Page 265

Index

A

Acceptable exposure limit, 37, 52, 56

Acetylcholinesterase (AChE), 60-61, 113, 115, 146, 148, 169

See also Cholinesterase

Acoustic detectors, 53, 55, 57, 58, 59, 84, 256-257

Acquired immune deficiency syndrome, see Human immunodeficiency virus

Adenosine 5'-triphosphate, 87

Advance Lightweight Chemical Protection program, 38

AEL, see Acceptable exposure limit

Aeromedical Isolation Team, 26

Aerosols and vapors, 2, 22, 162

atropine, 113

biologic agents, 137, 138, 140, 146, 152, 154

covert exposure, 41

decontamination, 106

detection and measurement, 44, 45, 47-51, 56, 86-87, 88-89, 226, 227

personal protective equipment, 35, 38

vesicants, 122, 123

see also Respirators

Aged persons, 103, 108

Agency for Toxic Substances and Disease Registry, 75-76, 101

Agriculture

chemicals industry, 39, 116

crop contamination, 22

AIDS, see Human immunodeficiency virus

Aircraft, see Unmanned aerial vehicles

American Psychiatric Association, 171, 250

American Psychological Association, 171, 250

American Red Cross, 167, 171, 250

American Society for Testing and Materials, 35

Aminophenones, 127

Aminopyridines, 151, 242

Amyl nitrite, 125, 241

Analyte 2000, 93

ANL, see Argonne National Laboratory

Anthrax, 9, 10, 21, 69, 72, 79, 83, 89, 107, 131, 132, 133-136, 147, 162, 191, 192, 244

Antibiotics, see Drugs, antibiotics

Antibodies, 9, 134-135, 191

assay probes, 81-82, 84

monoclonal antibodies, 10, 61, 62, 81, 82, 119, 122, 144, 149, 152, 157, 158, 162, 192, 242

see also Immunoassays; Vaccines

Antibody fragments, 10, 85-86, 93, 149, 152, 154, 162, 192

Anticholinesterase compounds, 5, 44, 60-61, 118



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Page 265 Index A Acceptable exposure limit, 37, 52, 56 Acetylcholinesterase (AChE), 60-61, 113, 115, 146, 148, 169 See also Cholinesterase Acoustic detectors, 53, 55, 57, 58, 59, 84, 256-257 Acquired immune deficiency syndrome, see Human immunodeficiency virus Adenosine 5'-triphosphate, 87 Advance Lightweight Chemical Protection program, 38 AEL, see Acceptable exposure limit Aeromedical Isolation Team, 26 Aerosols and vapors, 2, 22, 162 atropine, 113 biologic agents, 137, 138, 140, 146, 152, 154 covert exposure, 41 decontamination, 106 detection and measurement, 44, 45, 47-51, 56, 86-87, 88-89, 226, 227 personal protective equipment, 35, 38 vesicants, 122, 123 see also Respirators Aged persons, 103, 108 Agency for Toxic Substances and Disease Registry, 75-76, 101 Agriculture chemicals industry, 39, 116 crop contamination, 22 AIDS, see Human immunodeficiency virus Aircraft, see Unmanned aerial vehicles American Psychiatric Association, 171, 250 American Psychological Association, 171, 250 American Red Cross, 167, 171, 250 American Society for Testing and Materials, 35 Aminophenones, 127 Aminopyridines, 151, 242 Amyl nitrite, 125, 241 Analyte 2000, 93 ANL, see Argonne National Laboratory Anthrax, 9, 10, 21, 69, 72, 79, 83, 89, 107, 131, 132, 133-136, 147, 162, 191, 192, 244 Antibiotics, see Drugs, antibiotics Antibodies, 9, 134-135, 191 assay probes, 81-82, 84 monoclonal antibodies, 10, 61, 62, 81, 82, 119, 122, 144, 149, 152, 157, 158, 162, 192, 242 see also Immunoassays; Vaccines Antibody fragments, 10, 85-86, 93, 149, 152, 154, 162, 192 Anticholinesterase compounds, 5, 44, 60-61, 118

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Page 266 Anticonvulsants, see Seizures and anticonvulsants Antidotes, see Drugs, antidotes/antitoxins Antiinflammatory agents, 127 Anti-Terrorism and Effective Death Penalty Act of 1996, 17, 168 APA, see American Psychiatric Association; American Psychological Association Argentine hemorrhagic fever, 146 Argonne National Laboratory, 81, 179 Assays, 5, 6, 44, 64, 72, 73, 79, 96, 145-146, 189 probe technologies, 80-83, 85-86 transducer technologies, 80, 83-86 see also Immunoassays ASTM, see American Society for Testing and Materials Atmospheric dispersion models, 179-182, 183, 193 ATP, see Adenosine 5'-triphosphate Atropine methonitrate, 116, 121, 122 Atropine sulfate, 113, 114-115, 116, 121, 241 ATSDR, see Agency for Toxic Substances and Disease Registry Automatic Chemical Agent Detection Alarm, 57 B Battle Dress Overgarment (BDO), 38, 224 BChE, see Butyrylcholinesterase ß-chlorovinyldichloroarsine, see Lewisite Benzodiazepines, see Diazepam; Lorazepam; Midazolam Biological agents and warfare, general broad spectrum defenses, 158-161 chemical vs, 13-14 civilian response capabilities, current, 23-28 committee's approach, 2, 20-21 computer applications, 12 decontamination, 106-107 detection and measurement, 66-71, 78-96, 234-238, 255 list of, 263-264 nonspecific defenses, 10, 131, 158-161, 192 personal protective equipment, 41-42 surveillance and investigation, 66-74 terrorism scenarios considered, 21-22 see also Clinical diagnoses; Covert exposures of population; Drugs, antibiotics; Vaccines; specific agents Biological Integrated Detection System (BIDS), 86-87 Biological Weapons Act of 1989, 16 Biological Weapons Convention, 16 Blister agents, 48, 52, 53, 54, 55, 58 see also Lewisite; Sulfur mustard Blood agents and tests biological, 78, 86, 89 chemical, 51, 52, 54, 60-64 (passim), 72, 76 see also Cyanide Bolivian hemorrhagic fever, 146 Botulism, 9, 10, 21, 76, 83, 131, 148-152, 162, 163, 192, 245, 258 Breathing apparatus, see Masks, filtering; Respirators Brucellosis, 11, 21, 72, 136-137, 163, 193, 245 Bubblers and impingers, 89-90 Butyrylcholinesterase, 118, 121, 122, 242 C Calcium chelators, 124 Canadian Bacterial Disease Network, 69, 232 Capillary gas chromatography, 61 Carbamates, 115 Carboxyesterase, 122 CBDCOM, see Chemical Biological Defense Command CBIRF, see Chemical Biological Incident Response Force CBMS, see Chemical Biological Mass Spectrometer CBNP, see Chemical and Biological Nonproliferation Program C/B-RRT, see Chemical/Biological Rapid Response Team CBWCA, see Chemical and Biological Weapons Control Act of 1991 CCHP, see Crimean Congo hemorrhagic fever CCP, see Crisis Counseling Assistance and Training Program Center for Mental Health Services, 167 Centers for Disease Control and Prevention (CDC), 26, 37, 190 biological agents, 30, 149 (Continued on next page)

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Page 267 (Continued from previous page) covert exposure surveillance, 7, 8, 41, 66-71, 73-74, 77 decontamination procedures, 101 hemorrhagic fevers, 146, 147 inventory of resources, 232, 245, 257 legislation, 17 state-level cooperation, 7, 67-69, 73, 77 vaccines, 141-142, 146 Central nervous system, 113, 114, 115, 117, 118, 121, 137, 169 ChE, see Cholinesterase Chemical agents and warfare, general biological vs, 13-14 civilian response capabilities, current, 23-28, 117-120, 124, 125-126, 128-130 committee's approach, 2, 20-21 computer applications, 12 detection and measurement, 5-6, 43-64, 226-231, 256-257 DoD hotline, 26-27 drug treatment, 112-130 list of, 261-262 probable actions, flow chart, 185 surveillance and investigation, 74-75 terrorism scenarios considered, 21-22 Tokyo subway incident, 30-31, 44, 75, 102, 166, 169 see also Drugs, antidotes/antitoxins; Personal protective equipment; specific agents Chemical and Biological Nonproliferation Program, 19, 94 Chemical and Biological Weapons Control Act of 1991, 16-17 Chemical Biological Defense Command, 26 Chemical Biological Incident Response Force, 26, 86, 100 Chemical Biological Mass Spectrometer, 94 Chemical/Biological Rapid Response Team, 26 Chemical Stockpile Emergency Preparedness Program, 37, 103 Chemical Weapons Convention, 16 Children, 39, 103, 222 Cholinesterase, 5, 44, 60-61 Chromatography, 61, 87, 93 capillary gas chromatography, 61 gas chromatography, 54, 62-63, 86, 226, 227, 228 gas chromatography mass spectrometry, 6, 61, 86, 190 gas chromatography tandem mass spectrometry, 61, 62 high-performance liquid chromatography, 86 See also Spectroscopy Cidofovir, 148 Ciprofloxacin, 135, 244 Cleaning agents, 98, 99-100, 103-104, 106, 122, 242-243 see also Showering Clinical diagnoses, 3, 4, 5, 6, 41, 44, 59-64, 65, 71-77, 78, 96, 189, 190 biological agents, 133-134, 137-141 (passim), 144, 145, 146, 148-149, 152, 153, 156 communications requirements, 32, 33, 185, 189 computer tools, 175-176, 178, 191, 193, 194 cyanide, 125 diarrhea, 68, 113, 153, 156 inventory of resources, 233, 255, 257 nausea, 138, 152 nerve agents, specific, 114, 116 psychological impacts, 166, 169, 173 respiratory effects of agents, 40, 107, 113, 125, 134, 145, 152, 153 side effects, 115, 116, 121, 128, 131, 142, 150 triage and, 107 urinanalysis, 60, 61, 62, 72, 231 vesicants, 122, 127 veterinary medicine, 72, 73 vomiting, 113, 138, 141, 152, 153, 156 see also Assays Clothing decontamination, 8, 98, 99, 109, 191 gloves, 4, 35, 36, 41, 98, 102, 106, 147 gowns, 4, 36, 41, 106, 147 hoods, 38, 39, 40-41, 142 personal protective equipment, general, 4, 13, 34, 35, 38, 41, 223-225 phosgene, 123 CNS, see Central nervous system Colorimetric sensors, 45, 54, 56, 60-61, 79, 83, 84, 226-231, 256 paper detectors, 45, 54, 55, 57, 226, 228 Combating Terrorism (PDD-62), 18

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Page 268 Communications, 3-4, 29-33, 189, 190-191, 193, 232 computer applications, 12, 75-76, 174, 175-176, 183 covert exposure response, 68, 71, 75-76, 77 DoD hotline, 26-27 Emerging Infections Program (CDC), 68 infrastructure protection, 18 intelligence military, information, 3-4, 21, 24, 28, 29-33, 41, 121, 158, 174-175, 183, 187, 189 Internet, 20, 71 poison control centers, 74-75, 76 research recommendations, 4, 32, 34, 189, 190-191 triage and, 107 see also Epidemiological approaches Computer applications, 3, 12, 174-183 atmospheric dispersion models, 179-182, 183, 193, 194 clinical diagnoses, 175-176, 178, 191, 193, 194 communications, 12, 75-76, 174, 175-176, 183 cost factors, 183 databases, 20, 30, 69, 73-74, 175-176, 194 inventory of resources, 221-259, 257, 259 detection and measurement, 8, 58, 73-74, 76-77, 175-176, 177-178 DNA chips, 80-81, 234 education and training, 3, 174-183, 191, 193, 194 emergency response personnel, 174-175, 176-177, 183 Internet, 20, 71 inventory of computer resources, 252-253 research recommendations, 12, 182-183, 193-194 urban areas, 180, 182 Convulsions, see Seizures and anticonvulsants Corticosteroids, 157 Cost factors, 2-3, 22, 28, 187 computer applications, 183 decontamination, 99, 103, 104, 105, 106 detection and measurement, 6, 46, 47-51, 57, 59, 63, 64, 87, 96, 183 drug treatments, 111, 116, 135 personal protective equipment, 39 vaccines, 131, 133, 154 Council of State and Territorial Epidemiologists, 71, 73 Covert exposures of population, 3, 22, 41, 44, 65-77, 175 CDC role, 7, 8, 41, 66-71, 73-74, 77 communications, 68, 71, 75-76, 77 computer tools, 8, 58, 73-74, 76-77, 175-176, 177-178 funding, 7, 67 local preparedness, 65, 67-68, 70-71, 77 medical personnel, 6-7, 66, 67, 68 research recommendations, 7-8, 77 state-level preparedness, 7, 65, 67-68, 70-71, 77 see also Detection and measurement of agents Crimean-Congo hemorrhagic fever, 147 Crisis Counseling Assistance and Training Program, 11, 167 Critical Incident Stress Debriefing, 11, 168, 170 Crop contamination, 22 Crowd control, 105, 177, 262 CSEPP, see Chemical Stockpile Emergency Preparedness Program CSTE, see Council of State and Territorial Epidemiologists Cyanide, 21, 125, 261 detection and measurement, 5, 44, 55, 60, 63-64, 128 drug treatment, 10, 125-127, 128-129, 163, 191, 192, 241, 259 Cyclone samplers, 89 Cyclosarin, 61 D DARPA, see Defense Advanced Research Projects Agency Databases, 20, 30, 69, 73-74, 175-176, 194 inventory of resources, 221-259, 257, 259 Data Elements for Emergency Department Systems, 69 Decontamination, 8-9, 19, 24, 91, 97-107, 108-109, 156, 185 cleaning agents, 98, 99-100, 103-104, 106, 122, 242-243; see also ''showering" infra (Continued on next page)

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Page 269 (Continued from previous page) clothing, 8, 98, 99, 109, 191 computer applications for, 174, 178, 182, 183, 193, 194 cost factors, 99, 103, 104, 105, 106 defined, 97 DoD, general, 105, 240, 258 drugs, antidote use and, 113, 114, 124 electronic technologies, 106-107 emergency response personnel, decontamination of, 99, 102 eyes, 106, 122-123 hospital facilities, 5, 6, 8, 100-106 inventory of products, 239-240, 258 mass, 104-106 medical personnel, 5, 6, 8, 100-103, 106 personal protective equipment, 36 psychological aspects of, 9, 102, 105, 107, 108, 109, 191 research recommendations, 8-9, 102-104, 105, 108-109, 191 showering, 8, 98, 99, 100, 104, 109, 122, 191 standard operating procedures, 8, 19, 24, 98-103, 105, 108-109, 191 technical, 97-99, 103 types of, 98, 99 Defense Advanced Research Projects Agency, 94, 133, 145, 148, 158, 160, 161, 234, 236-237, 244, 248, 249, 252 Defense Against Weapons of Mass Destruction Act of 1996, 17 Defense Authorization Act (FY97), 17 Defense Protective Service, 76 Defense Special Weapons Agency, 180, 253 Dengue fever, 132, 146, 147, 245, 258 Deoxyribonucleic acid, 74, 77, 80-81, 82, 92, 122, 136, 141, 146, 159, 160, 234, 235, 236, 237, 246 Department of Defense, 26-27 Chemical/Biological Rapid Response Team, 26 DARPA, 94, 133, 145, 148, 158, 160, 161, 234, 236-237, 244, 248, 249, 252 decontamination, 105, 240, 258 Defense Protective Service, 76 Defense Special Weapons Agency, 180, 253 detection technology, 46, 58, 90, 94, 232, 255, 256 drugs, antidotes, 113 funding, 17, 105 Global Emerging Infections Surveillance and Response System, 69 hotline, 26-27 inventory of resources, 232, 255, 256, 257 vaccines, 133, 134, 136, 143, 146, 154 see also terms beginning "U.S."; specific agencies Department of Energy, 17, 94, 171, 180, 181, 255, 256, 258 Department of Health and Human Services, 1, 25 funding, 17 psychological impacts of attack, 171 vaccines, 136, 143 see also Office of Emergency Preparedness Department of Justice, 17 Department of Veterans Affairs, 26, 250 Detection and measurement of agents, 3, 5-6, 18-19, 24, 26-27, 103, 185, 188, 190 acoustic, 53, 55, 57, 58, 59, 84, 256-257 aerosols and vapors, 44, 45, 47-51, 56, 86-87, 88-89, 226, 227 biological agents, 66-71, 78-96, 234-238, 255 chemical agents, 5-6, 43-64, 226-231, 256-257 computer tools, 8, 58, 73-74, 76-77, 175-176, 177-178 cost factors, 6, 46, 47-51, 57, 59, 63, 64, 87, 96, 183 cyanide, 5, 44, 55, 60, 63-64, 128 DoD, general, 46, 58, 90, 94, 232, 255, 256 emergency response personnel, 43, 44-45, 57, 59, 64, 190 environmental, 6, 86-95, 178, 190, 226, 229, 230, 231, 234, 255 fluorescence techniques, 72, 81, 82, 84, 85, 90, 92, 93-95, 236, 238 inventory of resources, 226-231, 234-238, 255-257 local authorities preparedness, 56-57 military personnel vs civilians, 13 nerve agents, 5, 44, 47-51, 53, 55, 56, 58, 60-62, 226-231 paper detectors, 45, 54, 55, 57, 226, 228 point detection, 91-95 powered air purifying respirators, 37 (Continued on next page)

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Page 270 (Continued from previous page) research recommendations, 6, 57-59, 64, 95-96, 125, 190 sampling technology, 88-95 signal processing technologies, 52-55 (passim), 58, 80, 82, 83, 85, 90, 159 standards, 44, 64 stand-off detection, 90-91 vesicants, 5, 45, 55, 60, 62-63, 229 see also Assays; Chromatography; Clinical diagnoses; Covert exposures of population; Miniature technology; Spectroscopy Dexamethasone, 124 DHHS, see Department of Health and Human Services Diagnosis, see Clinical diagnoses Diarrhea, 68, 113, 153, 156 Diazepam, 113, 115, 117, 121, 241 Dichloroformoxime, see Phosgene Dicobalt ethylene diamine tetraacetic acid, 127, 128, 163, 192 4-Dimethylaminophenol, 128 Disaster Medical Assistance Teams, 25-26, 167 Disaster Response Network, 171 5,5'-dithio-bis (2-nitrobenzoic acid), 61 Dizocilpine, 120 DNA, see Deoxyribonucleic acid Domestic Preparedness Program (U.S. Army), 45, 57, 168 Doxycycline, 135, 244 DRN, see Disaster Response Network Drugs, antibiotics, 9, 10-11, 31, 69, 92, 96, 133-164 (passim), 191, 244-249, 259 emergency response personnel, 150, 155, 157 FDA, 131, 132, 139, 146, 147, 149, 153, 157, 161 see also Vaccines; specific drugs Drugs, antidotes/antitoxins, 4, 9, 10-11, 110-131 (passim), 149, 155, 160-161, 162-163, 191, 192, 241-243, 258-259 cyanide, 10, 125-127, 128-129, 163, 191, 192, 241, 259 emergency response personnel, 112-119 (passim), 121, 126, 129, 152, 160-161 FDA, 113, 116, 118 hospitals, 111, 117, 121, 125, 130 vesicants, 9, 10, 123-125, 158, 162, 164, 191, 192, 242-243, 259 topical skin protectants, 123, 124, 156-158, 242 see also specific drugs Drugs, general, 1, 4, 9-11, 24, 110-164 administration methods, 10, 115, 121-122, 123, 135, 142, 162, 193 central nervous system, 113, 114, 115, 117, 118, 121, 137, 169 cost factors, 111, 116, 131, 133, 135, 154 funding, 140-141, 153, 160, 258 investigational new drugs, 110, 111-112, 131, 132, 139, 146, 147, 149, 153, 156, 188, 258, 259 legislation, 18 military personnel vs civilian, 13 nerve agents, 9, 10, 113-122, 162, 191, 192, 241-242, 259 prophylactic, 111, 115, 116-120, 121, 124, 129, 134; see also Vaccines regulatory approval, 28; see also Food and Drug Administration research recommendations, 9, 10-11, 111, 121-122, 126-127, 136, 143-144, 146, 148, 152, 153, 154, 158, 161-164, 191-193 seizures and anticonvulsants, 9, 11, 63, 113, 114, 115, 121, 122, 125, 144, 162, 191, 192 side effects, 115, 116, 121, 128, 131, 142, 150 see also Vaccines; specific drugs DSWA, see Defense Special Weapons Agency E Eastern equine encephalomyelitis, 144, 145, 246, 258 Ebola virus, 16, 132, 133, 146, 147, 148, 258, 263 Edgewood Research, Development and Engineering Center (U.S. Army), 86, 95 EDI, see Emerging Infectious Disease Initiative EDTA, see Dicobalt ethylene diamine tetraacetic acid Education and training, 7, 71, 77, 106, 190, 193 children, 39 (Continued on next page)

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Page 271 (Continued from previous page) clinical diagnosis, 3, 66, 75-76, 175-176, 178, 191, 193, 194 computer tools, 3, 174-183, 191, 193, 194 decontamination and triage, 108 Domestic Preparedness Program (U.S. Army), 45, 57, 168 hazardous substances emergency events surveillance system, 66, 75 legislation on, 18 local response plans, 25, 39, 77, 173, 190 preemptive systems, 22 psychological effects, 11-12, 71, 168, 170-172, 173 public, 39, 173 standards, 36 EEE, see Eastern equine encephalomyelitis EIS, see Epidemic Intelligence Service Electrochemical sensors, 46, 52, 83, 256-257 Electrotechnologies, decontamination, 107 ELISA, see Enzyme-linked immunosorbent assay Emergency Medical Service, 112 Emergency response personnel, 23, 25, 185 computer tools, 174-175, 176-177, 183 decontamination of, 99, 102 detection and measurement, 43, 44-45, 57, 59, 64, 190 drugs, antibodies, 150, 155, 157 drugs, antidotes/antitoxins, 112-119 (passim), 121, 126, 129, 152, 160-161 Hazmat teams, 4, 5, 6, 8, 23, 25, 36, 43, 44-45, 57, 59, 64, 65, 75, 93, 99, 100, 101, 104-105, 112-115 (passim), 121, 152, 166, 190 Metropolitan Medical Strike Teams, 25, 28, 55-57, 59, 76, 100, 105, 114, 168, 188 protective equipment, 35-36, 41, 42, 108 psychological impacts, 166, 167-168, 170-171, 173, 176, 193 Emerging Infections: Microbial Threats to Health, 74 Emerging Infections Program (CDC), 7, 67-69 Emerging Infectious Disease Initiative, 257 EMS, see Emergency Medical Service Environmental Protection Agency, 17, 35, 170, 173, 180, 230, 256 Enzyme-linked immunosorbent assay (ELISA), 61, 62, 72 Epidemic Intelligence Service, 70 Epidemiological approaches, 11, 26, 66, 70, 189, 190-191 CDC, 7, 26, 66-69, 73-74, 190-191 computer tools, 175-176 education on, 70, 190 inventory of resources, 232, 245, 257 recommendations, 7 state-level, 4 see also Centers for Disease Control and Prevention; Covert exposure of population ERDEC, see Edgewood Research, Development and Engineering Center Eyes decontamination, 106, 122-123 mustard, 122-123 protection, 4, 36, 41, 106, 147 F Fab, see Antibody fragments FABS, see Force-amplified biological sensor FDA, see Food and Drug Administration Federal Bureau of Investigation, 17-18, 236 Federal Emergency Management Agency, 11, 17, 18, 25, 27, 102, 167, 170 Federal government role, general, 3, 4, 33 see also Funding; Legislation; specific departments and agencies Federation of American Scientists, 71 FEMA, see Federal Emergency Management Agency Fiber-optic evanescent wave guide, 85, 94 Fingerprinting/gene sequencing, 74, 77, 95-96, 191, 235 First responders, see Emergency response personnel Flame photometry, 52 Fluorescence techniques, 72, 81, 82, 84, 85, 90, 92, 93-95, 236, 238 Food and Drug Administration, 28, 188, 232, 237, 255 biologic agent drug treatments, 131, 132, 139, 146, 147, 149, 153, 157, 161 cyanide drug treatments, 129 investigational new drugs, 110, 111-112, 131, 132, 139, 146, 147, 149, 153, 156, 188, 258, 259 (Continued on next page)

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Page 272 (Continued from previous page) nerve agent antidotes, 113, 116, 118 new drug applications, 156, 158 vaccines, 131, 132, 146, 147, 153 vesicant drug treatment, 123, 124 Food contamination, 2, 12, 22, 67, 68, 194, 237 see also Botulism; Brucellosis; Crop contamination Force-amplified biological sensor, 84 Fourier transform infrared spectrometry (FTIR), 55, 58 FOWG, see Fiber-optic evanescent wave guide Funding, 17, 28, 96 covert exposure preparedness, 7, 67 drugs, 140-141, 153, 160, 258 psychological treatment, 167, 170 see also Research recommendations G GA, see Tabun Gas chromatography, 54, 62-63, 86, 226, 227, 228 Gas chromatography mass spectrometry (GC/MS), 6, 61, 86, 190 Gas chromatography tandem mass spectrometry (GC-MTMS), 61, 62 GB, see Sarin GD, see Soman Genetics, 89-90, 160 DNA, 74, 77, 80-81, 82, 92, 122, 136, 141, 146, 159, 160, 234, 235, 236, 237, 246 gene sequencing/fingerprinting, 74, 77, 95-96, 191, 235 genetic engineering of pathogens, 21 pathogen gene mapping, 18 reverse transcriptase, 92 RNA, 74, 77, 80, 81, 92, 122, 144, 145-146, 159, 160, 234 see also Immunoassays Gentamicin, 139 Global Emerging Infections Surveillance and Response System, 69, 232, 257 Global Infectious Disease and Epidemiology Network, 76, 175, 232, 257 Global NBC Emergency Response Technology Program, 38 Global Public Health Intelligence Network, 69 Global Surveillance Program, 69 Gloves, 4, 35, 36, 41, 98, 102, 106, 147 G nerve agents, 47-51, 56, 58, 62, 115, 231, 261 see also Sarin; Soman; Tabun Gowns, 4, 36, 41, 106, 147 Gulf War, see Persian Gulf War H Hantaan virus, 147 Hazardous materials, general, 4, 5-6, 18-19, 27-28 Hazardous substances emergency events surveillance system, 66, 75 Hazard prediction and assessment capability, 180 Hazmat teams, 4, 5, 6, 8, 23, 25, 36, 43, 44-45, 57, 59, 64, 65, 75, 93, 99, 100, 101, 104-105, 112-115 (passim), 121, 152, 166, 190 HD, see Sulfur mustard Heat stress, 38, 39, 189 Hemorrhagic viruses, 21, 41, 72, 76, 146-148, 245 see also specific diseases Heparin promethazine, 124, 243 High-efficiency particle respirators, 41, 42 High-performance liquid chromatography, 86 HIV, see Human immunodeficiency virus Hoods, 38, 39, 40-41, 142 Hospitals, 5, 26, 28, 185, 187 communication with law enforcement authorities, 30-31 decontamination facilities/procedures, 5, 6, 8, 100-106 drugs, antidotes, 111, 117, 121, 125, 130 personal protective equipment, 4, 5, 34, 36, 42, 106, 147 quarantine, 147 see also Medical personnel HPLC, see High-performance liquid chromatography Human immunodeficiency virus, 67, 80, 81, 143, 161 Hydroxocobalamin, 127, 128, 163, 192

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Page 273 I Immunoassays, 5, 61, 62, 72, 80-85, 87, 92-93, 229, 234-235, 237, 238 ELISA, 61, 62, 72 immunoPCR, 82, 229 Impingers and bubblers, 89-90 Improved Chemical Agent Point Detection System, 58 IMS, see Ion mobility spectrometry IND, see Investigational new drugs Information requirements, see Communications; Education and training; Intelligence, information Infrared spectroscopy, 53, 226 Intelligence, information, 3-4, 21, 24, 28, 29-33, 41, 121, 158, 174-175, 183, 187, 189 medical personnel involvement, 3-4, 21, 24, 28, 29-33 International perspectives covert exposure recognition, 69 treaties, 16 see also Japan, Tokyo subway incident; Persian Gulf War Internet, 20, 71 Investigational new drugs, 110, 111-112, 131, 132, 139, 146, 147, 149, 153, 156, 188, 258, 259 Ion mobility spectrometry, 46, 56, 57, 58, 59 Ipratropium bromide, 117, 121, 122 Israel Gulf War, 39 personal protective equipment, 38, 39, 40, 222 U.S./Israel Agreement on Cooperative Research and Development Concerning Counter-Terrorism, 38 J Japan, Tokyo subway incident, 30-31, 44, 75, 102, 166, 169 Joint Chemical Agent Detector (JCAD), 58 Joint Chemical Biological Agent Water Monitor (JCBAWM), 58 Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 4, 36, 101 Joint Service Lightweight Integrated Suit Technology (JLIST), 38 Joint Service Lightweight Standoff Chemical Agent Detector (JSLSCAD), 58 Joint Vaccine Acquisition Program, 133, 143 Junin virus, 132, 146, 147 L LANL, see Los Alamos National Laboratory Lassa fever, 146, 147, 246, 259, 263 Law enforcement authorities and personnel, 3, 23, 30-31 computer tools, 174-175, 176 crowd control, 105, 177, 262 FBI, 17-18, 236 medical personnel liaison with, 30-31 protective equipment, 35-36 see also Emergency response personnel Lawrence Livermore National Laboratory, 93, 180, 240, 253 Legislation, 16-18, 67, 68, 168 see also specific laws Lewisite, 47-50, 122, 123, 231, 243, 261 Ligand-based probes, 82-83, 84, 93-94, 237, 256 LLNL, see Lawrence Livermore National Laboratory Local Firefighter and Emergency Services Training Act of 1996, 17 Local preparedness and response, 3, 4, 22-23, 27-28, 172, 187, 190 CDC funding, 7 covert exposure recognition, 65, 67-68, 70-71, 77 decontamination, 105 detection and measurement, 56-57 education and training, 25, 39, 77, 173, 190 legislation, 17, 68 poison control centers, 74-75, 76 see also Emergency response personnel; Hospitals; Urban areas Lorazepam, 115, 117, 121 Los Alamos National Laboratory, 93, 160, 179

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Page 274 M Masks, filtering, 4, 35-41 (passim), 98, 102, 116, 147, 222 Mass spectrometry, 54, 63, 85-86, 94, 229, 231, 234, 238, 256 Medical personnel, 5, 6 computer tools, 174-175 covert exposure recognition, 6-7, 66, 67, 68 decontamination facilities/procedures, 5, 6, 8, 100-103, 106 detection and measurement, 43, 59 intelligence, information, 3-4, 21, 24, 28, 29-33 law enforcement, communication with, 30-31 military, 26 personal protective equipment, 4, 5, 19, 34, 35-36, 41, 42, 100, 103, 106, 108, 147 psychological effects of attack, 168, 170-172, 173 response scenarios, 23, 25 veterinary, 72, 73, 111, 116 see also Emergency response personnel; Hospitals; Public health officials; Triage procedures Memantine, 120 Membrane technology, 38, 40 Mental illness, see Psychological effects Methanesulfonate salt of pralidoxime, 118 Methemoglobin, 21, 127, 128, 163, 192 Metropolitan Medical Strike Teams, 25, 28, 55-57, 59, 76, 100, 105, 114, 168, 188 Midazolam, 117 Mine Safety and Health Administration, 35 Miniature technology biological agent detectors, 93, 94, 178, 234 chemical agent detectors, 6, 64, 95, 178, 190, 226, 229, 230, 231, 255 MMST, see Metropolitan Medical Strike Teams Monitoring systems, see Detection and measurement of agents Monocolonal antibodies, 10, 61, 62, 81, 82, 119, 122, 144, 149, 151, 152, 157, 158, 162, 192, 242 Monoisonitrosoacetone, 118 Mustard agents, see Sulfur mustard Myasthenia gravis, 115 Mycotoxins, 11, 21, 76, 154, 156, 157-158, 193, 247-248, 258 N N-acetylcysteine, 124, 127, 192, 242 NAME, see Nitroarginine methylester National Aeronautics and Space Administration, 38, 84, 255, 256 National Atmospheric Release and Advisory Center, 180-181 National Center for Infectious Diseases, 73 National Coordinator for Security, Infrastructure Protection, and Counter-Terrorism, 18 National Counterterrorism Plan, 25 National Disaster Medical System, 11, 25-26, 28, 167, 188 National Fire Protection Association, 35 National Infrastructure Protection Center, 18 National Institute for Occupational Safety and Health, 34-35, 37 National Institute of Allergy and Infectious Diseases, 148 National Institutes of Health, 140-141, 147-148, 153 National Notifiable Disease Surveillance System, 7, 66-67 National Oceanic and Atmospheric Administration, 180 Nausea, 138, 152 see also Vomiting Naval Medical Research Institute, 26, 87, 93 Naval Research Laboratory, 91 NDMS, see National Disaster Medical System Nerve agents, general committee's list of, 2, 21, 261 decontamination, 102, 113, 114 detection and measurement, 5, 44, 47-51, 53, 55, 56, 58, 60-62, 226-231 drug treatment, 9, 10, 113-122, 162, 191, 192, 241-242, 259 personal protective equipment, 4, 36, 37 psychological vs neurological impacts, 169 symptoms, 60-62, 113; see also Seizures and anticonvulsants see also Central nervous system; G nerve agents; specific agents

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Page 275 NFPA, see National Fire Protection Association NIAID, see National Institute of Allergy and Infectious Diseases Nicotine hydroxamic acid methiodide, 118, 242 NIH, see National Institutes of Health NIOSH, see National Institute for Occupational Safety and Health NIPAC, see National Infrastructure Protection Center Nitric oxide synthase inhibitor, 124, 243 Nitroarginine methylester, 124 NMRI, see Naval Medical Research Institute NOAA, see National Oceanic and Atmospheric Administration NRL, see Naval Research Laboratory Nuclear Regulatory Commission, 171 O Oak Ridge National Laboratory, 94, 95 Occupational Safety and Health Administration, 188 exposure standards, 56 personal protective equipment, 4, 35, 42, 188 Office of Emergency Preparedness (OEP), 25, 171 role in report at hand, 1, 18, 19 Officials, see Law enforcement authorities and personnel; Public health officials Optical transduction, 84-85 Organophosphates, 60, 61-62, 115, 116, 118, 119 OSHA, see Occupational Safety and Health Administration P Paper detectors, 45, 54, 55, 57, 226, 228 PAPR, see Powered air purifying respirators Para-aminoheptanophenone (PAHP), 129, 241 Para-aminooctanoylphenone (PAOF), 128, 241 Para-aminopropiophenone (PAPP), 128, 241 PBBs, see Polybrominated biphenyls PCBs, see Polychlorinated biphenyls PCR, see Polymerase chain reaction PDDs, see Presidential Decision Directives Penicillin, 134, 135 Persian Gulf War, 39, 112, 115, 166 Personal protective equipment, 1, 3, 4-5, 18-19, 24, 34-42, 158, 189 Battle Dress Overgarment, 38, 224 clothing, 4, 13, 34, 35, 38, 41, 223-225 cost factors, 39 defined, 34 emergency response personnel, 35-36, 41, 42, 108 eyes, 4, 36, 41, 106, 147 general public, 4, 34, 39, 40, 41, 42, 222-225 gloves, 4, 35, 36, 41, 98, 102, 106, 147 gowns, 4, 36, 41, 106, 147 heat stress, 38, 39, 189 hoods, 38, 39, 40-41, 142 hospitals, 4, 5, 34, 36, 42, 106, 147 inventory of available products, 222-225 Israelis, 38, 39, 40, 222 levels of protection, 35, 36, 37, 40 masks, 4, 35-41 (passim), 98, 102, 116, 147, 222 medical personnel, 4, 5, 19, 34, 35-36, 41, 42, 100, 103, 106, 108, 147 nerve agents, 4, 36, 37 OSHA, 4, 35, 42, 188 regulatory approval of, 4, 28, 189 research recommendations, 5, 42, 189 shelters vs, 39 skin, 35, 37, 38, 41; see also Topical skin protectants; "gowns" supra splash protection, 35, 37; see also "gowns" supra testing, 5, 35, 37, 189 types of, 34-35 see also Respirators; Shelters, protective Pharmacological therapy, see Vaccines; terms beginning "Drugs …" Phosgene, 5, 10, 21, 44, 47-48, 63, 122, 123, 127, 130, 163, 192, 242, 259 Photoacoustic infrared spectroscopy (PIRS), 53 Photo ionization detectors (PIDs), 53 pH paper, 45 PHS, see Public Health Service Piezoelectric transducers, 83-84, 256

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Page 276 Plague, 9, 11, 21, 72, 132, 137-139, 147, 163, 193, 246 Planning Guidance for the Chemical Stockpile Emergency Preparedness Program, 101 Point detection, 91-95 Poison control centers, 74-75, 76, 111, 125 Polybrominated biphenyls, 98 Polychlorinated biphenyls, 98 Polymerase chain reaction, 27, 72, 82, 92-93, 136, 229, 231, 232 Post traumatic stress disorder, 9, 11, 165-166, 169, 173 Powered air purifying respirators, 4, 37-38 PPE, see Personal protective equipment Pralidoxime chloride (2-PAM), 113, 114-115, 116, 117, 118, 121, 242 Preemption of attack, 2, 22 see also Intelligence, information Presidential Decision Directives, 17, 18, 33 Pressure-demand supplied air respirator, 35 Probe technologies, 80-83, 84, 85-86 Program for Monitoring Emerging Diseases (ProMED), 71, 175, 232 Prophylactic drugs, 111, 115, 116-120, 121, 124, 129, 134 see also Vaccines Protective equipment, see Personal protective equipment; Shelters, protective Psychological effects, 3, 9, 11-12, 24, 71, 165-173, 193 acute, 165, 166-167 aged persons, 103, 108 community-wide, 172 crowd control, 105, 177, 262 decontamination procedures, 9, 102, 105, 107, 108, 109, 191 diagnosis, 166, 169, 173 education and training, 11-12, 71, 168, 170-172, 173 emergency response personnel, 166, 167-168, 170-171, 173, 176, 193 funding, 167, 170 inventory of resources, 250-251, 259 medical personnel, 168, 170-172, 173 neurological vs, nerve agents, 169 post traumatic stress disorder, 9, 11, 165-166, 169-170 professional training, 170-172, 193 research recommendations, 11-12, 170, 172-173 standard operating procedures, 11, 12, 192 testing guidelines, 35 urban areas, 168, 171, 172 PTSD, see Post traumatic stress disorder Public health officials, 12, 22, 32, 33, 176, 193 Public Health Service, 28, 96 Disaster Medical Assistance Teams, 25-26, 167 Metropolitan Medical Strike Teams, 25, 28, 55-57, 59, 76, 100, 105, 114, 168, 188 Pyridostigmine, 115, 241 Q Q fever, 11, 21, 72, 140-141, 163, 193, 246, 258 Quarantine, 147 3-quinuclidinyl benzilate, 117 R Raman spectroscopy, 54 Rapid assessment and initial detection (RAID) teams, 27 Recombinant vaccines, 10, 149, 151, 152, 162, 192 Regional-level preparedness and response, 25-26 covert exposure, 7, 8 poison control centers, 74-75, 76 Regulatory issues, 28, 42, 189 see also Environmental Protection Agency; Food and Drug Administration; Occupational Safety and Health Administration; Standards Research recommendations, 41, 189-194 committee approach, general, 1-2, 3, 18-19 communications and intelligence, 4, 32, 34, 189, 190-191 computer applications, 12, 182-183, 193-194 covert exposure, 7-8, 77 (Continued on next page)

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Page 277 (Continued from previous page) decontamination and triage, 8-9, 102-104, 105, 108-109, 191 detection and measurement techniques, 6, 57-59, 64, 95-96, 125, 190 drugs, vaccines, and other therapeutics, 9, 10-11, 111, 121-122, 126-127, 136, 143-144, 146, 148, 152, 153, 154, 158, 161-164, 191-193 improper use, 39 pathogen gene mapping, 18 personal protective equipment, 5, 42, 189 psychological effects, 11-12, 170, 172-173 Respirators, 4, 5, 35, 37-42 (passim), 127 civilian equipment, 4, 5, 34, 39, 40, 41, 189 inventory of available products, 222-225 powered air purifying respirators, 4, 37-38 self-contained breathing apparatus, 35, 37, 40, 41, 42 Respiratory agents, 4, 60, 63, 261 phosgene, 5, 10, 21, 44, 47-48, 63, 122, 123, 127, 130, 163, 192, 242, 259 Respiratory effects of agents, 40, 107, 113, 125, 134, 145, 152, 153 Reverse transcriptase, 92 Ribavirin, 147, 249 Ribonucleic acid, 74, 77, 80, 81, 92, 122, 144, 145-146, 159, 160, 234 Ricin, 11, 21, 153-154, 155, 164, 193, 247, 258 Rift Valley fever, 146 Riot control, see Crowd control RNA, see Ribonucleic acid S Sampling devies bubblers/impingers, 89-90 cyclone samplers, 89 viable particle-size impactors, 88 virtual impactors, 89 Sarin, 52, 61, 62, 115 cyclosarin, 61 Tokyo subway incident, 30-31, 44, 75, 102, 166, 169 SBIR, see Small business innovative research SCBA, see Self-contained breathing apparatus Scopolamine, 117, 121, 122 SDA, see Strand displacement amplification SEB, see Staphylococcal enterotoxin B Second-order Closure Integrated Puff (SciPUFF), 180 Seizures and anticonvulsants, 9, 11, 63, 113, 114, 115, 117, 121, 122, 125, 144-145, 162, 191, 192 Selectively permeable membrane technology, 40 Self-contained breathing apparatus, 35, 37, 40, 41, 42 Sentinel Surveillance Networks, 68 SFM, see Swept frequency acoustic interferometry detector Shelters, protective, 39, 41, 42, 105 Shipboard Automatic Lightweight Standoff Chemical Agent Detector, 58 Showering, decontamination, 8, 98, 99, 100, 104, 109, 122, 191 Side effects, 115, 116, 121, 128, 131, 142, 150 Signal processing technologies, 52-55 (passim), 58, 80, 82, 83, 85, 90, 159 Skin, 52 anthrax, 133, 134 blister agents, 48, 52, 53, 54, 55, 58 decontamination, 100, 106 showering, 8, 98, 99, 100, 104, 109, 122, 191 mycotoxins, 156 personal protective equipment, 35, 37, 38, 41 gowns, 4, 36, 41, 106, 147 topical skin protectants, 123, 124, 156-158, 242 see also Vesicants Small business innovative research, 20, 254 Smallpox, 9, 10, 21, 41, 72, 131, 133, 141-144, 148, 162, 191, 192, 247, 258 Sodium nitrite, 125 Sodium thiosulfate, 124, 125 Soman, 42, 61, 62, 115 Special Operations Forces Nonintrusive Detector, 58 Spectroscopy, 61, 228, 232 chemical biological mass spectrometers, 94 Fourier transform infrared spectrometry, 55, 58 gas chromatography mass spectrometry, 6, 61, 86, 190 (Continued on next page)

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Page 278 (Continued from previous page) gas chromatography tandem mass spectrometry, 61, 62 infrared, 53, 226 ion mobility spectrometry, 46, 56, 57, 58, 59 mass spectrometry, 54, 63, 85-86, 94, 229, 231, 234, 238, 256 photoacoustic infrared spectroscopy, 53 raman spectroscopy, 54 Splash protection, 35, 37 see also Gowns Standard operating procedures, 19, 24, 64, 185, 190 decontamination, 8, 19, 24, 98-103, 105, 108-109, 191 hazardous materials plans, general, 5, 6, 8 military vs civilian, 13, 186-187 psychological effects, 11, 12, 192 see also Triage procedures Standards detection and measurement, 44, 64 drugs, antidote administration, 114 exposure, 37, 40, 52, 56 medical personnel protection, 4, 5 protective equipment, 4, 35, 36, 37, 42, 188, 189 testing, 5, 35, 37, 39, 42, 189 see also Regulatory issues Stand-off detection, 90-91 Staphylococcal enterotoxin B, 11, 21, 152-153, 160-161, 163, 193, 247 State-level preparedness and response, 3-4, 25, 27, 189 CDC support, 7, 67-69, 73, 77 children, 39 covert exposure, surveillance, 7, 65, 67-68, 70-71, 77 legislation, 17, 67, 68 Stem cells, 159, 244 Strand displacement amplification, 92 Streptomycin, 135, 138, 248 Substance Abuse and Mental Health Services Administration, 167 Sulfur mustard, 5, 21, 37, 47-51, 52, 62, 65, 122-123, 124 eyes, 122-123 Surface acoustic wave sensors, 53 Swept Frequency Acoustic Interferometry detector, 58 Symptoms, see Clinical diagnoses; Side effects T Tabun, 52 TAS, see Transcription-Based Amplification System TDG, see Thiodiglycol Thermoelectric conductivity, 52 Thienylcyclohexlpiperidine, 120 Thiodiglycol, 60, 62-63, 122 T-2 mycotoxins, 11, 21, 76, 154, 156, 157-158, 164, 193, 247-248, 258 Tokyo subway incident, 30-31, 33, 44, 75, 102, 166, 169 Topical skin protectants, 123, 124, 156-158, 242 Training, see Education and training Transcription-Based Amplification System, 92 Transducer technologies, 80, 83-86, 256 Transportation systems, contamination, 12, 58, 194 patient, 59, 64, 102 Tokyo subway incident, 30-31, 33, 44, 75, 102, 166, 169 Triage procedures, 3, 8-9, 19, 24, 97, 102, 103, 107-109, 126, 185, 191 defined, 97, 107 TSP, see Topical skin protectants Tularemia, 21, 72, 139-140, 248, 258 U UAV, see Unmanned aerial vehicles Ultraviolet radiation, 107, 238 Unconventional Pathogen Countermeasures, 158 United States Policy on Counterterrorism (PDD-39), 17-18 Unmanned aerial vehicles, 91, 236 Up-converting phosphor technology, 85 Urban areas, 4, 31, 91 computer models, 180, 182 Domestic Preparedness Program (U.S. Army), 45, 57, 168 Emerging Infections Program, 68 Metropolitan Medical Strike Teams, 25, 28, 55-57, 59, 76, 100, 105, 114, 168, 188 psychological impacts of attack, 168, 171, 172 Urinanalysis, 60, 61, 62, 72, 231

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Page 279 U.S. Air Force, 69, 224 U.S. Army, 37, 45, 57, 86, 96, 102, 168, 225 U.S. Army Chemical Biological Defense Command, 26-27 U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), 26, 82, 241, 242, 247 U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 26, 87, 93, 94, 141, 145, 147-148, 153, 154, 238, 239, 245, 246, 247-248 U.S./Israel Agreement on Cooperative Research and Development Concerning Counter-Terrorism, 38 U.S. Marine Corps, 26, 86, 240 U.S. Navy, see terms beginning ''Naval" V VA, see Department of Veterans Affairs Vaccines, 3, 9-11, 19, 111, 131-143 (passim), 145, 146, 149, 150-151, 153, 154, 157-159, 162-164, 191, 192 CDC, 141-142, 146 cost factors, 131, 133, 154 DHHS, 136, 143 DoD, general, 133, 134, 136, 143, 146, 154 FDA, 131, 132, 146, 147, 153 inventory of resources, 244-249 legislation on, 18 military personnel vs civilian, 13, 187 recombinant vaccines, 10, 149, 151, 152, 162, 192 Vapors, see Aerosols and vapors Venezuelan equine encephalomyelitis (VEE), 144, 145, 146, 248 Vesicants, 2, 4, 21, 35 aerosols and vapors, 122, 123 clinical diagnosis, 122, 127 decontamination, 21, 122-123 detection and measurement, 5, 45, 55, 60, 62-63, 229 drug treatment, 9, 10, 123-125, 158, 162, 164, 191, 192, 242-243, 259 topical skin protectants, 123, 124, 156-158, 242 FDA, 123, 124 Lewisite, 47-50, 122, 123, 231, 243, 261 list of, 261 phosgene, oxime, 122, 123 sulfur mustard, 5, 21, 37, 47-51, 52, 62, 65, 122-123, 124 see also Blister agents Veterinary medicine, 72, 73, 111, 116 Viable particle-size impactors, 88 Viral encephalitides, 9, 10, 21, 72, 144-146, 163, 192, 246 see also specific diseases Viral hemorrhagic fevers, 21, 41, 72, 76, 146-148, 163, 245 see also specific diseases Virtual impactors, 89 Vitamin E, 124, 157 Vomiting, 113, 138, 141, 152, 153, 156 VX nerve agent, 52, 56, 58, 115, 231, 261 W Wally Wise Guy program, 39 Water contamination, 2, 12, 22, 58, 67, 91, 194, 228, 237 Western equine encephalomyelitis (WEE) 132, 144, 145, 146, 249, 258 World Health Organization, 69, 141, 232 World Wide Web, 20, 250-251, 254, 259 X X-rays, 107 Y Yellow fever, 132, 146, 263