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INTRODUCTION

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Chemical, biological, radiological, nuclear, and explosive (CBRNE) agents present a growing threat to businesses and communities around the world. Occupational health professionals are in the unique position to contribute to the overall preparedness strategy. The attributes that the occupational health professional brings to this challenge include

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  • Expertise in toxicology, infectious disease, and physical trauma

  • Training in epidemiology and emergency response

  • Experience in health and safety program planning and training

  • Familiarity with outreach to businesses and medical facilities

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The 2010 United States National Security Strategy stated that there is no greater danger to the nation than a terrorist attack with a weapon of mass destruction. The real nature of these threats was recently highlighted with the mailing of ricin toxin to the White House and the bombings in Boston in 2013. The Bacillus anthracis attacks of 2001 and the release of sarin gas in a Tokyo subway demonstrated the tremendous direct and indirect impact these events can have on communities, the workplace, and the health care system.

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Current national security efforts include planning and exercises, research and development, and educational outreach. Professionals from diverse backgrounds working in public and private partnerships have come together to address the CBRNE threat. What had been an area limited to specialized military units has evolved to include first responders, police, firefighters, emergency medical services, hazardous materials (Hazmat) response units, and bomb squads. Preparation for potential bioterrorist acts shares much in common with preparation for natural occurring pandemics from influenza or other novel viral threats, like the SARS virus in 2004. Ultimately, a coordinated, methodical approach will result in the nations being prepared to recognize, respond, and contain a terrorist event.

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CHEMICAL AGENTS

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Chemical weapons were used during World War I leading to extensive morbidity. The agents consisted primarily of chlorine, mustard agent, and phosgene. Nerve agents were developed by Germany during World War II although they were never deployed. In the 1950s and 1960s, both the United States and the former Soviet Union developed large stockpiles of both nerve agents and mustard agents. After signing the Chemical Weapons Convention in 1996, both nations pledged to destroy their arsenals of these compounds. As of 2013, the United States is still in the process of destroying stockpiles and closing arsenals.

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Chemical weapons (nerve agents and mustard) were used in the Iran-Iraq war resulting in over 100,000 casualties. These have also been used by terrorist groups, the most notable being the release of Sarin on a subway in Tokyo by a cult terrorist group. There were 12 casualties and some impacted were medical responders. In addition, over 5000 persons sought care, most having no evidence of exposure or toxicity. The Tokyo event demonstrated the need for preparedness at emergency medical facilities, both to protect themselves from secondary exposure and to be able to effectively triage large numbers of persons presenting after ...

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