Largely, I agree with your posting. All of us have seen video of troops putting on their MOPP IV gear when the Iragi scuds were landing in Kuwait during Desert Storm. The point of a chemical agent is to force the troops to put on their defensive gear that degrades their ability to perform needed tasks.

The sarin used in the Tokyo subway was NOT deployed in an effective manner. Rather than dispersing the agent in an aerosol, it was left in jars to spill on the ground. In a terrorist event, for non--persistent agents to be effective, they must be aerosolized in a confined space like a subway or a ventilation system. Were these agents deployed in the open, they would be degraded by UV light and simply evaporate and be gone in a short period of time. The military can employ non-persistent nerve agent through area bombardment with artillery, missiles, or aerial application by bombing or sprays. That is the only way to acheive a sufficient concentration in the open.

Persistent nerve agent--VX--is an oily substance that, well, persists. Sorry. It is more akin to spraying diesel fuel. It does not evaporate quickly and gets on you when you walk through the area.

In fact, a single drop of nerve agent on the skin, untreated, and you will die. Simple as that. No hospitals stock sufficient Mark I kits to treat mas casualties from a chemical attack. No hospitals maintain adequate stocks of Cyanide Treatment kits or amyl nitrite inhalant capsules to treat a meaningful (more than a few) casualties. They are simply too expensive and go quickly out of date.

The other significant problem with nerve agents or other chemical is decontamination. Very few hospitals have appropriate decontamination equipment, facilities, or trained personnel to decontaminate patients. Sad but true. You take one patient with a chemical agent into an ER and everyone in the place is exposed.

I have been "decontaminated" by the army at Aberdeen Proving Ground, outside, in November, in my bare skin by a bunch of privates in chemical suits. These kids did it frequently as that is home to the Army Medical Institue of Chemical Defense. I happened to leave Kirk Army Health Center by the wrong door while they were in the process of decontaminating folks that were at risk for exposure........"excuse me Major, you just walked through the hot zone! Come with me and put your clothes in this plastic bag. The privates will decontaminate you and poor clorox on your large ass".

My team maintains decontamination shelters and equipment, and a sufficient supply of nerve agent and cyanide antidote to treat 1500 casualties, lucky if you are in Winston-Salem, NC and we happen to be training, I guess. We frequently pre-position our equipment quietly for major events and out of concern of heightened risk.

Biologic agents that are infectious, like smallpox are a lesser concern, in my opinion, as if smallpox is released in the US, it will quickly spread everywhere, as there is no immunity to it in the world. That includes the Arab world.

A nuclear dispersal device (dirty bomb) detonated in a city would be too bad for the people that are killed outright by the blast. The panic associated with radiation is the desired outcome. The actual risk to the citizens of the area are actually minimal. There are no immediate life threats due to radiation, rather a life-long increased risk of developing cancer. There is a program on this very topic on PBS tonight.

Given that, I have made no ADDITIONAL preparation for a terrorist event personally. I think that living in rural NC at the beach I am exposed to less risk than others. However, the preparations that I have already made for a major hurricane will suffice for anything that might come my way from a terrorist, I believe.

Hope this helps.

Jeff Anderson, M.D.
MAJ, MC, FS, USAR (retired)
National Medical Response Team (WMD)--East