Disaster Medicine,
Mass Casualties and Warfare
Topics H thru Z

Nuclear, Biological, Chemical Agent Exposure

Medical aspects of warfare, terrorism and disasters. Injuries, death, disability, and emotional stress caused by a catastrophic event, such as a large-scale natural disaster or a terrorist attack. Information on biological and chemical toxins and other agents for military leaders and health-care providers. These are sites with information intended for healthcare provider and includes details about the disease, recommended treatments and specific issues relating to recognizing biological or chemical agent exposure in emergency departments.

Last Updated: 09 November 2004

H

Handbook on the Medical Aspects of NBC Defense Operations FM 8-9 Part III - Chemical

Health Alert Network

Health Resources and Services Administration

Health Service Support in a Nuclear, Biological, and Chemical Environment Tactics, Techniques and Procedures

HEICS - Hospital Emergency Incident Command System Plan Version 3 The Hospital Emergency Incident Command System (HEICS) is an emergency management system which employs a logical management structure, defined responsibilities, clear reporting channels and a common nomenclature to help unify hospitals with other emergency responders. HEICS features a flexible management organizational chart which allows for a customized hospital response to the crisis at hand. There is an organizational chart with forty-nine positions grouped into one of four sections. This all results in an organized division of tasks and a realistic span of control for each manager. This organizational structure provides a platform for common terminology to enhance communication and improve documentation.

HN1 Nitrogen Mustard Emergency Response Card (NIOSH)

HN2 Nitrogen Mustard Emergency Response Card (NIOSH)

HN3 Nitrogen Mustard Emergency Response Card (NIOSH)

Homeland Defense Reducing the consequences of weapons of mass destruction incidents by enhancing the preparedness, protection, and response capabilities of local, state, and federal agencies.

Hospital Preparedness for Mass Casualties by the American Hospital Association with the support of the Office of Emergency Preparedness U.S. Department of Health and Human Services

How to handle Anthrax and other biological agent threats (PDF)

Hydrogen Cyanide Emergency Response Card (NIOSH)

HYPERTOX Provides information in Clinical Toxicology. The site is designed for emergency ward management, undergraduate and postgraduate teaching of clinical toxicology. It includes self test and interactive clinical cases.

I

Incapacitating Agents, 3-quinuclidinyl Benzilate

Incapacitating Agents, Agent 15

Incapacitating Agents, Cannabinoids

Incapacitating Agents, LSD

Incendiary Agents, Magnesium and Thermite

Incendiary Agents, Napalm

Incendiary Agents, White Phosphorus

Inhalational Anthrax - This site provides information about the pathogenesis and imaging of inhalational anthrax. The content represents the combined efforts of the Armed Forces Institute of Pathology and the American Registry of Pathology, Washington DC and INOVA Fairfax Hospital, Fairfax VA.

Injuries and Mass Trauma Events - Information for Health Professionals. CDC, National Center for Injury Prevention and Control

International Nursing Coalition for Mass Casualty Education (INCMCE) - This international coalition consists of organizational representatives of Schools of Nursing, nursing accrediting bodies, nursing specialty organizations and governmental agencies interested in promoting mass casualty education for nurses.

Investigation of Anthrax Associated with Intentional Exposure and Interim Public Health Guidelines, October 2001

Interactions Between Nerve Agent Pretreatment and Drugs Commonly Used in Combat Anesthesia (PDF)

Iraq's Biological Weapons: The Past as Future? (JAMA. 1997;278:418-424)

Irritants: Cs, Cn, Cnc, Ca, Cr, Cnb, PS

J

Johns Hopkins Center for Civilian Biodefense

Journal of the American Medical Association Consensus Statement (JAMA): Anthrax as Biological Weapon

L

Locate Alternate Care Sites During an Emergency - In the aftermath of a bioterrorist event or other public health emergency, hospitals may be overwhelmed by a sudden influx of patients. The alternate care site selection tool is designed to allow regional planners to locate and rank potential alternative sites-stadiums, schools, recreation centers, motels, and other venues based on whether they have adequate ventilation, plumbing, food supply and kitchen facilities, and other factors.

Lung-Damaging Agents, Chlorine

Lung-damaging Agents, Chloropicrin

Lung-damaging Agents, Diphosgene

Lung-damaging Agents, Phosgene

Lung-damaging Agents, Toxic Smokes: Nox, Hc, Rp, Fs, Fm, Sgf2, Teflon

M

Managing Hazardous Material Incidents - Recommendations for prehospital and hospital management. Three volume online set (with a video available by mail) comprises recommendations for on-scene (prehospital) and hospital medical management of patients exposed during a hazardous materials incident. From Agency for Toxic Substances and Disease Registry.

Mass Trauma Casualty Predictor - In the confusion that often follows a mass trauma event, managing a hospital can be challenging. Past mass trauma events show patterns of hospital use. It is possible to estimate initial casualty volume and pattern after a mass trauma event. Public health professionals and hospital administrators can use this information to handle resource and staffing issues during a mass trauma event. CDC, National Center for Injury Prevention and Control

Medical Management of Biological Casualties: Anthrax

Medical Management of Biological Casualties U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, & Hosted by the Nuclear Biological and Chemical Medical (NBC-Med) Information Server Multimedia Course (Text & Images). For more information see Education; U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) or the Nuclear Biological and Chemical Medical (NBC-Med) Information Server

Medical Management of Chemical and Biological Casualties Course:  Field Training Exercise Instructor's Guide

Medical Management of Chemical Casualties Handbook (Third Edition) - United States Army Medical Research Insttitute of Chemical Defense, Department of the Army, Department of Defense For more information see Chemical Casualty Care Division; United States Army Medical Research Institute of Chemical Defense or the U.S. Army Medical Research and Materiel Command

Medication Administration, MARK I Nerve Agent Antidote Kit

MedWeb: Biomedical Internet Resources Emory University Health Sciences Center Library's list of links and resources for the biomedical industry.

Microbes.info - A microbiology information portal containing a vast collection of resources including articles, news, frequently asked questions, and links pertaining to the field of microbiology.

Mustard Gas Emergency Response Card (NIOSH)

N

National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances (AEGLs - EPA)

National Association of County and City Health Officials

National Association of Local Boards of Health

National Center for Infectious Diseases NCID is committed to the prevention and control of traditional, new and reemerging infectious diseases in the United States and around the world. The site includes publications and resources.

National Disaster Medical System (NDMS) - DHHS

National Disaster Reference Database NASA

National Domestic Preparedness Office (FBI)

National Guard Bureau

National Hazards Center at the University of Colorado

National Health and Medical Services Response to Incidents of Chemical and Biological Terrorism  JAMA. 1997;278:362-368

National Health Information Center - Announcements, Health information, resource database, publications and conference information from the National Health Information Center.

National Institute for Urban Search and Rescue

National Laboratory Training Network

National Library of Medicine (NLM) Sources: Anthrax

National Memorial Institute for the Prevention of Terrorism (MIPT)  - Internet based best practices and lessons learned information network for first responders and emergency planners nationwide.  Special interest terrorism related material for the Responder community and a searchable library catalog. You can also find upcoming terrorism related conferences and training events, most of which are available for free on the Internet.

National Mental Health Services

National Symposium on Terrorism Sources

National Voluntary Organization Active in Disasters

NBC Medical Defense

Nerve Agents In Children: Dosing Card - US Army Medical Research Institute of Chemical Defense

Nerve Agents In Children: Guidelines - US Army Medical Research Institute of Chemical Defense

Nerve Agents, G-series: Tabun, Sarin, Soman

Nerve Agents, V-series: Ve, Vg, Vm, Vx

Nitrogen Mustard Fact Sheet - CDC

Nuclear Biological Chemical Preparedness Final Report - American College of Emergency Physician's Nuclear, Biological and Chemical (NBC) Task Force has developed a report containing the core content of a National curriculum for training emergency providers to detect and respond to these incidents.

Nuclear Regulatory Commission (NRC)

Nuclear Regulatory Commission - Emergency Response

O

Occupational Safety and Health Administration (OSHA)

Office of Emergency Preparedness (OEP) - U.S. Dept Health and Human Services

Office of Hazardous Materials Safety - Safe Transportation of Hazardous Materials (DOT)

Office of Response and Restoration (National Oceanic and Atmospheric Administration)

Oklahoma City National Memorial Institute for the Prevention of Terrorism

Osmium Tetroxide - Material Safety Data Sheet

P

Pan American Health Organization (PAHO) - Information on Public Health and related issues in the Americas. Includes information on disasters and humanitarian aid (through USAID), Country Health Profiles, Publication Resources, Technical Information of Health Issues, a Media Center with Press Releases and photographs, Information about the PAHO, and links to outside Public Health resources.

Pathology & Virology - Martindale's Health Science Guide - In-depth resource on Pathology and Virology

Personal Protective Equipment

Plague

Plague as a Biological Weapon: Medical and Public Health Management - JAMA. 2001

Plague Information - Public Health Emergency Preparedness & Response. (CDC) Centers for Disease Control and Prevention

Potassium Cyanide Emergency Response Card (NIOSH)

Potassium Iodide: Use of Potassium Iodide During Radiological Emergencies -[Spanish Version] - Information for the Public, NYSDOH EMS

Potassium Iodide (KI) and Radiological Emergencies - Fact Sheet - NYSDOH EMS

Predicting Casualty Severity and Hospital Capacity - Information for Health Professionals. CDC, National Center for Injury Prevention and Control

Prophylactic Use of Potassium Iodide (KI) in Radiological Emergencies - Information for the Physicians, NYSDOH EMS

Protocol for Responses to Assignments Involving Unknown Substances (New York City Fire Department, October 23, 2001)

Provision of Emergency Medical Care for Crowds

Public Health Preparedness and Response - Links Centers for Disease Control (CDC)

Public Health Training Network

Pyridostigmine - Used as a Nerve Agent Pretreatment Under Wartime Conditions (PDF)

Pyridostigmine - USAMRICD Special Publication 03-01 (Frequently Asked Question) - US Army Medical Research Institute of Chemical Defense

Pyridostigmine: - USAMRICD Special Publication 98-01  (LTC James M. Madsen) (HTML)

Pyridostigmine: - USAMRICD Technical Memorandum 90-4  Pyridostigmine (Fredrick R. Sidell, M.D.) (PDF)

Q

Q Fever

R

Radiation - Healthfinder

Radiation Emergencies - Updated page from the CDC provides information on radiation emergencies, including general facts, as well as specific information for the public, first responders, clinicians, and hospitals.

Radiation Emergency Response (CDC)

Radiation Exposure (MEDLINEplus)

Radiological Dispersal Devices ("Dirty Bombs") - CDC

Radiological Dispersal Devices ("Dirty Bombs") - NRC

Radiological Terrorism Rapid Response Card  [ PDF  30Kb ] -  NYSDOH, EMS

Rapid Assessment of Injuries from Mass Trauma Events - This data instrument will help health departments and other decision-makers collect core data useful for investigating the number, type, timing, and severity of injuries associated with a mass trauma event. The instrument was adapted from a tool initially used to collect information about injuries among survivors of the World Trade Center bombing. Its contents or format can be modified to accommodate the circumstances of a particular mass trauma event. CDC, National Center for Injury Prevention and Control

Recommendations for Hospitals: Patient Decontamination, Staff Protection and Equipment Required and Evidence Collection (California Emergency Services Authority)

Recognition of Illness Associated with the Intentional Release of a Biologic Agent - Centers for Disease Control and Prevention

Ricin - EMedicine

Ricin Emergency Response Card (CDC/NIOSH)

Ricin Fact Sheet - CDC

S

Sarin Emergency Response Card (NIOSH)

Sarin Fact Sheet - CDC

Smallpox

Smallpox (CDC) - Home page for all CDC smallpox information. Includes basic information as well as information for health and lab professionals. Part of the CDC Public Health Emergency Preparedness and Response site.

Smallpox (CDC) - this information is intended for the healthcare provider (private and public) and includes details about the disease, recommended treatment, and specific issues relating to recognizing Smallpox in emergency departments.

Smallpox (MEDLINEplus)

Smallpox (healthfinder)

Smallpox as a Biological Weapon : Medical and Public Health Management - JAMA. 2000

Smallpox Diagnosis/Evaluation (Signs & Symptoms) - Clinical presentation, patient evaluation, rash illness algorithm.

Smallpox Information - Guide: Dept. H.H.S.

Smallpox, Pink Book, Chapter 21, Epidemiology and Prevention of Vaccine-Preventable Diseases PDF (2.64 MB/21 pages) Apr 2002. Smallpox disease and vaccine information from standard textbook for vaccine-preventable diseases

Smallpox Vaccination and Adverse Events Training Module

Smallpox Vaccination Clinic Guide Logistical Considerations and Guidance for State and Local Planning for Emergency, Large-Scale, Voluntary Administration of Smallpox Vaccine in Response to a Smallpox Outbreak

Smallpox: What Every Clinician Should Know (video) Dec 13, 2001. Archived video web cast on University of North Carolina School of Public Health site

Smallpox: What Every Clinician Should Know (online training) Interactive program to train clinicians on the recognition, diagnosis, treatment, and prevention of smallpox; CME, CNE, CHES, and CEU credit available

Sodium Cyanide Emergency Response Card (NIOSH)

Special Pathogens Branch (SPB), CDC - Special Pathogens Branch (SPB), Centers for Disease Control and Prevention - General and technical information about viral hemorrhagic fevers (VHFs), such as Ebola hemorrhagic fever, Lassa fever, hantavirus pulmonary syndrome (HPS), and hemorrhagic fever with renal syndrome (HFRS). These viruses are highly pathogenic and require handling in special laboratory facilities designed to contain them. Work also includes the study of other emerging viral disease agents that do not cause hemorrhagic fever, but require Biosafety Level 4 (BSL-4) handling, such as Nipah virus and tick-borne encephalitis virus.

Staphylococcal Enterotoxin B

T

T-2 Mycotoxins

Terrorism Injuries

Textbook of Military Medicine: Anthrax

Textbook of Military Medicine: Medical aspects of chemical and biological warfare. Office of The Surgeon General Department of the Army, United States of America

The Agents of Biological Warfare: Photos From the Pathology Division, US Army Military Research Institute for Infectious Disease (USAMRIID), Fort Detrick, Md.

The Centers for Disease Control and Prevention (CDC) up-to-date Information and Advisories on Anthrax

The Centers for Disease Control and Prevention (CDC) Webcast: Anthrax-What Every Clinician Should Know

The Complementary Role of Environmental and Security Biological Control Regimes in the 21st Century - JAMA. 1997;278:369-372

The Counter-Terrorism Page - Since 1995 The Counter-Terrorism Page has been a resource to those studying Terrorism. Our approach is to be free from hyperbole and hype, and focused on presenting the tools and information that is sought by professionals and academics.

The Defense Threat Reduction Agency Internet site, DTRALink

The Medical NBC Battle Book - USACHPPM Tech Guide 244 (PDF)

The Threat of Biological Weapons: Prophylaxis and Mitigation of Psychological and Social Consequences.  JAMA. 1997;278:425-427

TOXNET - Provides a cluster of databases on toxicology, hazardous chemicals, and related areas.

Treatment of Biological Warfare Agent Casualties

Treatment of Biological Warfare Agent Casualties: Anthrax

Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries

Triage of Mass Casualty Situations

Tularemia as a Biological Weapon: JAMA. 2001

U

Unit Field Sanitation Team

United States Postal Service guidance regarding harmful biological or chemical weapons

U.S. Army Medical Research and Materiel Command Provides information on Medical Chemical Defense, Nerve Agents, Cyanide, Skin Decontamination and Protection, Performance Effects of Protectant Drugs, and Chemical Casualty Management.

US Army Medical Research Institute of Infectious Diseases (USAMRIID): As the Department of Defense's lead laboratory for medical aspects of biological warfare defense, USAMRIID conducts research to develop vaccines, drugs, and diagnostics for laboratory and field use. In addition to developing medical countermeasures, USAMRIID formulates strategies, information, procedures, and training programs for medical defense against biological threats. This website also provides numerous links to other sites involved in biological warfare defense.

US Department of Health and Human Services Biological Incidents: Preparedness and Response

Urticants, Phosgene Oxime

V

VAERS: The Vaccine Adverse Event Reporting System - A cooperative program for vaccine safety of the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). This Web site provides a nationwide mechanism by which adverse events following immunization (AEFI) may be reported, analyzed and made available to the public. The VAERS Web site also provides a vehicle for disseminating vaccine safety-related information to parents/guardians, healthcare providers, vaccine manufacturers, state vaccine programs and other constituencies.

Venezuelan Equine Encephalitis

Vesicants, Mustard: Hd, Hn1-3, H

Vesicants, Organic Arsenicals: L, ED, MD, PD, HL

Viral Hemorrhagic Fevers

Vomiting Agents: Dm, Da, Dc

VX Emergency Response Card (NIOSH)

VX Fact Sheet - Centers for Disease Control and Prevention (CDC)

W

WMD Threats: Sample guidelines reissue (PDF)

Working Group on Civilian Biodefense Consensus Statement

World Anthrax Data Site: Detailed Occurrence Data

World Health Organization (WHO): Emerging and Other Communicable Diseases, Surveillance and Control

World Health Organization World Wide Web Server  -The website of the World Health Organization contains downloadable newsletters and the latest health information.

World Wide Web Virtual Library: Epidemiology  -WWW Virtual Library Directory of Epidemiology Related Sites.