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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents Interim Report on Current Capabilities Committee on R&D Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents Division of Health Science Policy INSTITUTE OF MEDICINE Board on Environmental Studies and Toxicology Commission on Life Sciences NATIONAL RESEARCH COUNCIL NATIONAL ACADEMY PRESS Washington, D.C. 1998
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities 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 forum responsible for this report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to the procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. 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. Additional copies of this report are available from in limited quantities from the Division of Health Sciences Policy, Institute of Medicine, 2101 Constitution Avenue, N.W., Washington, DC 20418. The full text of the report is also available on-line at http://www.nap.edu/readingroom. For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom. Copyright 1998 by the National Academy of Sciences . All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities COMMITTEE ON R&D NEEDS FOR IMPROVING CIVILIAN MEDICAL RESPONSE TO CHEMICAL AND BIOLOGICAL TERRORISM INCIDENCE 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, 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 JOSHUA LEDERBERG, Sackler Foundation Scholar, Rockefeller University, New York City MATTHEW S. MESELSON, Thomas Dudley Cabot Professor of Natural Sciences, Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts 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, John 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 Project Staff FREDERICK J. MANNING, Project Director CAROL MACZKA, Senior Program Officer C. ELAINE LAWSON, Research Associate JENNIFER K. HOLLIDAY, Project Assistant JAMAINE TINKER, Financial Associate
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities INDEPENDENT REPORT REVIEWERS This report has been reviewed 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 authors, the IOM, and the NRC in making the 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: MICKEY EISENBERG, Professor of Medicine and Head, Emergency Medicine Service, University of Washington Medical Center, Seattle 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 SANFORD S. LEFFINGWELL, Vice President, HLM Consultants, Dacula, Georgia FREDERICK A. MURPHY, Dean, School of Veterinary Medicine, University of California, Davis KENT OLSON, Executive Medical Director, California Poison Control System, and Clinical Professor of Medicine, Pediatrics, and Pharmacy, University of California, San Francisco ROBERT J. URSANO, Professor of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland PETER H. WALD, Medical Director,Atlantic Richfield Company, Los Angeles ANNETTA P. WATSON, Research Staff, Health and Safety Reserach Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee The individuals listed above have provided many constructive comments and suggestions, but responsibility for the final content of this report rests solely with the authoring committee, the IOM, and the NRC.
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities Abbreviations AEL Acceptable exposure limit ASTM American Society for Testing and Materials ATSDR Agency for Toxic Substances and Disease Registry BIDS Biological Integrated Detection System CAM Chemical agent monitor CBIRF Chemical Biological Incident Response Force CBWCA Chemical and Biological Weapons Control Act CCP Crisis Counseling Assistance and Training Program CDC Centers for Disease Control and Prevention CISD Critical incident stress debriefing CLS Commission on Life Sciences CMHS Center for Mental Health Services CSEPP Chemical Stockpile Emergency Preparedness Program DMAT Disaster Medical Assistance Team DNA Deoxyribonucleic acid DoD Department of Defense DoE Department of Energy EEE Eastern equine encephalomyelitis EIDI Emerging Infectious Disease Initiative EIS Epidemic Intelligence Service ELISA Enzyme-linked immunosorbent assay EPA Environmental Protection Agency
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities FBI Federal Bureau of Investigation FDA Food and Drug Adminstration FEMA Federal Emergency Management Agency GA Tabun GB Sarin GD Soman HHS Health and Human Services (Department of) HSEES Hazardous substances emergency events surveillance IDLH Immediately dangerous to life and health IND Investigational new drug IOM Institute of Medicine JUN Junin virus LD50 Dose lethal to 50 percent of the population exposed MiniCAD Chemical agent detector MMST Metropolitan Medical Strike Team NBC Nuclear, biological, chemical NDMS National Disaster Medical System NFPA National Fire Protection Association NIOSH National Institute for Occupational Safety and Health NMRI Navy Medical Research Institute OEP Office of Emergency Preparedness OSHA Occupational Safety and Health Admistration 2-PAM Pralidoxime chloride PCC Poison control center PCR Polymerase chain reaction PDD-39 Presidential Decision Directive 39 PHS Public Health Service PPE Personal protective equipment PTSD Posttraumatic stress disorder R&D Research and Development RVF Rift Valley fever SAW Surface acoustical wave
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities SCBA Self-contained breathing apparatus SEB Staphylococcal enterotoxin B SOPs Standard operating procedures USAMRIID US Army Medical Research Institute of Infectious Diseases UV Ultraviolet VA Veterans Administration VEE Venezuelan equine encephalomyelitis VIG Vaccinia-immune globulin WEE Western equine encephalomyelitis WHO World Health Organization
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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities This page in the original is blank.