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It would be a grave mistake to assume that terrorists will not be able and willing to take advantage of biotechnology to develop new chemical or biological threats. Preincident intelligence about the specific agent suspected will always be important, for it is not feasible, and perhaps not possible, to be prepared for all possible agents in all possible circumstances. As a practical matter, the committee has taken as its reference point the relatively short list of chemical and biological agents that have constituted the core of military weapons programs: nerve agents, cyanide, phosgene, vesicants such as mustard; the infectious microorganisms causing anthrax, brucellosis, plague, Q-fever, tularemia, smallpox, viral encephalitis, and hemorrhagic fever; the bacteria-produced poisons botulinum toxin and staphylococcal enterotoxin B; the plant-derived toxin ricin, and fungal metabolite T-2 mycotoxin. Appendix C and Appendix D provide longer lists of chemical and biological agents respectively.

The committee also recognizes that for nearly any specific locale, a terrorist attack of any sort is a very low-probability event, and for that reason expensive or time-consuming actions in preparation for such events are extremely difficult for local governments to justify. As a result, the committee has given special attention to actions that will be valuable even if no attack ever occurs. A second tier of recommendations focus on specific actions that would be valuable in a few more likely scenarios. A third level of suggestions, which are likely to be more prominent in the final report than here, involves more generic, long-term research and development.

This interim report describes current preparedness at each of four levels of medical intervention—local first responders, initial treatment facilities, state departments of emergency services and public health, and a variety of federal agencies. The specific capabilities assessed are preincident intelligence; detection of agents in the environment; personal protective equipment; safe and effective patient extraction; recognition of signs and symptoms in patients; detection of agent exposure in clinical samples; detection of covert exposures of a population; mass-casualty triage procedures; decontamination of exposed individuals; availability, safety, and efficacy of drugs and other therapeutics; and prevention and treatment of psychological effects. This executive summary discusses these capabilities under three broad headings (1) detection, (2) protection, and (3) treatment.

Detection of Agents in the Environment

Hazardous materials or “Hazmat” teams are routinely equipped with a variety of chemical detectors and monitoring kits, primarily employing chemical-specific tests indicating only the presence or absence of a suspected chemical or class of chemical. The most common detectors test for pesticides, chlorine, and cyanide, but not specifically for phosgene, vesicants, or nerve agents. Although chemical tests, detectors, and monitors used by the military (Appendix G) are commercially available for civilian use, for various reasons they have not been acquired by civilian organizations in appreciable numbers.

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