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basis. It would be a serious tactical and strategic mistake to ignore (and possibly undermine) these long-neglected mechanisms in efforts to improve the response of the medical community to additional, albeit very dangerous, toxic materials. It would be similarly ill advised to ignore the existing mechanisms for providing federal disaster assistance to local communities.

Local governments and hospitals are reluctant to spend large amounts of money and time preparing for what they judge as unlikely events. Federal organizations can, therefore, be very important. This is particularly true in the case of biological agent incidents, where onset of signs or symptoms is delayed, variable, and potentially continuing, and victims may be widely dispersed. The National Disaster Medical System (NDMS), for example, would be a critical component of response to any large-scale biological attack. The NDMS might also serve a useful role in a large-scale chemical attack, though the rapid onset of effects from these agents puts a premium on actions within the first few hours following exposure. For that reason, properly trained and organized Metropolitan Medical Strike Teams organized by local communities with Public Health Service funding may be the most useful federal help in managing the medical consequences of a chemical attack. Similar help from deployable military teams will be optimal only if intelligence allows for predeployment or the attack occurs near the team's home base.

Finally, it will be apparent that federal regulations intended to protect the public in very different circumstances may have, in fact, impeded efforts to prepare for chemical or biological terrorism. Regulations on worker safety apparel, for example, have made it difficult for civilian rescue workers to take advantage of military equipment specifically designed for protection from chemical warfare agents. Similarly, the difficulty of obtaining the human efficacy data currently required for FDA approval of specific treatments for chemical and biological warfare agents may limit their use in mass-casualty situations. Furthermore, in the case of many treatments, collection of the data on efficacy necessary for full FDA approval will not be possible for ethical reasons or economically attractive to a potential manufacturer because of limited market potential.



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