NATIONAL ACADEMY PRESS
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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.
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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.
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
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.
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
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
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