Chemical Terrorism

By James A. Geiling, MD, FCCP

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Summary

As with many activities in medicine, conducting casualty management through the use of a checklist ensures that all aspects are thoroughly addressed. The 10 steps in the management of casualties of chemical terrorism are as follows:

1. Maintain an index of suspicion.
2. Protect yourself.
3. Assess the patient.
4. Decontaminate as appropriate.
5. Establish a diagnosis.
6. Render prompt treatment.
7. Practice good HAZMAT protection.
8. Alert the proper authorities.
9. Assist in the epidemiologic/criminal investigation.
10. Maintain proficiency and educate health-care personnel about chemical agents.⁴

Many parts of the world have faced the threat and experienced the consequences of chemical terrorism. That menace has, unfortunately, now moved throughout the world. Education, planning, equipment purchases, and training must occur in order for hospitals and physicians in most institutions to prepare for such horrific events. Preparation has usually involved emergency department personnel, those with the greatest understanding of and interaction with the prehospital environment and disaster planning. Large chemical terrorist events or even commercial HAZMAT incidents, however, may result in 25% of admitted casualties requiring mechanical ventilation and critical care.¹⁴

Critical care physicians traditionally practice within the confines of the ICU. Moving outside the unit to assist with mass casualty incident triage, codes, or preoperative consultation, particularly in concert with the evolving hospitalist function, will necessarily involve intensivists in supporting a hospital's response to a terrorist event. This expansion in roles and responsibilities requires that an understanding of disaster management, including the consequent management of chemical, biological, radiologic, nuclear, and explosive events, be part of the critical care physician's education and training.¹⁵ The Centers for Disease Control and Prevention have embarked on an ambitious program to develop a public health distance-learning system in order to assist in such an educational process.¹⁶ These and other efforts, as well as integration of such education into physician-training programs,¹⁷ will yield a cadre of physicians well prepared to face the medical challenges posed by modern terrorist threats.

Additional sources of information are listed after the references.

ACKNOWLEDGMENTS: The author would like to thank COL Tom Fitzpatrick, Chief of Critical Care Medicine, Walter Reed Army Medical Center and the Chemical Casualty Care Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground for their support and assistance in this endeavor.

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