ABSTRACT
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 A. Executive Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 B. Legistlative Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412 C. The Federal Response Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
II. Chemical Warfare (CW) Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 A. Means of Intoxication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 B. Clinical Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
1. Nerve Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 2. Vesicants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 3. Blood Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 4. Pulmonary Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
C. Emergency Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 1. Nerve Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 2. Vesicants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 3. Blood Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 4. Pulmonary Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
III. Programs to Protect Civilian Populations. . . . . . . . . . . . . . . . . . . . . . . . . . . 419 A. Civilian vs. Military Response Considerations. . . . . . . . . . . . . . . . . . . . 419 B. The Israeli Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 C. Chemical Stockpile Emergency Preparedness Program . . . . . . . . . . . . . 421
IV. Elements of the Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 A. Clues to the Presence of Chemical Warfare Agents . . . . . . . . . . . . . . . . 422 B. HAZMAT Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 C. Currently Available Detection Technology. . . . . . . . . . . . . . . . . . . . . . . 423 D. Laboratory Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
1. Nerve Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 2. Vesicants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426 3. Cyanide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
V. Protection of First Responders and Victims . . . . . . . . . . . . . . . . . . . . . . . . . 426 A. Programs to Improve the Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
1. Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426 2. The Chemical and Biological Hotline . . . . . . . . . . . . . . . . . . . . . . . . 427 3. Chemical Weapons Improved Response Program . . . . . . . . . . . . . . . 427 4. Applied Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 5. Mass Casualty Decontamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428
VI. Issues Related to Low-Dose Exposure to Chemical Agents. . . . . . . . . . . . . 430 VII. Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 Acknowledgment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
The past 20 years have evidenced a steady, upward trend in the number of nations having chemical warfare (CW) capability. The proliferation and use of CW agents within unstable sectors of the world is an additional cause for grave concern regarding the possible future use of such agents, both in open conflict and in the hands of terrorists. The televised images shown of the reactions to potential CW missile attacks by Iraq against targets in Saudi Arabia and Israel during the Gulf War are still vivid in our minds. The bombings of the World Trade Center in New York in 1993 and the Alfred P. Murrah Federal Building in Oklahoma City in 1995 brought the face of terrorism into every American home with startling clarity. Terrorism is no longer something that happens overseas, occurs at an American embassy, or is encountered only by travelers. In fact, the face of the terrorist can be that of someone’s neighbor or one-time classmate. Terrorism can derive from clandestine, state-directed initiatives or from small splinter groups with special interests or agendas. The Aum Shinrikyo cult in Japan successfully manufactured the CW agent sarin and combined psychological manipulation and religious zeal to support the terrorist actions of its organization. Access to chemical manufacturing facilities and suppliers around the globe provides terrorists the availability of precursors and chemical reagents, while faltering economic conditions can pave the way for theft or sale of the chemical agents themselves. A particularly troubling phenomenon is the availability of accurate information about the chemical properties, uses, and effects of CW agents on the Internet. This medium makes once highly sensitive information available to virtually every person on earth.
