National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
×

Chemical and Biological Terrorism

Research and Development to Improve Civilian Medical Response

Committee on R&D Needs for Improving Civilian Medical
Response to Chemical and Biological Terrorism Incidents

Health Science Policy Program

INSTITUTE OF MEDICINE
and
Board on Environmental Studies and Toxicology

Commission on Life Sciences

NATIONAL RESEARCH COUNCIL

NATIONAL ACADEMY PRESS
Washington, D.C. 1999

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, NW • Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

Support for this project was provided by the Office of Emergency Preparedness, Department of Health and Human Services (Contract No. 282-97-0017). This support does not constitute an endorsement of the views expressed in the report.

Library of Congress Cataloging-in-Publication Data

Chemical and biological terrorism: research and development to improve civilian medical response / Committee on R&D Needs for Improving
Civilian Medical Response to Chemical and Biological Terrorism Incidents, Health Science Policy Program, Institute of Medicine, and Board on
Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council.
p. cm.
Includes bibliographical references and index.
ISBN 0-309-06195-4 (hardcover)
1. Chemical warfare—Health aspects. 2. Biological
warfare—Health aspects. 3. Civil defense—United States. 4.
Terrorism—Government policy—United States. 5. Disaster
medicine—United States. I. Institute of Medicine (U.S.). Committee
on R & D Needs for Improving Civilian Medical Response to Chemical
and Biological Terrorism Incidents. II. National Research Council
(U.S.). Board on Environmental Studies and Toxicology.
RA648 .C525     1999
358'.3—dc21                         98-58069

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This report is also available online at http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom.

Copyright 1999 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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Committee on R&D Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents

PETER ROSEN (Chair), Director, Emergency Medicine Residency Program, School of Medicine, University of California, San Diego

LEO G. ABOOD, Professor of Pharmacology, Department of Pharmacology and Physiology, University of Rochester Medical Center*

GEORGES C. BENJAMIN, Deputy Secretary, Public Health Services, Department of Health and Mental Hygiene, Baltimore, Maryland

ROSEMARIE BOWLER, Assistant Professor and Fieldwork Coordinator, Department of Psychology, San Francisco State University

JEFFREY I. DANIELS, Leader, Risk Sciences Group, Health and Ecological Assessment Division, Earth and Environmental Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California

CRAIG A. DeATLEY, Associate Professor, Department of Emergency Medicine and Health Care Sciences Program, The George Washington University, Washington, D.C.

LEWIS R. GOLDFRANK, Director, Emergency Medicine, New York University School of Medicine and Bellevue Hospital Center, New York

JEROME M. HAUER, Director, Office of Emergency Management, City of New York

KAREN I. LARSON, Toxicologist, Office of Toxic Substances, Washington Department of Health, Olympia

MATTHEW S. MESELSON, Thomas Dudley Cabot Professor of the Natural Sciences, Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts

DAVID H. MOORE, Director, Medical Toxicology Programs, Battelle Edgewood Operations, Bel Air, Maryland

DENNIS M. PERROTTA, Chief, Bureau of Epidemiology, Texas Department of Health, Austin

LINDA S. POWERS, Professor of Electrical and Biological Engineering, and Director, National Center for the Design of Molecular Function, Utah State University, Logan

PHILIP K. RUSSELL, Professor of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

JEROME S. SCHULTZ, Director, Center for Biotechnology and Bioengineering, University of Pittsburgh

ROBERT E. SHOPE, Professor of Pathology, University of Texas Medical Branch, Galveston

ROBERT S. THARRATT, Associate Professor of Medicine and Chief, Section of Clinical Pharmacology and Medical Toxicology, Division of Pulmonary and Critical Care Medicine, University of California, Davis Medical Center, Sacramento

*Deceased, January 1998.

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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Committee Liaisons

JUDITH H. LAROSA, Professor and Chair, Department of Community Health Services, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, and Liaison to the Board on Health Science Policy

WARREN MUIR, President, Hampshire Research Institute, Alexandria, Virginia, and Liaison to the Board on Environmental Studies and Toxicology

Study Staff

FREDERICK J. MANNING, Project Director

CAROL MACZKA, Senior Program Officer

C. ELAINE LAWSON, Program Officer

JENNIFER K. HOLLIDAY, Project Assistant (May 1997 through May 1998)

THOMAS J. WETTERHAN, Project Assistant (June 1998 through November 1998)

Institute of Medicine Staff

CHARLES H. EVANS, JR., Head, Health Sciences Section

ANDREW POPE, Director, Health Sciences Policy Program

LINDA DEPUGH, Section Administrative Assistant

JAMAINE TINKER, Financial Associate

National Research Council Staff

JAMES REISA, Director, Board on Environmental Studies and Toxicology

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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Independent Report Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report:

JOHN D. BALDESCHWIELER, Professor of Chemistry, California Institute of Technology, Pasadena

DONALD A. HENDERSON, University Distinguished Professor, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

DAVID L. HUXSOLL, Dean, School of Veterinary Medicine, Louisiana State University, Baton Rouge

JOSHUA LEDERBERG, Sackler Foundation Scholar, Rockefeller University, New York

H. RICHARD NESSON, Senior Consultant, Partners Health Care System, Inc., Boston

MICHAEL OSTERHOLM, Chief, Acute Disease Epidemiology Section, Minnesota Department of Health, Minneapolis

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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ANNETTA P. WATSON, Research Staff, Health and Safety Research Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee

MELVIN H. WORTH, Clinical Professor, State University of New York-Brooklyn and Uniformed Services University of Health Sciences, and Institute of Medicine Scholar-in-Residence

The committee would also like to thank the following individuals for their technical reviews of single chapters of the draft report:

ROBERT E. BOYLE, Formerly Technical Advisor, Chemical Warfare and NBC Defense Division, Office of the Deputy Chief of Staff for Operations, Plans, and Policy, Department of the Army, Washington, D.C.

GREGORY G. NOLL, Hildebrand and Noll Associates, Inc., Lancaster, Pennsylvania

ROBERT S. PYNOOS, Professor and Director, Trauma Psychiatry Service, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles

JOSEPH J. VERVIER, Senior Staff Scientist, ENSCO, Inc., Melbourne, Florida, and formerly Technical Director, Edgewood Research, Development and Engineering Center, Aberdeen Proving Ground, Maryland

Although the individuals listed above have provided many constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests solely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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Preface

American military forces have been struggling with the issue of chemical and biological warfare for decades—a 1917 National Research Council Committee laid the groundwork for the Army Chemical Warfare Service—but it was the attack of the Tokyo subway with the nerve gas sarin in March 1995 that suddenly put the spotlight on the danger to civilians from chemical and biological attacks. The Federal Emergency Management Agency (FEMA) and the Department of Health and Human Services' Office of Emergency Preparedness (OEP), which is responsible for medical services, have an admirable record of helping state and local governments cope with floods, storms, and other disasters, including terrorism, but, fortunately, no direct experience with the consequences of chemical or biological terrorism. In May 1997, the Institute of Medicine was asked to help OEP prepare for the possibility of chemical or biological terrorism, and, with help from the National Research Council's Board on Environmental Studies and Toxicology, formed this committee to provide recommendations for priority research and development (R&D).

In the ensuing year and a half, the committee met four times, heard presentations on existing technology and ongoing R&D, attempted to absorb a virtual mountain of information, and formulated their recommendations. In the process, a number of things became clear to me. I suspect the rest of the committee would agree, but I will exercise the chair's prerogative at this point, and share the view from my perspective.

First, there is no way to prepare in an optimal fashion for a terror incident. There is too low an incidence to justify the enormous financial

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outlay it would take to optimally prepare every community for every possible incident. Furthermore, there are not enough incidents for any community to acquire enough experience to make a significant impact on response to the next episode.

Second, although there is a sophisticated technology, described within the body of the report, for in-line detection of an opposing forces chemical agent, it will not be possible to select the sites to protect in a civilian setting with such technology, even if the expense could be borne. At best, it might be possible to selectively protect a public arena where the President was to give an address.

Third, there is no guarantee that the terrorist will announce the attack. Without such an announcement, there will be no recognition that a biological attack is occurring until enough cases, including a number of fatalities, are observed and reported to allow recognition of an epidemic of an unusual disease. Since exposed victims will almost certainly not seek medical care in the same facility, the problem becomes compounded even more greatly. *

Fourth, virtually all the militarily important biologic agents present with early clinical symptoms that resemble viral flu syndromes. Since these are the most common form of acute illness, and since they are usually mild and nonserious, it is probable that the early victims of the attack will be unrecognized, and sent home from a physician's office or Emergency Department as a mild viral syndrome. Therefore, in any response planning, it has to be acknowledged that it will be impossible to prevent ALL mortality, no matter how good a technology can be developed, and no matter how much money we are willing to spend to enhance our response.

Fifth, there is a huge gap between detection technology and therapy. There are many biologic agents, and certainly many chemical agents for which there are no known treatments. We should not expect that terrorists will choose the agents for which we are prepared, and for which we have effective treatment, even if they are the easiest to create and disperse, such as anthrax or sarin.

Sixth, the approach that the committee found most useful to consider in making its recommendations was considering how to superimpose a response

* For example, in Wyoming this year (Summer 1998), there has been an epidemic of E. coli diarrhea from a contaminated spring that fed the water supply of the small town of Alpine. There were well over a hundred cases that involved 12 states since the tourists who acquired the disease were from many different locations. It took at least two months to find the source of the contamination, and the only reason that the epidemic was recognized as early as it was, is that there were only a small number of medical facilities available to the victims.

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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to a terror attack upon the systems that are already in place to deal with nonterror events. For example, an earthquake, or a chemical spill, or a flu epidemic will all stress and often overload existing medical facilities. There must be systems in place to deal with these problems, not only on a local basis, but when help must be brought in from outside the afflicted area. These are the systems that will be most appropriate to build on for an effective response to an incident of chemical or biological terrorism.

Seventh, communication between the medical community and agencies that gather and analyze intelligence about potential terrorists and attacks is critical. As alluded to above, it will not only shorten the identification issues and lead to more effective responses, but will clearly lower mortality.

There are a number of areas that will not be covered in this report. For example, it was not possible for the committee to discuss every conceivable biological and chemical weapon that might be used in an attack. It is probable that to prepare only for the list of known weapons and most likely agents will take a commitment and a financial expenditure that will exceed the resources of virtually all communities.

The committee's charge did not include making recommendations on organization and training of individuals and groups faced with managing the consequences of a chemical or biological incident, nor on how to equip such persons or groups, nor on what therapeutic options they should choose. Nevertheless, as noted in our interim report, the committee believes that it would be irresponsible to focus solely on R&D while ignoring potentially simpler, faster, or less expensive mechanisms, such as organization, staff, training, and procurement. Examples from our interim report include:

Survey major metropolitan hospitals on supplies of antidotes, drugs, ventilators, personal protective equipment, decontamination capacity, mass-casualty planning and training, isolation rooms for infectious disease, and familiarity of staff with the effects and treatment of chemical and biological weapons.

Encourage the CDC to share with the states its database on the location and owners of dangerous biological materials. State health departments in turn should be encouraged, perhaps by education or training on the effects of the agents and medical responses required, to add infections by these materials to their lists of reportable diseases.

Convene discussions with FDA on the use of investigational products in mass-casualty situations and on acceptable proof of efficacy for products where clinical trials are not ethical or are otherwise impossible.

Develop incentives for hospitals to be ambulance-receiving hospitals, to stockpile nerve-agent antidotes and selected antitoxins and put

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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them in the hands of first responders (this may require changes to existing laws or regulations in some states), to purchase appropriate personal protective equipment and expandable decontamination facilities and train emergency department personnel in their use.

Supplement existing state and federal training initiatives with a program to incorporate existing information on possible chemical or biological terror agents and their treatment into the manuals, SOPs, and reference libraries of first responders, emergency departments, and poison control centers. Professional societies and journal publishers should be recruited to help in this effort.

Intensify Public Health Service efforts to organize and equip Metropolitan Medical Strike Teams in high-risk cities throughout the country. Although MMSTs are designed to cope with terrorism, because they use local personnel and resources, they also increase the community's general ability to cope with industrial accidents and other mass-casualty events.

Even though the tasks of being prepared and responding adequately appear at times to contain insurmountable obstacles, the committee does believe that by utilizing the resources that are present, along with improvements in communications, monitoring capabilities, detection, and therapeutics, it will be possible to minimize the damage that a terror attack will cause. It is not our intent to leave the readers of this report with feelings of hopelessness. Even if preparation for certain attacks only forces the attackers to choose a weapon that we have not prepared for, we will have developed a system with which we can improvise. The goal, as always in medicine, is to reduce morbidity and mortality and minimize suffering.

In closing I would like to offer my sincere thanks to the staff of the Institute of Medicine, who made our meetings as comfortable and efficient as possible and pulled our sometimes splintered efforts into a coherent whole, and to the members of the committee, busy professionals who volunteered precious time and energy in a highly collegial manner. It was a privilege to work with this outstanding group.

PETER ROSEN, M.D.
CHAIR

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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Abbreviations

AChE

Acetylcholinesterase

AEL

Acceptable exposure limit

AIDS

Acquired immune deficiency syndrome

APA

American Psychological Association or American Psychiatric Association

ANL

Argonne National Laboratory

ASTM

American Society for Testing and Materials

ATP

adenosine 5'-triphosphate

ATSDR

Agency for Toxic Substances and Disease Registry

   

BAL

British antiLewisite

BChE

Butyrylcholinesterase

BDO

Battle Dress Overgarment

BIDS

Biological Integrated Detection System

BW

Biological warfare or biological weapon

   

CAHBS

Civilian Adult Hood Blower System

CAM

Chemical agent monitor

CAPS

Civilian Adult Protective System

CBDCOM

Chemical Biological Defense Command

CBIRF

Chemical Biological Incident Response Force

CBMS

Chemical Biological Mass Spectrometer

CBNP

Chemical and Biological Nonproliferation Program

CBPSS

Chemical Biological Protective Shelter System

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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C/B-RRT

DoD Chemical/Biological Rapid Response Team

CBWCA

Chemical and Biological Weapons Control Act

CCHF

Crimean Congo hemorrhagic fever

CCP

Crisis Counseling Assistance and Training Program

CDC

Centers for Disease Control and Prevention

cDNA

Complementary (or copy) deoxyribonucleic acid

ChE

Cholinesterase

CISD

Critical incident stress debriefing

CLS

Commission on Life Sciences

CMHS

Center for Mental Health Services

CN-

Cyanide anion

CNS

Central nervous system

CSEPP

Chemical Stockpile Emergency Preparedness Program

CSTE

Council of State and Territorial Epidemiologists

CW

Chemical warfare or chemical weapon

CWA

Chemical warfare agent

   

4-DMAP

4-Dimethylaminophenol

DARPA

Defense Advanced Research Projects Agency

DHHS

Department of Health and Human Services

DMAT

Disaster Medical Assistance Team

DNA

Deoxyribonucleic acid

DNTB

5,5'-dithio-bis (2-nitrobenzoic acid)

DoD

Department of Defense

DoE

Department of Energy

DRN

Disaster Response Network

dsRNA

Double-stranded ribonucleic acid

DSWA

Defense Special Weapons Agency

   

EDTA

Ethylene diamine tetraacetic acid (dicobalt)

EEE

Eastern equine encephalomyelitis

EF

Edema factor

EIDI

Emerging Infectious Disease Initiative

EIS

Epidemic Intelligence Service

ELISA

Enzyme-linked immunosorbent assay

EMCR

Electronic medical care record

EMS

Emergency Medical Service

EMT

Emergency medical technician

EPA

Environmental Protection Agency

ERDEC

Edgewood Research, Development and Engineering Center, U.S. Army

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FABS

Force-amplified biological sensor

Fab

Antibody fragment

FBI

Federal Bureau of Investigation

Fc

Crystallizable fragment (of antibody)

FDA

Food and Drug Administration

FEMA

Federal Emergency Management Agency

FOWG

Fiber-optic evanescent wave guide

FTIR

Fourier Transform Infrared Spectrometry

   

GA

Tabun

GB

Sarin

GC/FTIR

Gas Chromatography Fourier Transform Infrared Spectrometry

GC/MS

Gas Chromatography Mass Spectrometry

GC-MS-MS

Gas Chromatography Tandem Mass Spectrometry

GD

Soman

GF

Cyclosarin

   

HAZMAT

Hazardous materials

HD

Sulfur mustard

HIV

Human immunodeficiency virus

HMT

Hexamethylene tetramine

HPAC

Hazard prediction and assessment capability

HPLC

High-performance liquid chromatography

HSEES

Hazardous substances emergency events surveillance

   

IDLH

Immediately dangerous to life and health

IMS

Ion mobility spectrometry

IND

Investigational new drug

IOM

Institute of Medicine

IPDS

Improved Chemical Agent Point Detection System

IU/L

International units per liter

   

JCAD

Joint Chemical Agent Detector

JCAHO

Joint Commission on Accreditation of Healthcare Organizations

JCBAWM

Joint Chemical Biological Agent Water Monitor

JLIST

Joint Service Lightweight Integrated Suit Technology

JPOBD

Joint Program Office for Biological Defense

JPOCD

Joint Program Office for Chemical Defense

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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JSLSCAD

Joint Service Lightweight Standoff Chemical Agent Detector

JUN

Junin virus

   

LANL

Los Alamos National Laboratory

LCR

Ligase chain reaction

LD50

Dose lethal to 50 percent of the population exposed

LF

Lethal factor

LIDAR

Light detection and ranging

LLNL

Lawrence Livermore National Laboratory

   

MALDI-MS

Matrix-assisted laser desorption mass spectrometry

MANAA

Medical aerosolized nerve agent antidote

MARCORSYSCOM

Marine Corps Systems Command

MiniCAD

Miniature chemical agent detector

MMST

Metropolitan Medical Strike Team

   

NAME

Nitroarginine methylester

NARAC

National Atmospheric Release and Advisory Center

NBC

Nuclear, biological, chemical

NDA

New Drug Application

NDMS

National Disaster Medical System

NFkB

Nuclear factor-kappa B transcription factor

NFPA

National Fire Protection Association

NIAID

National Institute of Allergy and Infectious Diseases

NIH

National Institutes of Health

NIOSH

National Institute for Occupational Safety and Health

NIPAC

National Infrastructure Protection Center

NMRI

Naval Medical Research Institute

NOAA

National Oceanic and Atmospheric Administration

NRC

National Research Council or Nuclear Regulatory Commission

NRL

Naval Research Laboratory

NSWC

Naval Surface Warfare Center

   

OEP

Office of Emergency Preparedness

OP

Organophosphate

ORNL

Oak Ridge National Laboratory

OSHA

Occupational Safety and Health Administration

   

2-PAM

Pralidoxime chloride

PA

Protective antigen

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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PAHP

para-aminoheptanophenone

PAOP

para-aminooctanoylphenone

PAPP

para-aminopropiophenone

PAPR

Powered air purifying respirator

PBB

Polybrominated biphenyls

PCB

Polychlorinated biphenyls

PCC

Poison control center

PCR

Polymerase chain reaction

PDD

Presidential Decision Directive

PHS

Public Health Service

PID

Photo ionization detector

PIRS

Photoacoustic infrared spectroscopy

PPE

Personal protective equipment

ProMED

Program for Monitoring Emerging Diseases

PTSD

Post traumatic stress disorder

   

RBC

Red blood cell

RDEC

Research, development, and engineering center

RNA

Ribonucleic acid

RT

Reverse transcriptase

RVF

Rift Valley fever

   

SAW

Surface acoustic wave

SBIR

Small business innovative research

SciPUFF

Second-order Closure Integrated Puff

SCBA

Self-contained breathing apparatus

SCPS

Simplified Collective Protection System

SDA

Strand displacement amplification

SEB

Staphylococcal enterotoxin B

SFAI

Swept frequency acoustic interferometry

SOF

Special Operations Forces

SOPs

Standard operating procedures

STEPO

Self-contained Toxic Environment Protective Outfit

   

TAS

Transcription-based amplification system

TDG

Thiodiglycol

TOF-MS

Time-of-flight mass spectrometry

TSP

Topical Skin Protectant

TSWG

Technical Support Working Group

   

UAV

Unmanned aerial vehicle

UPT

Up-converting phosphor technology

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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USAMRICD

US Army Medical Research Institute of Chemical Defense

USAMRIID

US Army Medical Research Institute of Infectious Diseases

UV

Ultraviolet

   

VA

Veterans Affairs (Department of)

VEE

Venezuelan equine encephalomyelitis

VIG

Vaccinia-immune globulin

VX

Persistent nerve agent (o-ethyl S-[2-(diisopropylamino)ethyl]-methylphosphorofluoridate)

   

WEE

Western equine encephalomyelitis

WHO

World Health Organization

WMD

Weapons of mass destruction

WWW

World Wide Web

   

YF

Yellow fever

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Contents

Executive Summary

1

1 Introduction

15

Legislative Background

16

Charge to the Committee

18

Data Collection

19

Assumptions and Parameters of This Report

20

Current Civilian Capabilities

23

2 Pre-Incident Communication and Intelligence:  Linking the Intelligence and Medical Communities

29

R&D Needs

33

3 Personal Protective Equipment

34

Types of PPE and Regulatory Standards

34

Access to PPE

35

Potential Advances

36

R&D Needs

42

4 Detection and Measurement of Chemical Agents

43

Chemical Warfare Agents in the Environment

43

Clinical Laboratory Analysis for Exposure to Chemical Warfare Agents

59

R&D Needs

64

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5 Recognizing Covert Exposure in a Population

65

Surveillance and Investigation of Biological Agents

66

Laboratory Capacity and Surveillance

71

Chemical/Toxin Surveillance

74

Aids for Clinical Diagnosis Based on Signs and Symptoms

75

R&D Needs

77

6 Detection and Measurement of Biological Agents

78

Detection of Biological Agents in Clinical Samples (Patient Diagnostics)

79

Detection of Biological Agents in the Environment

86

R&D Needs

95

7 Patient Decontamination and Mass Triage

97

Decontamination

97

Mass-Casualty Triage Procedures

107

R&D Needs

108

8 Availability, Safety, and Efficacy of Drugs and Other Therapies

110

Chemical Agents

112

Biological Agents

131

Summary of R&D Needs

161

9 Prevention, Assessment, and Treatment of Psychological Effects

165

Long-Term Effects of Terrorism (Post Traumatic Stress Disorder)

165

Short-Term Effects of Terrorism (Acute Needs)

166

First Responders

167

Neurological vs. Psychological Responses

169

Treatment Methods

169

Training

170

Community Effects

172

R&D Needs

172

10 Computer-Related Tools for Training and Operations

174

Medical Vigilance and Dose Reconstruction

175

Models Facilitating Assessment and Planning

176

Support for Decontamination and Reoccupation Strategies

182

R&D Needs

182

Suggested Citation:"Front Matter." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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Page xix

11 Conclusions and Recommendations

184

Recommendations for Research and Development

189

References

195

Appendixes

 

A Committee and Staff Biographies

215

B Inventory of Chemical and Biological Defense Technology, with Gap and Overlap Analysis

221

C Lethal and Incapacitating Chemical Weapons

260

D Centers for Disease Control and Prevention List of Restricted Agents

263

Index

265

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Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response Get This Book
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The threat of domestic terrorism today looms larger than ever. Bombings at the World Trade Center and Oklahoma City's Federal Building, as well as nerve gas attacks in Japan, have made it tragically obvious that American civilians must be ready for terrorist attacks. What do we need to know to help emergency and medical personnel prepare for these attacks? Chemical and Biological Terrorism identifies the R&D efforts needed to implement recommendations in key areas: pre-incident intelligence, detection and identification of chemical and biological agents, protective clothing and equipment, early recognition that a population has been covertly exposed to a pathogen, mass casualty decontamination and triage, use of vaccines and pharmaceuticals, and the psychological effects of terror. Specific objectives for computer software development are also identified. The book addresses the differences between a biological and chemical attack, the distinct challenges to the military and civilian medical communities, and other broader issues. This book will be of critical interest to anyone involved in civilian preparedness for terrorist attack: planners, administrators, responders, medical professionals, public health and emergency personnel, and technology designers and engineers.

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