ANESTHESIOLOGISTS IN THE MANAGEMENT OF CASUALTIES FROM CHEMICAL AND BIOLOGICAL WARFARE AGENTS

Approaches to Management of Chemical and Biological Warfare Incidents

Anesthesiologists may be confronted with the management of victims from the deliberate or accidental release of CBW hazards. It is important to have a system of management that allows for the safety of the medical responders and provides the correct treatment for the patient. Given the risks associated with CBW release, management should be considered in terms of management of the incident and management of the patient's condition. In terms of the four properties of agents in the CBW spectrum (see "Agents of Chemical and Biological Warfare: Background and Development"), management of the incident is determined by persistency and transmissibility, and management of the patient's condition is determined by toxicity and latency.

Many chemical hazards have very limited persistency, and decontamination is not required. Limited persistency means reduced risk of contact transmission to other persons. However, certain chemical agents have long persistency and high transmissibility. Many such agents do not pose a significant threat by inhalation but may be absorbed through the epithelia (e.g., the nerve agent VX). For such agents, careful decontamination is essential.

Most classic biological warfare agents have low persistency because they are rapidly degraded by the environment, and they depend on host transmission by means of an incubation period. In such cases, transmissibility is high. Anthrax is a notable exception; its spores have very long persistency but no infective transmissibility. At the other extreme, the viral hemorrhagic fevers have very short persistency but high infective transmissibility.