Sick to Death: Biological Weapons 101 with Dr. Judith Lucci

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English: Color-enhanced electron micrograph of Ebola virus  (Photo credit: Wikipedia)

I had a lovely luncheon the other day with the fascinating Dr. Judith Rocchiccioli, and she promised to come and share her expertise with you.
True to her word, this morning we're going to be talking about viruses and sabotage/terrorism. 

Fiona - 

Judith, please take a moment and introduce yourself. Can you please give us your background/credentials about why you are an expert on this subject?

Judith -
Hi, Fiona, many thanks for inviting me. I have a PhD in nursing and have written a few scholarly papers on the subject of infectious diseases.

Judith Lucci

I am a nurse and have many years of clinical practice in addition to teaching. For a long time I taught Infection and Immunity and that piqued my interest in these subjects. I can remember when we got our first case of HIV to a small hospital in Richmond where I worked at the ICU. It was so scary and hush, hush and nobody knew what in the world we were dealing with. 

Since then, I have written my third novel, Viral Intent, where I used a virus as part of my plot

 

Fiona - 
You just finished a scholarly paper on Ebola for a healthcare organization didn't you?

Judith - 
Yes, it was a commissioned book, primarily meant to quell the fear and miscommunication that was permeating America during the fall.

When we talk about biologics as weapons of mass destruction, we are actually talking about any organism from nature that can be packaged to kill i.e. a virus, bacteria or fungi.

Fiona -
The thought of a deadly virus with no known cure and highly contagious in nature is terrifying to people. And you used this as a plot line in your book - can you tell a little more about your novel?

Judith -
I write the Alexandra Destephano series of medical thrillers and the third one, Viral Intent, opens in the ED when several patients are admitted with what looks like a hemorrhagic disease. It turns out they are political operatives who are front men, setting up for a political convention, Operation Fix America, where the national leadership and President will be meeting the next day. The disease is Ebola-like, but infection docs and CDC cannot truly diagnose the illness because it is replicating so quickly.

As the book progresses, one of the operative dies and things in New Orleans, just continue to go south.

Fiona -
ED for those of you who don't recognize the term is the Emergency Department the new name for the ER.

Judith explain the issue with the CDC and replication, please.

Judith -
Well, one of the problems with any type of virus or bacteria is how quickly they reproduce and replicate. Bacteria/virus that replicate and mutate quickly are more virulent and make it more difficult to diagnose and treat. 

Think of how we have to change the flu vaccine every year because the virus constantly outsmarts us and every year we have to anticipate and examine how the virus has replicated.

then we try to create a vaccine for the next few years...

Fiona - 
And the scientists are working hard on an ebola vaccine.

Judith -
Oh, yes for sure, and we will see one soon. I think they are pretty close based on the research from my ebola book.

Fiona - 

If we are writing a plot line, and we want to include germ terrorism, how hard would that be to develop a do-able plot that would pass scientific muster.

Judith -
I think the possibilities for a plot line in germ warfare, WMD, chemicals, and other noxious substance are as active a possibility as the research skill and imagination of the author.

I think, in all honestly, ebola is probably more difficult to use to kill large numbers of people because it is spread by body fluids. The scientific community is actively discussing this now. 

However, as a very imaginative person, I would consider a unique way to project the virus into/ on to someone's flesh, kind of like they did with the plague with poison arrows years ago.

Remember how the Persians and Romans used to kill people by dipping their arrows into a dead carcass of an animal or person?

Fiona - 
...and also catapulting dead animals over the curtain wall into the bailey of the castles.

Judith - I think it was Barbossa that did this.

He used decomposing bodies, yes, animals into their castles. Yuk, but smart back then.

You know, there is history that during the Civil War in America and the French American War, both sides used the blankets and clothing of dead soldiers who'd died from smallpox in an effort to decimate the troops.

In fact, every war probably used some type of biologic weapon to kill. The Germans used anthrax and cholera in WWI...Viet Cong used needle sharp sticks dipped in infected feces and left them in the ground to gas disease and death.

Fiona - 
When the soldiers walked through, they would pick up the  micro-organisms

Judith - 
Yes, I would imagine it was most likely cholera since that's the worse GI (gastrointestinal) organis. Cholera is also good to infect the water supply.

Fiona - 
With a biologic, what considerations must an author keep in mind - off the top of my head I'm thinking - the life of the germ, the necessary temperatures for stability... can you help us with a partial list?

Judith -
I think, overall, you have to look at who is the enemy and how many they want to kill. Do they want to terrify or have mass casualties. The best agents are those that will spread via the air and is breathed in. So, you have to think about your vehicle of delivery. How can you deliver the most devastating blow...with the least amount of detection.

Cost is a factor as well. Poor terrorist organizations (I personally not sure if there is a poor terror group) use the cheap stuff. Homeland Security report a potential of 1200 biologic agents that are possibilities.

Fiona - 
1200??? Yipes!

Judith -
There is a debate about whether ebola would be a good agent for suicide bombers. The fragments of the blast could cause a spread of the disease.

I think your best airborne weapon is anthrax...remember that from the postal letters after 9/11? Anthrax becomes entrenched in the human host and a lethal poison develops. You could use crop dusters, small planes, and other mobile agents for that. Remember, anthrax comes from cattle, sheep, goats. It is a Category A agent.

Others could be Yellow fever or Q fever.

Fiona - 

So say it is airborne - what would they do just uncap a vial - have some kind of aerosol contraption - stick it in vent systems?...

Judith - 

I could see releasing a potent poison in an aerosol can and releasing it on a train or subway. Even a perfume atomizer could do real damage. Boy, I am a sick, perverted person to think of these things....

Fiona - 

The NSA will be following up. While we wait for their knock on your door, can you tell me your favorite scar story?

Judith -
My scar story... 

Four years ago, I was teaching abroad and was in Rome. I was with my friend, Crazy Patty at the Coliseum and short on time, we started running down the cobblestone street (I think the Appian Way) where I fell on my wrist. I remember a collective gasp and lots of people looking at me on the ground, but everyone seemed paralyzed to help. 

My hand was virtually on top of my wrist, my friend, who was running for the tour bus had left me. Suddenly, the most handsome man EVER appeared out of nowhere and bent down and gave me a big of ICE...no one has ice in Italy, particularly at the Coliseum in June. The man was dressed in tight black jeans, a white flowing poet shirt, and he held the ice on wrist, helped me up, kissed me on both cheeks, flagged a taxi, and disappeared.

It was amazing. I am sure he was an angel. His voice was incredible, melodious. Anyway, that was it for him, I spent 16 hellish hours at the Vatican Hospital and flew home for surgery. Everytime I see the scar, I remember the angel and how lucky I was to meet him.

Fiona -

I want a story like that and a friend named Crazy Patty - at first I was upset that she left you - but whoop! She left you, and that gave your angel a chance to flutter down to Earth and do his gallant act.

Judith -
Anyway, made a believer out of me! He was totally the best looking thing I have ever seen.

Fiona -
Lucky girl.

Any last advice for medical terror writers?

Judith - 
As authors, the best thing to do with this content is to use your imagination, check out the authenticity and go with it....

Thank you kindly for your help. 

You can catch up to Judith here:

Chaos at Crescent City Medical Center  http://amzn.to/1cvmNLt

The Imposter  http://bit.ly/U5GjbG

Viral Intent  http://bit.ly/1sbIk5k

Facebook  http://on.fb.me/1lgpFOP

Alexandra Destephano Novels  http://on.fb.me/1lxeDr5

Author Interview  http://bit.ly/1sbIk5k

Fiona Quinn's Newsletter Link, Sign up HERE

Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.

Code Blue: Information for Writers with Sarah Clark

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A CODE BLUE is defined a cardiac or respiratory arrest.

Here to help us understand what

happens during a CODE BLUE is Sarah Clark. 

Sarah spent 29 years as a nurse. Her positions included: ICU, Emergency Department, Med/Surg, telephone triage, long-term acute care, and teaching at the nursing school. For the last 3 ½ years, she has been the simulation coordinator for hospitals.

If you are writing a crisis that begins outside of the hospital, most likely the patient will be arriving in an ambulance.

Prior to arriving at the hospital the EMS will have sent a bullet-ed report to the CHARGE NURSE. 3-5 minutes before arriving they will encode – this is the report/notification.

At the beginning of the shift, the charge nurse will have assigned rooms within the Emergency Department. Emergency is now called E.D. not E.R. by hospital staff. 
* Your lay person would probably still call it the E.R. 
* It would be a mistake to have the doctors and nurses call it that
   now. 
The charge nurse is on the radio and manages the room flow. The charge nurse will assign the case to a room. 

When the EMS unit brings the patient in, they go straight to their room/nurse.

If they coded on the scene or in the ambulance, several things are already in place for the hospital staff.
· The patient will have pads already in place (often, one on back
   and one on front) for performing shocks and be on a backboard,
   facilitating CPR compressions. 

· The patient will be intubated
· The patient will (when available in that locale) have a LUCAS
   unit in place. A LUCAS will perform chest compressions for 
   CPR, leaving the health providers hands free for other things. If
   the LUCAS is in place, they will most likely leave it at the
   hospital until the patient is no longer in need. It has a battery and
   can operate for around three hours without be connected to a
   power source. It can be plugged in and many ambulances have
   electrical plugs. 

· The patient will have an I.V. line in place.

If the patient comes in with vital signs, then as a writer, you need to decide which of the above you would like to have in place.

Let’s pretend for a moment that a patient presented at the E.D. with signs of a cardiac event. While in the E.D., he codes. Immediately the team goes into action.

Here are the players:

· Medication R.N.
· Airway Manager
· Person Performing Chest Compressions
· Code Cart Manager
· BLS Team Leader - this is the PROVIDER. They no longer call

  the person making the decisions “doctor” with the lack of 

  physicians the provider could be a physician, physician's assistant,
 or nurse practitioner
· Documenter
· Family Guide 

MEDICAL RN stands on the right hand side of the patient. 

· Check for IV access, patency (the quality of being unblocked)
· Establish IV if none present.
· Prime tubing with 1 liter NS (normal saline)
· Administer ordered meds
· Communicate when med has been administered
· Protect the IV site. This is IMPERATIVE. That IV is the patients

   life line in an emergency. If the nurse can not find a vein they

   will place the line in the bone with an IO or intraosseus line. T
   The nurse will say “Drill ’em.” This method is fast and relatively
    safe. 

   VIDEO QUICK STUDY Trigger alert. Graphic. (12:00)
* The IV line is most at risk when the patient is being moved from
   one stretcher to another. GURNEY is a term that is no longer in
   use.

Ambu Bag

The AIRWAY MANAGER :

stands at the top of the stretcher and is usually a respiratory therapist. This is NOT a nurse. A respiratory therapist has an associates degree – a two-year degree in providing respiratory aid.

· Open airway
· Ventilate with Ambu bag 

· Requests suction setup 
· 2 People: 1 to seal the airway and 1 to squeeze the
  bag 

  * An Ambu bag is 100% oxygen. 

  * During a code the patient is manually ventilated. 

· This person will often stand on the left, or if need be, they can get

    right up on the gurney with the patient. This person needs to get

    the chest compressed a full 2” or it is ineffectual. Most people

    will wear out after two minutes and need to be replaced. 

· Any qualified person can do the compressions. 

· They monitor/check for pulse 

· If the patient did not come in with EMS then they will place a

   back board and a Zoll pad (for shocks) there are 2 pads – one on
   the back and one on the front. They can cause fire (chest hair)
   They no longer use paddles.

· Two people can rotate responsibilities to give the person giving

   compressions a chance to rest. They must monitor the quality of 

   the compression.

· Stands next to the cart –  everything they will need during a

  code is in the cart. She will hand people things as they are 

  needed. 

· They must be a nurse, and it is best if they are familiar with the

   layout of the code cart
· They hand in:

  * Back board 

  * Zoll Pads

  * Set up for suction
  * IV tubing with one liter of NS 
· Prepare the Empinepherine 
· Hands in meds as ordered
· Operates Zoll defibrillator
· Communicates with the runner for needed supplies

So for example:
The provider will say, “Give an amp of Epi.”
Code cart manager replies, “Epi.” As she hands it to the medication

                       nurse.
The medication nurse says, “Epi.” Then administers the meds and

                       says, “Epi’s in.” 

BLS TEAM LEADER
· This is the provider (doctor/physician's assistant/nurse practioner)
· Stands at the end of the bed and does not do anything hands on to

   prevent tunnel vision. 

· Needs to be able to see everything
· Makes all decisions about the patient 

THE DOCULMENTER
· Ideally, this is the patient’s nurse – in reality it will be a newer 

  nurse. The documenter stands next to the provider.
· Charting – documenting everything that takes place
· Ensure participants sign the code sheet
· Timer – is UBER IMPORTANT!

“It’s been two minutes. Time for a rhythm check.”

EVERY TWO MINUTES:
· Check the rhythm on the heart monitor
· Check pulse in the femoral area of the groin. That would be here:

· Change out the compressor if they are human. 
· Decide if you are at a shockable rhythm
· Shock them.

“It’s been three minutes do you want another epi?”

EVERY THREE MINUTES:

· Epinephrine helps vaso constrict to shunt the blood to the heart 

  effectively – it is the first line drug to use in a code, and it can be

  administered every three minutes. 

FAMILY GUIDE
· Determines if the family wishes to stay
· Positions the family near the exit
· Answers questions briefly and honestly
· Reminds the team the family is present (tendency towards gallows

   humor to break the stress)
· Escort the family out if needed


In every hospital there is a RAPID RESPONSE TEAM. This is a pre-code team that includes an experienced nurse and a respiratory therapist. They identify the patient’s risk of coding and move him to ICU.

NURSES SAY “CRAP.”

When do they stop?

1) The patient is stabilized
2) The patient is declared deceased
    · Typically, they will call it if the efforts have not worked and 

       the patient flat lined for over twenty minutes.
    · If they were brought in with a flat line, it’s usually called – 

       because of the length of time they were down. 

    · If the spouse/parent is on the way, for example, they 

      will try to continue efforts until the spouse has arrived. 

    · Often it’s the family that asks the team to stop 
    · Sometimes they continue for longer than they normally would

       have to give the family time to come to the conclusion on their

       own. This helps with the grief process. 

And there you have it. 

A huge thank you to Sarah Clark  for her expertise.

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Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.