Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical WarfareAlthough military strategists might view chemicalwarfare agents as simply one means to immobilize ordestroy an enemy force, others may view such weaponsas abhorrent extensions of conventional warfare.Current US policy prohibits using chemical weaponsagainst an adversary, but this policy is not shared byall other nations; therefore, to be effective, militarymedical personnel must be knowledgeable, trained,and prepared. Although healthcare providers are usuallynot involved in the political or military decisionssurrounding the use of chemical weapons, they mustbe ready to deal with the military and civilian casualtiesresulting from the use of such agents, cognizantof what constitutes a chemical threat and the militarytactics that could be employed against them, familiarwith the acute and chronic medical effects of chemicalagents to plan appropriate medical support, knowledgeableof the diagnostic tools available to identifyspecific etiologic agents to which their patients mayhave been exposed, and aware of the most effectivemethods of intervention and prevention.From the standpoint of military strategy, two reasonsare commonly cited for a combatant to employchemical weapons. First, chemical weapons can behighly effective when densely applied onto concentrated,largely immobile forces or populations. This factorlargely accounted for their use against entrenchedtroop positions during World War I. During the ColdWar, military strategists anticipated similar intensechemical warfare bombardments from Warsaw Pactforces in the European theater. The second reason oftenused to support chemical weapon use is that chemicalattacks can be initiated at lower levels to encumber anopponent with defensive equipment or to create panicand disorder among poorly trained or unpreparedtroops. Application onto enemy troops or civilianpopulations can also have a strong demoralizing effect.Therefore, the United States military must maintain astrong readiness posture in the face of a continuingchemical warfare threat.SummaryThe military healthcare provider must be preparedto recognize military or civilian casualties of chemicalwarfare or terrorism, which requires an informedunderstanding of the historically based likelihood ofchemical warfare agent use or threat. Providers mustbe able to clearly recognize agent-exposure symptomsagainst a varying background of typical injury andchemical exposure stress behaviors. Providers mustalso be informed, to the fullest extent possible, aboutanticipated chemical attacks by hostile forces or terroristactivities. This intelligence requires consideration of anadversary’s political factors and motivation, chemicalagent or toxicant possession or access, chemical warfareoffensive and defensive capabilities, and any strategicadvantage to be realized through agent use. As ahealthcare provider manages individuals suspected tohave been exposed to chemical warfare agents, initialrecognition of the type of agent used may be facilitatedthrough an understanding of tactics, modes of agentdissemination, likely routes of casualty exposure, physicalagent properties, and other factors determining thepersistence of these toxicants in the environment.References1. Sartori M. The War Gases. New York, NY: D Van Nostrand Company, Inc; 1943.2. Prentiss A. Chemicals in War: a Treatise on Chemical Warfare. New York, NY: McGraw-Hill Book Company, Inc; 1937.3. Haber LF. The Poisonous Cloud: Chemical Warfare in the First World War. Oxford, England: Clarendon Press; 1986:15–40.4. Fries AA, West CJ. Chemical Warfare. New York, NY: McGraw-Hill Book Company Inc; 1921: 53–59.5. Brophy LP, Miles WD, Cochrane RC. The Chemical Warfare Service: from Laboratory to Field. Washington, DC: Office ofthe Chief of Military History; 1959.6. Stockholm International Peace Research Institute. The Problem of Chemical and Biological Warfare. New York, NY: HumanitiesPress; 1971.7. Fair SD. Mussolini’s chemical war. Army. 1985;35(1):47.8. Foreign developments in chemical warfare. Chemical Warfare. 1923;9(9):19.146