|
Items in cart [0] |
Questions? Call 888-624-8373 |
| [ Top of Page ] [ Home ] [ Contact Us ] [ Help ] [ The National Academies Home ] | ||
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 101
Our society is too complex a'~d intetconnectec! to defenc! against a/! possible
threats. As some threats are diminished, others may arise; terrorists may
change their goals anc! tactics.... For that reason, strengtI,e'~ing the nation-
al effort in long-se' m research that can create new solutions should be a
cornerstone ofthe strategyfor countering te'A`orisn~. Making the Nation
Safely: TI?e Role of Science and Technology ill Countering Terrorism, 2002
Tire September 11, 2001 terrorist attacks on tire United States, along
with the subsequent deliberate spread of potent forms of anthrax bacteria
through tire U.S. mail, leave mol~itizecl diverse `,O O ,, O
.~.nf~>h'l'7~ng sc'`~' merit
local and national responses to prevent, detect,
and defenc! against acts of terrorists. Since the ~~' 3~6 0~'n00~ `~3
founding of the National Academy of Sciences in
1863, tire importance of mobilizing science,
r ~ - — ~ — C'
dlelFense~ of Rhea nation hats
~ been OL centt~31 purposed of
medicine, and engineering in defense of tile tIie con~po'ie'it scientific
nation has been a central purpose of tile compo- eie`~nts now colie`ct'vely
Relet scientific elements I low collectively known
as the National Academies. Indeed, tire National
Academies' ability to create, maintain, and draw
from a reservoir of scientific, medical, and tecl~nological knowledge has
underpinned many of Else nation's security strategies.
known as The National
Academies
z
~ 0
UJ ~
6 —
I
OCR for page 102
OCR for page 104
OCR for page 105
OCR for page 107
OCR for page 109
OCR for page 112
Representative terms from entire chapter:
gulf war
iI~~.~6r 7~ i.~-~E Al Jim Or BALM
Cot~vtt~c Tom
Tire Institute of Medicine leas concluctect or participated in a number of
studies focuses! on better understancling tire threats of terrorism and iclen-
tifying ways to prevent terrorist attacks or Educe timid consequences.
In 1998, the IOM ~ eleasec! C/~en7ical I'm/ Bio/ogicc~/ Terrorism: Research anc!
Development to l~nprove Civilian Meclica/ Response, a r epo~-t treat assesses! the
state of tire alit for detecting potential cl~emical and biological agents and
for protecting both else targets of attack Alice tire l~ealtl~ care providers who
will be vital ill respo~cli~g to sucks attacIcs. Tl~e report identified 61 specif-
ic Research & Development (R&D) needs ilk tire following areas: pre-inci-
clent intelligence; detections ant] identification of clinical and biological
agents ilk else environment and ire clinical samples from victims; personal
protective equipment; recognizing covert exposures of a population; mass-
casualty decontamination acid triage procedures; availability, safety, and
efficacy of drugs, vaccines, and Artier therapeutics; prevention and treat-
ment of psycl~ological effects, and computer related tools for training
and operations.
Following tire events of September 11, tire National Academies initiat-
ec} a project drawing on the experience of more than 100 dist~nguisI~eci
experts Fisons a variety of felcis to help tire federal government street the
complex new challenges posed by terrorism. Making the Nation Safer: The
Role of Science and TecI~no/ogy in Countering Terrorism (2002) outlines a
national strategy by which the strengths of U.S. science, medicine, and
e~gineeri'~g cart be enlister] on a continuing basis to assist tire nations in
anticipating, preventing, ant! responding to ter-
MaL`~g tI7e Nation Sa Crab Prism. Issued by the Natiol al ResearcI, Council,
The Role of Sc'ente ai7~'
IeChnOlogy In Cling
I; Aim
cribe`s opportunities for
reducing current: and future
risks lthr`~' Ilium
re`~3~:Lrch and ~levelopment
aCtivities.
tire report identifies numerous I
~~l,J\,i/~.,\ Sp~i: '[~3~>r ,,q,~r~-' B~`,'~
Groups That Can Help Respond to a Terrorist Attack
Using a Chemical Agent
Many (if not most) cities and many industries have IJAZMAT teams trained
and equipped to clear with accidental spiffs and releases of toxic industrial
chemicals. They have not been trained or equippecl to clear with terrorist inci-
dents, but chemical weapons of the types that would most plausibly be used by
terrorists are not fundamentally different frown the chemicals that these teams
already address.
Among the first responders to chemical terrorism, fire departments can be a
major resource. Ail fire departments have personnel who are trained and
equipped to work with respirators ant] protective gear (as hazardous vapors are
always a part of fires), and they are of course trained to deal with emergencies.
The police are not routinely equipped to respond to chemical incidents per se
(although they play an essential role in maintaining order). Equipping police
units with protective gear is, however, a practical way of ext~ancling the
number of individuals who can actively participate in the response to a chem-
ical inciclent.
Weapons of Mass Destruction Civil Support Teams from the Department of
Defense are cJep~oyecl around the country. These groups have a ~imitecl but
possibly useful capability to coordinate communications among responders and
to carry out chemical and biological analyses.
Another substantial capability in place is the military, including active-cluty,
reserve, and National Guarc] personnel. The military has trained anc] equipped
for chemical warfare flaring tire past 50 years. It maintains large supplies of rel-
eva'~t eq~ipment-protective suits, prophylactics, and meclica~ countermeasures
against nerve ant] blister agents. These assets are geared, however, to wars on
foreign battlefields. An important issue is to understand how to use this capa-
bi~ity in time of need inside the continental Uniter] States. As of April 2002, 27
teams hac] been depioyecij with five more authorized and in the planning stage.
SOURCE: Making the Nation Safer: The Role of Science and Technology in
Countering Terrorism, 2002, page 128.
IPA;~/~(r 'lI-~E i4(f7~.~ 6~1716~Al i.~S IN BALM
expancled research efforts to procluce new vaccines ant! other therapeutics
treat target bioterrorist agents and new tools for surveillance of infectious
agents in the environment for identification of pathogens and for rapid
acid accurate diagnoses of diseases linked to bioterrorist agents.
The nation s public health system weakener! by years of unclerinvestment
must be revitalized and g Ives surge capacity to massage the masses of
people who may be exposer! to pathogens or other haza~^clous substances
during a terrorist attack.
Tl~e anthrax attacks of 2001 moved bioterroris~n From I~ypotI~etical to
teal. Bioterroris~n is flow a priority for policy-makers r esearcI~ers public
heat officials and members of private industry altI~ougl~ tI~ese commu-
nities continue to struggle witty finding affordable and effective protective
measures. Biological Threats a`?c! Terrorism: Assessing the Science acid Response
Capabilities: A Workshop stimn?ary (2002) reviews current knowledge about
potential bioterrorist agents inclucling anthrax and
smallpox and presents a discussion of the steps needed
to strengthen response capacity. Issued for tire lOMs
Forum on Emerging Infections tire workshop summary
presents participants arguments treat bioterrorism is an
urgent national security issue for which policy-makers
ant] the public must clevelop acid ~naintai~ a coorclinat-
ecl set of response initiatives. Specific priorities fall into
tiered areas: developing vaccines ant! therapeutics treat
act against bioterrorist agents; implementing a r esearch
agenda that reflects current and emerging unclerstand-
ing of bioterrorism threats; anti strengthening tile pub-
lic-l~ealti~ infiastructure in order to ensure effective response to an attack.
Changes in the public loyalty system sI~oulc] inclucle improving com~unica-
tio~ and information programs; expanding laboratory capacity at local
state ant! fecleral levels; entrancing surveillance systems for detecting sus-
picious outbreaks of disease; and strengtI~eing local agencies titan likely
will serve as else first line of defense against bioterrorist attack. To
strengthen response capabilities most efficiently many workshop partici-
pants caller! for expanding partnerships within ant! among government
industry acaclemia tire healths care system ant] tire intelligence
community. Tire Uniter] States also scow enlist tire air! of artier countries
ant! international organizations in improving bioterrorism response
preparedness globally.
If. \~' ~l-~ir A. Bl~rl~~3~M
Since 1997, as part of tire fecleral government's efforts to combat ter-
rorism, tire Office of Emergency Preparedness (OEP) leas proviclect funds to
the nation's most heavily populated cities to help them clevelol~ plans for
coping witty else health acid medical consequences of a catastrophic terror-
ist attack with chemical, biological, or racliological agents. More than 120
cities leave now r received funneling tl~rougI~ tile Metropolitans Medical
Response System (MMRS) program. For assistance in jucI~,-inb- the program's
effectiveness, the OEP turned to the Institute of Medicine. Preparing for
Terrorisn?: Tools for Eva/~'ati'~g the Metropo/itn'~ Meclica/ Response Systemic
Program (2002) provides a detailed guicle for assessing both tire level of
preparedness of cities tight leave participated its tile program anal flow well
its officials leave managed tile program. Among its proposed tools, tile
r eport lists 23 essential capabilities that any community must leave its orcler
to be able to respond effectively to the wicle variety of terrorism attacIcs
float it may suffer; How well each city leas clevelopec! those capabilities can
be measured tl~rougI~ a tI~ree-part process Bleat includes a site visit by a
team of expert peers, observation of exercises and drills within the co~n-
munity, and periodic review of documents and records. Since the threats
of terrorism are continually clanging, the evaluation of preparedness also
must be a continual process rather than a one-time event or even a series
of events s,oacec! at Doing time intervals.
Timid tr't~ ]~tit3~)
I; ]~ p(~3~ CRI11~AL [.~S IN ~EAl711
PREPARING FOR 810~L AND CH EMICAl TERRORISM
.~4~\ Vact:~e
Anthrax is an attractive biological weapon, and its deadly capability
has prompted the U.S. Department of Defense to launch a mandatory vac-
cination program for military personnel. But concerns leave been raised
about the vaccine's efficacy ant! safety. The A'~t/~rax Vaccine: Is It Safe? Does It
Work? (2002) co~clucies treat AVA is indeed boric effective amuck safe. It, I~ow-
eve~; cloes have certain drawbacks, inclucling a six-`iose vaccination scI~ed-
ule over 18 nones titan u'~cierscores the need for a better vaccine.
Altl~ougI~ tire current vaccine can still be used tire Movement shoulc! vig-
orously support r esearcl~ to improve aci'~inistration of else current vaccine
and to develop a better alternative. TO Centers for Disease Control and
Prevention requested an IOM review of its anthrax vaccine research pro-
gram. An Assessment of the CDC A'~t/?rax Vaccine Safety and Efficacy Research
Program (2002) found that CDC bead provided a generally complete ant!
appropriate response to tire charge frosts Congress but Protect treat acicli-
tional research needs had become evident following tire bioterrorist events
of 2001 and made recommendations about else leadership
of tire overall program.
Sn1~Ipox Vaccine
Public and scientific concern about smallpox as a bioweapon also
emerged after September 11. How best to respond] continues to be a mat-
te'- of national clebate. Following tire Presidents decision to immunize
500000 first responders bite CDC was cl~argec!
witty implementation of the program. The small-
pox vaccine (vaccinia virus) is highly effective in
preventing the disease but its use is not without
risIc. Recognizing the usefulness of independent
scientific advice CDC requester! lOM assistance in
evaluating issues that Bigly arise as the vaccina-
tion program unfoiclect. A standing committee was established to provide
continuing assessment and advice. TI,ree letter reports Review of the
Centers for Disease Control and Preve/7tior?'s Smallpox Vaccination Program
Implementation: Letter Report #1 (2003) Letter Report #2 (2003) and Letter
Report #3 (2003) have been isst~ecI. The second report offers updated rec-
ommendations that reflect changes made by the government to the pro-
gram ant] the thirc! report reaffirms the neec! for a pause in the smallpox
vaccination program. Tire program originally called for phased-in vaccina-
The~ smatipt3x vaccine
(~ci'3~a virus) is highly
effective in preventing
it 0~;~' t)~t its ~0 i~
not without risk.
I1{J,N,L,J,,\ SECT ~~r A,'\rI-) I3~O'I'rk17~;~sf~
tion, beginning Title I~ealtl~ workers who would! form volunteer teams ciur-
in', a bioterrorist attack. A second wave of vaccinations was to include
other health workers and traditional "first responders," sucks as police anct
firefighters. Uncler the revised plan, states could begins vaccinating all
healths worI
INEt)~/~.~(r 'l~E I<(J'l-~ GAL [~.S IN GARY
Strategies for Preparing for and Responding to the
Psychological Consequences of Terrorism
Summary of Recommendations
Preventive Measures
:
· Recon~men~at~or~ 2-1: HHS, inclucJi~g NIH, SAM HSA, and CDC, should devel-
op evidence-based techniques, training, and education in psychological first aid.
e Recommendation 2-~: HHS, including NIH, SAM HSA, and CDC, should devel-
op public health surveillance for pre-event, event, and post-event factors related to
the psychological consequences of terrorism.
Education and Training for Providers
Recommendation 3-1: Academic healthcare centers, professional associations
and societies for mental health professionals, and state boards of educations, in col-
laboratio`~ with HHS, including SAM HSA, NIH, and CDC, should ensure the educa-
tion and training of mental health care providers on responding to the psychological
consequences ot terrorism.
· Recommendation 3-2: Academic centers and professional associations and soci-
eties, in collaboration with HHS, including SAM HSA, NIH, and CDC, should ensure
the education and training of relevant professionals in health fields in the psycholog
ical consequences of terrorism.
· Recommendation 3-3: SAM HSA, in collaboration with academic centers and
state and local health care agencies, should ensure the provision of education and
training in the psychological consequences of terrorism for a range of relevant com-
munity leaders and ancillary providers.
Workplace Preparedness
~ Recommendation 3-4: NIOSH, the Department of Labor, and the Department
of Education should erasure appropriate g~ideli'~es to protect people in a variety of
work environments including response sectors, food production and distribution,
and schools
Research Needs
· Recommendation 3-5: Federal agencies should coordinate research agendas,
cooperate in funding, and award timely and sufficient funding.
Ensuring Preparedness Through a Comprehensive Public Health Strategy
~ Recommendation 4-1: DHHS and the Department of Homeland Security should
analyze terrorism preparedness to ensure that the public health infrastructure is pre-
pared to respond to the psychological consequences of terrorism.
· Recommendation 4-?: Federal, state, and local disaster planners should address
Psychological consequences in their planning and preparedness for terrorist attacks.
SOURCE: Preparing tor the Psychological Consequences of Terrorism: A Public Health
Strategy, 2003, page 18.
H{J,~A.~\ 5~'rR3~7 y ANI) 8~;~M
Ui0~9gica' Warfare '4gt't~ts
Currently, the United States leas a limited repertoire of licensee] med-
ical countermeasures that tire Department of Defense can use to protect
itemizers of the are forces against more tea a clozen bacteria, viruses,
ant! toxins identifier! as possible biological warfare agents. As part of its
Chemical acid Biological Defense Program, DoD is engaged its research anc!
development efforts aimed at malting available a be odder ravage of ~neclical
cou~tern~easures. In tire National Defense Authorization Act for Fiscal Year
2002, Congress directed flee Secretary of Defense to contract witty tire
Institute of Medicine and flee National Research Couch for a study of tire
review acid approval process for new medical countermeasures in order to
identify flew approaches to accelerate titan process and to identify metI~-
ods for assuring that new countermeasures will be safe ant! effective. The
Institute of Medicine/National Research Council Committee on
Accelerating tire Research, Development, and Acquisition of Medical
Countermeasures against Biological Warfare Agents has releaser! an inter-
im report that provicles information on study progress, but cloes not con-
tain findings and recommendations. The committee will issue a final report
by the enc! of 2003.
~:~L ~~S (A lERR(~SM
Tire Oklahoma City bombing, intentional crashing of airliners on
Septembe' 11, 2001, anthrax attacI
OCR for page 110
IN~.~.~(r 1~E I
I, s~'ipi7~r Aims 8~3r~£~M
Defense in 1997 to contribute to the integrates] international surveillance
ant] response effort through tire establishment of the
Global Emerging Infections Surveillance ant] Response
System. At the request of tire system's managers, Else
IOM leas evaluated the system's structure and progress.
Perspectives oil the Department of Defe'?se Globe! Emerging
l'~fectio`~s Surveillance and Response System (2001 ~ co'~-
clucles that it is well organized and comprises an app'-o-
p~-iate response to tire thereat posed to national security
by emerging infectious diseases. The ~ eport recommend-
ed solve refinements to the system and called for Else
government to increase fi~a'~cial support to Whelp ensure
its long-term success.
Selected Recommendations for Military and Veterans
The Role of Vaccine Acquisition and Availability in the Military: The Department
of Defense: (DoD) should combine all vaccine acquisition responsibilities under a
single DoD authority and consolidate infrastructure, funding, ar1d~perso~nel for
acquisition programs for biodefense and naturally occurring infectious disease vac-
cines. DoD should also work toward arrangements with manufacturers that ensure
consistent vaccine availability by acJdressing long term commitment, predictable vol-
umes and prices, indemnification, and intellectual property issues; and should also
seek a new approach to the regulation of certain special-use vaccines that remain
in Investigational New Drug status at FDA (Protecting Our Forces: Improving Vaccine
Acquisition anc! Availabi/ity in the U.S. Military, 2002)
Focus on Gulf War Veterans: TI1e Department of Veterans Affairs (VA) should pro-
vicle specific training to health care providers calling for Gulf War veterans to ensure
that they are skilled in patient-centered care, and the VA should further ensure that
such providers are allowed sufficient time with each patient in order to provide
patient-centered care.
In conducting treatment research, the VA should use a hierarchy of evidence struc-
ture that includes effectiveness studies as well as efficacy studies for any future treat-
ment guidelines it develops for symptoms or illnesses of Gulf War veterans. Current
VA and Department of Defense Gulf War registries should be used as one way to
identify patient samples and serve as a sampling frame for future treatment effec-
tiveness studies. (Gulf War Veterans: Treating Symptoms and Sync/rom es, 2001 ~
