Chemical terrorism and the ethics of decontamination

Journal of Clinical Ethics

Volumn 15, Issue 2, 2004, Pages 149-160

  Trotter, Griffin ^a  

^a SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CHEMICAL WARFARE; DISASTER; EMERGENCY HEALTH SERVICE; ETHICS; HOSPITAL; HUMAN; MEDICAL DECISION MAKING; PRIVACY; REVIEW; SKIN DECONTAMINATION; TERRORISM; WASTE MANAGEMENT;

HEALTH CARE AND PUBLIC HEALTH; WAR AND HUMAN RIGHTS ABUSES;

CHEMICAL WARFARE; CIVIL RIGHTS; DECISION MAKING, ORGANIZATIONAL; DECONTAMINATION; EMERGENCY SERVICE, HOSPITAL; ETHICS, CLINICAL; HUMANS; PRIVACY; RESCUE WORK; TERRORISM; TRIAGE;

EID: 7244242667     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (33)

1. Several months before the Tokyo attack, Aum Shinrikyo deployed sarin in an apartment complex in nearby Matsumoto, killing seven. Nevertheless, Tokyo hospitals remained unprepared. See W.A. Lake, P.D. Fedele, and S.M. Marshall (for the Mass Casualty Decontamination Research Team, MCDRT), "Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident," U.S. Army Soldier and Biological Chemical Command (SBCCOM), ECBC-TR-125, January 2000, in 21st Century Complete Guide to Bioterrorism, Biological and Chemical Weapons, Germs and Germ Warfare, Nuclear and Radiation Terrorism, CD-ROM (Aberdeen Proving Ground, Md.: SBCCOM, Edgewood Chemical Biological Center, 2000), 37-38.
2. S. Ohbu et al., "Sarin Poisoning on Tokyo Subway," Southern Medical Journal 90 (1997): 587-93; H. Nozaki et al., "Secondary Exposure of Medical Staff to Sarin Vapor in the Emergency Room," Intensive Care Medicine 21 (1995): 1032-35.
3. S. Ohbu et al., "Sarin Poisoning on Tokyo Subway," Southern Medical Journal 90 (1997): 587-93; H. Nozaki et al., "Secondary Exposure of Medical Staff to Sarin Vapor in the Emergency Room," Intensive Care Medicine 21 (1995): 1032-35.
4. D.C. Wetter, W.E. Daniell, and C.D. Treser, "Hospital Preparedness for Victims of Chemical or Biological Terrorism," American Journal of Public Health 91 (2001): 710-6.
5. When hazmat emergencies involve gases - as in the catastrophic methylisocyanate poisoning in Bhopal, India, in 1984 - conditions may mimic the worst chemical terrorism scenarios. In Bhopal, release of methylisocyanate occurred after water was introduced into a storage tank. There were 60,000 serious injuries and 2,500 to 5,000 deaths. Lake, Fedele, and Marshall, "Guidelines for Mass Casualty Decontamination," see note 1 above, p. 37.
6. Lake, Fedele, and Marshall note that, during the Iraqi Scud missile attacks on Tel Aviv, only two died but psychiatric casualties were high - constituting approximately 75 percent of the casualties. Healthcare providers also tend to get psychologically keyed up during such events - there were 230 atropine overdoses because of false suspicions of nerve agents on the Iraqi warheads. See note 1 above, p. 14.
7. J. J. Stanton, "Should Approach to Bioterrorism Change?" Security Management 45, no. 6 (2001): 138-40.
8. S.J. Freedberg, Jr., "Beyond the Blue Canaries," National Journal 33, no. 10 (2001): 700-705.
9. x, which is volatile and behaves more like the G agents (such as sarin - GB, and soman - GD).
10. These drugs can be administered or self-administered easily via auto-injectors (such as we find in the military Mark I kit) and they work synergistically. Atropine, which works the fastest, has a shorter duration of action than the other agents and may be required repeatedly in significant poisonings. One important nerve agent - soman - damages acetylcholine and doesn't respond to oximes other than HI-6, which is not routinely available in the U.S.
11. R.L. Irwin, "The Incident Command System," in Disaster Response: Principles of Preparation and Coordination, ed. E. Auf der Heide, (1989), Center for Excellence in Disaster Management and Humanitarian Assistance, http://coedmha.org/, accessed 18 March 2002; see note 4 above.
12. B.D. Mahoney, "Disaster Medical Services," in Emergency Medicine A Comprehensive Study Guide, 4th ed., ed. J.E. Tintinalli (New York: McGraw-Hill, 1996), pp. 20-5.
13. Federal Emergency Management Agency, "FEMA's Mission," http://www.fema.gov/about/ mission.htm, accessed 6 March 2002.
14. E. Auf der Heide, "Triage" in Disaster Response: Principles of Preparation and Coordination, ed. E. Auf der Heide, see note 10 above.
15. SBCCOM, see note 1 above.
16. R. Baker and M. Strosberg, "Triage and Equality: An Historical Reassessment of Utilitarian Analysis of Triage," Kennedy Institute of Ethics Journal 2 (1992): 103-23.
17. N. Pesik, M.E. Keim, and K.V. Iserson, "Terrorism and the Ethics of Emergency Medical Care," Annals of Emergency Medicine 37 (2001): 642-46; J. Leaning, "Physicians, Triage and Nuclear War," Lancet 2 (1988): 269-70.
18. N. Pesik, M.E. Keim, and K.V. Iserson, "Terrorism and the Ethics of Emergency Medical Care," Annals of Emergency Medicine 37 (2001): 642-46; J. Leaning, "Physicians, Triage and Nuclear War," Lancet 2 (1988): 269-70.
19. Environmental Protection Agency, "First Responders' Environmental Liability due to Mass Decontamination Runoff," http://www.epa.gov/ceppo/ pubs/onepage.pdf, accessed 1 March 2002.
20. I b i d.
21. Lake, Fedele and Marshall, "Guidelines for Mass Casualty Decontamination," see note 1 above, p. 17. The standard NAAK Mark I contains an AstroPen auto-injector (2#mg atropine), and a pralidoxime chloride auto-injector (600 mg 2-PAM).
22. B. Domres, M. Koch, A. Manger, and H.D. Becker, "Ethics and Triage," Prehospital and Disaster Medicine 16 (2001): 53-8.
23. H.J. Siegelson, "Preparing for a Terrorist Attack: Mass Casualty Management," (paper presented at the Third International WMD Conference, St. Petersburg, Fla., 15 January 2002).
24. Lake, Fedele, and Marshall, "Guidelines for Mass Casualty Decontamination," see note 1 above, p. 20; H.J. Siegelson, "Preparing for Terrorism and Hazardous Material Exposures," Health Forum Journal (January/February 2001): 32-5.
25. Lake, Fedele, and Marshall, "Guidelines for Mass Casualty Decontamination," see note 1 above, p. 20; H.J. Siegelson, "Preparing for Terrorism and Hazardous Material Exposures," Health Forum Journal (January/February 2001): 32-5.
26. J.F. Waeckerle, "Domestic Preparedness for Events Involving Weapons of Mass Destruction," Journal of the American Medical Association 283 (2000): 252-4.
27. The American Hospital Association suggests that the federal government create exclusions from the HIPAA (Health Insurance Portability and Accountability Act of 1996) requirements for mass casualty situations when irregularities in compiling, safeguarding, and transferring medical records are logistically necessary. "Hospital Preparedness for Mass Casualties," (final report of the proceedings of an invitational American Hospital Association forum, Chicago, 8-9 March 2000, in American Medical Association, Bioterrorism Awareness, CD-ROM (Chicago, Ill.: American Medical Association, 2000).
28. The Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities, The Model State Emergency Health Powers Act, http://www.publichealthlaw.net/MSEHPA/MSEHPA2.pdf, accessed 10 April 2002.
29. I b i d.
30. Lake, Fedele, and Marshall, see note 1 above, p. 14. In Tokyo, "approximately 4,000 of the 5,510 victims were deemed to have not been exposed to any significant amount of the chemical agent, yet they sought medical treatment."
31. See note 3 above.
32. "Bio-Terrorism Questions and Answers," http://www.hcfa.gov/ medlearn/terrorqa.htm, accessed 2 March 2002.
33. Because hazmat decontamination protocols have long been the province of local authorities, over management at higher levels is likely to present less of a problem in preparing for decontamination than in preparations for other facets of the medical response to terrorism.