ABSTRACT
I. Introduction-the Chemical Warfare Agents...................................................................... 628 II. Use of CWAs in the Twentieth Century............................................................................. 628
A. Exposure of Military Personnel during War ............................................................... 628 B. Exposure of Military Personnel during Training......................................................... 630 C. Exposure of Civilians during Terrorist Attacks........................................................... 630
III. Terrorism, Natural Disaster, and Warfare: Psychological Outcomes ................................. 631 A. Terrorism and Its Outcomes ........................................................................................ 631 B. Natural Disasters and Their Outcomes ........................................................................ 633 C. Warfare and Its Outcomes ........................................................................................... 633 D. Outcomes Summary: Acute Stress Disorder and Posttraumatic Stress Disorder........ 634
IV. Chemical Accidents as Catastrophes: Special Considerations............................................ 634 A. Insidious Nature of Chemicals..................................................................................... 635 B. Process of Decontamination ........................................................................................ 635 C. Wearing of PPE ........................................................................................................... 635 D. Ability to Control One’s Environment (viz., Locus of Control) ................................. 636
V. Direct Central Nervous System Effects of CWAs and Stress ............................................ 636 A. Acute Exposure to Nerve Agents ................................................................................ 636 B. Chronic or Repeated Exposure to Nerve Agents ........................................................ 638 C. Acute and Chronic Exposure to Mustard Gas............................................................. 639 D. Acute Stress Exposure: Biochemical and Neuroanatomical Correlates of PTSD....... 640 E. Animal Models of ASD and Posttraumatic Stress Syndrome..................................... 643 F. Treatment of PTSD...................................................................................................... 644 G. Potential Interaction between Stress and CWAs ......................................................... 644
VI. Summary and Conclusions.................................................................................................. 645 References ..................................................................................................................................... 645
Chemical warfare agents (CWAs) have been used on the battlefields by armed forces as well as against civilians by terrorists and armed forces during the twentieth and twenty-first centuries. This chapter addresses several issues encountered by medical planners when confronted by the use, or threat of the use, of chemical weapons. It discusses the types of CWAs, their principal target organs and physiological effects, and also considers their use in twentieth century warfare and in terrorism. Importantly, it contrasts the military combat and civilian terrorism scenarios. Calling upon a review of the disaster literature and military training and simulations, we summarize the additional physiologic and psychological, both acute and chronic, consequences of the use and threat of use of CWAs in both military and civilian settings. In addition to potential psychological effects of CWA exposure, the threat of chemical attack may evoke fear, helplessness, and horror. We review the methodologies and findings from these diverse studies, attempting to apply them to the fortunately, infrequent circumstance of chemical terrorism. We argue that there is a good basis from these historical studies to support planning the response to chemical terrorism. Such planning must include early involvement of mental health experts in assessment and treatment of psychological health. The early involvement of these experts will mitigate the early as well as the delayed psychological effects.
