Chemical Weapons Attack Research Articles

Mission Failure: Emergency Medical Services Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events

Only 4% of the United States Homeland Security funding for public safety terrorism preparedness is allotted to emergency medical services (EMS), despite the primary threat from a mass-terrorism chemical weapons attack (MTCWA) being personal injury. This study examines the preparedness of the EMS to respond to, treat, and transport victims of such attacks. It was hypothesized that US EMS agencies lack the necessary equipment to mitigate large-scale morbidity and mortality from a MTCWA. Seventy after-action reports from full-scale, chemical weapons exercises conducted in large cities across the US were examined by the Office of Domestic Preparedness, Chemical Weapons Improved Response Program to ascertain if EMS responders had personal protective equipment sufficient to operate at the scene of a MTCWA. Of the 50 after action reports that mentioned EMS personal protective equipment, only six (12%) EMS agencies equipped their staff with personal protective equipment. Results indicate that EMS responders are not prepared to safely respond to MTCWAs, which may result in a significant loss of life of victims and responders.

The Whole Range of Saddam Hussein's War Crimes

Middle east RepoRt 239 ■ SUMMER 2006 On October 19, 2005, in a former presidential palace that had been hastily refurbished to resemble a respectable courtroom, Saddam Hussein went on trial. The case brought against Hussein and his seven co-defendants was based on events in the town of al-Dujayl in 1982, where Hussein’s regime countered an assassination attempt on its leader with the execution of 148 people. But these will not be the last charges filed against top figures in the old regime. The Supreme Iraqi Criminal Tribunal has jurisdiction to try crimes of genocide, crimes against humanity and war crimes committed during the period of Ba‘thist rule between 1968 and 2003, which include the chemical attack on the Kurdish village of Halabja in 1988, the invasion of Kuwait in 1990 and the repression of the Shi‘i uprising in southern Iraq in 1991. It is still unclear how many of the crimes of which the old regime is accused will actually be prosecuted. On April 4, 2006, however, the prosecution team announced that charges related to the Anfal genocide against the Kurds in 1987–1988, a campaign that included the Halabja attack, will be brought after the al-Dujayl verdict, which is expected in August. The progress of the trial so far has left a pertinent question unanswered. Why is Hussein not standing trial for biological and chemical weapons attacks on Iranian soldiers and civilians during the 1980–1988 Iran-Iraq war? That these gross violations of international norms will probably not be taken up by the tribunal reveals the international and domestic politics involved in the trial. To be more precise: Saddam Hussein’s war crimes can only be fully addressed if the court uncovers the collusion of Western firms and governments with Hussein’s illicit weapons programs during the 1980s. Let us hope, given that intrusive political context, that at the end of the trial we are not shocked by what we partly suspect: that an opportunity for regional reconciliation in the wider Persian Gulf area has been lost, that the trial has reproduced Iraq as a place of imperial competition, and that history has denied the Iraqi people the opportunity to engage the past to lend speech to those voices which would constitute the new, post-Ba‘thist civil society. Let us hope, in short, that the trial does not create yet another discontinuity in the history of the country.

There is no cold zone: The hazardous materials zone model and mass terrorism chemical weapon events

This study examined 70 after action reports (AARs) from full-scale chemical weapons exercises held in large cities across the United States by the Office of Domestic Preparedness’ Chemical Weapons Improved Response Program (CWIRP). These exercises were held to determine that, if “hot, warm, and cold” zones were established, did victims stay in the hot zone until they could be decontaminated, and did responders observe the hot-warm-cold zone demarcations? Only 35 percent of reports indicated that responders utilized the zone concept, less than 20 percent of reports indicated that victims were compliant with the zone model, and less than 15 percent of reports indicated that responders properly observed the zones that were created. Results indicate that use of the zone model for a mass terrorism chemical weapons attack (MTCWA) is not well utilized, and that responders operating in the cold zone need personal protective equipment.

Unmasking Procedures following a Chemical Attack: A Critical Review with Recommendations

U.S. Marine Corp and Army doctrine specifies a process for troops to remove the field protective mask in the aftermath of a chemical weapon attack. At the company/battery level, this procedure culminates in exposure of the respiratory system of selected troops to potential gas vapor. Commanders in the field rely on front-line corpsman and medics to provide lifesaving first aid in the event that toxic exposures take place. After this initial stabilization, casualties would be evacuated to an Echelon I medical facility, typically a Battalion Aid Station. The current tactical unmasking procedure, as specified in doctrine, is critically analyzed from a field medical perspective. Easy to implement recommendations are made, both to prevent lethal exposures and to better treat toxicity should prevention fail.

Assessment of Psychosocial Impacts of a Chemical Weapons Attack on Civilian Population of Sardasht, Iran

Assessment of Psychosocial Impacts of a Chemical Weapons Attack on Civilian Population of Sardasht, Iran

Nuclear North Korea: A Debate on Engagement Strategies (review)

Reviewed by: Nuclear North Korea: A Debate on Engagement Strategies Leon V. Sigal (bio) Nuclear North Korea: A Debate on Engagement Strategies. By Victor D. Cha and David C. Kang. New York: Columbia University Press, 2005. 280 pages. $18.95 paper. In Nuclear North Korea: A Debate on Engagement Strategies, Victor Cha and David Kang make a commendable effort to get beyond the bumper-sticker sloganeering that passes for public discourse in the United States to conduct a civilized debate on what to do about North Korea. For the most part, the book lives up to their aspirations "to produce scholarship on Korea that is empirically rich, analytical rigorous, and policy-relevant." Starting from very different interpretations of North Korean intentions, they end up calling for conditional U.S. engagement with North Korea. Kang, who teaches government at Dartmouth College, posits that North Korea has not come close to starting a war because it is weak and deterrence works. As it grows weaker, "the chances for war or unprovoked provocative acts becomes even slimmer." Having a few crude nuclear devices will not change that. Analysts who view North Korea as a threat, he says, smuggle in unwarranted assumptions about the irrationality of North Korea's leadership. Instead, Kang contends, "North Korea is truly trying to reach a modus vivendi with the rest of the world." Its reforms are real: it "is opening up and many of the changes are becoming irreversible." He rests his case for engagement on accelerating this transformation: "We should encourage this trend, not hinder it." Yet, why should Americans care more about how North Korea runs its economy than about its nuclear weapons programs? Any rationale for engagement that does not confront this question is ultimately unpersuasive. Kang sidesteps the question by quoting Marcus Noland's assertion that "through a policy of engagement either Pyongyang will evolve toward a less threatening regime, or engagement will undermine the ideological basis of the Kim Jong-il regime and eventually cause its collapse." Skeptics might wonder whether the regime will go quietly into that good night—or might worry whether an arms race might break out in Northeast Asia in the meantime. North Korea has genuine security concerns, Kang argues. A policy of pressure [End Page 170] will only make it feel more insecure. "If we really have no intention of starting a war in northeast Asia, let's put it in writing, conclude a peace treaty, and finally end the cold war." He never says what's in it for us. Why shouldn't we insist that it eliminate its nuclear arms and missile programs in return? Cha, who taught at the Edmund Walsh School of Foreign Service at Georgetown University before joining the Bush administration's National Security Council staff, argues that even though deterrence is robust enough to prevent an all-out attack, "North Korea could perceive some use of limited force as a rational or optimal choice even when there is little or no hope of victory." Desperate to avoid collapse or dominance by the South, the North could lash out and launch a preemptive or preventive war. Short of war, it can and does use coercive bargaining—"deliberate, limited acts of violence to create small crises and then negotiates down from the heightened state of tension to a bargaining outcome more to [its] liking than the status quo." In the worst case, Cha says, the North could use "long-range artillery barrages, missiles strikes, or chemical weapons attacks" avoiding American targets "to hold Seoul hostage with the hope of negotiating a new status quo." Many of the examples Cha cites as evidence of this behavior seem ill-chosen. The 1994 shooting down of a U.S. reconnaissance helicopter that strayed into North Korean air space was hardly a case of a deliberate North Korean manipulation of violence. The June 1999 deadly naval clash was not the result of a deliberate provocation by the North to "extort concessions from a fearful ROK" but came about as the result of an interaction: after South Korean ships rammed the intruders, the North fired in response. So did more recent naval firefights with South Korea and Japan. Cha...

The protection of critically ill patients in a military chemical warfare environment

We describe two instances where patients were being cared for in a critical care area of a military field hospital during the recent conflict in Iraq. Both were critical care patients when chemical weapon attack alarms sounded and we describe the measures taken to protect them from this threat. Both made uneventful recoveries but one case highlights the need to develop a method of giving oxygen enriched air to the spontaneously ventilating patient. We describe an improvised method of delivering oxygen through a standard UK military respirator using equipment that is readily available in a field hospital, and suggest that a more permanent solution is required.

Operation Castle Cascade: Managing Multiple Casualties from a Simulated Chemical Weapons Attack

In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article.

Rescue of Hematopoietic Stem Cells Following High-Dose Radiation Injury Using Ex Vivo Culture on Endothelial Monolayers

Military personnel are at significant risk for potentially lethal myeloablative injury secondary to nuclear accident, nuclear attack, or chemical weapons attack. In an attempt to develop culture conditions in which hematopoietic stem cells might be rescued from the effects of radiation, we irradiated (1,000 cGy split dose) 6-week-old C57BL/6 (Ly 5.1) and syngeneic C57BL/6 (Ly 5.2) mice and tested whether bone marrow mononuclear cells (MNCs) harvested postirradiation could be rescued via coculture in porcine microvascular endothelial cell (PMVEC) monolayers. We found that a subpopulation of bone marrow MNCs exposed to 1,000 cGy could be maintained and expanded over 10 days in a PMVEC culture (3.8-fold expansion), whereas liquid suspension culture did not maintain a significant number of hematopoietic cells postirradiation. Colony-forming assays demonstrated that murine MNCs exposed to 1,000 cGy did not give rise to granulocyte/macrophage colony-forming units (CFU-GM), erythroid burst-forming units (BFU-e), or CFU-Mix in 14-day cultures, whereas irradiated MNCs that were subsequently cultured in PMVEC-generated CFU-GM, BFU-e, and CFU-Mix at cloning efficiencies of 1.3%, 0.2%, and 0.2%, respectively. In survival studies, we found that 78% of mice that were irradiated and then transplanted with irradiated/PMVEC-expanded MNCs were alive at day 50, compared with 18% of irradiated control mice (p < 0.05). We also observed that mice transplanted with irradiated/PMVEC-expanded MNCs showed complete hematologic recovery. At 8 weeks post-transplant, we found evidence of Ly 5.1 donor cells in both the bone marrow and the spleen of the transplanted animals, but the levels of engraftment were low (range, 0-5.1%; mean, 1.9%). These results demonstrate that a subpopulation of bone marrow stem cells are capable of surviving the effects of high-dose radiation if these cells are placed in coculture with endothelial cell monolayers.

The Commitment Trap: Why the United States Should Not Use Nuclear Threats to Deter Biological and Chemical Weapons Attacks

The Commitment Trap: Why the United States Should Not Use Nuclear Threats to Deter Biological and Chemical Weapons Attacks

Reclassifying chemical relics of the Cold War

Among the detritus of the Cold War are tens of thousands of chemical agent identification sets (CAIS) that the Army used from 1928 to 1969 to train soldiers to defend themselves against chemical weapons attacks. These kits now need to be destroyed. How to do so—a problem complicated by technical, legal, environmental, and societal issues—is the gist of a recent National Research Council study called for by Congress. Most of the approximately 10,000 kits—more are expected to surface as Army bases close—contain glass vials of small quantities of the blister agents sulfur mustard (ClCH 2 CH 2 SCH 2 CH 2 Cl) and lewisite (Cl 2 AsCHCHCl). The Army has classified the kits as chemical warfare materiel, which precludes their disposal at commercial hazardous waste facilities. Because they are considered nonstockpile materiel, the Army, by law, is not allowed to incinerate them at the eight U.S. installations slated to destroy the nation's arsenal of chemical weapons. The Army's solution, which it documented in a r...

Bioterrorism: an emerging threat

Prior to the 1998 Vancouver Asian Pacific Economic Summit, emergency physicians were briefed on the possibility of terrorist-related biological or chemical weapons incidents. As part of a training exercise, the “victim” of a chemical weapon attack was brought to our ED. Because of confusion and ignorance, the “victim,” the physician, several members of the ED staff, and a number of other patients also became “casualties.”

Epidemiological association in US veterans between Gulf War illness and exposures to anticholinesterases

To investigate complaints of Gulf War veterans, epidemiologic, case-control and animal modeling studies were performed. Looking for OPIDP variants, our epidemiologic project studied 249 Naval Reserve construction battalion (CB24) men. Extensive surveys were drawn for symptoms and exposures. An existing test (PAI) was used for neuropsychologic. Using FACTOR, LOGISTIC and FREQ in 6.07 SAS, symptom clusters were sought with high eigenvalues from orthogonally rotated two-stage factor analysis. After factor loadings and Kaiser measure for sampling adequacy (0.82), three major and three minor symptom clusters were identified. Internally consistent by Cronbach's coefficient, these were labeled syndromes: (1) impaired cognition; (2) confusion-ataxia; (3) arthro-myo-neuropathy; (4) phobia-apraxia; (5) fever-adenopathy; and (6) weakness–incontinence. Syndrome variants identified 63 patients (63/249, 25%) with 91 syndromes. With pyridostigmine bromide as the drug in these drug-chemical exposures, syndrome chemicals were: (1) pesticide-containing flea and tick collars (P<0.001); (2) alarms from chemical weapons attacks (P<0.001), being in a sector later found to have nerve agent exposure (P<0.04); and (3) insect repellent (DEET) (P<0.001). From CB24, 23 cases, 10 deployed and 10 non-deployed controls were studied. Auditory evoked potentials showed dysfunction (P<0.02), nystagmic velocity on rotation testing, asymmetry on saccadic velocity (P<0.04), somatosensory evoked potentials both sides (right P<0.03, left P<0.005) and synstagmic velocity after caloric stimulation bilaterally (P-range, 0.02–0.04). Brain dysfunction was shown on the Halstead Impairment Index (P<0.01), General Neuropsychological Deficit Scale (P<0.03) and Trail Making part B (P<0.03). Butylcholinesterase phenotypes did not trend for inherent abnormalities. Parallel hen studies at Duke University established similar drug-chemical delayed neurotoxicity. These investigations lend credibility that sublethal exposures to drug-chemical combinations caused delayed-onset neurotoxic variants.

The legal status of U.S. negative security assurances to non‐nuclear weapon states

Has the United States committed itself not to use nuclear weapons against countries that forswear them? This article summarizes the gradual change in how this question has been answered from the 1960s, when the United States would not even say that it had no “intention” of using nuclear weapons against such countries, to 1995, when President Clinton made a formal but qualified declaration that it would not do so. It then describes why this declaration (a so-called “negative security assurance”) is binding—“legally binding” to some and “politically binding” to others— and discusses whether it precludes the use of nuclear weapons to counter a biological or chemical weapon attack.

Unconventional nuclear, biological, and chemical weapons delivery methods: Whither the “smuggled bomb”

This article examines the threat of rogue state nuclear, biological, or chemical (NBC) weapons attacks on the U.S. homeland using terroristic methods. The latter include flying a weapon into the United States, driving it across a border, or sailing it into a port. Rogue state motivations for launching terroristic attacks are examined, as are U.S. wartime and peacetime defense capabilities. This study finds that, in contrast to missile‐delivered NBC weapons, the military utility of terroristic attacks would be limited because the United States could marshal effective defenses. The article concludes with recommendations for improving U.S. defenses against terroristic NBC attacks.

Treatment of Chemical and Biological Warfare Injuries: Insights Derived from the 1984 Iraqi Attack on Majnoon Island

The potential use of chemical and biological weapons, while being banned by international treaties, has never been higher than now. The current Persian Gulf crisis, and the easy availability of these weapons by "terrorist nations," makes the danger all too real. The experience derived from the Iraqi attack on Majnoon Island demonstrates the devastating effects of these weapons when used during modern warfare. Exposure to the agents used during the 8 years of the Iran-Iraq War results in a triad of injuries: skin burns, ocular damage, and pulmonary distress. Specific antidotes are available for some agents used in warfare; however, the clinical presentation following exposure to the different toxins is extremely similar, making a bedside diagnosis of the specific agent involved almost impossible. The Majnoon Island experience has shown the value of prevention, when possible, and decontamination, of both casualties and equipment. The prompt implementation of general treatment strategies, as well as specific antidotes, are paramount for the successful management of patients after a chemical weapons attack.