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ACRONYMS AND ABBREVIATIONS
CHASE: Cut Holes and Sink ’EmCHATH: Chemically Hardened Air Transportable Hospital ADAPC: Alcohol and Drug Abuse Prevention and Control CP DEPMEDS: Chemically Protected Deployable Medical CPAP: continuous positive airway pressure CPRP: Chemical Personnel Reliability Program ARDS: adult respiratory distress syndrome CSEPP: Chemical Stockpile Emergency Preparedness Program Ct: the product of the concentration (in milligrams per cubic AUIB: Aircrew Uniform, Integrated Battlefield meter of air) and the time (in minutes) of exposure to a gas BAL: British anti-LewisiteBALT: bronchus-associated lymphoid tissue BDRP: Biological Defense Research Program DANC: Decontaminating Agent, Non-Corrosive DAS: diacetoxyscripenol, also called anguidine BIDS: Biological Integrated Detection System DIC: disseminated intravascular coagulation BZ: 3-quinuclidinyl benzilate (now called QNB) DKIE: Decontamination Kit, Individual EquipmentDLCO: lung diffusing capacity for carbon monoxide DM: diphenylaminearsine, also called adamsite CaEDTA: calcium ethylenediaminetetraacetic acid CAI: Chemical (Surety Material) Accident or Incident CAIRA: Chemical Accident or Incident Response and DPRK: Democratic Peoples Republic of Korea CBPS: Chemical and Biological Protected Shelter C-CHF: Crimean-Congo hemorrhagic fever virus CD: cluster of differentiationCDAE: Chemical Defense Aircrew Ensemble CDC: Centers for Disease Control and Prevention CDTF: Chemical Decontamination Training Facility 50: effective dose (also called the incapacitating dose) for CHAMP: chemically hardened air-management plant Medical Aspects of Chemical and Biological Warfare JACADS: Johnston Atoll Chemical Agent Destruction JSLIST: Joint Service Lightweight Integrated Suit Technology FDA: U.S. Food and Drug AdministrationFDECU: field deployable environmental control unit FEMA: Federal Emergency Management AgencyFLD: Field Hospital FM: titanium tetrachlorideFMC: Field Medical Card FTIR: Fourier Transform Infrared spectrometer Lcr: low calcium responseLCt50: the vapor or aerosol exposure (Ct, concentration • time) that is lethal (L) to 50% of the exposed population LD50: the dose (D) that is lethal (L) to 50% of the exposed LOPAIR: long-path infra red GC–MS: combination of GLC and MS techniques GLC: gas–liquid chromatographyGVO: Green Vinyl Overboot MACOM: Major Army CommandMASH: Mobile Army Surgical Hospital HEPA: high-efficiency particulate air (filter) HFRS: hemorrhagic fever with renal syndrome MDMA: 3,4-methylenedioxymethylamphetamine HHS: US Department of Health and Human Services MED50: the dose that is minimally effective for mild cognitive impairment in 50% of the exposed population HMMWV: high-mobility, multipurpose, wheeled vehicle HPLC–MS: high-performance liquid chromatography–mass MMPI: Minnesota Multiphasic Personality Inventory MOPP: mission-oriented protective posture MOU: Memorandum of UnderstandingMPE: most probable event MRI: Medical Reengineering InitiativemRNA: messenger RNA ICBPG: Improved Chemical and Biological Protective Glove ID50: the dose that incapacitates 50% of the exposed population IFA: indirect fluorescent antibodyIFN- γ: interferon gamma NAPP: nerve agent pyridostigmine pretreatment NBCRS: Nuclear Biological Chemical Reconnaissance ISO: International Organization for Standardization (from the NBC–PC: nuclear, biological, chemical protective covers ITAR-TASS: Information-Telegraph Agency of Russia– SEB: staphylococcal enterotoxin BSGOT: serum glutamic-oxaloacetic transaminase SIPRI: Stockholm International Peace Research InstituteS-LOST: sulfur mustard, for Lommell and Steinkopf OPA: isopropyl alcohol and isopropylamine solution OPIDN: organophosphorus ester–induced delayed neuro- TAP: toxicological agent protective (ensemble) TCDD: 2,3,7,8 tetrachlorodibenzo-p-dioxin PAO2 – Pa O2: alveolar–arterial difference in the partial TEMPER: tent, extendable, modular, personnel PaO2: partial pressure of arterial oxygen THA: tetrahydroaminoacridine, also called tacrine 2-PAM Cl: 2-pyridine aldoxime methyl chloride, also called PDDA: Power-Driven Decontamination Apparatus PEEP: positive end-expiratory pressurePEG300: polyethylene glycol 300 PF: protection factorPFIB: perfluoroisobutylene UNSCOM: United Nations Special Commission USAMRICD: U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland USAMRIID: U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland USAMRMC: U.S. Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland ppm: parts per millionPPW: patient protective wrap VIG: vaccinia immune globulinVKA: vegetable killer acid VPFRU: Vapor-Protective, Flame-Resistant Undergarment QNB: 3-quinuclidinyl benzilate (current name for BZ) VX: ethyl-S-dimethylaminoethyl methylphosphonothiolate RDIC: resuscitation device, individual, chemical RME: receptor-mediated endocytosisRNA: ribonucleic acid Yops: Yersinia outer-membrane proteins RSCAAL: Remote Sensing Chemical Agent AlarmRT-PCR: reverse transcriptase polymerase chain reaction SBR: small-box respiratorSCPE: Simplified Collective Protective EquipmentSDS: sodium dodecyl sulfate Medical Aspects of Chemical and Biological Warfare Aircrew uniform, integrated battlefield (AUIB), 373Air delivery Aberdeen Proving Ground, Maryland, 398, 409–410 See also Edgewood Arsenal, Maryland See also Aerosol; Inhalational injury; specific agent See Aeromedical Isolation Team (AIT) M21 Remote Sensing Chemical Agent (RSCAAL), 381 Acetylcholine (ACh), 132–134, 136, 159, 647 Portable Automatic Chemical Agent, 60–62 Acetylcholinesterase (AChE), 131–132, 134, 182–184 Activated charcoal, 217, 362–363, 366, 370, 373, 670 Allergic contact sensitivity, 238–239, 249, 314, 316–317 Adenosine triphosphate (ATP), 275, 383, 431 S-Adenosylhomocysteine hydrolase inhibitors, 552 See also Viral encephalitides; specific virus Advanced trauma management (ATM), 326–327 See U.S. Army Medical Department (AMEDD) Aeromedical Isolation Team (AIT), 432, 434 American Type Culture Collection (ATCC), 463, 646 2-Amino thiazoline 4-carboxylic acid, 276 particle size, for biological agents, 440 See also Inhalational injury; specific agent that harbor disease, 487–488, 514, 524, 527–528 See Aircrew Eye/Respiratory Protection (AERP) system Afghanistan, 3, 67–68, 102, 104, 656–658, 665 vaccines for, 434, 460, 464, 568, 576, 578 weapons directed against, 12, 16, 34–35, 37, 51, 60, 428– See also specific agent or animal Aging, of organophosphoryl–cholinesterase bond, 162, 182– See Argentine hemorrhagic fever (AHF) history, 10, 16, 32, 42–44, 50, 68, 417–418, 420, 427, 431–432, See also Aerosol; Inhalational injury; specific material Aircrew Eye/Respiratory Protection (AERP) system, 369–370 Aircrew personal protective equipment, 368–370 Medical Aspects of Chemical and Biological Warfare recent use, 4, 420–421, 452–453, 462, 464, 468 See also Bacillus anthracis history, 12, 16, 34–35, 37, 51, 60, 428–429 See also specific agent or animal using biological weapons, 420–421, 446, 645 See Alimentary toxic aleukia (ATA) See American Type Culture Collection (ATCC) See also specific antibiotic Anticonvulsants, 154–155, 165, 187, 191, 279 See Advanced trauma management (ATM) administered in absence of nerve agent intoxication, 160 dosage and administration, 160–161, 169 and endurance time in protective gear, 394 and nerve agent cardiovascular effects, 156 See also Defoliants; specific agent or plant and nerve agent–induced seizures, 154–155 and nerve agent pretreatments, 184–187, 191 topical ocular administration, 147, 166–167, 215 See Aircrew uniform, integrated battlefield (AUIB) Aum Shinrikyo, 4, 75, 113, 118, 131, 169, 274, 342, 438, 463, 678 Autoinjectors, 54, 73, 155, 159–161, 163–165, 169, 252, 341 Arab–Israeli Six-Day War (1967), 57, 65 Argentine hemorrhagic fever (AHF), 592–593, 595–596, 599 Automatic G-Agent Fixed Installation Alarm, 53 Arrhythmias, 156, 165–166, 239, 253, 277 inhalational injury, 440introduction to, 4–6 Bacillus anthracis, 383, 439, 468–469, 474 occupational exposure, 398–399, 402–408, 432, 434 protective equipment against, 431, 447–448 See also Biological agents; specific agent risk of transmission to medical staff, 356 susceptibility and nonsusceptibility, 441 vaccines, 60–61, 73, 434, 441, 460, 462, 681–683 Biological bombs, 32–33, 44, 51–52, 59, 441–442, 444 Biological Defense Research Program, 434–435 Biological Integrated Detection System (BIDS), 74, 377, 382– Bari mustard disaster (Italy), 40, 103–104, 200 attempts to control, 13, 419–420, 678–679 Cold War, 50–52, 55, 58–60, 420–422, 426, 430, 656 Barrier nursing procedures, 432–433, 598 early proposals and usage, 12, 88, 416–417 Battalion aid station (BAS), 327, 329, 331, 335 indications of possible attack, 448–449 and military healthcare provider, 6, 445, 447, 683–684 Battlefield health service support, 326–328 Belladonna, 289–290, 294–295, 297–299 strategic and tactical concerns, 445–446, 456–458 unconventional/clandestine use, 442, 446–447, 458 World War I, 16, 21–22, 90–97, 417, 446, 459, 540 World War II, 36–37, 42–44, 103–104, 417–419, 426–427, 446, See Biological Integrated Detection System (BIDS) advantages and disadvantages, 442–445, 456–459, 684 Binary weapons programs, 65–66, 70–72, 75, 104 nonhuman targets of attack, 434, 459–461 versus nuclear and chemical weapons, 458–459 availability or ease of production, 438–439, 457, 678 Biological Weapons Anti-Terrorism Act, 75, 633 defense against, 1–6, 425–435, 438, 443–446, 677–684 Biological Weapons Convention, 419–420, 422 delivery systems, 121, 420–421, 429, 438–442, 446, 457, 656, compliance, 432, 435, 455, 458, 462–463, 679 and Soviet biological warfare program, 4, 452–453, 455–456 detection, 74, 377, 382–384, 431, 447–449 viral encephalitides carried by, 567, 573 incapacitation caused by, 292, 431, 439–440 Medical Aspects of Chemical and Biological Warfare British anti-Lewisite (BAL), 102, 218, 220, 261 British anti-Lewisite (BAL) Eye Ointment, 42 Bolivian hemorrhagic fever, 593, 595–596, 599 Brucella canis, 514–515, 517–518 biological, 32–33, 44, 51–52, 59, 441–442, 444 chemical, 28, 40, 49–50, 59, 65–66, 71 See also specific type of bomb Brucella suis, 51, 429, 514–515, 517 and assassination of Reinhard Heydrich, 645 history, 10, 43–44, 417, 427, 429–430, 514 history, 32, 43, 417, 421, 427, 644–645 mechanism of action, 609–611, 647–649 mustard, 98–100, 202, 205–208, 214, 238, 342–343 Butyrocholinesterase (BuChE), 132, 136–139, 192, 301 BZ (3-Quinuclidinyl benzilate), 5, 119, 159, 294–296 anticholinergic delirium produced by, 296 nerve agent–induced, 145, 147–149, 158, 167–168, 170 Bristol-Myers Squibb Oncology Division, 237 See Chemical defense aircrew ensemble (CDAE) See Chemical (Surety Material) Accident or Incident (CAI) See Casualty Decontamination Center (CDC); Centers for See Chemical Accident or Incident Response and Assis- Calcium ethylenediaminetetraacetic acid (CaEDTA), 261 See Chemical Decontamination Training Facility (CDTF) Centers for Disease Control and Prevention (CDC), 540, 551– Central Intelligence Agency (CIA), 428, 454, 456–457, 461–462 of nerve agents, 145, 149–155, 170, 233–234 Canister mask arrangement, 364, 366–369 Cerebrospinal fluid (CSF) examination, 576 See Chemically Hardened Air-Management Plant CHASE (Operation Cut Holes and Sink ’Em), 62–64 See Chemically Hardened Air Transportable Hospital of nerve agents, 145, 155–157, 165–166, 169 Chemical accident/incident response and assistance, 409–411 Chemical (Surety Material) Accident of Incident (CAI), 409 Chemical Accident or Incident Response and Assistance Chemical agent monitor (CAM), 70, 378–379 decontamination certification with, 355–357 Chemical agents, 4–6, 10, 18–19, 22–24, 27, 29–31, 34–35, 37– 39, 41, 52–53, 57, 62–63, 66–69, 72–74, 118–119 Casualty decontamination, 329, 331–335, 340–341, 352, 386– Casualty Decontamination Center (CDC), 329 See Chemical and Biological Protected Shelter (CBPS) See Crimean-Congo hemorrhagic fever (C-CHF) release, See Delivery systems; specific system See Chemical Casualty Site Team (CCST) See Cluster of differentiation (CD) Medical Aspects of Chemical and Biological Warfare Chemical and Biological Protected Shelter (CBPS), 385 Chemical bombs, 28, 40, 49–50, 59, 65–66, 71 civil–military relations and, 408–411 decontamination, 329, 331–335, 340–341, 352 attempts to control, 13, 115, 117, 411–412, 678–679 World War I, 6, 24, 91–92, 100–101, 200, 205 and military healthcare provider, 6, 111–126, 328–335, 683– See also Chemical Warfare Service (CWS) Chemical decontamination methods, 158, 354–355, 357–358, Chemical Decontamination Training Facility (CDTF), 71 Chemical defense aircrew ensemble (CDAE), 373 World War II, 36–47, 103–104, 125, 131, 200, 290 Chemical Warfare in Southeast Asia and Afghanistan (Haig), 68 Chemical Warfare School, 26, 29, 35, 48, 71 biological warfare programs, 426, 428, 632 and medical personnel, 329, 331–332, 334, 338, 340–341 World War I, 15–18, 22, 91–94, 363–364, 393 See also Collective protection; Masks; Mission-oriented nations with capability for use, 114, 116, 679 protective posture (MOPP); specific item versus nuclear and biological weapons, 458–459 Chemically Hardened Air-Management Plant (CHAMP), 385 Chemically Hardened Air Transportable Hospital (CHATH), reduction or elimination, 115, 117, 411–412 Chemically protected deployable medical system (CP Chemical Weapons Convention, 75, 115, 117, 679 Chemical Personnel Reliability Program (CPRP), 399–402 and inhalational injury, 252, 259–261, 264 Chemical protective footwear cover (CPFC), 374 Chemical protective overgarment (CPOG), 373 Chemical Stockpile Emergency Preparedness Program Japanese invasion of, 35–36, 200, 218, 417–418, 485 See Chloroform–methanol extraction (CMR vaccine) CN (1-Chloroacetophenone), 27, 119, 292, 309–310, 316–321 history, 5, 11, 14–15, 27, 88–93, 95, 119, 248 binary weapons programs, 65–66, 70–71 biological warfare programs, 50–52, 55, 58–60, 420–422, detection developments, 53–54, 60–62, 66–67, 70 See CS (o-Chlorobenzylidene malononitrile) nerve agent production and development, 49 offensive chemical agent developments, 49–50, 57–59 Chloroform–methanol extraction (CMR vaccine), 532 protective device developments, 52–53, 60–62, 67, 69–70 See Sulfur trioxide–chlorosulfonic acid (FS smoke) Cholera, 10, 12, 16, 33, 37, 42, 417–419, 462 Cholinesterase (ChE) inhibitors, 130–142, 164, 236 See also Nerve agents; Organophosphorus compounds; Combat vehicle filtration protection system, 368 See Central Intelligence Agency (CIA) Conjunctivitis, 98–99, 208, 210, 214–215, 238, 314 riot control agent use during, 309–310, 313 of medical equipment and facilities, 124–125, 157, 353, 357 Continental United States (CONUS), 326, 328 and biological defense program, 434–435 Convention on Prohibition of Bacteriological and Toxin Convulsions, 154–155, 158, 165, 187, 239 Clostridium botulinum, 644, 646–647 See also Botulinum toxins; Botulism Clostridium tetani, 644, 646–647 Coxiella burnetii, 430, 524–526, 528–529 Cluster of differentiation (CD), 542, 622 Medical Aspects of Chemical and Biological Warfare See Chemically protected deployable medical system (CP See Collective protection equipment (CPE) See Chemical protective footwear cover (CPFC) pharmacokinetics and pharmacodynamics, 276 poisoning presentation and management, 277–279, 342 See Chemical protective overgarment (CPOG) See Chemical Personnel Reliability Program (CPRP) CR (dibenz(b,f)-1:4-oxazepine), 319–320 Crimean-Congo hemorrhagic fever (C-CHF), 439, 593–596, CS ( o-Chlorobenzylidene malononitrile), 119, 292, 310–316 dermatological effects, 312–314, 320–321 nations with capability for use, 114ocular effects, 314, 321 severe medical complications from, 317–318 See Decontaminating Agent, Non-Corrosive (DANC) See Chemical Stockpile Emergency Preparedness Program See Cerebrospinal fluid (CSF) examination See Chemical Surety Inspection (CSI) See Dichlorodiphenyltrichloroethane (DDT) Decontaminating Agent, Non-Corrosive (DANC), 34, 62 Decontaminating Solution 2 (DS2), 62, 374, 388 casualty, 329, 331–335, 340–341, 352, 386–387, 408–410 See Chemical Warfare Service (CWS) chemical methods, 158, 354–355, 357–358, 363 equipment, 124–125, 353, 357, 387–388 biochemical basis for poisoning, 274–276 history, 22–24, 33–34, 42, 47, 54, 62, 70, 97–98 of trichothecene mycotoxins, 658, 665–666, 670 nerve agents, 47, 157–158, 168–169, 354–355, 387 Deseret Test Center, Fort Douglas, Utah, 430 physical methods, 354, 358, 363–364, 370 skin, 157–158, 333, 335, 352–353, 356, 386–387, 408, 669–670 biological agent, 74, 377, 382–384, 431, 447–449 See also specific agent or method Decontamination apparatus/systems, 62, 70, 97–98, 388 Decontamination area, 332–333, 335, 409 Decontamination Kit, Individual Equipment (DKIE) standoff, 53–54, 74, 380–381, 447–448 Decontamination kits, 158, 335, 353–354, 387–388 Defense Research Establishment, Ottawa, Canada, 658 history, 44, 51, 56, 60, 62, 104, 419, 428 M8 Chemical Agent, 335, 355, 357, 377–379 and protective clothing use, 370–371, 406–407 biological agents, 121, 420–421, 429, 438–442, 446, 457, 656, and chemical warfare capability, 114, 116 See Direct fluorescent antibody (DFA) staining history, 27, 31, 36–37, 39–40, 51–52, 58–59 See Diisopropyl fluorophosphate (DFP) 4,15-Diacetoxyscripenol (DAS), 660–661, 666 Demustardizing Apparatus, Commercial Type, 33 Dengue hemorrhagic fever, 593–596, 598–599 Diazepam, 154–155, 165–169, 191, 279, 347 Deoxyribonucleic acid (DNA), 515, 660–662, 679 See Disseminated intravascular coagulation (DIC) Deoxyribonucleic acid (DNA) viruses, 540–541 Dichlorodiphenyltrichloroethane (DDT), 483 Deoxyverrucarol (DOVE)–protein conjugate, 671 Department of Defense Appropriation Authorization Act, 66– Department of Defense Biological and Chemical Defense Diisopropyl fluorophosphate (DFP), 132, 152–153, 233, 301 of mustard, 201–202, 205–210, 214, 217, 238–239, 342–343 of nerve agents, 143–145, 161–162, 167 4-Dimethylaminophenol (4-DMAP), 279–281 of riot control agents, 312–314, 316–317, 320–321 Medical Aspects of Chemical and Biological Warfare Direct fluorescent antibody (DFA) staining, 495–496 See Division Support Command (DISCOM) V: Continental United States (CONUS), 328 See 3,4-Methylenedioxymethylamphetamine (MDMA) Disseminated intravascular coagulation (DIC), 595–597 Distilled mustard agent (HD), 38–39, 198–200 Edgewood Arsenal, Maryland, 19, 26, 30, 38–39, 49, 93, 101, See Decontamination Kit, Individual Equipment (DKIE) DM (diphenylaminearsine), 27, 119, 292, 309, 319 See Eastern equine encephalitis (EEE) See 4-Dimethylaminophenol (4-DMAP) Electrocardiography (ECG), 156, 165–166 Electroencephalography (EEG), 153, 235–236 See Enzyme-linked immunosorbent assays (ELISAs) Emergency medical treatment (EMT) station, 331–335 See Nausea-producing agents; specific agent; Vomiting See Decontaminating Solution 2 (DS2) Dugway Proving Ground, Utah, 427, 429, 432, 457 See Viral encephalitides; specific virus Endothelial-derived relaxing factor (EDRF), 275 nerve agent–induced, 145, 147–149, 158, 167–168, 170 in toxic inhalational injury, 252, 255–256, 258–261, 265 Eastern equine encephalitis (EEE), 570–574, 576–579 for toxin exposure diagnosis, 614, 617, 627, 668 Eastern equine encephalitis (EEE) virus, 562–564 Eastern equine encephalitis (EEE) virus complex, 564–566 Ebola hemorrhagic fever, 432, 434–435, 439, 593–596 and viral encephalitides, 564, 567–568, 572 Enzyme-linked immunosorbent assays (ELISAs) See also specific agent diagnosis for Chemical Personnel Reliability Program, 402–403 and viral encephalitides, 564, 567–568, 571–572 Equipment decontamination, 124–125, 353, 357, 387–388 as bacterial agent vector, 33, 380, 482–489, 498 Erythrocyte cholinesterase (RBC-ChE), 132, 136–137 baseline and periodic measurements, 404–405 Food and Drug Administration (FDA), 188, 463 Food poisoning, 463, 622, 644, 646, 649, 659 Food supply contamination, 442, 446–447, 459, 469 See 2-Pralidoxime chloride (2-PAM Cl) Fort Detrick, Maryland, 43–44, 426–432, 434, 460, 616, 623– Forward Support Medical Company (FSMC), 329 Fourier Transform Infrared (FTIR) spectrometer, 380Fowl pest, 460 Fox, Leon A., 31–32, 426FOX Nuclear, Biological, Chemical Reconnaissance System See Food and Drug Administration (FDA) See also World War I; World War II See Field deployable environmental control unit (FDECU) Francisella tularensis, 383, 429, 504, 506–507 Federal Emergency Management Agency (FEMA), 411–412 Field deployable environmental control unit (FDECU), 385 See Forward Support Medical Company (FSMC) See Sulfur trioxide-chlorosulfonic acid (FS smoke) See Fourier Transform Infrared (FTIR) spectrometer Medical Aspects of Chemical and Biological Warfare Fusarium semitectum var semitectum, 658 See also Antiplant weapons; specific grain Gas–liquid chromatography (GLC), 668–669 Ground crew personal protective equipment, 365–368 staphylococcal enterotoxin–induced, 622–627 See also Diarrhea; Nausea; Vomiting Gulf War syndrome, xvi, 73, 105, 190, 191, 195, 297 See also Chemical Warfare Service (CWS); Chemical Corps history, 29, 34, 57, 64, 67, 69, 290, 427 and status of chemical proliferation, 114, 679 biological warfare programs, 16, 32, 36–37, 418, 426, 459, Hantavirus pulmonary syndrome (HPS), 594–595 chemical warfare programs, 5, 14–15, 89, 130–131 See Riot control agents; specific agent See also World War I; World War II See Hexachloroethane (HC); Zinc oxide (HC) and pyridostigmine pretreatment, 185–186 and biological warfare, 445, 447, 683–684 and chemical warfare, 111–126, 328–335, 683–684 See Gas–liquid chromatography (GLC) Chemically Hardened Air Transportable (CHATH), 385 and work/rest cycles, 329–330, 371, 403, 405 and protective gear, 125, 329–330, 367, 370–371, 394, 403, Helminthosporium oryzae van Brede de Haan, 460 in casualty-receiving area, 331–333, 335, 340, 410 Hemagglutination assays, 497, 507, 517–518, 531 Hemagglutination-inhibition (HI) tests, 566, 573 See High-performance liquid chromatography–mass See Hantavirus pulmonary syndrome (HPS) See also Viral hemorrhagic fevers; specific virus Hemorrhagic fever with renal syndrome (HFRS), 593–595, See High-efficiency particulate air (HEPA) filters See Human Genome Organization (HUGO) Human immunodeficiency virus (HIV) infection, 550, 552 Humoral immunity, 505, 528, 542, 551, 683 Hussein, Saddam, 72–74, 113, 416, 421, 679 Heydrich, Reinhard, assassination of, 645 See Hemorrhagic fever with renal syndrome (HFRS) High-efficiency particulate air (HEPA) filters, 430, 432, 434 history, 10, 16, 37–38, 40–42, 104, 273–274 High-mobility, multipurpose, wheeled vehicle (HMMWV), High-performance liquid chromatography–mass spectrometry See Hemagglutination-inhibition (HI) tests Hydroxocobalamin (vitamin B12a), 279, 281 See High-mobility, multipurpose, wheeled vehicle pralidoxime chloride–induced, 163–164, 170 Hypochlorite solution, 352–358, 387, 408 for nerve agent decontamination, 158, 341 for riot control agent decontamination, 314 Medical Aspects of Chemical and Biological Warfare Influenza viruses, 680–681Information-Telegraph Agency of Russia–Telegraph Agency See Improved Chemical agent monitor (ICAM) See Indirect fluorescent antibody (IFA) staining nerve agent–induced, 139–144, 157, 161, 167 See Installation Medical Authority (IMA) pulmonary effects, 253, 256, 258–259, 265–266, 343 therapeutic considerations, 252–253, 255 to staphylococcal enterotoxins, 622–623 2-pralidoxime chloride (2-PAM Cl), 73, 155, 163, 169 See also Organophosphorus compounds; Carbamates; See also specific insect or agent Installation Medical Authority (IMA), 402–404, 406–407, 409 against staphylococcal enterotoxin B, 628 Institute of Especially Pure Biopreparations, 454–455 against viral encephalitides, 564, 576–579 International Declaration Concerning the Laws and Customs Improved Chemical agent monitor (ICAM), 378–379 Incapacitating agents, 118–119, 287–302 mustard use during, 3–4, 104, 114, 116–117, 157, 198, 200– nerve agent use during, 104, 114, 116–117, 122–123, 230, biological warfare program, 421–422, 462–463, 657, 679 chemical warfare capability, 114–115, 117, 185–186 See Installation Response Force (IRF) See Riot control agents; specific agent Isolation procedures, 432–433, 497, 547, 598 of surplus chemical weapons, 72, 411–412 Indirect fluorescent antibody (IFA) staining, 531 Italian–Ethiopian War, 34–35, 102, 200 Individual Equipment Decontamination Kit, 70 See Information-Telegraph Agency of Russia–Telegraph Lane, Benjamin I., 13Laos, 3, 67–68, 421, 656–658, 665 See Johnston Atoll Chemical Agent Destruction System biological warfare programs, 32, 36–37, 417–418, 426–427, See Lightweight Decontamination System (LDS) Imperial Unit 731, 417–418, 427, 483, 540 invasion of China, 35–36, 200, 218, 417–418, 485 sarin incidents in, 4, 75, 113, 118, 131, 169, 274, 342, 438, Johnston Atoll Chemical Agent Destruction System Joint Service Lightweight Integrated Suit Technology Improved Chemical and Biological Protective Glove differential diagnosis, 200, 212, 219–220 Vapor-Protective, Flame-Resistant Undergarment Joint United States/United Kingdom/Russia Trilateral mixed with mustard, 201, 218nations with capability for use, 114, 116 Korean War, 47–48, 104, 394, 418–419, 429, 485, 594 Lipopolysaccharide (LPS), 504, 515, 526, 528Liston, W. G., 486 Litter decontamination station, 332–333, 410 See Operation Large Area Coverage (LAC) Medical Aspects of Chemical and Biological Warfare LOPAIR ( long-path infra red) alarm, 53–54
psychological effects of wearing, 393–395 Lymphoid changes, 471, 495, 505–506, 571, 625 D-Lysergic acid diethylamide (LSD), 52, 293, 302 World War I, 15–18, 22, 91–94, 363–364, 393 World War II, 37, 40–41, 43, 103, 365, 394 Mass casualty biological (toxin) weapon (MCBW), 605–606, Major histocompatibility complex (MHC), 505, 622–623 See Medical Augmentation Team (MAT) biological agents directed against, 459, 461 Marburg hemorrhagic fever, 439, 593–596 See Medical Chemical Advisory Team (MCAT) See Mass Casualty Biological (Toxin) Weapon (MCBW) See 3,4-Methylenedioxymethylamphetamine (MDMA) See Mobile Army Surgical Hospital (MASH) Chemical–Biological: Aircraft, M43, 369 Chemical–Biological: Aircrew MBU-19/P, 369–370 See Medical Department Activity (MEDDAC) Chemical–Biological: Field, M40, 363–364, 366–368 Medical Aspects of Chemical Warfare (Vedder), 102 Chemical–Biological: Field, M17A2, 363, 366–367 Medical Biological Defense Research Program, 615 Medical Chemical Advisory Team (MCAT), 411 Medical Collective Protection Systems, 384–385 Medical Department Activity (MEDDAC), 398 Medical Management of Chemical Casualties Course, 398, 409 Medical Management of Chemical Casualties Handbook, 401 Medical Reengineering Initiative (MRI), 328 biological warfare threat and, 6, 445, 447, 683–684 chemical warfare threat and, 6, 111–126, 328–335, 683–684 safety from chemical contamination, 125, 157 in biological warfare environment, 445, 447, 683–684 in chemical warfare environment, 111–126, 328–335, 683– Medical treatment facility (MTF), 328, 409 Minnesota Multiphasic Personality Inventory (MMPI), 311 nerve agent–induced, 144–147, 166–168, 170 Mission-oriented protective posture (MOPP) gear, 101, 123– Memorandum on Gas Poisoning in Warfare with Notes on its Pathology and Treatment (U.S. Army War College), 23–24 Memorandums of Agreement (MOAs), 401, 408–409, 411 and heat stress, 125, 329–330, 367, 370–371, 394, 403, 405– and medical personnel, 329, 331–332, 334, 338, 340–341 psychological effects of wearing, 362, 393–395 Mission-oriented protective posture (MOPP) levels, 328, 372 3-Mercaptopyruvate sulfurtransferase, 276 See Multiple Launch Rocket System (MLRS) Binary contamination with biological agents, 459, 461 Methanesulfonate salt of pralidoxime (P2S), 163 See Memorandums of Agreement (MOAs) Mobile Army Surgical Hospital (MASH), 328 3,4-Methylenedioxymethylamphetamine (MDMA), 293 in toxin prophylaxis, 615, 651, 671, 682–683 See Mission-oriented protective posture (MOPP) See Major histocompatibility complex (MHC) Michigan Department of Public Health, 473 Medical Aspects of Chemical and Biological Warfare See Military occupation specialty (MOS) Mustard burns, 98–100, 202, 205–208, 214, 238, 342–343 as viral encephalitides vector, 562–564, 566–568, 573, 577 as viral hemorrhagic fever vector, 593–594, 596 See Medical Reengineering Initiative (MRI) See also Trichothecene mycotoxins; specific toxin NAD+ (nicotinamide adenine dinucleotide), 203 See Medical treatment facility (MTF) Multiple Launch Rocket System (MLRS) Binary Chemical NAPP (nerve agent pyridostigmine pretreatment) effects of nerve agents on, 145, 149, 232 See Nerve agent pyridostigmine pretreatment set (NAPPS) of nerve agents, 145, 147, 167–168, 170 Mustard (HS), 118–119, 198–217, 230–231 for toxin exposure diagnosis, 614, 617, 627, 638, 650 biochemical mechanisms of injury, 202–204 National Academy of Science, 43, 217, 220, 426 National Research Council (NRC), 17, 43, 426 and combined injuries, 347–348, 355–356 See North Atlantic Treaty Organization (NATO) decontamination, 22–24, 33–34, 54, 157–158, 213, 354–355, dermatological effects, 98–100, 201–202, 205–210, 214, 217, See also specific agent; Vomiting agents See Nuclear, biological, and chemical (NBC) officer differential diagnosis, 200, 212–213, 219–220, 343 See Nuclear, biological, chemical protective covers (NBC- history, 5, 10, 27, 29–31, 34–40, 46, 56–57, 62–63, 102–104, See FOX Nuclear, Biological, Chemical Reconnaissance long-term health effects, 97–101, 217, 230, 236–239 nations with capability for use, 114–116 Nerve agent pretreatments, 132, 134, 181–193 ocular effects, 202, 208–211, 214–215, 238 pulmonary effects, 211–212, 215–217, 237–238 and central nervous system effects, 154, 187 recent use, 3–4, 69, 198, 200–201, 205, 214–216, 230, 237–239 See also Pyridostigmine; specific agent Nerve agent pyridostigmine pretreatment set (NAPPS), 189 binary weapons, 65–66, 70–72, 75, 104 World War I use, 16, 19–24, 95–101, 119, 198, 200–201, 205, and blood cholinesterase activity, 138–139 cardiovascular effects, 145, 155–157, 165–166, 169 central nervous system effects, 145, 149–155, 170, 233–234 versus commonly used cholinesterase inhibitors, 139 in contemporary U.S. munitions inventory, 131 decontamination, 47, 157–158, 168–169, 354–355, 387 dermal exposure, 143–145, 161–162, 167 effects on organs and organ systems, 144–157, 230, 341–342 electrocardiographic (ECG) effects, 156, 165–166, 235–236 electroencephalographic (EEG) effects, 153 history, 5, 30, 36, 46, 49, 56–58, 62–63, 103–104, 130–131, inhalational injury, 139–144, 157, 161, 167 intermediate syndrome caused by, 232–233 long-term health effects, 153–154, 170, 230–236 Norfolk Supply Center, Norfolk, Virginia, 429 North Atlantic Treaty Organization (NATO), 70, 74, 182, 185, of viral hemorrhagic fevers, 592–593, 595–596 nations with capability for use, 114, 116 neuropsychiatric effects, 145, 149–155, 233–235 ocular effects, 144–147, 166–168, 170 See National Research Council (NRC) Nuclear, biological, and chemical (NBC) officer, 362, 445 Nuclear, biological, chemical protective covers (NBC-PC), 669 versus chemical and biological weapons, 458–459 pulmonary effects, 145, 147–149, 167–168, 170 for biological agent–exposed patients, 432–433, 598 treatment, 54, 73, 154–155, 157–170, 230 triage considerations, 341–342, 344–346 ventilatory support, 148, 158–159, 166–169 See also specific agent; Smokes and chemical surety mission, 398–399, 402–408 and U.S. biological warfare program, 398–399, 432, 434 of nerve agents, 145, 149–155, 233–235 of mustard, 202, 208–211, 214–215, 238 of nerve agents, 144–147, 166–168, 170 Medical Aspects of Chemical and Biological Warfare See Pralidoxime chloride (2-PAM Cl) p-Aminoheptanoylphenone (PAHP), 280–281 p-Aminooctanoylphenone (PAOP), 281 p-Aminopropiophenone (PAPP), 275, 280–281 viral encephalitides infection through, 571–572 Operation Cut Holes and Sink ‘Em (CHASE), 62–64 Operation Desert Shield, Operation Desert Storm Partial pressure of carbon dioxide (PCO2), 253, 264 Partial pressure of oxygen (PO2), 252, 278 Passive hemagglutination assays (PHAs), 497 Patient decontamination, 329, 331–335, 340–341, 352, 386–387, See Organophosphorus ester–induced delayed neurotoxic- Patient-isolation procedures, 432–433, 497, 547, 598 See Protection Assessment Test System (PATS) Organophosphorus compounds, 130, 132, 231, 233–234 See Polymerase chain reaction (PCR) See also Nerve agents; specific agent See Portable Decontamination Apparatus (PDA) Organophosphorus ester–induced delayed neurotoxicity See Power-Driven Decontamination Apparatus (PDDA) See Positive end-expiratory pressure (PEEP) biological agent delivery via, 420–421, 442 See also Mission-oriented protective posture (MOPP) gear dosage and administration, 163–164, 169 and pyridostigmine pretreatment, 184–187 biological warfare threat during, 2, 6, 72–74, 416, 421, 438, See also 2-Pralidoxime chloride (2-PAM Cl); specific drug Oxygen supplementation, 253, 255, 257, 266, 279 chemical warfare threat during, 2, 6, 72–74, 117, 130–131, medical aftermath of, xvi, 73, 105, 190, 191, 195, 297pyridostigmine pretreatment use during, 185, 188–191 See Poly(ADP-ribose) polymerase (PADPRP) Personal decontamination, 157, 329–330, 352, 408 Personnel decontamination, 352, 386–387 for chemical surety inspection, 401–402 See Staphylococcal enterotoxin B (SEB) See Passive hemagglutination assays (PHAs) history, 10, 16, 32–33, 37, 42, 75, 416–417, 431, 454, 462–463, on U.S. military installations, 483–484 history, 5, 10, 27, 29–30, 36–38, 40, 248 weapons directed against, 44, 51–52, 60, 427–429, 431, 460– World War I use, 16, 19, 21, 91–93, 95, 119 See also Defoliants; specific agent or plant Plaque reduction neutralization (PRN) antibodies, 573 differential diagnosis, 200, 219–220, 638 Pneumonic plague, 454, 489, 491, 494, 497 Poly(ADP-ribose) polymerase (PADPRP), 203 Physical decontamination methods, 354, 358, 363–364, 370 See also specific agent diagnosis for Chemical Personnel Reliability Program, 403–406 Portable Decontamination Apparatus (PDA), 62, 70, 388 as nerve agent pretreatment, 187, 191–192 Positive end-expiratory pressure (PEEP), 253, 257, 259, 266 Positive-pressure total body suits, 432–434 Medical Aspects of Chemical and Biological Warfare Power-Driven Decontamination Apparatus (PDDA), 388 of wearing mission-oriented protective posture gear, 362, 2-Pralidoxime chloride (2-PAM Cl), 149, 162–165 dosage and administration, 163–165, 169 and endurance time in protective gear, 394 and nerve agent cardiovascular effects, 156 and nerve agent–induced seizures, 154–155 and pyridostigmine pretreatment, 184–187 biological warfare testing involving, 428–429 for Chemical Personnel Reliability Program, 403–404, 406 of mustard, 211–212, 215–217, 237–238 of nerve agents, 145, 147–149, 167–168, 170 See Plaque reduction neutralization (PRN) antibodies of riot control agents, 311–312, 315–316, 321 of staphylococcal enterotoxin B, 624–627 of toxic inhalational injury, 253, 256, 258–259, 265–266, 343 Pulmonary toxicants, 118–119, 247–267 See also Inhalational injury; specific agent Protection Assessment Test System (PATS), 365–366 See 2-Pralidoxime chloride (2-PAM Cl) See 2-Pralidoxime chloride (2-PAM Cl) dosage and administration, 187–188, 191 See also Chemical defense equipment; Masks; Mission- oriented protective posture (MOPP) gear; specific item and nerve agent cardiovascular effects, 156 and nerve agent–induced pulmonary effects, 158 and nerve agent–induced seizures, 154–155, 165 as nerve agent pretreatment, 134, 149, 154–156, 158, 165, See 2-Pralidoxime chloride (2-PAM Cl) See Methanesulfonate salt of pralidoxime (P2S) See Staphylococcal enterotoxin B; specific toxin Reverse transcriptase polymerase chain reaction (RT-PCR), See Quick Doff Hood/Second Skin (QDH/SS) See Richardson, Flory, and Kops (RFK) mask Ribosomal ribonucleic acid (rRNA) analysis, 504, 525 Richardson, Flory, and Kops (RFK) mask, 22 See BZ (3-Quinuclidinyl benzilate) See BZ (3-Quinuclidinyl benzilate) clinical manifestations and pathology, 635–637detection, 383 history, 10, 420–421, 446, 463–464, 632–633 See Erythrocyte cholinesterase (RBC-ChE) RDIC (resuscitation device, individual, chemical), 159, 169 Receptor-mediated endocytosis (RME), 648–649 Remote sensing capability, 53–54, 74, 380–381, 447–448 Rift Valley fever (RVF), 434, 444, 593, 595–596, 599 Remote Sensing Chemical Agent Alarm (RSCAAL) Rift Valley fever (RVF) virus, 593, 595, 599 Riot control agents, 118–119, 292, 307–322 depth and frequency of, and toxic inhalational injury, 250, severe medical complications from, 317–318 Medical Aspects of Chemical and Biological Warfare See also Tear agents; specific agent See Receptor-mediated endocytosis (RME) Schäfer method of assisted ventilation, 159 Rocky Mountain Arsenal, Denver, Colorado, 460–461 that harbor plague, 480–482, 486–488, 498 that harbor viral hemorrhagic fevers, 592–594, 596 Roosevelt, Franklin D., 36, 43–44, 125, 426–427 See Simplified Collective Protective Equipment (SCPE) for Chemical Personnel Reliability Program, 399–404 See Remote Sensing Chemical Agent Alarm (RSCAAL) See Sodium dodecyl sulfate (SDS) polyacrylamide gel biological warfare programs, 420, 422, 453, 455, 679 chemical warfare capability, 75, 115–116, 218, 679 See Staphylococcal enterotoxin A (SEA) of surplus chemical agents, 45–46, 62–64 See Staphylococcal enterotoxin B (SEB) with biological agent–exposed patients, 433 See Staphylococcal enterotoxin D (SED) See Staphylococcal enterotoxin E (SEE) Self-decontamination, 157, 329–330, 352, 408 electroencephalographic (EEG) effects, 153, 236 history, 30, 36, 46, 49–50, 58–59, 63–64, 66, 103, 130–131 long-term health effects, 154, 232, 235–236 nations with capability for use, 114–115 Serratia marcescens, 32, 428–429 and pyridostigmine pretreatment, 184–186 recent use in Japan, 4, 75, 113, 118, 131, 169, 274, 342, 438, long-term health effects, 153–154, 232, 235 nations with capability for use, 114, 116 Simplified Collective Protective Equipment (SCPE), 385–386 Skin decontamination, 157–158, 333, 335, 352–353, 356, 386– See Standing operating procedures (SOPs) trichothecene mycotoxin use, 419, 421, 609, 657–658 Small-box respirator (SBR), 18, 91, 93–94, 364, 393 Soviet Institute of Microbiology and Virology, 420 Soviet PKhR-RM Chemical Agent Detector Kit for Medical chemoprophylaxis and chemotherapy, 552–553 biological warfare program, 4, 29, 55, 67–68, 418, 429, 452– chemical warfare program, 47, 54–55, 67–68, 72, 104, 114– See Streptococcal pyrogenic exotoxins (SPE) See Streptococcal enterotoxin A (SPE-A) See Streptococcal enterotoxin C (SPE-C) See also Variola virus; Vaccinia vaccines and cyanide poisoning, 273–274, 280, 282 SS John Harvey, 40, 103–104, 200 decontamination with, 353–354, 357–358, 388, 616, 669–670 Standing operating procedures (SOPs), 401, 407–408 Standoff detection, 53–54, 74, 380–381, 447–448 Sodium dodecyl sulfate (SDS) polyacrylamide gel electro- Staphylococcal enterotoxin A (SEA), 622–623 Staphylococcal enterotoxin B (SEB), 621–628 differential diagnosis, 473, 613–614, 638 Medical Aspects of Chemical and Biological Warfare Staphylococcal enterotoxin C1 (SEC1), 622 Staphylococcal enterotoxin C2 (SEC2), 622 Staphylococcal enterotoxin C3 (SEC3), 622 Staphylococcal enterotoxin D (SED), 622–623 Staphylococcal enterotoxins, 5, 622–623 Staphylococcus aureus, 622–623, 626 and pyridostigmine pretreatment, 184–186 Tactical Biological Standoff Detection System, 448 See Toxicological agent protective (TAP) ensemble for riot control agent exposure, 320–321 for toxic inhalational injury, 253, 257, 264, 266 history, 11, 13, 35–36, 56, 90, 104–105 See also Riot control agents; specific agent Strategic Biological Standoff Detection System, 448 Streptococcal enterotoxin A (SPE-A), 622–623 and protective gear use, 125, 329–330, 367, 370–371, 394, Streptococcal enterotoxin C (SPE-C), 622–623 TEMPER (tent, extendable, modular, personnel) system, 384
Streptococcal pyrogenic exotoxins (SPE), 622–623 See Tetraethyl pyrophosphate (TEPP) and biological weapons, 117–118, 422, 438, 446–447, 461, Tetracycline, 473, 497–498, 507, 531–532 Sulfur trioxide-chlorosulfonic acid (FS smoke), 262–263 Super tropical bleach (STB), 54, 388, 408 Sverdlovsk accident, 4, 68, 420, 452–453, 468 biological weapons programs, 456–458, 461, 678–679 See N,N’-Trimethylenebis-[pyridine-4-aldoxime bromide] chemical warfare, 48, 55–56, 71–72, 94, 124 as biological agent vector, 504, 525, 528, 593–594, 596 See Thin-layer chromatography (TLC) See N,N’-Trimethylenebis-[pyridine-4-aldoxime bromide] chemical weapons, 4, 13, 72, 75, 104–105, 113, 115, 117, 411 See Triorthocresyl phosphate (TOCP) Tooele demilitarization plant (Utah), 72, 411 Triage categories, 331, 334, 339–341, 344–347 Toxic Chemical Training for Medical Support Personnel Toxicological agent protective (TAP) ensemble, 404 Toxic shock syndrome toxin-1 (TSST-1), 622–623, 627–628 mechanisms of action, 608–611, 648–649 water purification methods effective against, 617–618 See also Biological agents; specific agent use in Southeast Asia, 419, 421, 609, 657–660, 665–666, 668 Medical Aspects of Chemical and Biological Warfare Trimethoprim/sulfamethoxazole, 498, 518, 531 N,N’-Trimethylenebis-[pyridine-4-aldoxime bromide] biological warfare and defense programs, 425–435, 455, See Chemical Warfare Service (CWS); Chemical Corps chemical warfare policies, 29, 36, 44–45, 48, 56, 63, 72, 75, See Toxic shock syndrome toxin-1 (TSST-1) See also Continental United States (CONUS) United Nations Special Commission (UNSCOM) U.S. Army Chemical Research and Development Center, U.S. Army Medical Department (AMEDD), 328, 428 U.S. Army Medical Research Institute of Chemical Defense U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 431–434, 596, 599, 616, 623, 651 See also U.S. Army Medical Research Institute of Infectious U.S. House of Representatives Committee on Armed Services, Special Inquiry Into the Chemical and Biological Threat, U.S. Senate Committee on Governmental Affairs, 114 See U.S. Army Medical Research Institute of Chemical See also Francisella tularensis See U.S. Army Medical Research Institute of Infectious for animals, 434, 460, 464, 568, 576, 578 biological agent, 60–61, 73, 434, 441, 460, 462, 681–683 biological warfare programs, 32, 418–419, 427, 455, 645 See also specific agent or vaccine chemical/biological weapons reports/inspections, 63, 104– and Iraqi chemical weapons program, 69, 73–74, 114, 201, Vaccinia-immune globulin (VIG), 550–552 United Nations Special Commission (UNSCOM), 421, 463, 679 See Viral hemorrhagic fever (VHF) syndrome Vickers Medical Containment Stretcher Transit Isolator, 432 off-gassing from contaminated wounds, 356 adaptation of biological warfare during, 419 defoliant use during, 56, 62, 104–105, 297 riot control agent during, 56, 62, 104–105 See Vaccinia-immune globulin (VIG) for bacterial agent dispersal, 33, 37, 50 alphavirus structure and replication, 569–570 See also specific vector or agent See Venezuelan equine encephalitis (VEE) See 2,4-Dichlorophenoxyacetic acid (VKA) Venezuelan equine encephalitis (VEE) virus, 5, 562–564 isolation and containment procedures, 598 nosocomial transmission, 592–593, 595–596 Trinidad donkey (TrD) strain, 571, 577–578 Venezuelan equine encephalitis (VEE) virus complex, 564–566 Viral hemorrhagic fever (VHF) syndrome, 592 See also Biological agents; specific agent for nerve agent–exposed patients, 148, 158–159, 166–169 for toxic inhalational injury, 252–253, 257, 259, 266 See 2,4-Dichlorophenoxyacetic acid (VKA) relation of cholinesterase activity to, 139 Medical Aspects of Chemical and Biological Warfare Western equine encephalitis (WEE) virus, 562–564 Western equine encephalitis (WEE) virus complex, 565–567 and blood cholinesterase activity, 138–139 Wet bulb globe thermometer (WBGT) index, 329–330, 407 Whole-body-protection equipment items, 375 nations with capability for use, 114–116 and pyridostigmine pretreatment, 184–186 heat categories and, 329–330, 371, 403, 405 World Health Organization, 419, 443, 456, 540, 542–543 World Trade Center bombing (New York), 446World War I, 5, 13–25, 90–97 Allied chemical warfare program, 13–16, 93–94 biological warfare programs, 16, 21–22, 90–97, 417, 446, Walter Reed Army Medical Center, Washington, D. C., 432, chemical casualties, 6, 24, 91–92, 100–101, 200, 205 See Alarms; Detection; specific detector War Research Service (WRS), 43, 426–427 gas casualty treatments, 23–24, 95–101 mustard use during, 16, 19–24, 95–101, 119, 198, 200–201, protective devices, 15–18, 22, 91–94, 363–364, 393 riot control agent use during, 309–310, 320 decontamination with, 158, 353–354, 357–358, 388, 616, toxic inhalational injury during, 248, 254–260, 343 and protective gear use, 370–371, 406–407 biological warfare programs, 36–37, 42–44, 103–104, 417– 419, 426–427, 446, 483–485, 540, 632, 644–645 Water supply contamination, 442, 446, 459 chemical warfare preparations, 37–40, 125, 131, 200, 290 demilitarization of captured weapons after, 45–46 protective devices, 37, 40–43, 103, 365, 394 See Wet bulb globe thermometer (WBGT) index Weapons disposal programs, 45–46, 62–64, 72, 411–412, 431, Wound decontamination, 352, 355–357, 387 and protective gear use, 125, 329–330, 367, 370–371, 394, in casualties with combined injuries, 340, 347–348 outer-membrane proteins (Yops), 485–486, 491staining for, 495–496 virulence factors, 485–486See also Plague Xenopsylla cheopis, 482–483, 486–487 Yersinia pseudotuberculosis, 482, 485 Ypres, Belgium, 14–15, 90, 200, 248, 308 Yellow rain, 419, 421, 609, 656–660, 665–666, 668 Yeltsin, Boris, 4, 68, 420, 422, 453–455 Yersinia pestis, 75, 463, 482, 485–486, 491

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