Chemical, biological, radiological and nuclear terrorism: an introduction for occupational physicians

Leon Trotsky [1] recognized the power of terrorism whenhe stated that ‘War, like revolution is founded uponintimidation. A victorious war, generally speaking,destroys only an insignificant part of the conquered army,intimidating the remainder and breaking their will . . .Terror . . . kills individuals, and intimidates thousands.’It has been previously argued that ‘weapons of massdestruction’, now more accurately known as ‘weapons ofmass effect’, would never be used by terrorists becausethey would have nothing to gain by inflicting casualties ona large scale. Events of recent years have led towidespread re-evaluation of emergency preparednessarrangements by the USA, the North Atlantic TreatyOrganization alliance and the European Union. The UKhas a history of dealing with the consequences ofconventional terrorism and has well-developed systems inplace for detecting and dealing with chemical and nuclearaccidents and communicable disease outbreaks.This wasenhanced by comprehensive guidance and training onplanning for major incidents and many individuals andinstitutions with an international reputation in nuclearbiological and chemical defence [2–4].This article considers examples of chemical,biological,radiological and nuclear terrorism,the agents that may be