Terrorism and Weapons of Mass Destruction (WMD) Impacting Occupational Safety and Health

Please select one of the following for more information concerning other occupational safety health issues which have not be covered by other individual Web pages. 
Also go to   Emergency Management Strategic Healthcare Group (EMSHG). 

Department of Veterans Affairs - FY 2005 Annual Performance and Accountability Report -  see page 35 . 

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Department of Veterans Affairs	OSHA, CDC, and Others
OSHA: OSHA Best Practices For Hospital-Based First Receivers Of Victims From Mass Casualty Incidents Involving The Release Of Hazardous Substances   - December 21, 2004: Comments Docket       Number GE2004-1	White House: White House Directive - December 17, 2003:   The term "first responder" refers to those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence, and the environment, including emergency response providers as defined in section 2 of the Homeland Security Act of 2002 (6 U.S.C. 101), as well as emergency management, public health, clinical care, public works, and other skilled support personnel (such as equipment operators) that provide immediate support services during prevention, response, and recovery operations. Presidential Order (E.O.) Establishes Interagency Coordinating Council for Emergency Preparedness and Individuals with Disabilities
Veterans Health Administration: Smallpox:   http://vaww.va.gov/smallpox   VHA Directive 2002-033 Steps Required to establish a Practical Medical Center Emergency Mass-Casualty Decon Capability VHA DIRECTIVE 0320  - VHA's fourth mission, emergency medical preparedness VHA Directive establishes policy concerning the establishment of a Disaster Notification of Selection for VA's Mass-Casualty Decontamination Program - February 3, 2003:   Staff nominated for training should be medically cleared to use level C PPE by their Occupational Health Unit, according to OSHA Respiratory Protection Standard 29 CFR 1910.134. Statement of The Honorable Robert H. Roswell, M.D. before congress April 10, 2003:   An inaugural VA  Decontamination Training Course was held March10- 14, 2003 in Reno, Nevada <intranet>Estimated Staffing (in PPE) for Hospital Emergency Decontamination (based on 6 hours)</< A> intranet>	Proposed Airborne Exposure Limits for Chemical Warfare Agents H, HD, and HT (Sulfur Mustard). Federal Register July 22, 2003 (Volume 68, Number 140)]  -- CDC proposes that 0.003 mg/m\3\, becomes a 5-minute Ceiling limit value (CEILING-5M); and 0.0001 mg/m\3\, becomes a 12-hour TWA (GPL-12) and it is adjusted to 0.00002 mg/m\3\ to meet carcinogenicity protection levels below thresholds of significant risk.  Federal Register Search
PPE Levels A to D  - slides and explanation.  NIOSH Respirator Certification Status for Use by Emergency Responders in Chemical, Biological, Radiological, and Nuclear (CBRN)Environments:    Level A and B Self-Contained Breathing Apparatus - Certified by NIOSH Air-Line Respirator standard under development. Level C PAPR - Certification standard under development -  Last Updated Concept Paper was March 2005 - For tight fitting full face respirators only.  "Examples of use scenarios: sustained support operations; long-term use for decontamination, traffic control, rehabilitation, rescue and recovery; agent known, quantified, and controlled." APR - Air Purifying Respirators Certified by NIOSH  NIOSH Certification of Protective Clothing Cooling Systems Respirator Technologies: Closed Circuit  - A combination of supplied air and filter CO2 scriber.      PAPR Technical Advancements: Designed for continuous self-diagnostics with Instant user alerts in case of pressure-drop, motor malfunction, low batteries etc.     Can be programmed to alert user when filters need changing.   Usage information: Entire usage history of the respirator recorded and time-stamped. Can be downloaded to PC for documentation.    Designed to pressurize protective suits.	DEPARTMENT OF DEFENSE: Edgewood Chemical Biological Center - Homeland Defense Testing team and the Improved Response Program have produced valuable reports addressing the needs of first responders in the several different areas to include mass causality decontamination, protective equipment, equipment suitability, and response templates. USACHPPM - Technical Guide provides PPE guidance to Army Medical Department Military Medical Treatment Facility Personnel Handling WMD casualties at their fixed facilities.    Note pages 48 to 50 - "...Level B may be ideal..." - "...Level C may be sufficiently protective ...".  A basis for these conclusions is not provided.  Authors use "intuitive" judgment.                     Defense Logistics Agency recalls respirators (Navy ND Mark V gas masks) "not suitable or effective" not approved by NIOSH for non-military personnel. Military MOPP Gear - Mission Oriented Protective Posture (5 levels, i.e., 0 to 4 - level 3 adds respirator)   Technical Characteristics - gulf war  SBCCOM/SCEBD-EN:   Tests of Level A (1998) and Level B (1999) Protection Against CBNR agents. Chemical Stockpile Emergency Preparedness Program (SCEPP)  - Off-Post Monitoring Page 19 - "  ...in 1995 and 1996 OSHA stated that the PAPRs may be used in a CSEPP response with proper emergency response plans, adequate monitoring equipment, and respiratory maintenance procedures, when IDLH (immediately Dangerous to Life and Health) levels are not exceeded and a "Buddy System" is in effect." Chemical and Biological Systems Technology Navy Occupational Safety and Health Program Manual - Supplied air respirators shall be used "when the contaminate has insufficient order, test or irritating properties, or..." contains medical questionnaire for respirator use. Guidelines for Use of Personal protective Equipment by Law Enforcement Personnel During A Terrorist Chemical Agent Incident :  Page 6 - Level C is adequate for Officers working on the perimeter of the Warm Zone - not in the Hot Zone.     Management of Patients with Potiential Exposure to Anthrax Spores
	Office of Personnel Management (OPM): Federal Manager's/Decision Makers Emergency Guide - “shelter-in-place” for a short time (officials expect this time would not exceed a few hours due to the availability of trained local responders and emergency services).                     A Federal Employee's Emergency Guide - Each agency will "determine the risks faced by its employees, develop a comprehensive strategy and assess the benefits provided by any protective equipment."                       No Differential Pay for mailroom employee - anthrax.                            A Manager's Guide: Traumatic Incidents at the Workplace
7-minute   ER decontamination and personal protective equipment web video (must have real-player or equivalent - free download - May need to contact your ADP person to allow download).  This product was produced via the EMSHG but is found in many libraries, e.g. National Library of Medicine - Washington D.C.   -- NOTE:  Video takes 2 minutes to download. Disaster Nomenclature - What is it  ?	Office of Workers' Compensation Programs (OWCP): OWCP Guidance on Filing for Workplace Anthrax Exposure - Antibiotic therapy offered to employees is generally of a prophylactic nature rather than treatment of an established injury and thus not covered by WC. Treatment of a reaction to a vaccine is covered if the vaccine/therapy is provided by the agency and probably covered if encouraged by  the agency.      Administering a post-exposure hepatitis B vaccine booster is considered medical treatment.
DASHO Conference Call October 23, 2001  DASHO Conference Call July 25, 2000	CDC (Centers for Disease Control and Prevention:  Interim Guidelines for Hospital Response to Mass Casualties from a radiological incident   - December 2003:  Includes contamination containment, PPE (N95 respirator recommended if there is a respiratory hazard), and decontamination    Recognition of Illness Associated With Exposure to Chemical Agents - October 3, 2003:   A covert release of a chemical agent might not be identified easily for at least five reasons.  Clues to suggest a release.                       CDC Recommendations for Civilian Communities Near Chemical Weapons Depots: Guidelines for Medical Preparedness  - "Hospital personnel should follow Environmental Protection Agency (EPA) and National Institute for Occupational Safety and Health (NIOSH) guidelines when managing patients exposed to unknown chemicals."                               CDC Respiratory Protection Program Manual  For People Who Process, Sort, and Deliver the Mail      CDC Bioterrorism Update: Smallpox Preparedness     Smallpox: What Every Clinician Should Know -- A Self-Study Course                    List of WDM Agents                       Information/Exposure Management/Treatment  Training                   Protecting Building Environments from Airborne Chemical, Biological, or Radiological Attacks                   USPHS/FOH Protocol for Taking Surface Wipe Samples  - Screening for the presence of anthrax bacteria in non-threat areas                    Lab Protocols                         Mailrooms and Mail-handlers                   11/2/01 - Investigation of Bioterrorism-Related Anthrax and Interim Guidelines of Clinical Evaluation of Persons with Possible anthrax      11/7/01 - Protecting Investigators Performing Environmental Sampling for Bacillus anthraces: Personal Protective Equipment                    Latest news from CDC concerning biological hazards.                   NIOSH POCKET GUIDE TO CHEMICAL HAZARDS (NPG)                    Bioterrorism Preparedness and  Response      Field Testing for Anthrax - example of a  kit to determine if additional tests are need.                      There is no screening test for anthrax                   Components of the National Pharmaceutical Stockpile                     Bioterrorism Readiness Plan: A Template for Healthcare Facilities
VA Subcommittee on PPE and Decontamination Materials	TITLE 42 - THE PUBLIC HEALTH AND WELFARE - CHAPTER 6A - PUBLIC HEALTH SERVICE - SUBCHAPTER II - GENERAL POWERS AND DUTIES - Part G - Quarantine and Inspection  - "Apprehension, detention, or conditional release of individuals ... may be specified from time to time in Executive orders of the President."
VA Emergency Management Strategic Healthcare Group	NFPA -  News Rlease for Protective Ensembles for Chemical/Biological Terrorism Incidents.  NFPA 1994 breaks protection down into classes:   Class 1 (most protective) - agent unknown      Class 2 (victims are not ambulatory) - direct contact with agent probable.          Class 3 (victims are ambulatory) - direct contact with agent possible. Slide presentation  - NIOSH presentation concerning updating NFPA 1994.                    "Recommended practice for responding to hazardous materials" NFPA 471 5-2.3 Air Purifying respirators (use only when type and quantity of contaminate is known).  Add good warning properties.                     Hazard Analysis Check MSDS - Caution should be used in the use of bleach for disinfections to avoid reaction with other materials.  NOTE: To find other MSDS sites, please scroll down to the "Material Safety Data Sheets" section on this page .
	Department of Homeland Security:  On Feb. 26, 2004, DHS adopts, as DHS standards , three NIOSH criteria for testing and certifying respirators for protection against chemical, biological, radiological, and nuclear (CBRN) exposures. U.S. DEPARTMENT OF HOMELAND SECURITY ISSUES FIRST STANDARDS FOR - PERSONAL PROTECTIVE EQUIPMENT FOR FIRST RESPONDERS Regulations Implementing the Support Anti-terrorism by Fostering Effective Technologies Act of 2002 (the SAFETY Act)  - Provides "liability protection for Sellers of 'qualified antiterrorism technologies." Report - Working Group on Radiological Dispersal Device (RDD) Preparedness – Medical Preparedness and Response Sub-Group  --(page 5) - "Medical Guidelines – Radiological Protection for First Responders and First Contact Medical Personnel" – Level C is “general sufficient for particulates” ...”If chemical agents are suspected, level B or higher protection is required.
Information from:   International Association for Healthcare Security & Safety (IAHSS). www.iahss.org	Department of Health and Human Services (HHS): National Bioterrorism Hospital Preparedness Program - CBRNE   Filtration, Air-Cleaning Systems to Guard Building Environments from CBRN attacks         Health Care Financing Administration:  Under the Emergency Medical Treatment and Labor Act (EMTALA).  There may be situations where referral of a potentially exposed patient prior  to the actual examination is appropriate.        HHS recommends against use by first responders of hand-held assays to evaluate and respond to an incident involving unknown powders suspected to be anthrax or other biological agents.
VHA Decontamination Planning and Implementation	Presidential Directive 39
DEPARTMENT OF VETERANS AFFAIRS EMERGENCY PREPAREDNESS ACT OF 2002 --- Public Law 107-287	Combating Terrorism PDD 62
Legal Authorities of the Veterans Health Administration Emergency Management Program This includes the Summary of Agency  Directives and Handbooks	Berkeley Laboratory:  Advice for Safeguarding Buildings Against Chemical or Biological Attack
Frank Denny (00S1) Notes On NIOSH/NIST/SBCCOM Meetings NIOSH Public Meeting  - National Institute for Occupational Safety and Health Public Meeting to be held on December 13, 2005, to Continue Discussions of Concepts for Standards for Approval of Respirators for Use Against Chemical, Biological, Radiological, and Nuclear Agents (CBRN) and Concepts for Standards for a Multi-Function Powered, Air-Purifying Respirator (PAPR).   High flow PAPRs as part of the final standard is likely and retrofited loose fitting respirators lower priority. July 2005 - Agenda Concept for CBRN Powered Air Purifying Respirator (PAPR) Standard  -   This is for full-face PAPRs and addresses PAPRs for high air breathing volume performance (3 of 4 PAPRs tested could not meet high air breathing volume specifications).  Normal volume is 40 LPM, high is 88 LPM, and Peak is 103 LPM for 10 minutes.  3M Presentation at AIHA conference concerning" Mean and Maximum Peak Inspiratory Flow Values and Durations in Normal Adults Exercising at Light, Moderate, and Heavy Workloads " October 2002 June 2002	Occupational Safety and Health Administration  (OSHA): OSHA's Emergency Preparedness and Response Page Evacuation Plans and Procedures eTool  OSHA's National Emergency Management Plan :  Press Release (2/4/04)   Application of 29 CFR 1910.120, Hazardous Waste Operations and Emergency Response (HAZWOPER), applies to terrorism incident responses.   11/24/03 Smallpox page Bioterrorism OSHA Comments and Position on Anthrax  Anthrax e-tool                        Health care workers are among those that OSHA specifically lists as being at risk for anthrax exposure OSHA Preamble to the Respirator Standard OSHA approval of respirators tested and approved by other Federal agencies for use against unique contaminants.   OSHA has removed the phrase "when they exist" from the final standard. Interpretations:     Application of 29 CFR 1910.120 to a terrorist incident - page  1,  2, and  3:  OSHA and 29 CFR 1910.120 are enforced during cleanup not during a terrorist event.   Hospital Decontamination is covered.                        Skilled Support   - the designated hospital employees who will set up and operate the decontamination facility must have at least first responder operations level training." "are part of an emergency response" "hospital employees who...are part of an emergency response to a release of hazardous substance may be considered skilled support personnel ..."  "Skilled support personnel...must be given ...what chemical hazards are involved..."     OSHA generally relies on the National Institute [for] Occupational Safety and Health (NIOSH)  both for the requirements of the aforementioned standard and for general guidance on respiratory issues.    Pulmonary Function Tests not required    "contaminants have a tendency to migrate through cartridge/canister sorbet material during periods of storage or non-use. "    Chemical Protective Clothing  and equipment - a lower level of protective clothing is used by personnel involved in decontamination.                    Escape Respirators - mouth bit respirator        OSHA Documents     Emergency response training necessary for hospital physicians/nurses that may treat contaminated patients.                    Emergency response training requirements for hospital staff - 1997      Leather gloves are considered personal protective equipment.     Level of personnel protective equipment (PPE) required for medical personnel treating victims. Hazardous Waste Operations and Emergency Response standard and the level of respiratory protection that would be required for a hospital staff member decontaminating a chemically contaminated patient. Publications: Hazardous Waste Operations and Emergency Response       Hospitals and Community Emergency Response -- What You Need to Know      EMERGENCY PREPAREDNESS AND RESPONSE     Principal Emergency Response and Preparedness Requirements in OSHA Standards and Guidance for Safety and Health Programs. -- Publication # 3122 OSHA News: OSHA News Release - December 21, 2004:   The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) today released information to help hospitals safeguard their own employees as they care for patients injured in incidents involving chemical, biological or radiological materials.     OSHA News Release - January 6, 2005:   The Annex provides guidelines for implementing worker safety and health support functions during national incidents, including acts of terrorism, major natural disasters, or man-made emergencies. Citations: Failure to develop and implement an emergency response plan and to train employees required to assist in containment and clean-up.
NEWSLETTER - Developing Critical Incident Stress Management (CISM) Programs for the VA	EPA: National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances (NAC/AEGL Committee)       Interim Recommendations for Cleanup of Commercial and Residential Buildings Following Bacillus anthraces Spore Release.
Emergency Escape Respirators:	National Institute for Occupational Safety and Health (NIOSH):    Certified Equipment List Safety Management in Disaster and Terrorism Response - Protecting Emergency Responders, Volume 3 NIOSH Certifies First Air-Purifying Respirators for Protection Against CBRN Exposures.    "If unknown or high levels of hazardous contaminants are encountered after the APR wearer enters an area, standard practice calls for the wearer to immediately leave the area."      NIOSH announces new computer software that enables administrators of workplace respiratory-protection programs to consider the effects of relative humidity on the service life of NIOSH-approved organic vapor (OV) chemical cartridges.   CD-ROM can be ordered from NIOSH at 1-800-35-NIOSH (1-800-356-4674).       Statement of Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Full Facepiece Air Purifying Respirator (APR) - Note:  Canister Test Challenge and Test Breakthrough Concentrations, flow rate, etc for establishing service life.  This is note for PARR.                   Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents   - "personal protective equipment, including respiratory protection and protective clothing, are based upon the anticipated level of exposure risk associated with different response situations" - levels A to C.                        Chemical and Biological - Respiratory Protection Workshop Report  - The diverse group of emergency responders potentially include: ...private clinics and hospital workers.                    "What you should know in deciding whether to buy escape hoods, gas masks, or other respirators for preparedness at home and work."                      Acceptance of Applications for the Testing and Evaluation of Full-Facepiece Air Purifying Respirators (APR) for Use Against Chemical, Biological, Radiological and Nuclear (CBRN) Agents.   Letter to manufacturers     CBRN APR Cautions and Limitations for Use:NIOSH will immediately begin accepting applications to test and evaluate CBRN SCBA Retrofit Kits.       Draft Standard for Emergency Escape Respirators                   HOW TO DETERMINE IF YOUR SCBA RESPIRATOR IS NIOSH CERTIFIED FOR CBRN ENVIRONMENTS                      Certification Program Support for Respirator Manufacturers -- October 2002     (NOTES)                    July 31, 2002 --  Standards Development Efforts for Full Facepiece Air Purifying Respirators Used (APR) to Protect Emergency Response Workers Against CBRN Agent  -- 108 of the 151 chemicals can be addressed - full face mask. (NOTES)      Publication:  Protecting Emergency Responders - Lessons Learned from Terrorist Attacks:                  Performance and Availability of Personal Protective Equipment A Guide for Evaluating the Performance of Chemical Protective Clothing                    Recommendations for Chemical Protective Clothing
	Manufacturers: Recall of MSN CBRN Canister - Millennium Gas Mask
	JCAHO: Special 24-page issue of Perspectives,   provides guidance to health care organizations in preparing for terrorists attacks that may involve nuclear, biological, and/or chemical incidents. Level B
	Universities: Johns Hopkins Bio-defense Main Page:       Bio-agent fact sheet       Drexel  Main Page (Triage,  morgue,  PPE/Respirators)                  George Washington University  - Disrobing may take significant time.                     Emery University - "Dressed in blue spacesuit-like outfits, each with its own air supply, the 24-member Crawford Long Hospital decontaminate-nation team..."
	Union and Organizations: Emergency Planning for Chemical Spills  - Respirators        Union  files unfair labor practice against the FAA over allegations that the agency declined to negotiate how to convey anthrax safety information.                   Organization:   HAZMAT for Healthcare       OSHA Interpretation  (adobe acrobat file). National Research Council -  Committee on R&D Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents
	FTC Broadens Warnings to Marketers of Bioterrorism Defense Products  Emergency Escape Hood Recall - Story in Wall Street Journal (Wednesday June 12, 2002) Tests found it did not "screen out tear gas and various chemical-warfare agents," such as Sarin.                      Recall of certain 3M Breathe Easy™ PAPR cartridges
	US Army Handbook - Medical Management of Biological Casualties
	2000 Emergency Response Guidebook
	Federal Emergency Management Agency (FEMA): Hospital Response to Radiation Accidents
	National Funeral Directors Association (NFDA) to address disaster situations and specifically, mass fatality incidents - Disaster Mortuary Operational Response Teams
	General Accounting Office Report GAO-03-316 - Better Guidance is Needed to Improve Communication Should Anthrax Contamination Occur in the Future
	American Hospital Association  Overview of Needs Assessment for Hospitals related to mass casualty events.                    South Carolina Hospital Association - Hospital Disaster Preparedness: Meeting a Requirement or Preparing for the Worst?
	STATES: California EMSA  Patient Decontamination Staff Protection and Equipment Required Evidence Collection      Long Island College Hospital (LICH) in Brooklyn  - Staff members can use 20 new positive-pressure medical air hose hookups, which plug right into the hoods of their decontamination suits.                     Fiscal Year 2002 Authorized Equipment Purchase List Texas Bioterrorism
	Congressional Bill H.R. 3253 Department of Veterans Affairs Emergency Preparedness Act of 2002.  The Secretary shall select VAMCs to assist in disasters or emergencies. VAMC will be prepared to protect staff responding or assisting in support of emergency efforts.  Pending resolution in conference, the Senate passed, as amended.
	InterAgency Board (IAB) for Equipment Standardization and Interoperability   Standardization Equipment List 2001
	General Services Administration: Equipment and Products on the GSA schedule are pre-negotiated prices so manufactures cannot sell their products to agencies for more than that price and agencies can buy for less than the negotiated price. GSA Schedule , Level A-D decontamination equipment ( GSA equipment search).  Note:  Other Federal Agencies, e.g., Forestry, have stockpiles of PPE equipment.   GSA walk-in stores   Mail Memorandum from the Office of Science and Technology Policy titled "Purchase of Anthrax Detection Technologies"                    GSA Policy Advisory       Guidelines for Federal Mail Centers in the Washington, DC, Metropolitan Area for Managing Possible Anthrax Contamination Contractors  for environmental testing                      Contractor survey of ability to conduct biological or chemical testing                     Contractors on the Environmental Services Schedule, including detailed information on their specialties                     Irradiated mail - Memo from GSA - 01/21/02 -  Backup Hyperlink
	Federal Bureau of Investigation (FBI):  Has jurisdiction over the investigation and tracking of terrorism in the US.  Terrorism - "...unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives."
	H.R. 5005   "Homeland Security Act of 2002" dated November 19, 2003.
	Department of Justice Office of Justice's Programs, Office of Science and Technology Department of Justice has a training catalog that includes "Hospital Emergency Management: Concepts and Implications of WMD Terrorist Incidents" (page 13).
	National Institute of Justice Guide for the Selection of PPE for Emergency First Responders (Guide 102-00) - Respiratory Protection - PercutaneousGarments - Apperal
	Publication Search -- National Library of Medicine
	Center for Infectious Disease - University of Minnesota
	Office of Science and Technology Policy OSTP advises that federal agencies cease using equipment that test for anthrax.
	Other Countries United Kingdom - "The Decontamination of People Exposed to [CBRN] Substances or Materials" Number of people seeking medical advice will be higher than the number exposed (5 to 1)   The last edition of the Australia List of Designated Hazardous Substances [NOHSC:10005(1999)] is available electronically.
	Consolidated Safety Services, Inc. is currently working with the National Institute for Occupational Safety and Health (NIOSH) The Emergency Responder Safety and Health Database
	Federation of American Scientists - before - Senate 2002 - Healthcare Workers need training to protect themselves
	Consultants: Brickman Associates - OSHA's New Respirator Standard: Implications for Medical Service Providers and Medical Assessments.    DARPA Chemical and Biological Sensors Standards Study
	Oak Ridge National Laboratory - Detection Equipment Oak Ridge Institute for Science and Education - Managing Radiation Emergencies
	Manufacturers' Limitations: Aramsco -  Comsumer Alert - US government neither endorses not approves the use of an safety products for NBC                    Moldex - Biohazard warnings  - Company Advisory on SARS
	American Medical Association (AMA): Bioterrorism: Frequently Asked Questions
	Ricin PPT Presentation   ---   CDC fact page   --  CDC/NIOSH Emergency Response Card (PPE recommendations)
	Manufacturers: CBRN respirator cnaister recalled by MSA -
	President's Disaster Management E-gov Initiative - The site is oriented toward helping users find information and services across a wide range of relevant Disaster Management offerings, as distinct from offering a specific suite of integrated services.
	Books and Publications : Military Medical/NBC Technology   magazine - Tokyo incident sarin gas is attracted to clothing .  Need for a mass spectrograph gas chromograph.                   Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response                       The New England Journal of Medicine     Acute Exposure Guideline Levels for Selected Airborne Chemicals - National Academies Press     Standing Operating Procedures for Developing Acute Exposure Guideline Levels for Hazardous Chemicals (2001) - National Academies Press  Nuclear, Biologic, and Chemical Warfare (NBC) A Handbook for Medical Personnel    Written and Compiled by:  James L. Fishback, Lt. Col., USAFR MC SFS -- 303 Fighter Squadron (AFRES) Whiteman AFB MO 65305-5258                     Publication review of Medical Management of Radiation Accidents                     Annals of Emergency Medicine  - 28:2 August,   1996,129-135 "Report on the 640 Victims of the Tokyo Subway Sarin Attack."  - Hospital 1 3/4 miles from event - 80% of victims self referral - some staff had eye or throat pain, nausea, or meiosis. ooooooooooooooooooooooooooooooooooooo