Up Front With Martin B. Deutsch



June 1, 2006 -- Over the course of the last two months, I've been briefing BizTraveLife readers about how they can prepare for and react to a terrorist attack that involves one of the distressingly numerous kinds of weapons of mass destruction (WMD).

My mentor on this unsentimental journey has been Dr. Kevin M. Cahill, one of the most accomplished physicians and humanitarians of our time. You can read about Cahill and his recommendations below because I've gathered all four of the BizTraveLife reports here. It makes for enlightening--and dare I say daunting and sometimes worrisome--reading.

A final note: Surf here to download a copy of Ready New York, an excellent preparedness brochure created by the city's Office of Emergency Management. It is an extremely useful guide for Americans in general and for business travelers in particular.

Above all, do no harm. Keep calm. Listen carefully to first responders. Stay out of harm's way as much as possible. That's not generic advice, but the thoughtful recommendations of Dr. Kevin M. Cahill, the highly regarded expert on tropical diseases and the leading physician on the New York Police Department's counter-terrorism unit. Dr. Cahill has briefed me on what to do before, during and after a terrorism attack regardless of whether the emergency is biological, chemical or nuclear. Over the next few weeks, I'll present the specific actions that Dr. Cahill suggests you take during each kind of crisis. Before we begin, some background on this extraordinary man, whom the eminent British medical journal, The Lancet, has described more than once as one of the great physicians of the 20th century. Dr. Cahill, whose practice is located on Manhattan's Fifth Avenue, has written 38 books, which are circulated in 65 countries and translated into many languages, including French, Italian, Spanish, Arabic and Japanese. The books deal with a range of topics: humanitarian assistance; the role of medicine in building bridges to understanding tolerance and peace; and exotic diseases, one of his medical specialties. In 1992, Dr. Cahill launched the Center for International Health and Cooperation, which provides on-site assistance in troubled regions such as Iraq, Somalia, the Sudan and Kosovo. Over the years, the Center's board has attracted notable figures like Cyrus Vance and John Cardinal O'Connor. Some current board members include former United Nations Secretary-General Boutros Boutros-Ghali and Jan Eliasson, who last week was named Sweden's foreign minister. A third-generation physician, Dr. Cahill lectures several times a year at the Royal College of Surgeons in Dublin.

Compared to nuclear and chemical weapons, the biological agents of terrorism are relatively easy to procure, transport and distribute. Worse, an incubation period of at least six days allows a perpetrator ample time to escape or move on to infest other venues. This information comes from a conversation with Dr. Kevin M. Cahill, the world-renowned physician, humanitarian and author. He serves with New York City's police counter-terrorism unit and, not so incidentally, was the man who late in 2001 diagnosed the first two cases of anthrax found in the United States. Toxic agents such as anthrax can be produced in a laboratory and spread in any number of ways, including by airplane or via the mails, as we learned five years ago. The more deadly form can also be inhaled or transferred by touching untreated animal skins, as we recently discovered in New York. Dr. Cahill says that when anthrax is suspected, it can be dealt with prophylactically with an antibiotic such as Cipro. He also discussed smallpox, which has been nearly eradicated, but is still a threat because a few of the remaining vials went missing after the breakup of the Soviet Union. Vaccination can be an effective measure against smallpox, but Dr. Cahill says its benefits must be measured against possible serious side effects. Smallpox vaccination also raises the issues of vaccine availability and the logistics of mass inoculations. He also talked about plague, which can be effectively treated with a combination of antibiotics. This column has only touched the surface of biological terrorism, which is a complex and fluid scenario.

There are significant and discernible differences between biological and chemical forms of warfare. We're back with Dr. Kevin M. Cahill, the chief medical advisor for counter-terrorism for New York City's Police Department, in pursuit of some basic insight into how you can protect yourself against the primary types of terrorism. Last week, it was biological agents. Next week, nuclear. As for chemical agents, Dr. Cahill says that they deliver an immediate impact while biological agents have incubation periods before the symptoms appear. Chemical terrorism is most likely to take the form of gas--nerve agents, mustard, chlorine and Sarin. These gasses kill or incapacitate by choking, blistering or severely damaging your breathing and circulatory functions. Sarin gas was used with devastating effect in the Tokyo subway attack in 1995. Chemicals were employed in the 1980s by Saddam Hussein against Iran and mustard gas was first used on the battlefields of Europe in World War I. In assessing chemical terrorism, Dr. Cahill refers to "hot zones" and "cold zones," depending on where the intended victims are in relation to the immediate dispersal of the agents. Hot zones are generally downwind from the initial delivery blast. In a hot zone, Dr. Cahill urges you to obey the primary responders. He also notes that many hospitals have emergency units that offer specialized equipment such as decontamination showers and tents. Further out, in the cold zone, if the chemical is outside, his advice is to seek shelter indoors, the higher the floor the better. If the impact is inside, head for fresh air. And it's crucial that the general populace avoids panicking, which often causes as many fatalities and injuries as the terrorist attack itself.

The multi-faceted Dr. Kevin M. Cahill, whom we have been debriefing on counter-terrorism preparations, was called to the Vatican 25 years ago this week after the attempted assassination of John Paul II. The Pontiff reportedly asked personally for "the…American" and he stayed for ten days. Turning from the religious to the secular, specifically nuclear terrorism, Dr. Cahill stresses the difference between small, so-called dirty devices, and larger, far more cataclysmic weapons, such as the atomic bombs dropped on Japan in 1945. A dirty bomb, which can be carried in a suitcase or a briefcase, is relatively easy to assemble and one can be bought or stolen on the worldwide nuclear black market. A dirty bomb's main purpose is not to kill, but to provoke panic and chaos. If you're involved in a "dirty incident," you should vacate the area immediately. Distance trumps any local shielding you could find. Following the advice of first responders is also critical. Larger nuclear weapons are far more difficult to make and distribute. Full-scale production plants are required and delivery methods are complex. In the event of an attack with a large-scale nuclear device, you frankly have few, if any, options in the immediate delivery zone, which may be a mile or more in radius. If there's any warning, look for deep underground shelters, such as subways. Potassium iodide may be helpful in preventing thyroid cancers, which were numerous after the Chernobyl accident. Radiation monitors are being set up in some U.S. cities and hospitals can help with decontamination. (Nuclear radiation never completely disappears because of the complicated half-life scenario.) Finally, Dr. Cahill, our guide through the weapons of mass destruction, is currently working on his 39th book. He says it will explore "the pulse of humanitarian aid" around the world.

Copyright © 2001-2006 by Martin B. Deutsch. All rights reserved.