Chemical Terrorism

By James A. Geiling, MD, FCCP

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Case Scenario

Discussion

The acute onset of this event with obvious casualties most likely signals a chemical agent or hazardous material (HAZMAT) release in the area of the food court. However, many clues (see Table 8) may signal a chemical weapon (or biological weapon for completeness).

Mass casualty incidents or those involving HAZMATs will require excess hospital capabilities and therefore involve the hospital's administration and leadership. When there are numerous casualties and mass care, particularly if they involve a suspected chemical or biological weapon, public health agencies must be involved in the interest of public welfare. While often unrecognized, an additional source of medical information may come from local veterinary agencies and personnel. Command and control of local disasters or terrorist events begins with the mayor and local resources, including law enforcement agencies; their employment at the hospital itself may become necessary for the safety of health-care workers and patients. Local officials normally remain in charge of the event, depending on the resources required. However, the nature of a suspected terrorist event often requires state or federal government assets. Organizations that may appear include the state Emergency Management Agency, the Federal Bureau of Investigation, the Federal Emergency Management Agency, and other agencies.

Poststudy questions 1 to 5 relate to the case scenario presented here.

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