National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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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 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

Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
×

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.

Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
×

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

Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
×

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.

Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
×

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

Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
×

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

Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
×

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

Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 1998. Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities. Washington, DC: The National Academies Press. doi: 10.17226/9519.
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This report addresses the U.S. civil preparedness for chemical or biological terrorist incidents. In particular, the report provides interim findings regarding (1) collection and assessment of existing research, development, and technology information on detecting chemical and biological agents as well as methods for protecting and treating both the targets of attack and the responding health care providers, and (2) provision of specific recommendations for priority research and development.

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