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

Medical Aspects of Chemical Warfarerespiratory system quickly recovers from acute exposureto RCAs, but prolonged exposure can predisposethe casualty to secondary infections. Further careshould be as described in Chapter 10, Toxic InhalationalInjury and Toxic Industrial Chemicals.Cardiovascular SystemTransient hypertension and tachycardia have beennoted after exposure to RCAs, primarily because of theanxiety or pain of exposure rather than a pharmacologicaleffect of the compound. 201 Whatever the cause,adverse effects may be seen in individuals with hypertension,cardiovascular disease, or an aneurysm.Laboratory FindingsNo specific laboratory study abnormalities are helpfulin diagnosing RCA exposure. Appropriate tests canbe ordered to guide treatment if respiratory tract or skininfection is suspected. Arterial blood gasses can be orderedif there is a concern about adequate ventilation. 196New Developments and Future UseAs documented throughout this chapter, the military’sinterest in and occasional use of RCAs has notonly kept pace with their development, but in manycases the military has spearheaded the effort. Althoughmost of this historical activity predated the currentregulations guiding research, development, and useof RCAs (ie, prior to the Chemical Weapons Convention),it is probable that this trend will continue intothe future.Recent years have witnessed a fundamental methodologicalshift in biomedical science research. Thetraditional method of identifying biologically activecompounds before determining their application todisease has been replaced, in part, by identifyingbiological targets (ie, protein receptors) first, followedby identifying the chemical compounds capable ofbinding to the targets and altering their function. Theadvancement of microarray, proteomics, toxicogenomics,database mining techniques, and computationalmodeling techniques has greatly accelerated the abilityto identify novel biological targets with desiredphysiological effects. Likewise, high-throughputtechnologies capable of identifying biologically activecompounds such as in-vitro tissue culture systemsintegrated with automated robotics test stations,combinatorial chemistry, and quantitative structureactivity relationship methods have accelerated newdrug discovery. New RCAs are likely to be a productof this research.Neuropharmacology is an area of biomedicalresearch likely to yield future RCAs. The increasedincidence and awareness of neurological disorders inthe general population, such as Alzheimer disease inthe elderly and attention deficit disorders in children,ensure a healthy research base aimed at discoveringbioactive compounds capable of altering cognitivefunctions, perception, mood, emotions, bodily control,and alertness.Although OC and CS, today’s RCAs of choice, arevery safe if deployed appropriately, more research isneeded to illuminate the full health consequences oftheir use. The limited financial resources of the military’schemical defense programs dictate that fundsbe spent on measures to defend against more lethalchemical agents and toxins that could be used byAmerica’s enemies. Law enforcement agencies andmanufacturers also have limited resources to thoroughlyinvestigate the safety of these compounds.Currently, federal resources are more wisely used toprevent disease and address healthcare issues that affectthe population at large.The control of the administration of RCAs might bedifficult to regulate, particularly in the areas and underthe circumstances in which the use of RCAs has apparentlybeen misused (eg, the West Bank and Gaza Strip,and Seoul, South Korea). Despite the concern aboutthe occasional loss of life of those exposed to RCAsor the occasional injury among innocent bystanders,there is serious doubt that a prohibition of the use ofRCAs would be effective. Although in some instancesdialogue and negotiation should precede the use ofRCAs, these agents have proved effective in curbingdamage to property and persons in threatening situations.Although RCAs sometimes cause permanentinjury or death, especially when used in enclosedspaces or against those with existing cardiopulmonarycompromise, in most situations the amount of injuryis small compared to what might have happened ifmore extreme measures (physical or lethal force) hadbeen used.SUMMARYRCAs are intended to harass or to cause temporaryincapacitation. The intended target might be rioters ina civil disturbance, or if approved by the president ofthe United States, the military in an armed conflict.Although developed to have a high margin of safety,RCAs can cause injury or death when used in spaces472