Medical Aspects of Chemical Warfare Abbreviations and Acronyms ABBREVIATIONS AND ACRONYMS A CPRP: chemical personnel reliability program CR: dibenz(b,f)(1,4)oxazepine AA: arachidonic acid CS: o-chlorobenzylidene malononitrile AC: hydrogen cyanide CSA: The Covenant, the Sword, and the Arm of the Lord ACGIH: American Conference of Governmental Industrial Hy- CSEPP: Chemical Stockpile Emergency Preparedness Program gienists CSF: colony-stimulating factor Ach: acetylcholine CSMSPD: chemical surety medical support program director AChE: acetylcholinesterase Ct: concentration (C) of agent vapor or aerosol in air multiplied ADMS: assistant director of medical services by time (t) of exposure AEF: American Expeditionary Forces CWA: chemical warfare agent AEGL: acute exposure guidance level CWC: Chemical Weapons Convention (1993) AML: area medical laboratory CWS: US Army Chemical Warfare Service AMN: atropine methylnitrate AR: Army Regulation ARC: American Red Cross D ARDS: acute respiratory distress syndrome ATCA: 2-aminothiazoline-4-carboxylic acid DA PAM: Department of the Army pamphlet ATNAA: antidote treatment nerve agent autoinjector DA: diphenylchloroarsine ATP: adenosine triphosphate DC: diphenylcyanoarsine aTSP: active topical skin protectant DCE: defense coordinating element A-V: atrial-ventricular DEET: N,N-diethyl-meta-toluamide DEPMEDS: deployable medical system DFP: diisopropyl phosphorofluoridate B DHHS: Department of Health and Human Services DHP: diisopropylfluorophosphate BA: bromoacetone DHS: Department of Homeland Security BAL: British anti-Lewisite (dimercaprol) DM: diphenylaminoarsine BALF: bronchoalveolar lavage fluid 4-DMAP: 4-dimethylaminophenol BAS: battalion aid station DMS: director of medical services BBC: bromobenzyl cyanide DNA: deoxyribonucleic acid BChE: butyrylcholinesterase DoD: Department of Defense BEF: British Expeditionary Forces DOE: Department of Energy BMZ: basement membrane zone DOJ: Department of Justice BTX: batrachotoxin DOT: Department of Transportation BZ: 3-quinuclidinyl benzilate DVA: Department of Veterans Affairs C E CA: bromobenzyl cyanide ECG: electrocardiogram CaE: carboxylesterase EDTA: ethylenediaminetetraacetate CAI: chemical accident or incident EEG: electroencephalogram CAIRA: chemical accident or incident response and assistance EKG: electrocardiogram cAMP: adenosine 3’,5’-cyclic monophosphate EMEDS: expeditionary medical support CANA: convulsive antidote, nerve agent EMS: emergency medical service CAS: Chemical Abstracts Service EMT: emergency medical technician CB: chemical-biological EOC: emergency operations center CBIRF: Chemical/Biological Incident Response Force EPA: Environmental Protection Agency CBR: chemical, biological, and radiological Eq: equine CBRN: chemical, biological radiological, and nuclear ER: endoplasmic reticulum CBRNE: chemical, biological, radiological, nuclear, explosive Er: YAG: erbium: yttrium-aluminium-garnet CBRRT: chemical biological rapid response team ESF: emergency support function CDC: Centers for Disease Control and Prevention CEA: cultured epidermal autograft cGMP: current Good Manufacturing Practice F CHASE (Operation): Cut Holes and Sink ‘Em ChE: cholinesterase FBI: Federal Bureau of Investigation CK: cyanogen chloride FBS: fetal bovine serum CN- : cyanide anion FCC: federal coordinating center CN: chloroacetophenone FDA: Food and Drug Administration CNO- : cyanate FEMA: Federal Emergency Management Agency CNS: central nervous system FHP: force health protection COLPRO: collective protection FOC: full operational capability CP EMEDS: collectively protected expeditionary medical support FRC: forward resuscitation care xxiii Medical Aspects of Chemical Warfare Abbreviations and Acronyms G L GA: tabun LCt50: the vapor or aerosol exposure that is lethal to 50% of the GABA(A): gamma-aminobutyric A exposed population GB: sarin LD50: median lethal dose GD: soman LDPI: laser Doppler perfusion imaging GF: cyclosarin LHON: Leber hereditary optic neuropathy GK-11: gacyclidine LPS: lipopolysaccharide GM1: monosialotetrahexosylganglioside LSD: lysergic acid diethylamide GSA: General Services Administration GSH: glutathione M H MAC: multiagency coordination MANAA: medical aerosolized nerve agent antidote H: mustard MCE: maximum credible event H2O2: hydrogen peroxide MDMA: 3, 4-methylene-dioxymethylamphetamine H2S: hydrogen sulfide MEDCOM: medical command HAZMAT: hazardous materials MEDEVAC: medical evacuation HAZWOPER: hazardous waste operations and emergency MITS: medical identification and treatment systems response MO: medical officer HC: hexachloroethane MOPP: mission-oriented protective posture HCN: hydrogen cyanide MPE: most probable event HD: mustard (distilled) MRI: magnetic resonance imaging HE: high explosives MRT: mean residence time HHS: Department of Health and Human Services MRT: medical response team HN2: nitrogen mustard MS C LRIP: milestone C low rate initial production HSS: health service support MT: metric ton Hu PON1: human paraoxonase 1 MTF: medical treatment facility HWA: Heereswaffenamt MULO: multipurpose overboot I N ICAM: improved chemical agent monitor N2O: nitrogen oxide ICG: indocyanine green N2O4: nitrogen tetroxide ICS: incident command system NAAG: N-acetyl-aspartyl-glutamate IDLH: immediately dangerous to life or health NaCN: sodium cyanide IgG: immunogammaglobulin NAD+ : nicotinamide adenine dinucleotide IL: interleukin NaNO2: sodium nitrite IM: intramuscular NATO: North Atlantic Treaty Organization IMA: installation medical authority NBC: nuclear, biological, chemical IND: investigational new drug NCO: noncommissioned officer IOC: initial operational capability NCS: National Communications System IOT&E: initial operational test and evaluation NDA: new drug application IP: intraperitoneal injection NDMS: National Disaster Medical System IPE: individual protective ensemble/equipment NF: number facility IV: intravenous NIMS: National Incident Management System NIOSH: National Institute for Occupational Safety and Health NMDA: N-methyl D-aspartate J NO: nitric oxide NO : nitrogen dioxide JFO: joint field office 2 NORTHCOM: Northern Command JPEO: joint program executive office NRP: National Response Plan JPEO-CBD: Joint Program Executive Office for Chemical Biologi- NSAID: nonsteroidal antiinflammatory drug cal Defense NSP: neurotoxic shellfish poisoning JPMO: joint product management office JSGPM: joint service general purpose mask JSLIST: joint service lightweight integrated suit technology O JSMLT: joint service mask leakage tester JSPDS: joint service personnel skin decontamination system OC: oleoresin capsicum JTF: joint task force OH: hydroxyl radical OP: organophosphorus OPCW: Organization for the Prohibition of Chemical Weapons K OPIDN: organophosphorus ester–induced delayed neurotoxicity Ops: operations KCN: potassium cyanide OSHA: Occupational Safety and Health Administration Km: a measure of the strength of binding of a substrate to an enzyme xxiv Medical Aspects of Chemical Warfare Abbreviations and Acronyms P U PADPRP: poly(adenosine diphosphate-ribose) polymerase UN: United Nations PAF: platelet-aggregating factor USACHPPM: US Army Center for Health Promotion and Preven- 2-PAM Cl: 2-pralidoxime chloride tive Medicine 2-PAM: 2-pralidoxime USAMRICD: US Army Medical Research Institute of Chemical PAPP: p-aminopropiophenone Defense PARP: poly(ADP-ribose) polymerase USAMRIID: US Army Medical Research Institute of Infectious PATS: protection assessment test system Diseases PB: pyridostigmine bromide USDA: US Department of Agriculture PBN: alpha-phenyl-N-tert-butylnitrone USJCOM: US Joint Forces Command PBN: N-tert-butyl-alfa-phenylnitrone USMC: US Marine Corps PbTx: brevetoxin PCP: phencyclidine PFIB: perfluoroisobutylene V pHu: plasma-derived human V/Q: ventilation profusion ratio PKC: protein kinase C VAC: Vacuum-Assisted Closure Therapy PLA : phospholypase A2 2 VR1: vallinoid receptor subtype 1 pMo: plasma-derived mouse 2-PMPA: 2-pentanedioic acid POM: program objective memorandum W PPE: personal protective equipment PR: protective ratio WBGT: wet-bulb globe temperature PS: chloropicrin WMD: weapons of mass destruction PTSD: posttraumatic stress disorder PTX: palytoxin R RADS: reactive airways dysfunction syndrome RBC-ChE: red blood cell cholinesterase RCA: riot control agent RD50: dose required to cause a 50% decrease in respiration REM: rapid eye movement RH: relative humidity rHu BChE: recombinant human butyrylcholinesterase RNA: ribonucleic acid RPM: respiratory rate, pulse, and motor function RSDL: Reactive Skin Decontamination Lotion S SCN- : thiocyanate SE: status epilepticus SERPACWA: skin exposure reduction paste against chemical warfare agents SMART: special medical augmentation response team SNS: strategic national stockpile SRBD: seizure-related brain damage SS: Schutzstaffel START: simple triage and rapid treatment STEL: short-term exposure limit STM: Sacco triage method STX: saxitoxin T TBSA: total body surface area TEN: toxic epidermal necrosis TIC: toxic industrial chemical TIM: toxic industrial material TNF: tumor necrosis factor TRP: transient receptor potential TTX: tetrodotoxin TWA: time-weighted average xxv Medical Aspects of Chemical Warfare Index INDEX A chemical weapons and, 129, 145 compared with Aum Shinrikyo, 129 Aberdeen Biological Chemical Agent Disposal Facility description, 129 mustard agent container drainage, 597 Alexander, Lt. Col. Stewart Abood, Leo Bari disaster and, 105 anticholinergic deliriant research, 424 Alkyl methylphosphonic acids Abramson, Dr. Harold nerve agents