|Published||Editor: Susan K. Boyer, RN
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Information For Patients: Frequently Asked Questions On Chemical Warfare Agents
Q. Which chemicals are most likely to be used to create a deliberate outbreak?
A. While any toxic chemical can theoretically be used as a chemical weapon, historical precedent suggests that two significant types are most likely to be chosen nerve agents and blister agents. Nerve agents are chemicals that are related to the organophosphorus group of pesticides, which interfere with the functioning of the nervous system. Blister agents (e.g. mustard gas) act on the eyes, lungs, and skin to cause burns and blisters. Other chemical compounds, such as those containing chlorine, arsenic or cyanide can also be of concern.
Q. How would governments find out that a deliberate outbreak had taken place?
A.Unlike biological agents, the effects of chemical weapons will usually be rapidly apparent.Nerve agents act within minutes. Blister agents may take longer, but their initial effects will be noticed quickly (within hours). It is likely that hospitals, poisons centres or emergency services will receive calls for assistance within a short period of time for groups of affected people exhibiting similar symptoms and signs.
Q. What kind of monitoring system is in place for infectious disease outbreaks or chemical attacks?
A. Detection and monitoring for the presence of chemical weapons is the task of specialised military units in most countries. There are commercially available detection kits for the commonly known chemical weapons, and civil authorities such as fire brigades, police, and emergency medical personnel can use these. An increase in the frequency of calls to emergency services, poison centres or hospital emergency departments from people simultaneously developing similar symptoms is likely to be the earliest indicator that a chemical attack has occurred. Monitoring for such calls should be implemented at local or regional level.
Q. How would a response be coordinated?
A. Member States of WHO may request support by contacting the country office, Regional Offices (ROs) and/or Headquarters (HQ). A list of experts for immediate contact is available in both HQ and the ROs in case of need. Member States of the Organization for the Prohibition of Chemical Weapons (OPCW) http://www.opcw.org/memsta/namelist.htm can request international assistance. The OPCW may mobilize a response system consisting of an Advanced Coordination and Assessment Team (ACAT), who can arrive within hours to assess requirements and mobilize international assistance measures. Assistance provided may include investigative actions, medical personnel and supplies, or specialized functions such as chemical weapons detection and decontamination units. Resources can be made available to non-Member States if a request directed to the UN Secretary General is approved. At country level, contact points include poisons centres, emergency response centres, public health departments, civil defence and military units. A worldwide list of poisons centres (YellowTox) is available at http://www.intox.org . Contact details for local poisons centres can usually be found in the telephone directory.
Q. What treatment is available?
A. Specific antidotal treatment for nerve agent poisoning is available, but it must be administered immediately by medical personnel who are experienced in its use. For the effects of most other chemical weapons (including the blister agents), symptomatic and/or supportive treatment are indicated.
Q. Where is information available about dealing with a deliberate chemical event?
A. The IPCS INTOX Programme promotes poison control and chemical safety, minimizing the adverse health effects resulting from toxic exposure http://www.intox.org . Information on the health effects of a large number of chemicals is available free of charge at http://www.inchem.org .
Q. Would mass vaccination be an option in the case of a chemical attack?
A. There are no vaccinations available to protect against the effects of chemical weapons. There are specific pre-treatment medications that can enhance post- exposure treatment of nerve agent poisoning.Such medications are usually only provided to military or emergency service personnel who are at special risk of nerve agent exposure.
Q. What should national governments be doing now?
A.Countries should have contingency plans to cope with any naturally occurring or deliberate outbreak of infectious disease or release of toxic chemicals.They should be aware of the international guidance published by WHO. The most important response to any outbreak is a public health response to ensure the safety and treatment of people who potentially could be exposed to a dangerous pathogen or chemical. This should include investigating stocks of drugs, vaccines, antidotes, protective equipment and decontamination materials to ensure that adequate supplies are available to deal with any natural or deliberate outbreak. It should also include the consideration of an effective method of distributing these stocks in case of need. Countries should also be developing multi-sectoral approaches to dealing with any outbreak of infectious disease or chemical exposure. This might include planners from ministries of health, defence, agriculture, environment and the interior. Coordination between the organizations/authorities that could be involved is required. Effective, robust, protected communication links need to be established and maintained. Roles need to be clearly defined and there needs to be a clear line of command, without at the same time hindering rapid action.
Q. What can be done globally?
A. National and international institutions must work together to strengthen the public health infrastructure, including specialist laboratories, epidemiologists, poisons centres and hazardous chemicals response units. Investment in the public health system is the best possible defence against outbreak of infectious disease or population health effects resulting from chemical releases, whether natural, accidental, or deliberate.