ABSTRACT
CONTENTS Introduction ...................................................................................................................356 Hazards from Chemical Weapons ..................................................................................356 Routes of Exposure .........................................................................................................357 Environmental Considerations ........................................................................................358 Signs Suggestive of a Chemical Attack ............................................................................359 Advice to Civilians Involved in a Chemical Release ........................................................359 Protection of First Responders ....................................................................................... 360 Organization of Rescue Operations after CW Attack .....................................................361 Decontamination of Casualties ...................................................................................... 362 Chemical Weapon Poisoning and Management ............................................................. 363
Nerve Agents ..................................................................................................... 363 Vesicating (Blistering) Agents ............................................................................ 366 Blood Agents (Cyanides) .....................................................................................367 Choking Agents (Lung Irritants) ........................................................................367 Psychotomimetic Agents .................................................................................... 368 Toxin Agents ..................................................................................................... 368
Long-Term Consequences of CW Exposure ................................................................... 369 Syndromic Medical Management .................................................................................. 369
Medical Forensic Samples .............................................................................................. 369 Logistics of the Health Services Response to a Civilian Chemical Attack .......................374 References .......................................................................................................................376
Introduction Toxic chemicals are defi ned as “any chemical which, through its chemical action on life processes can cause death, temporary incapacitation, or permanent harm to humans or animals” [1]. Since the late nineteenth century, industrial production and scientifi c investigation have continued to generate exponential increases in the number of chemical substances identifi ed, many toxic to humans, animals, or plants. Currently as many as 500,000 U.S. commercial products pose physical or health hazards [2]. In 1999, the Environmental Protection Agency (EPA) estimated that approximately 850,000 facilities in the country were working with hazardous chemicals, a fi gure which places in some perspective the perennial risk of hazardous material (HAZMAT) release due to mishaps in chemical manufacturing and storage, from industrial accidents, as a result of transportation accidents, or from accidents at home. In the United States where there is an eff ective regulatory and legal environment, most chemical spills are small with few casualties [3]. HAZMAT response guidelines, training, and equipment have been standardized by the National Fire Academy (NFA) and the Federal Emergency Management Agency (FEMA) to facilitate effi - cient and eff ective management of hazardous chemical accidents [4].
