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Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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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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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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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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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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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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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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

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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)

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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(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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(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

Suggested Citation:"Index." Institute of Medicine. 1999. Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, DC: The National Academies Press. doi: 10.17226/6364.
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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

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Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response Get This Book
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The threat of domestic terrorism today looms larger than ever. Bombings at the World Trade Center and Oklahoma City's Federal Building, as well as nerve gas attacks in Japan, have made it tragically obvious that American civilians must be ready for terrorist attacks. What do we need to know to help emergency and medical personnel prepare for these attacks? Chemical and Biological Terrorism identifies the R&D efforts needed to implement recommendations in key areas: pre-incident intelligence, detection and identification of chemical and biological agents, protective clothing and equipment, early recognition that a population has been covertly exposed to a pathogen, mass casualty decontamination and triage, use of vaccines and pharmaceuticals, and the psychological effects of terror. Specific objectives for computer software development are also identified. The book addresses the differences between a biological and chemical attack, the distinct challenges to the military and civilian medical communities, and other broader issues. This book will be of critical interest to anyone involved in civilian preparedness for terrorist attack: planners, administrators, responders, medical professionals, public health and emergency personnel, and technology designers and engineers.

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