What to do in case of an unthinkable chemical warfare attack or accident.

Successful management of casualties in a toxic chemical attack or accident depends on planning, preparation, and training. In many communities, physicians join other emergency rescue personnel to take part in periodic exercises and drills. In case of a large-scale attack or accident, all medical care providers will be needed to care for casualties. Chemical warfare agents are generally considered to be highly toxic, exotic materials, but most are not. Nerve agents are similar to, although more potent than, commonly used insecticides; cyanide and phosgene are widely available; the incapacitating agent BZ has effects identical to those of scopolamine; and most physicians with knowledge of chemotherapy are familiar with the effects of mustard. Although a chemical attack might be perceived as an uncontrollable disaster, the guidelines for successful management are the same as for any toxic chemical accident. Medical care of casualties depends on knowledge of the agent and timely intervention, and those responsible for such care must be ready.