Medical Aspects of Chemical and Biological Warfare

INTRODUCTION

“Gas! Gas!” This warning cry, so common in World War I, almost became real to U.S. forces again as they prepared to liberate Kuwait in late 1990. The threat of chemical, and even biological, warfare was foremost in the minds of U.S. military personnel during Operation Desert Shield, the preparation for

the Persian Gulf War. Iraq was known to have a large stockpile of chemical weapons and had demonstrated during its conflict with Iran that it would use them. It was not until after the Persian Gulf War that the U.N. Special Commission on Iraq confirmed that Saddam Hussein also had biological agents loaded in weapons. The chemical and biological

threats were major concerns to those in the military medical departments who would be called on to care for poisoned or infected casualties, possibly in a chemically contaminated environment. Fortunately the ground war of the Persian Gulf War (Operation Desert Storm) was brief, and even more

fortunately, our adversary did not employ these

weapons.

In the desert, during the fall and winter of 1990–1991, the threat of chemical warfare became very real to our military medical personnel. The threat of biological warfare was no less feared. The military medical departments realized that

medical personnel were not prepared to provide care to chemical or biological casualties or to function in a contaminated environment. This textbook should help accelerate the assimilation of medical defense information in the next war; in the past, such information has not been readily accessible. Two handbooks have also been prepared:

Medical Management of Chemical Casualties Handbook, Chemical Casualty Care Office, Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (September 1994); and Medical Management of Biological Casualties Handbook, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland

(March 1996).

Rapid and intense teaching programs helped prepare our medical healthcare providers, so that by the onset of Operation Desert Storm, they were as ready as any military medical personnel might be to go to war. Hundreds of thousands of troops were supplied with chemical pretreatment and therapeutic agents and thousands were immunized against anthrax and the botulinum toxins, the two most likely biological battlefield threats.

Two lessons were learned from this conflict, lessons that should never be forgotten by those in the military. The first was that there are countries that have chemical and biological weapons, and there are other countries that might obtain or produce them. The second was that the U.S.

military medical departments must be prepared at all times to treat both types of casualties. As long as potential adversaries exist, the U.S. military might face a chemical or biological battlefield.

Military medical personnel of the United States have not treated a chemical casualty on the battlefield for nearly 8 decades, and they have never treated a biological casualty. Chemical agents have not been used as weapons in a major war or in any military conflict in which the United States has

been involved since World War I. Despite the recent dissolution of the Warsaw Pact, the breakup of the Soviet Union, and other events that have seemingly reduced the conventional military threat to the United States, a textbook for military medical personnel on the management of chemical and biological agent casualties is still urgently needed.

The breakup of the Soviet Union, and the consequent glut of biowarfare experts on the world employment market, may have actually increased the threat of biological proliferation. In addition to the recent experience in the Persian Gulf, a review of other events of the past 2 decades bears out this conclusion.

Contents

Medical Aftermath of the Persian Gulf War
1.Overview:Defense Against the Effects of Chemical and Biological Warfare Agents
2.History of Chemical and Biological Warfare:An American Perspective
3.Historical Aspects of Medical Defense Against Chemical Warfare
4.The Chemical Warfare Threat and the Military Healthcare Provider
5.Nerve Agents
6.Pretreatment for Nerve Agent Exposure
7.Vesicants
8.Long-Term Health Effects of Nerve Agents and Mustard
9.Toxic Inhalational Injury
10.Cyanide Poisoning
11.Incapacitating Agents
12.Riot Control Agents
13.Field Management of Chemical Casualties
14.Triage of Chemical Casualties
15.Decontamination
16.Chemical Defense Equipment
17.Healthcare and the Chemical Surety Mission
18.Historical Overview of Biological Warfare
19.The U.S. Biological Warfare and Biological Defense Programs
20. Not Available
21.The Biological Warfare Threat
22.Anthrax
23.Plague
24.Tularemia
25.Brucellosis
26.Q Fever
27.Smallpox
28.Viral Encephalitides
29.Viral Hemorrhagic Fevers
30.Defense Against Toxin Weapons
31.Staphylococcal Enterotoxin B and Related Pyrogenic Toxins
32.Ricin Toxin
33.Botulinum Toxins
34.Trichothecene Mycotoxins
35.Medical Challenges in Chemical and Biological Defense for the 21st Century
Acronyms and Abbreviations
Index

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