Toxico-terrorism: Emergency Response and Clinical Approach to Chemical, Biological, and Radiological Agents

Robin B. McFee, DO, MPH, FACPM, Assistant Professor, Department of Preventive Medicine SUNY/Stony Brook Assistant Professor, Department of Medicine NYCOM, New York Institute of Technology Toxicologist, Long Island Regional Poison Information Center Winthrop University Hospital Mineola, New York Medical Director, Threat Science Jerry B. Leikin, MD, FABMT, FACEP, FACMT, FAACT, FACOEM, Director of Medical Toxicology Evanston Northwestern Healthcare--OMEGA Glenbrook Hospital Glenview, Illinois Professor of Emergency Medicine Feinberg School of Medicine Northwestern University Professor of Medicine, Pharmacology, and Health Systems Management Rush Medical College Chicago, Illinois

Part I: General Patient Principles1. Toxidrome Recognition2. Biodromes--Bioweapon Recognition 3. Countermeasures and Facility Preparedness: An Overview 4. Supportive Care5. Dermal Issues6. Neurological Issues in Emergency Bioterrorism7. Cardiac Issues 8. Musculoskeletal Manifestations of Bioterrorism9. Ophthalmological Issues10. Respiratory and Critical Care Unit Issues11. Gastrointestinal and Hepatic Issues12. Acute Psychiatric Issues13. Palliative and Expectant (Black Tag) Care14. Special Populations: Pediatrics15. Geriatrics: Bioterrorism, Emerging Threats, and Emergency Preparedness: Special Considerations for Geriatric Patients16. Special Populations: Women Who are Pregnant17. Women's Reproductive Issues18. Hospital Laboratory Issues Part II: EMS Issues19. Chempack20. Approach to Disaster and Mass Casualty Incidents21. Hazardous Materials (Hazmat) Emergencies22. Enhancing Hospital Emergency Preparedness23. EMS-ED Considerations24. Field Identification and Decontamination of ToxinsPart III: Emergency Department Preparedness25. Triage in the Emergency Department 26. Pharmacy Preparedness for Incidents Involving Nuclear, Biological, or Chemical Weapons 27. Hospital Staff IssuesPart IV: Specific Chemical Agent: Toxins/Toxicants28. Nerve Agents29. Blister Agents30. Chemical Asphyxiants31. Flammable Industrial Liquids and Gases32. Corrosive Industrial Agents33. Arsenic, Lead, and Mercury34. Pulmonary Agents35. Pesticides36. Nonlethal Weapons or Incapacitating Agents37. Other Chemical AgentsPart V: Biologicals38. CDC Category Explanation (A,B,C) Overview39. Anthrax40. Yersinia Pestis--Plague41. Botulism42. Smallpox (Variola) and Poxviruses43. Tularemia44. Hemorrahagic Fever 45. CDC Category B Agents 46. CDC Category C Agents47. Emerging Pathogens48. Avian Influenza 49. SARS: Severe Acute Respiratory Syndrome50. AgroterrorismPart VI: Ionizing Radiation 51. A Practical Basis for Early Management of Radiologically Injured or Ill Patients: Ionizing Radiation Physics and Instrumentation, Radiation Protection, Contamination Control, Dosimetry, and Radiological/Nuclear (R/N) Terrorism52. Diagnosis and Medical Management of Radiation Injuries and IllnessesPart VII: Explosives/Incendiaries53. Medical Management of ExplosivesPart VIII: Public Health Considerations54. Poison Information Centers55. Biosurveillance56. VaccinesAppendicesA. CDC Chemical Emergencies: OverviewB. CDC Laboratory Preparedness for Emergencies: Response to Suspicious SubstancesC. CDC Laboratory Preparedness for Emergencies: Facts about the Laboratory Response NetworkD. CDC Laboratory Preparedness for Emergencies: Laboratory Network for Biological TerrorismE. CDC Specimen-Collection Protocol for a Chemical-Exposure EventF. Centers for Disease Control and Prevention Shipping Instructions for Specimens Collected from People Who May Have Been Exposed to Chemical-Terrorism Agents: Collecting SpecimensG. Continuation Guidance--Budget Year Four, Focus Area D: Laboratory Capacity--Chemical AgentsH. Instructions for Shipping Blood Samples to CDC after a Chemical-Exposure EventI. Instructions for Shipping Urine Samples to CDC after a Chemical-Exposure EventJ. Sentinel Laboratory Guidelines for Suspected Agents of Bioterrorism: Clinical Laboratory Bioterrorism Readiness PlanK. Riot Control AgentsChlorine Use as a WeaponIntentional Use of Radiation as a Weapon