The role of the clinical laboratory in managing chemical or biological terrorism

Background: Domestic and international acts of terrorism using chemicals an d pathogens as weapons have recently attracted much attention because of se veral hoaxes and real incidents. Clinical laboratories, especially those af filiated with major trauma centers, should be prepared to respond rapidly b y providing diagnostic tests for the detection and identification of specif ic agents, so that specific therapy and victim management can be initiated in a timely manner. As first-line responders, clinical laboratory personnel should become familiar with the various chemical or biological agents and be active participants in their local defense programs. Approach: We review the selected agents previously considered or used in ch emical and biological warfare, outline their poisonous and pathogenic effec ts, describe techniques used in their identification, address some of the l ogistical and technical difficulties in maintaining such tests in clinical laboratories, and comment on some of the analytical issues, such as specime n handling and personal protective equipment. Content: The chemical agents discussed include nerve, blistering, and pulmo nary agents and cyanides. Biological agents, including anthrax and smallpox , are also discussed as examples for organisms with potential use in bioter rorism. Available therapies for each agent are outlined to assist clinical laboratory personnel in making intelligent decisions regarding implementati on of diagnostic tests as a part of a comprehensive defense program. Summary: As the civilian medical community prepares for biological and chem ical terrorist attacks, improvement in the capabilities of clinical laborat ories is essential in supporting counterterrorism programs designed to resp ond to such attacks. Accurate assessment of resources in clinical laborator ies is important because it will provide local authorities with an alternat ive resource for immediate diagnostic analysis. It is, therefore, recommend ed that clinical laboratories identify their current resources and the exte nt of support they can provide, and inform the authorities of their state o f readiness. (C) 2000 American Association for Clinical Chemistry.