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HARDBACK + PDF your price: $58.50 add to cart HARDBACK list:$49.95 Web:$44.96 add to cart PDF BOOK your price: $38.50 add to cart PDF CHAPTERS your price: $3.30 select Rights & Permissions Free Resources PDF Report Brief PDF EXECUTIVE SUMMARY Display this book on your site! Related Titles Naval Forces' Defense Capabilities Against Chemical and Biological Warfare Threats Gulf War and Health: Volume 5. Infectious Diseases Other Related Titles Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response (1999) Institute of Medicine (IOM) Web Search Builder Use this book's key terms to search within this book, across our collection, or across the Web. Skim This Chapter Skim this chapter and use this chapter's key terms to search within this book. Reference Finder Paste in your own text to find books that relate to your topic. Page 221   E-mail  Facebook  Digg  Stumble  Twitter More The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. Page 221 Appendix B Inventory of Chemical and Biological Defense Technology, with Gap and Overlap Analysis Page 221 Front Matter (R1-R22) Executive Summary (1-14) 1 Introduction (15-28) 2 Pre-Incident Communication and Intelligence: Linking the Intelligence and Medical Communities (29-33) 3 Personal Protective Equipment (34-42) 4 Detection and Measurement of Chemical Agents (43-64) 5 Recognizing Covert Exposure in a Population (65-77) 6 Detection and Measurement of Biological Agents (78-96) 7 Patient Decontamination and Mass Triage (97-109) 8 Availability, Safety, and Efficacy of Drugs and Other Therapies (110-164) 9 Prevention, Assessment, and Treatment of Psychological Effects (165-173) 10 Computer-Related Tools for Training and Operations (174-183) 11 Conclusions and Recommendations (184-194) References (195-212) Appendix A: Committee and Staff Biographies (213-220) Appendix B: Inventory of Chemical and Biological Defense Technology, with Gap and Overlap Analysis (221-259) Appendix C: Lethal and Incapacitating Chemical Weapons (260-262) Appendix D: Centers for Disease Control and Prevention List of Restricted Agents (263-264) Index (265-279)

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Page 221 Appendix B Inventory of Chemical and Biological Defense Technology, with Gap and Overlap Analysis

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Page 222 Personal Protective Equipment 07-Oct-98 Type Product Location/PI Breathing       RP51A Respirator canister Cabot Safety Products   PBE (Protective Breathing Equipment) Essex PB&R Corp.   SCU (Self-Contained Unit) Essex PB&R Corp.   VRU (Victim Rescue Unit) Essex PB&R Corp.   Plus 10 Filter Breathing Unit Essex PB&R Corp.   Escape hood/mask for VIPs Fume Free, Inc   QuickMask Respiratory Protective Escape Device Fume-Free, Inc.   FRENZY AIR 5000 breathing apparatus Giat Industries (France)   Respiratory protection filter kits Giat Industries   SPIROMATIC 90 Giat Industries   Recirculation Filter Blower ILC Dover, Inc.   CAPS (Civilian Adult Protective System) Israel Ministry of Defense Export Organization (SIBAT)   CHIPS (Chemical Infant Protective System) Israel Ministry of Defense Export Organization (SIBAT)   Children Hood Blower System Israel Ministry of Defense Export Organization (SIBAT)   Advanced Crew Member Blower System Israel Ministry of Defense Export Organization (SIBAT)   Portable Blower Infant Protective Crib Israel Ministry of Defense Export Organization (SIBAT)   M17 series masks MSA Defense Products   Respirator canister Model 800375 MSA Safety Products (Table continued on next page)

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Page 223 (Table continued from previous page) Type Product Location/PI Breathing       ESP Mask Communication System MSA Safety Products   Escort (SCBA) Escape Self Contained Breathing Apparatus Racal   Respirator Canister Model 456-00-07R 06 Racal   Disposable respirators Racal   Respirator canister Model 110100 Survivair   M-40A1 series masks Tradeways (Md)   Method for filtering CB agents from airflow in confined space TSWG (R&D only)   First responders mask (FIRM) TSWG (R&D only) Clothing       Mark IV permeable NBC Suit ADI (UK)   Remploy Tyvek F-M(ilitary) ensemble ADI   JLIST (Joint Service Lightweight integrated NBC protective suit technology) CBDCOM (R&D only)   STEPO (Self-contained toxic environment protective outfit) Chemfab Corp (NH)   Biomimetic materials DARPA/Molecular Geodesics (R&D only)   Man-in-Simulant Test Program Dugway Proving Grounds (R&D only)   Low-cost protective suits Geomet Technologies   Field Marking Kits Giat Industries   TOM suit kit Giat Industries   Gastight suit for internal breathing apparatus Giat Industries (Table continued on next page)

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Page 224 (Table continued from previous page) Type Product Location/PI Clothing       UNISCAPH gastight suit for external BA Giat Industries   Cool Vest Personal Cooling Garment ILC Dover, Inc.   Chemturion: Reusable Level A Suit ILC Dover, Inc.   Ready 1 Limited Use Level A Suit ILC Dover, Inc.   Cooling Vests Kappler Protective Apparel and Fabrics   Responder CSM Garments Kappler Protective Apparel and Fabrics   Pressure test kits Kappler Protective Apparel and Fabrics   Chemical Protective Overgarment Marine Corps Systems Command (R&D only)   Functionally Tailored Fibers and Fabrics Natick RDEC (R&D only)   Firefighters Integrated protective Suit - Combat (FISC) Natick RDEC (R&D only)   Advanced Lightweight Chemical Protection Natick RDEC (R&D only)   Level B Suit Responder-Geomet   Level A Suit Responder-Geomet   SARATOGA-Pyjama Chemical Protective Undergarment Tex-Shield, Inc (NJ)   CW-66 Chemical Protective Flight Coverall U.S. Air Force   (BDO) Battledress overgarment Winfield International (NY) Clothing and Breathing       Domestic Preparedness Civilian PPE Testing Program CBDCOM (R&D only) (Table continued on next page)

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Page 225 (Table continued from previous page) Type Product Location/PI Clothing and Breathing       (CBPSS) Chemical Biological Protective Shelter System Engineered Air Systems (Mo)   Individual Protective Kit Giat Industries   Rescue and Lifting Kit Giat Industries   Ventilated casualty bag Giat Industries   Ventilated casualty hood Giat Industries   ILC Dover Transportable Collective Protection System ILC Dover   M20A1 SCPE (Simplified Collective Protection System) ILC Dover, Inc.   Improvements to existing C/B Bomb suit Tech Escort Unit (R&D only)   Expedient Hazard Reduction System TSWG (R&D only)   ILC Dover Transportable Collective Protection System ILC Dover   Protection assessment test system U.S. Army (R&D only)

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Page 226 Chemical Agent Detection 30-Sep-98 Availability Product Source or Laboratory/PI Commercial       ACAMS Automated Continuous Air Monitoring System ABB Process Analytics   Remote molecular air quality monitoring system (FTIR) AIL Diversified Products Group   Nerve agent vapor detector (NAVD) Anachemia Canada Inc.   Paper, Chemical Agent Liquid Detectors, 3-WAY Anachemia Canada Inc.   C2 chemical agent detector kit Anachemia Canada Inc.   CUB 800 Bear Instruments, Inc.   Infrared Detector for Gas Chromatograph Biorad, Digilab Division   Transform spectrometer Bomem Inc.   TYPE 1306 Toxic-Gas Monitor Bruel and Kjaer Instruments   TYPE 1302 multigas monitor Bruel and Kjaer Instruments   Rapid Alarm and Identification Device (AID-1) Bruel and Kjaer Instruments   Chemical Surety Chamber and Lab Calspan Corporation   Automatic Liquid Agent Detector (ALAD) System Calspan Corporation   Miniature Chemical Agent Monitor (MINICAM) CMS Research Corporation   Detector tubes Draeger   Continuous Chemical Agents Sensor (CHASE) Elbit-Ati Instruments   4100 vapor detector Electronic Sensor Technology (Table continued on next page)

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Page 227 (Table continued from previous page) Availability Product Source or Laboratory/PI Commercial       Improved Chemical Agent Monitor (ICAM-APD) Environmental Technologies   APD2000 Hand-held CW/radiation detector/monitor Environmental Technologies   Miniature Chemical Agent Detector (ICAD) Environmental Technologies   Chemical Agent Monitor (CAM) Environmental Technologies   Detalac Automatic Detector of Nerve gas agents Giat Industries   Environmental Vapor Monitor (EVM) Graseby Dynamics Ltd (UK)   Point Chemical Agent Detector (GID-3) Graseby Dynamics   HP 6890 Plus Gas Chromatograph Hewlett-Packard   HP 2350 Atomic Emission Detector Hewlett-Packard Co.   HP 5973 MSD Hewlett-Packard Co.   Improved Chemical Agent Monitor (ICAM) Intellitec (Florida)   M8A1 automatic chemical agent alarm (M43A1 and M42) Intellitec (Florida)   AN/KAS-1 Chemical Warfare Directional Detector (standoff) Intellitec (Florida)   M21 Remote sensing chemical agent alarm (RSCAAL) Intellitec (Florida)   Nerve Agent Immobilized-Enzyme Alarm and Detector (NAIAD) Jasmin Simtec Limited   SAW MiniCAD miniature chemical agent detector Microsensor Systems, Inc.   CW Sentry Microsensor Systems, Inc.,   RCAD II Monitor Microsensor Systems, Inc., (Table continued on next page)

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Page 228 (Table continued from previous page) Availability Product Source or Laboratory/PI Commercial       EKHO Mine Safety Appliances Co.   Field MINICAMS (FM-2000) OI Analytical, Inc   Phemtochem Ion Mobility Spectrometer, Model 110 PCP Inc.   API 365 Pe Sciex   Microchromatography PerSeptive Biosystems, Inc.   AP2C Family of Chemical Agent Detectors Proengin S.A. (France)   MINIRAE Plus Rae Systems   Direct-Reading Tubes Sensidyne   M90D1-A Chemical detector Sensor Application Inc (VA)   Scentograph Plus II with AID/RCD Detector Sentex Systems Inc.   Scentoscreen (Gas Chromatograph) with Argon Ionization Detector Sentex Systems Inc.   SCX-20 VOC Monitor Spectrex Corporation   Dual Flame Photometric Detector SRI Instruments Inc.   TestMate portable blood cholinesterase test system TestMate, Inc   Miran Sapphire The Foxboro Company   Chemical agent point detection system for ships (CPDS) Tradeways Ltd (MD)   M8 Chemical detection paper Tradeways Ltd (VA)   M9 Chemical detection paper Tradeways Ltd (VA)   M256A1 Chemical detection kit Truetech Inc (NY)   M272 Water testing kit Truetech Inc (NY)   M18A2 Chemical detection kit Truetech, Inc (NY) (Table continued on next page)

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Page 229 (Table continued from previous page) Availability Product Source or Laboratory/PI Commercial       SATURN Varian Chromatography Systems   Portable GC/MS systems: Spectra Trak and CADIS Viking Instruments Corporation   Mass-Spec-On-Chip (MSOC) Westinghouse Electronic System Field testing       FBI Fly-away Laboratory Unknown   Nonintrusive interrogation of closed containers Battelle Columbus   CB mass spectrometer (CBMS I) Bruker Instruments   Air Transportable Modular Analytical Laboratory (MODLAB) CBDCOM   XM22 Advanced Chemical Agent Detector/alarm (ACADA) ERDEC/Nowack   SOF Chemical Agent Detector w low false positives Graseby   GI-MINI Miniature Chemical Warfare Detector/Monitor Graseby Dynamics   Rugged, portable GC-MS for CW agents LLNL   Multipurpose integrated chemical agent alarm (MICAD) Lockheed Martin   Shipboard Automatic Liquid Agent Detector (SALAD) Naval Sea Systems Command   Improved Point Detection System (IPDS) Naval Sea Systems Command   SAWRHINO (nerve and vesicant agents) NRL/Veneskey   LabChip applications to ChE and immunoassays of selected CBW agents ORNL/Ramsey (Table continued on next page)

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Page 230 (Table continued from previous page) Availability Product Source or Laboratory/PI Field testing       Bruker Ims Point Chemical Detector (PCD) Bruker Saxonia Analytik (Germany)   Minitube Air Sampling System (MASS) Canadian Centre for Advanced Instrumentation   Chemical Agent Detection System II (CADS II) Scientific Instrumentation Limited (Canada)   Laser Remote Detector Research Institute 070 BRNO (Czech Republic)   MARK 1 Detector Kit Chemical Agent Residual Vapor (RVD) Richmond Packaging (UK) Limited U.S. Government       Contract Labs EPA Envir Response Team Center (NJ) (Lafornara)   TAGA 6000E MS/MS-triple quadrapole EPA Envir Response Team Center (NJ) (Lafornara)   Mobile lab EPA Envir Response Team Center (NJ) (Lafornara) Laboratory Research       Canine detection of low level CW Auburn: Lackland AFB   Wearable dosimeter indicating cumulative exposure CWC Treaty Lab   Miniature GC-IMS DARPA (Technispan) G. Spangler   Joint service lightweight standoff chemical agent detector (JSLSCAD) JPOBD   Joint Service Chemical Agent Detector (JCAD) JPOCD   Joint Service Chemical Warning and Identification LIDAR JPOCD   Miniaturized liquid chromatography M.D. Porter, Iowa State University (Table continued on next page)

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Page 231 (Table continued from previous page) Availability Product Source or Laboratory/PI Laboratory Research       Micro-mass spectrometer for containment gas monitoring M.P. Sinha, Imaging and Spectrometry Systems Technology   Neuron Chip NRL/F. Ligler   Micro unmanned chemical and biological sensor vehicle NRL/R. Foch   CB mass spectrometer Block 2 (CBMS II) Oak Ridge National Laboratory   Advanced Ion-trap mass spectrometry ORNL/S. McLuckey   Capillary electrophoretic methods for monitoring spacecraft water NASA/R.L. Sauer   Enzyme-FET Sandia National Lab/Thomas   Parallel Micro Separations-based Detection (PMSD) SNL/Vitko   Noninvasive methemoglobin measurement USAMRMC Military       GS/MS detection of chlorovinylarsenous acid (from Lewisite) in urine USAMRMC   GS/MS detection of phosphonic acids (from GA, VX) in patient fluids USAMRMC

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Page 249 (Table continued on next page) Agent Treatment Source Availability Virus         Ribavirin (Virazole) ICN Pharmaceuticals Commercial   Developmental Proteins to Prevent Human Injury from Pathogens DARPA/en Vision (E. Barnea) Preclinical   Super Immune Cells DARPA/Harvard Med School (D. Scadden) Preclinical   Novel Bacteriophage Therapies for Vibrio Cholerae Infection DARPA/Harvard U. (J. Meklanos) Preclinical   Invasive (Intra-cellular) Antibodies DARPA/Scripps Research Inst. (P. Ghazal) Preclinical   Heat Shock Protein-Peptide Complexes as Anti-Viral Agents DARPA/U. of Connecticut (P. Srivastava) Preclinical   Structure-based Design of Acute Countermeasures to Viruses DARPA/U. of TX at Galveston (R. Shope) Preclinical   Prevention of Virus Assembly in Host Cells DARPA/U. of Wisconsin (S. Kornguth) Preclinical   Cytotoxic T Cell Responses to Virus Infection Scripps Research Inst./Whitton Preclinical   Glycyrrhizic acid derivatives USSR/Pokrovsky; USAMRIID/Huggins Preclinical   Monkeypox Virus Genome Sequencing USSR/Shchelkunov; USAMRIID/Jarling Preclinical WEE         WEE Vaccine Unknown IND

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Page 250 Prevention and Treatment of Psychological Effects 07-Oct-98 Source/Location Product Focus Availability American Psychiatric Assoc Disaster Psychiatry Web Site Multiple Open Literature (www)   Committee on Psychological Responses to Disaster Multiple Open Literature (www) American Psychological Assoc Disaster Response Network Multiple Open Literature (www) American Red Cross Disaster Mental Health Services Multiple (Training, short-term intervention) Department of Veterans Affairs On-line Publications, database Victims Open Literature (www)   National Center for PTSD Victims Open Literature (www) Disaster Mental Health Institute Training, consultation, interventions Multiple Fee-for-Service International Critical Incident Stress Foundation (Mitchell) Critical Incident Stress Debriefing training, network of providers Workers Fee-for-Service International Society for Traumatic Stress Studies Web Site, journal on stress and coping Victims Open Literature (www) National Research Council Studies on Risk Communication, 1989, 1996 Community Open Literature (www) Rutgers Center for Environmental Communication (Chess) Studies, advice to governments and industry on dealing with public concern Community Fee-for-Service Substance Abuse and Mental Health Services Admin (Flynn) FEMA Crisis Counseling Assistance and Training Program (CCP) Victims Federal Response Plan (Table continued on next page)

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Page 251 (Table continued from previous page) Source/Location Product Focus Availability U of Delaware Disaster Research Center (Nigg) Disaster Recovery as a Social Process and similar studies Multiple Open Literature (www) Uniformed Services Univ of Health Sciences (Norwood) Center for Stress Studies—Studies, advice on stress and coping in military Multiple Open Literature (www) Uniformed Services Univ of Health Sciences (Ursano) Psychiatry Dept.—Studies, advice on stress and coping in military situations Multiple Open Literature (www) Walter Reed Army Institute of Research (Belenky) Studies, advice on stress and coping in military situations Multiple Open Literature (www)

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Page 252 Computer Models 30-Sep-98 Availability Product/Model Agent Type Source Beta testing         BWD Incident Repository Bio DARPA/Oracle (S. Kennedy)   BWDAD (Biological Warfare Defense Anchor Desk) Bio DARPA/SAIC (R. Goodwin)   BITLAS (Biological integration team large area simulation model) Bio OptiMetrics, Inc.   Accelerated Consequences Management C/B DARPA (J. Silva)   GRIP (Global Response Incident Planner) C/B DARPA/BBN (M. Callaghan)   Field Inventory Survey Tool C/B DARPA/BBN (M. Callaghan)   Casualty Triage Tag C/B DARPA/Ellora Software (J. Bachant)   MMT and E (Military Medical Training and Evaluation) C/B DARPA/Michigan S.U. (J. Downs); U of TX (S. Hufnagel); SAIC   EMCR (Electronic Medical Care Record Repository) C/B DARPA/Oracle (S. Kennedy)   Essential Medical Data Set C/B DARPA/Oracle (S. Kennedy)   CODA (Chemical/biological Operational Decision Aid) C/B DARPA/Pacific - Sierra Research   COC (Command Operations Center of the Future) C/B DARPA/ScrenPro (J. Mantock)   AAHAWS (Automated atmospheric hazard assessment/warning system) C/B Mevatec Corp/ENSR Consulting (Table continued on next page)

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Page 253 (Table continued from previous page) Availability Product/Model Agent Type Souce Operational         HASCAL/SCIPUFF (Hazard Assessment System for Consequence Analysis) C/B Defense Special Weapons Agency   CATS/WMD (Consequences Assessment Tool Set) C/B Defense Special Weapons Agency   NBC Warn (Nuclear, biological, and chemical warning and reporting network software) C/B OptiMetrics, Inc.   ALOHA Chem EPA Planned         Pgm for Response Options and Technology Enhancements for Terrorism in Subways C/B Argonne National Lab (Policastro)   Urban Transport of CW/BW Aerosols C/B Lawrence Livermore (Ermak, Imbro); McArthur Found. (Stanford/Wilkening)   CBW Environment/Challege and Mobile Force Operability Modeling and Simulation C/B NSWC Dahlgren

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Page 254 Gap And Overlap Analysis A wide variety of sources were used in assembling the above inventory. The initial meeting of the committee in July of 1997 provided an overview of important organizations and R&D programs within the federal government. Follow-up with the briefers provided a more detailed list of projects and points of contact for technical information. The Office of Emergency Preparedness shared information on promising technology from its files, and of course the committee members themselves contributed both personal contacts and specific information from their own files and experience. The World Wide Web provided much information about both relevant commercial products and R&D activity, and the following databases were accessed and searched: National Technical Information Service, Defense Technical Information Center, Federal Research in Progress, Federal Conference Papers, Medline, MedStar, HSRProj. Although we are still actively seeking additional information on many of the technologies already located, information on the products in the above inventory was distilled from a ProCite database of more than 430 records and entered into a series of databases, a description of which constitutes this gap and overlap analysis. In the process, we eliminated most products or R&D that did not explicitly address military chemical or biological agents or appear to be sufficiently generic in nature to encompass those agents without a major change. Exceptions were made only in categories in which there were very few or no products or R&D explicitly directed at chemical and biological weapons. We also excluded technology represented in our database by only a single experiment, journal article, or SBIR contract (i.e., we focus on products and R&D programs). The overall organization of the inventory roughly parallels that of the interim report: Separate sections address detection (in the environment, and in patient fluids), detection of a covert attack in a population (Epidemiology), protection, decontamination, treatment, psychological effects, and computer software. The inventory has no sections on pre-incident intelligence or safe and effective patient extraction, because we uncovered no relevant products or research (we recognize that there is a great deal of intelligence activity devoted to prevention of terrorism, but our task is to address consequence management—our inclusion of a pre-incident intelligence section in the interim report was solely to make the point that whatever the readiness of the civilian medical community, any pre-incident warning will amplify effectiveness manyfold). An additional difference from the interim report organization is a section on computer models. The inventory includes a source for the products or the laboratory and PI performing the research, and a judgment about the product's state of development (availability).

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Page 255 Detection With 173 entries in the detector database, it became more manageable to divide the database into those detection devices intended for biological agents and those intended for chemical agents (there are 7 devices intended for both biological and chemical agents and these were included in each separate database). Biodetectors Most of the funding for biodetection devices comes from the Department of Defense (56%), with 18% from commercial ventures. DoE, FDA, NASA, and TSWG account for the remaining 26%. With only 6 (out of 73) devices commercially available, 92% are in either the field testing stage (40%) or still in the laboratory (52%). Where they are used. There are only 17 devices in the database that are explicitly intended for diagnostic purposes, that is, detecting biological agent in fluid or tissue samples from a patient. Most (85%) current devices are designed to detect biohazards in the environment (liquid, air, surface, or other). Seven devices in the inventory are designed to detect agent in either patients or the environment, and numerous others aimed at environmental monitoring or detection could be adapted to patient diagnostics, but not without considerable additional research. What is needed. The most prevalent medium needed is liquid (44%), although 18 devices are designed to detect agent in the air. Twelve devices utilize either liquid or air samples. Twenty-eight items (40%) provide numeric estimates of agent concentration. A third (33%) of the biodetection devices do not provide a quantitative estimate of the pathogen detected, and another 27% of the devices provide no information whatsoever about quantification. Speed and portability. According to the inventory, device portability is evenly distributed among hand-held, carriable by man, truck-loaded, or fixed. However, much of the newest research focuses on miniaturization of detectors. Fifty-nine percent of the devices in the inventory will provide results in a matter of minutes. Eight devices (11%) can or will detect agent in a matter of seconds. How they work. There are basically two types of technology needed in a biodetection device: (1) detection technology and (2) reporting technology. Detection technology refers to the mechanism by which the device differentiates the target from other organisms or molecules. Reporting technology

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Page 256 refers to the transduction mechanism that makes the detection event apparent to a human observer. Thirty percent of the devices in the inventory depend upon nucleic acid hybridization for detection, while 23% use antibody / antigen binding. The remaining devices use chemical reactions, the composition of agent (size, charge, mass), ligand / receptor binding, or more than one of these technologies. Forty-one percent of the reporting technology is optical, with other devices using technologies based on charge, color, mass, electrochemical reaction, or some combination. Chemical Detectors There are 100 entries in the chemical detector inventory. Twenty-eight percent of the entries are funded by the Department of Defense and 56% by commercial companies. Other funders include DoE, EPA, NASA, and TSWG. Chemical detection devices are much more developed than their biological counterparts; 60% of the items in the inventory are commercially available, with only 13% still in the field testing stage and 16% in the laboratory. It is also worth noting that there are three commercial devices that are designed specifically for a civilian market. Where they are used. The overwhelming majority (96%) of the chemical agent detectors are intended to detect agent in the environment, with only 4% designed to detect agent in patients. What is needed. Forty-two percent of the devices provide a numerical estimate of agent concentration, but 47% only indicate the presence or absence of agent. There are four items in the inventory that will indicate a ''High" or "Low" concentration of agent. Speed and portability. Ninety-two percent of the chemical detection devices in the inventory are able to provide information about agents within minutes or seconds (43% and 49%, respectively). Fifty-one percent are hand-held devices, 10% can be moved by one man, 12% can be moved by truck to the site of a suspected attack, and 23% are fixed in one location (e.g., a ship or a laboratory). How they work. The detector technology used by 24% of these devices depends upon a chemical reaction. Other technologies used in the detection process are: agent composition (mass, charge, or size) absorption, ligand/receptor binding, mass (mass spectrometry, piezoelectric, surface acoustic wave, or multiple technologies). For the reporting phase of the sources, technologies include: charge (1%), color (12%), electrochemical

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Page 257 (8%), atomic emission spectrum (1%), photo-acoustic (2%), surface acoustic wave (7%), or some combination or hybrid (8%) of these technologies. Recognition of Signs and Symptoms in Patients (Diagnosis) There are six products in this database. Three (the NBC indicator symptom matrix, Associates diagnostic software, and the Global Infectious Disease and Epidemiology Index [GIDEON]) are fully operational. The three Micromedex products (Poisindex, Drugdex, and Emergindex) are databases in use in poison centers and hospitals. Poisindex and Drugdex provide information on poisonous chemicals and drugs, while Emergindex is used for emergencies of unknown etiology. Only Emergindex is currently structured to provide diagnostic and treatment information based on signs and symptoms, but Micromedex is attempting to reengineer the other two databases to make this possible. At present, they require chemical or drug names as input. The NBC indicator symptom matrix assumes that one of the traditional military chemical weapons is involved, and simply facilitates differential diagnosis among them. The other databases are larger in scope, but include some or all of the chemical or biological weapon agents. Epidemiological Tools The products in this database are potentially relevant in identifying outbreaks of disease in populations (as opposed to individual patients). There are 15 entries, 12 of which are operational at this time, the Emerging Infectious Disease Initiative of the CDC, which is a long-term project just getting under way, and the Global Public Health Intelligence of Health Canada, and the DoD's Global Emerging Infections Surveillance and Response System (DoD-GEIS) are two recently announced initiatives to be started in the near future. Personal Protective Equipment There are 63 entries in the personal protective equipment database. Of these, the vast majority (86%) of these products are designed to protect against both chemical and biological agents (8 are for chemicals only and one is for biological agents only). Many of the products are commercially available (44%), but 3 items are unique to the military. Also represented is equipment from 18 other countries. The U.S. Department of Defense (17 entries) and the multi-agency Technical Support Working Group (6 entries) sponsor laboratory research or field testing in this area. The type of equipment is evenly divided between protective clothing and breathing apparatus (both at 41%), with 11 entries that offer both types of protection.

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Page 258 Decontamination Seventy-eight percent of the 33 products in this database involve strictly chemical decontamination. The remaining products are designed to decontaminate either biological agents alone (13%), or both biological and chemical agents together (9%). Only 10 (31%) are commercially available. Three of these 10 items are focused on decontamination of people, 4 on equipment or materiel decon, and 3 might be used for decon of either people or inanimate objects. Twenty-two entries (69%) are currently in research and development, which is largely funded by government agencies. The Department of Defense funds 50%, the Department of Energy 32%, and the multiagency Technical Services Working Group 9% of the decontamination products listed as in research or field testing. Only 4 of the 22 R&D items in the inventory are focused on biological agent decontamination; 2 items pertain to both chemical and biological agents; and 13 focus on chemical agents. Thirty-six percent of the products being researched are potentially applicable to human decontamination; the remainder focus solely on decon of inanimate objects. Treatment Of the 128 treatment products in the inventory, 88 (69%) are intended for biological agents, leaving 40 (32%) for the treatment of chemical agents. Funding for treatment research is provided largely by DoD (43%) and commercial institutions (34%). NIH accounts for 18% of the funding, leaving only 5% of the funding from the Public Health Service. Biological Agents The biological agents for which at least one treatment is being tested or is already available are: anthrax, brucella, C. botulinum, dengue, Ebola, EEE, Lassa, plague, Q-fever, ricin, SEB, smallpox, T-2 mycotoxin, tularemia, VEE, and WEE. Other entries involve broader treatments of more than one bacteria, virus, or toxin. Treatments for viruses, C. botulinum, and T-2 mycotoxin account for 35% of the treatment entries in the inventory (13%, 12%, and 10%, respectively) Despite the abundant research on treatments of biological agents, most (65%) are in the preclinical stage of development. There are 13 (15%) INDs and 16 (19%) commercially available treatment products. There are 5 INDs for C. botulinum treatments, 1 for EEE, 1 for Q-fever, 1 for ricin, and 1 for smallpox. With the exception of tularemia, which has only one commercially available product and none in development, all of the agents listed above have at least one preclinical product under investigation. As

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Page 259 might be expected, given the research status of most of the entries, there is no evidence or only partial evidence of efficacy in 53% of the treatment products. There is evidence of efficacy in animals in 21% of the entries, but only 3 (4%) entries with proven efficacy in humans. Chemical Agents The chemical agents considered for this inventory are: cyanide, nerve agents, phosgene, and vesicants. Out of the 40 treatment products in the inventory, 43% are for nerve agents, 30% for cyanide, 15% for vesicants, and 12% for phosgene. There is currently only one IND and it is for a cyanide treatment. As in biological treatments, most (53%) treatment products for chemical agents are in the preclinical stage of development; however, 35% of the chemical agent treatments are commercially available in the United States. There is animal evidence of efficacy in 68% of the entries, and 8 (20%) proven treatments in humans. The remaining products have no evidence or only partial evidence of efficacy. Psychological Effects This is a unique section of the inventory because the committee was unable to identify any "products" specifically connected with chemical or biological terrorism. The inventory thus focuses on information and resources regarding the psychological effects and treatment of trauma and disasters in general. There are 16 entries ranging from Web sites, to current studies, to publications. One entry focuses solely on rescue and health care workers; 4 solely on trauma victims themselves; and 2 focus on community-wide effects. The remaining seven include more than one of the above in their scope—usually victims and workers. Unfortunately, there is a dearth of information and resources about specific populations of victims such as the elderly, children, the disabled, and other special groups outside of the average adult male and female. Computer Models The 20 items in this database fall in two main categories: (1) information about agent transport, and (2) information about incident management. There are 10 models in each category. Most (13) are in beta testing, 4 are available for use at this time or are being used for purposes other than assisting authorities plan for responding to chemical or biological terrorism, and three are in the planning stage. The Department of Defense is funding 15 products, DoE 3, EPA 1, and 1 is funded by a commercial organization.

Representative terms from entire chapter:

chemical agent