Chemical Warfare Agents: Emergency Medical and Emergency Public Health Issues,☆☆,,★★

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Abstract

The threat of exposure to chemical warfare agents has traditionally been considered a military issue. Several recent events have demonstrated that civilians may also be exposed to these agents. The intentional or unintentional release of a chemical warfare agent in a civilian community has the potential to create thousands of casualties, thereby overwhelming local health and medical resources. The resources of US communities to respond to chemical incidents have been designed primarily for industrial agents, but must be expanded and developed regarding incident management, agent detection, protection of emergency personnel, and clinical care. We present an overview of the risk that chemical warfare agents presently pose to civilian populations and a discussion of the emergency medical and emergency public health issues related to preparedness and response. [Brennan RJ, Waeckerle JF, Sharp TW, Lillibridge SR: Chemical warfare agents: Emergency medical and emergency public health issues. Ann Emerg Med August 1999;34:191-204.]

Section snippets

INTRODUCTION

The threat of exposure to chemical warfare agents (CWAs) has traditionally been considered a military issue. Several recent events, however, have demonstrated that civilians may also be exposed to these agents.1, 2, 3 Potential sources of exposure for civilian populations include acts of terrorism, inadvertent releases from domestic chemical weapon stockpiles, direct military attacks, and industrial accidents. The intentional or unintentional release of a chemical warfare agent in a civilian

Terrorism

Terrorism has been defined as the use or threat of violence to sow panic in a society, to weaken or overthrow its leaders, and to bring about political change.4 Terrorists have previously used more conventional means of violence, such as bombings, assassinations, and hostage taking, to promote their causes. Several recent events have demonstrated that some terrorists now have access to weapons of greater lethality, including chemical, biological, and radiological agents.2, 3, 4, 5, 6 Terrorists

OVERVIEW OF CWA CLASSIFICATION AND CHARACTERISTICS

CWAs are broadly classified as nerve agents, vesicants, pulmonary agents, and cyanides (formerly “blood agents”). In addition to their more familiar generic names, chemical weapons are also referred to by military designator codes (Table).

Table. Chemical warfare agents.

CategoryCommon NameUS Military Code
Nerve agentsTabunGA
SarinGB
SomanGD
VX
VesicantsSulfur mustardHD
LewisiteL
Phosgene oximeCX
Pulmonary agentsPhosgeneCG
ChlorineCL
CyanidesHydrogen cyanideAC
Cyanogen chlorideCK
Their clinical effects, and

ISSUES IN DISASTER PREPAREDNESS

It is widely acknowledged that most prehospital and emergency medical personnel in the United States are currently not well prepared, trained, or equipped to deal with incidents involving chemical, biological, or nuclear weapons.7, 27, 29, 48, 49 Recent field and tabletop exercises have exposed serious deficiencies in preparedness and major problems of coordination.11, 27 Any emergency medical or public health response to a major incident involving a CWA will require coordination and

PRINCIPLES OF EMERGENCY RESPONSE AND MEDICAL TREATMENT

Regardless of whether civilian exposure to a CWA is the result of terrorism, a release from the military stockpile, or an industrial incident, a multidisciplinary approach will be necessary to address emergency medical and emergency public health needs. Coordination among prehospital personnel, law enforcement, emergency physicians, public health specialists, toxicologists, laboratorians, environmental engineers, and security personnel will be required.

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      Cyanide is a potential weapon of terror [1] and traditionally known poison. Historically, cyanide has been used as a chemical warfare agent [2–4] and also as a possible potential candidate for terrorist attacks [5]. The interaction of human to cyanide in day-to-day life is very common due to its board industrial applications such as rubber and plastic manufacturing, electroplating injury production, and as fumigants and pesticides [6–9].

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    From the National Center for Environmental Health, Centers for Disease Control and Prevention,* Atlanta, GA, and Center of Excellence in Disaster Management and Humanitarian Assistance, Honolulu, HI; Department of Emergency Medicine, Baptist Medical Center, Menorah Medical Center, University of Missouri–Kansas City School of Medicine, Kansas City, MO§; and US Navy Medical Corps, Naval Medical Research Center Detachment, Lima, Peru.II

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    Address for reprints: Richard J Brennan, MBBS, MPH, International Rescue Committee, 122 East 42nd Street, New York, NY 10168; 212-551-3000, fax 212-551-3180;E-mail [email protected].

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