- The Washington Times - Thursday, May 9, 2002

The United States lacks emergency-response antidotes for children in case of a nerve-gas attack, according to the U.S. Army neurologist in charge of preparing the nation's biochemical defenses.
While a U.S. firm has manufactured thousands of pediatric doses of nerve-gas antidotes for Israel, they are not legal in the United States, said Col. Jonathan Newmark.
Because the military sees its primary mission as protecting its fighters so they can withstand a chemical battlefield attack, it never purchased pediatric doses, said Col. Newmark, an Army colonel and chief of chemical casualty care at the U.S. Army Medical Research Institute of Chemical Defense in Edgewood, Md.
Col. Newmark and others gearing up the nation's emergency-response systems for nerve-gas terrorism say they are forced to borrow the Israeli models for practice operations even though they cannot read the Hebrew instructions and dosage information on the antidote kits.
They are unable to obtain English-language versions because the Food and Drug Administration has not yet approved the devices for children. The Department of Defense, which ordered adult-dosage kits for its troops, has not sought such approval.
A terrorism task force created by the American Academy of Pediatrics after September 11 is asking Congress to provide funding so that emergency pediatric doses of the antidotes will be available to firefighters and ambulances in high-risk areas.
The task force is asking Congress to include "child-specific language" in any new bills on preparing for a biological or chemical attack, said Dr. Joe Hagan, the head of the pediatric task force. That would require providing pediatric doses of antidotes to nerve and other chemical and biological agents.
The likelihood of a chemical weapons attack is small in remote, rural towns but great in cities such as Washington and New York, making it sensible to begin stockpiling the antidotes in such potential targets, Dr. Hagan said.
Col. Newmark, in an interview at Walter Reed Hospital where he is an attending neurologist, said U.S. authorities "don't have pediatric doses for auto-injections of atropine," one of two agents used to block a nerve-gas attack.
"Antidotes are not readily available if sarin or other nerve gases are used," added Dr. Hagan.
"Children are at risk because of their size," he said. Sarin the gas used by a terrorist group in Tokyo's subway in 1995 tends to cling to the ground and therefore affect children more than adults.
"Sarin is heavy you could walk with a 4-year-old child and you could feel OK while the kids are at risk," said Dr. Hagan, a pediatrician, who spoke by phone from his office in Burlington, Vt.
Although the two key anti-nerve-gas medicines, atropine and a blocking agent known as an oxime, are available in emergency rooms, many people exposed to nerve agents would die before they received treatment, the doctors said.
Nerve gases act so quickly that antidotes must be administered within a few minutes of the onset of symptoms.
"The way the military addresses this is when an Army squad is at risk they depend on buddy treating buddy you can't wait for a medic or evacuation there is no time," Dr. Hagan said.
"All troops at risk carry a Mark I auto-injector with atropine and a blocking agent. But it is not available in children's doses."
If a mass nerve-agent attack takes place in an area such as a shopping mall where many children are likely to be affected, the delay in delivering medication could mean many would die, the doctors said.
Little research has been done on human victims of nerve agents because they have been used only twice by the Aum Shinrikyo sect in Tokyo and by Iraqi President Saddam Hussein against Iran and against rebellious Iraqi Kurds in the late 1980s.
Saddam's use of nerve and mustard gas against Iran and the Kurds left between 45,000 and 100,000 casualties. Iran allowed European doctors to examine victims of Iraqi mustard-gas attacks, but the victims of nerve gas died so swiftly that there was little chance to study the way the nerve agents kill, Col. Newmark said.
"We still don't know what the nerve agent was in Halabja," he said, referring to the Kurdish town where about 5,000 men, women and children were killed in 1988 by gas bombs dropped from Iraqi helicopters.
Researchers are reluctant to say so publicly, for fear of criticism from animal rights groups, but they are experimenting on animals to learn how the nerve agents work and to develop better ways to fight them.

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