologies such as next generation auto-injectors will hasten delivery of existing and newly developed therapeutics. Several presentations provided additional details on the maturing concept for the use of biological scavengers as a medical pretreatment and as a therapy against nerve agents. The bio-scavenger program has clearly emerged from the concept stage to an advanced development effort and is now on-tract for the submission of a new drug application to the U.S. FDA.
Papers presented by medical professionals and researchers from Iran significantly expanded the knowledge base of acute and delayed effects from exposure to sulfur mustard and we have learned more about the psychological consequences associated with being the target of a chemical attack. This CBMTS may be one of the only venues where scientists working to develop new medical countermeasures to CW agents have the opportunity to interact with clinicians who work daily with patients who were exposed to chemical agents. This fact cannot be overlooked as accurate real-world data must be considered as pivotal when supporting concepts for new medical treatments or therapies.
I thank all of the presenters and session chairs and co-chairs in the chemical sector for their contributions to this productive and stimulating meeting. And thank the congress attendees for their interest in the subjects covered in this sector.
David Moore
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Sector III Report
Biological
Sessions: 1, 2, 12, 13a, 13b
Summary
Chair: Dr. David Robinson (US)
Co-Chair: Dr. Martin Schutz (Switzerland)
Co-Chair: Dr. Boris Zaitsev (Russia)
A major emphasis of the presentations and discussions in the Biological Sessions dealt with the relationships between deliberate releases of biological agents by terrorists and the recent outbreaks of infectious diseases. Several presenters described techniques and government efforts to provide materials, both for treatment and as research reagents, on a timely basis and to control the spread of naturally occurring communicable diseases. We were reminded that the agents of bioterrorism interest exist first as naturally occurring infectious diseases. Therefore, the key elements necessary to prevent the spread of natural occurring disease are also useful in the mitigation of the effects of a bioterrorist attack.
Another major emphasis was an increased appreciation of the economic effects of a bioterrorist attack targeting the domestic animal population or of an outbreak of a naturally occurring zoonotic disease. Several examples, including Foot and Mouth Disease in the United Kingdom, avian influenza in the United States, and the recent identification of cases of bovine spongiform encephalitis in Canada and the United States, have had major, costly effects on the economies of the affected countries with costs including indemnification, carcass disposal, and loss of markets due to restriction of imports by other nations.
In both cases, a critical component of the control is the ability to rapidly and accurately identify the causative agent. Several presenters described new, rapid and more specific procedures for the diagnosis of infections. The procedures and supporting equipment were generally smaller in size and simpler in operation than those employed in current tests. This has facilitated the development of mobile laboratories employing ever more sophisticated techniques to bring diagnostic procedures near to the areas where the samples are being collected. This precludes the necessity of having to ship the potentially dangerous samples over long distances to fixed laboratories with the time delays inherent in such activities.
While the research community continues to make progress in the diagnosis, control, and mitigation of the effects of highly infectious diseases and toxins, several presenters reminded us that additional threats may become important in the near future. Some of these could be the result of increasing information about the properties of some lesser known microorganisms and toxins. Other future threats could result from the changes in the genome of the microorganisms that could increase their stability, their communicability, or their resistance to the commonly used antibiotics or antivirals. These changes could occur either naturally by environmental pressures, by the inappropriate use of the drug, or by the deliberate manipulation of the genome by a terrorist group.
Interesting discussions were held during several sessions regarding information policy and access of the general public to scientific information that could be useful to a bioterrorist. The specific question is "To what extent should such information be published in the open literature and widely distributed?" No clear consensus arose from the discussions. The Chairs are convinced and sure that the CBMTS is the appropriate platform to continue these open discussions not only between scientists from the East and the West, but also between those from the developed and the developing countries.
So in conclusion we believe that, for all of the above reasons, the CBMTS is more than ever an appropriate and increasingly important forum to work the bioterrorism threat.
The Sessions of the meeting dealing with Biologicals continued to improve in quality, breadth and depth of the concepts and ideas presented. The Sector Chairs challenge the attendees to give these presentations wider distribution by submitting expanded manuscripts to the Journal of Medical Chemical, Biological and Radiological Defense (http_//www.jmedcbr.org), a free online journal edited by Dr. Barbara Price.
David Robinson
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Sector IV Report
Radiological and WMD-CBNR Policy and Issues
Sessions 6, 7, 10, 14, 15
Summary
Chair: Jiri Bajgar (Czech Republic)
Co-Chair: Dr. Jan Cerveny (US)
Co-Chair: Dr. Guilherme Santana (Brazil)
Session 6 was dedicated to radiological problems in connection to prevent nuclear terrorism including preparedness for these events, e.g. medical countermeasures or biodosimetry. As a part of the CBMTS Industry IV, interesting and useful technical demonstration prepared by Croatia-US was greatly appreciated.
The meeting of editors of Journal of Medical Chemical Biological and Radiological Defense was the topic of Session 7. It was focused to increased importance of the Journal for interested experts, institutions and organizations. All the participants to the CBMTS Industry IV were asked to contribute the Journal according to their possibilities in the field of medical chemical, biological, and radiological defense .
Session 10 - Posters. The authors were asked to present a three minute overview of their poster and to stand by their presentations after the session for any questions by the Congress participants. Authors of 11 countries presented posters addressing decontamination, chemical exposures, industrial chemical accidents, new oximes, field diagnostic laboratory deployments, bio- chem treatments, stockpiling, WMD training, and other related technical topics.
Session 14 contained contributions dealing with policy of several organizations like the OPCW, Military Schools and civil institutions or governments, responsible for the protections against and minimalization of use of chemical, biological, and radiological agents. Disturbance or the transport or stockpiles of these agents, either by accident or on purpose (terrorist attack) will give a disaster, which has to be managed. The importance of having scenarios and disaster plans in place is stressed by several authors in this session.
Session 15 WMD capabilities was focused to preparedness against terrorism from different views as area security initiative, robotics, synchronization of planning tool against terrorism and use of animals (dogs) for these purposes. Many problems were identified with respect to PPE for animals, appropriate drug dosages and as well as mission oriented equipment and procedure (e.g. reconnaissance, bomb disposal etc.) were discussed. The UASI initiative of DHS was outlined and the use of Argonne Natl Labs Emergency Response synchronization Matrix to plan for mass casualty incidents was explained.
Jiri Bajgar
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