title: Responding to chemical, biological, or nuclear terrorism: the indirect and long-term health effects may present the greatest challenge.
abstract: The possibility of terrorists employing chemical, biological, or nuclear/ radiological (CBN) materials has been a concern since 1995 when sarin gas was dispersed in a Tokyo subway. Contingency planning almost exclusively involved detection. containment, and emergency health care for mass casualties. However, it is clear that even small-scale CBN incidents--like the recent spread of anthrax spores through the mail--can cause widespread confusion, fear, and psychological stress that have lasting effects on the health of affected communities and on a nation's sense of well-being. More emphasis therefore needs to be placed on indirect effects and on the medical, social, economic, and legal consequences that follow months to years afterward. To respond effectively to CBN attacks, a comprehensive strategy needs to be developed that includes not only emergency response, but also long-term health care, risk communication, research, and economic assistance. Organizing an effective response challenges government institutions because the issues involved--eligibility for health care, the effects of low-level exposure to toxic agents. stress-related illnesses, unlicensed therapeutics. financial compensation--are complex and controversial.
authors.affiliation: Department of Veterans Affairs, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Hyams
authors.forename: Frances M
authors.initials: FM
authors.lastname: Murphy
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D023482:Bioterrorism / Q000523:psychology; D002619:Chemical Warfare Agents / Q000009:adverse effects; D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration*; D004189:Disaster Planning; D006268:Health Facilities; D006801:Humans; D008399:Mass Behavior; D009689:Nuclear Warfare; D011159:Population Surveillance; D011635:Public Health Administration; D018570:Risk Assessment; D023481:Terrorism / Q000523:psychology; D013995:Time; D014481:United States
chemical_list: D002619:Chemical Warfare Agents