Chemical and biological weapons. Implications for anaesthesia and intensive care ² S. M. White Department of Anaesthesia, Guy’s and St Thomas’ Hospital Trust, St Thomas’ Street, London SE1 9RT, UK In the wake of recent atrocities there has been renewed apprehension regarding the possibility of chemical and biological weapon (CBW) deployment by terrorists. Despite various inter- national agreements that proscribe their use, certain states continue to develop chemical and biological weapons of mass destruction. Of greater concern, recent historical examples support the prospect that state-independent organizations have the capability to produce such weapons. Indeed, the deliberate deployment of anthrax has claimed several lives in the USA since September 11, 2001. In the event of a significant CBW attack, medical services would be stretched. However, victim survival may be improved by the prompt, coordinated response of military and civil authorities, in conjunction with appropriate medical care. In comparison with most other specialties, anaesthetists have the professional academic background in physiology and pharmacology to be able to understand the nature of the injuries caused by CBWs. Anaesthetists, therefore, play a vital role both in the initial resuscitation of casualties and in their continued treatment in an intensive care setting. This article assesses the current risk of CBW deployment by terrorists, considers factors which would affect the severity of an attack, and discusses the pathophysiology of those CBWs most likely to be used. The specific roles of the anaesthetist and intensivist in treatment are highlighted. Br J Anaesth 2002; 89: 306–24 Keywords: complications, warfare; infection, biological warfare; intensive care; toxicity, chemical warfare ‘Armis bella non venenis geri’ (War is waged with weapons, not with poison). Roman adage. The devastating attacks on Washington and New York on Tuesday, September 11, 2001 focused worldwide attention on the potential consequences of a successful terrorist attack. The international media fanned speculation con- cerning the possible use of both chemical and biological weapons by terrorists. The political response to the September 11th atrocities (particularly in Europe and the USA) included reviews of civil defence policies to refine protocols for the management of the effects of chemical and biological weapon (CBW) use by terrorists. In addition to the reassessment of logistical capabilities, specific aspects of medical management were re-evaluated. Weapons of mass injury need not be very sophisticated to be devastatingly effective, as was demonstrated in New York. The terrorist destruction of chemical plants or nuclear power stations, for example, would undoubtedly result in significant death tolls, both immediately and over the longer term. However, there is evidence of more deliberate attempts by terrorist organizations to manufacture specific mass fatality weapons. United Nations inspections of Iraqi military establishments after victory in the Gulf War revealed biological, chemical and nascent nuclear weapon capabilities. The militant fervency of anti-West extremism amongst certain Middle Eastern religious and political groups (assisted by covert state support), particularly in the wake of recent events, has increased the possibility of high- fatality terrorist attacks. Deliberate release of anthrax spores, using the postal system as a delivery mechanism, has claimed several lives in Washington, USA. 17 Before the attacks on the USA, standardized protocols had been developed to manage accidental releases of hazardous materials (HAZMAT) 5 52 83 (indeed, accidental spillage of hazardous materials remains far more of a threat ² This article is accompanied by Editorial I. REVIEW ARTICLE British Journal of Anaesthesia 89 (2): 306–24 (2002) Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2002
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