Abstract
Catastrophic chemical or radiological events can cause thousands of casualties. Such disasters require triage procedures to identify the development of health consequences requiring medical intervention. Our objective is to analyze recent advancements in biotechnology for triage in mass emergency situations. In addition to identifying persons “at risk” of developing health problems, these technologies can aid in securing the unaffected or “worried well”. We also highlight the need for public/private partnerships to engage in some of the underpinning sciences, such as patho-physiological mechanisms of chemical and radiological hazards, and for the necessary investment in the development of rapid assessment tools through identification of biochemical, molecular, and genetic biomarkers to predict health effects. For chemical agents, biomarkers of neurotoxicity, lung damage, and clinical and epidemiological databases are needed to assess acute and chronic effects of exposures. For radiological exposures, development of rapid, sensitive biomarkers using advanced biotechnologies are needed to sort exposed persons at risk of life-threatening effects from persons with long-term risk or no risk. The final implementation of rapid and portable diagnostics tools suitable for emergency care providers to guide triage and medical countermeasures use will need public support, since commercial incentives are lacking.
Highlights
Such disasters require triage procedures to identify the development of health consequences requiring medical intervention
The endpoint of biological monitoring is often referred to as a biomarker, defined as “a change induced by a contaminant in the biochemical or cellular components of a process, structure or function that can be measured in a biological system” [15]
In the face of this burgeoning information and data being gathered by the National Institutes of Health and in other databases, the challenge for researchers interested in environmentally mediated disease or risk assessment is to understand the functionality of genetic polymorphisms and to relate this to disease
Summary
Threat scenarios involving chemicals include the deliberate release of illegally obtained or manufactured chemical warfare agents, the release of purchased or stolen industrial chemicals, and attacks on chemical manufacturing plants, storage sites, or transport vehicles. Several industrial accidents causing many casualties highlight the potential impact of a terrorist attack on chemical storage sites or transport vehicles. Terrorists could use any of the traditional chemical warfare agents, ranging from nerve gas and cyanide to pulmonary and vesicating (blister-causing) agents. Whether we like it or not, we must accept the existence of and the risk of chemical warfare agents (CWA) use against the society. The scenarios involve CWA, toxic industrial chemicals (TICs) and radioactive materials and became the standard reference cases against which diagnostic needs were discussed. The MASH project developed a number of well defined scenarios [4] involving radioactive materials which became the standard reference cases against which diagnostic needs were discussed
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