Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response

297 Pages·1999·16.89 MB·English

by  Institute of Medicine, Committee on R&D Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents

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Chemical and Biological Terrorism
Research and Development to Improve Civilian Medical Response
Committee on R&D Needs for Improving Civilian Medical
Response to Chemical and Biological Terrorism Incidents
Health Science Policy Program
INSTITUTE OF MEDICINE
and
Board on Environmental Studies and Toxicology
Commission on Life Sciences
NATIONAL RESEARCH COUNCIL
NATIONAL ACADEMY PRESS
Washington, D.C. 1999
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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
committee responsible for this report were chosen for their special competences and with regard for appropriate balance.
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
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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.
Library of Congress Cataloging-in-Publication Data
Chemical and biological terrorism: research and development to improve civilian medical response / Committee on R&D Needs for Improving
Civilian Medical Response to Chemical and Biological Terrorism Incidents, Health Science Policy Program, Institute of Medicine, and Board on
Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council.
p. cm.
Includes bibliographical references and index.
ISBN 0-309-06195-4 (hardcover)
1. Chemical warfare—Health aspects. 2. Biological
warfare—Health aspects. 3. Civil defense—United States. 4.
Terrorism—Government policy—United States. 5. Disaster
medicine—United States. I. Institute of Medicine (U.S.). Committee
on R & D Needs for Improving Civilian Medical Response to Chemical
and Biological Terrorism Incidents. II. National Research Council
(U.S.). Board on Environmental Studies and Toxicology.
RA648 .C525 1999
358'.3—dc21 98-58069
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Copyright 1999 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
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Committee on R&D Needs for Improving Civilian Medical Response to Chemical and Biological
Terrorism Incidents
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, Department of Emergency Medicine and Health Care Sciences
Program, The George Washington University, Washington, D.C.
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
MATTHEW S. MESELSON, Thomas Dudley Cabot Professor of the Natural Sciences, Department of Molecular
and Cellular Biology, Harvard University, Cambridge, Massachusetts
DAVID H. MOORE, Director, Medical Toxicology Programs, Battelle Edgewood Operations, Bel Air, Maryland
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, Johns 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
*Deceased, January 1998.
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Committee Liaisons
JUDITH H. LAROSA, Professor and Chair, Department of Community Health Services, Tulane University School
of Public Health and Tropical Medicine, New Orleans, Louisiana, and Liaison to the Board on Health Science
Policy
WARREN MUIR, President, Hampshire Research Institute, Alexandria, Virginia, and Liaison to the Board on
Environmental Studies and Toxicology
Study Staff
FREDERICK J. MANNING, Project Director
CAROL MACZKA, Senior Program Officer
C. ELAINE LAWSON, Program Officer
JENNIFER K. HOLLIDAY, Project Assistant (May 1997 through May 1998)
THOMAS J. WETTERHAN, Project Assistant (June 1998 through November 1998)
Institute of Medicine Staff
CHARLES H. EVANS, JR., Head, Health Sciences Section
ANDREW POPE, Director, Health Sciences Policy Program
LINDA DEPUGH, Section Administrative Assistant
JAMAINE TINKER, Financial Associate
National Research Council Staff
JAMES REISA, Director, Board on Environmental Studies and Toxicology
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Independent Report Reviewers
This report has been reviewed in draft form 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 institution in making its
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:
JOHN D. BALDESCHWIELER, Professor of Chemistry, California Institute of Technology, Pasadena
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
JOSHUA LEDERBERG, Sackler Foundation Scholar, Rockefeller University, New York
H. RICHARD NESSON, Senior Consultant, Partners Health Care System, Inc., Boston
MICHAEL OSTERHOLM, Chief, Acute Disease Epidemiology Section, Minnesota Department of Health,
Minneapolis
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ANNETTA P. WATSON, Research Staff, Health and Safety Research Division, Oak Ridge National Laboratory,
Oak Ridge, Tennessee
MELVIN H. WORTH, Clinical Professor, State University of New York-Brooklyn and Uniformed Services
University of Health Sciences, and Institute of Medicine Scholar-in-Residence
The committee would also like to thank the following individuals for their technical reviews of single chapters of
the draft report:
ROBERT E. BOYLE, Formerly Technical Advisor, Chemical Warfare and NBC Defense Division, Office of the
Deputy Chief of Staff for Operations, Plans, and Policy, Department of the Army, Washington, D.C.
GREGORY G. NOLL, Hildebrand and Noll Associates, Inc., Lancaster, Pennsylvania
ROBERT S. PYNOOS, Professor and Director, Trauma Psychiatry Service, Department of Psychiatry and
Biobehavioral Sciences, University of California, Los Angeles
JOSEPH J. VERVIER, Senior Staff Scientist, ENSCO, Inc., Melbourne, Florida, and formerly Technical Director,
Edgewood Research, Development and Engineering Center, Aberdeen Proving Ground, Maryland
Although the individuals listed above have provided many constructive comments and suggestions, it must be
emphasized that responsibility for the final content of this report rests solely with the authoring committee and the
institution.
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Preface
American military forces have been struggling with the issue of chemical and biological warfare for decades—a
1917 National Research Council Committee laid the groundwork for the Army Chemical Warfare Service—but it
was the attack of the Tokyo subway with the nerve gas sarin in March 1995 that suddenly put the spotlight on the
danger to civilians from chemical and biological attacks. The Federal Emergency Management Agency (FEMA)
and the Department of Health and Human Services' Office of Emergency Preparedness (OEP), which is responsible
for medical services, have an admirable record of helping state and local governments cope with floods, storms, and
other disasters, including terrorism, but, fortunately, no direct experience with the consequences of chemical or
biological terrorism. In May 1997, the Institute of Medicine was asked to help OEP prepare for the possibility of
chemical or biological terrorism, and, with help from the National Research Council's Board on Environmental
Studies and Toxicology, formed this committee to provide recommendations for priority research and development
(R&D).
In the ensuing year and a half, the committee met four times, heard presentations on existing technology and
ongoing R&D, attempted to absorb a virtual mountain of information, and formulated their recommendations. In
the process, a number of things became clear to me. I suspect the rest of the committee would agree, but I will
exercise the chair's prerogative at this point, and share the view from my perspective.
First, there is no way to prepare in an optimal fashion for a terror incident. There is too low an incidence to justify
the enormous financial