Emergency Preparedness: Managing Victims of Chemical, Biological, Radiological, Nuclear, or High-explosive (CBRNE) Agents

Preparing to manage disasters originating from natural events, industrial accidents, or, of more interest recently, caused intentionally by terrorists using chemical, biological, radiological, nuclear, or highexplosive (CBRNE) agents is a high priority for the US government and military as well as the American Society of Anesthesiologists. Even though natural and man-made disasters have occurred for millennia, the use of CBRNE agents and devices by terrorists in recent decades has emphasized the need for increased preparedness. Natural disasters that occurred in 2011 killed tens of thousands of people and caused more than 350 billion dollars in losses. The earthquake and resulting tsunami in Japan, earthquakes in Haiti and New Zealand, the floods in Thailand and the Eastern United States (caused by Hurricane Irene), and the tornados that touched down in Joplin, Missouri, and in Alabama have produced calamities that were almost unimaginable in the past. In Alabama and Missouri, whole neighborhoods were wiped off the map. In addition to the direct damage caused by the earthquake and tsunami in Japan, the effect on the Fukushima nuclear power plant in Okuma continues to cause significant concern and morbidity. The intent of this chapter is to review and highlight what anesthesiologists need to know to manage victims when natural disasters occur or when CBRNE devices or agents, whether used by terrorists or released during an industrial accident, result in a major disaster causing a high number of casualties.