"Although preparing for and responding to terrorism is a daunting challenge, it is not an insurmountable one," said committee chair Peter Rosen, director of the emergency medical residency program at the University of California, San Diego, School of Medicine. "By bolstering existing medical resources, improving communications, and developing better ways to monitor and detect threats, we can minimize the damage that a terrorist attack in the United States could cause."

Preparations for biological or chemical terrorism should build on systems already in place to handle hazardous materials spills, infectious disease outbreaks, and natural disasters, the report says. Because of their work in these areas, public health departments, poison control centers, and metropolitan police officials are best equipped to handle the challenges posed by terrorism. These entities must adapt new and emerging technologies for detecting chemical and biological warfare agents. They especially need faster, simpler, cheaper, and more accurate tools for detecting and identifying a wide spectrum of toxic substances that could be used in an attack.

Knowing who is going to attack, or when and where an attack might take place, is particularly difficult in a civilian setting, the report says. Military officials, for example, may know or suspect that an enemy has a stockpile of biological weapons and could vaccinate soldiers against some of these agents. But in the civilian environment, the enemy, weapon, and time and place of attack are unknown, making this sort of preparation impossible.

Nevertheless, high priority should be placed on preparing for certain types of attacks, the report says. Operations-related research is needed to advise federal authorities on how and where to stockpile antidotes to nerve agents, and on an effective system for distributing them. A vigorous national effort should be mounted to develop, manufacture, and stockpile improved vaccines for anthrax and smallpox, the committee recommended. And an aggressive program should be developed to locate substances to repair or limit the damage caused by vesicants such as mustard gas, which burn and blister body tissues through contact with the skin and lungs.

Other recommendations include:

* Improvements in the laboratory and epidemiology capabilities of the Centers for Disease Control and Prevention, as well as at the state and local level.

* Research into methods for quickly evaluating medical conditions of victims of chemical agents, and rapid, effective, and inexpensive decontamination of large groups of people and equipment.

* Development of educational materials on chemical and biological agents for both the general public and mental health professionals.

* Improvement and field testing of computer models to predict the spread of hazardous agents in an attack and to provide realistic training for emergency management officials.

Recent events suggest that terrorists in the United States and abroad may be more interested in using biological and chemical weapons than in the past, the report says. The 1995 nerve gas attack in the Tokyo subway by the religious cult Aum Shinrikyo, and the arrests of U.S. citizens for obtaining biological agents that could have been used in an attack have heightened public awareness of the threat.

The study was funded by the Office of Emergency Preparedness of the U.S. Department of Health and Human Services. The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter. The National Research Council -- the principal operating arm of the National Academies of Sciences and Engineering -- provides science and technology advice under the same charter.

Copies of Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response will be available in December from the National Academy Press (http://www.nap.edu/) at the mailing address in the letterhead; tel. 202-334-3313 or 1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News and Public Information.

Note: If no author is given, the source is cited instead.

• Accident and Trauma
• Health Policy

• Weapons Technology
• Energy Policy

• Bioterrorism
• Biological warfare
• Gulf War syndrome
• Military aviation
• Panic attack
• Nanomedicine