September was National Preparedness Month, a nationwide effort sponsored by the U.S. Department of Homeland Security (DHS) to educate and empower Americans to prepare for emergencies including natural disasters and potential terrorist attacks.

State and city homeland security officials, emergency medical services (EMS) directors, and fire and police chiefs are encouraged to mark the occasion by reviewing their risk of, and response to, a deliberate or accidental chemical disaster.

The security of chemical facilities has been a concern since 9/11, as has the security of chemicals and other hazardous materials being transported by truck, rail and barge. DHS finalized its long-awaited chemical security regulations late last year. The Chemical Facility Anti-Terrorism Standards are intended to prevent terrorists from accessing and using hazardous chemicals.

Terrorist threat aside, our nation's transportation system is particularly vulnerable with respect to chemicals and other hazardous materials. Each day, millions of tons of hazardous materials are transported across more than 200,000 miles of highway, track and inland waterways. The transport of these materials is regulated by the U.S. Department of Transportation.

Chemical Accidents Can and Do Happen

Modeling scenarios predict a serious chemical disaster could result in hundreds to a few thousand casualties depending on level of toxicity, length of exposure, atmospheric dispersion and persistence. In the event of a truck or rail accident involving a toxic chemical, there would be clear and imminent danger to the operator, emergency response teams and the surrounding communities.

Unfortunately, many of these chemicals are highly toxic and there are no antidotes to treat individuals who have been poisoned. The good news is that for some of the most toxic chemicals -- organophosphorus nerve agents and pesticides commonly used in agriculture -- antidotes are available for use by first responders.

This is significant, because organophosphate pesticides like malathion and parathion, which traverse our states and cities every day, could pose as great a threat as the 1995 Sarin attack on a Tokyo subway by the Aum Shinrikyo cult.

In the event of an accident involving an organophosphorus nerve agent, individuals who have been poisoned may have only minutes to receive the antidote, and emergency medical personnel may be unable to assist everyone in need. Given the rapidity of symptom onset, and the logistical challenges of providing immediate medical assistance to potentially large numbers of victims, the response is likely to be too little, too late -- particularly if the antidote is not readily available.

To further complicate matters, federal government stockpiles of chemical nerve agent antidotes would not be accessible for immediate use.

EMS Not Fully Prepared or Equipped for Chemical Disaster

Barriers to EMS readiness continue, especially for large-scale emergencies, such as natural disasters and terrorist attacks. EMS preparedness challenges have been linked to gaps in federal funding, education and training, equipment and supplies, and planning and coordination between agencies.

Most first responders report feeling vastly underprepared and underprotected for a disaster involving a chemical, biological or radiological agent/weapon. And the level of personal protection equipment available to emergency responders for these threats varies widely by region and service.

First-line antidotes for organophosphorus nerve agent poisoning have been supplied to state and local first responders since the 1990s. National Preparedness Month is an ideal time for officials to review chemical disaster response protocols to ensure antidotes and personal protective equipment are easily and quickly accessible to first responders. It also is a great time for officials to evaluate the inventory of antidotes in local stockpiles and on ambulances to ensure there is an adequate, in-date supply.

Antidotes are eligible for purchase through DHS grants. For more information about FY 2008 allocations, visit http://www.dhs.gov/xlibrary/assets/grant-program-overview-fy2008.pdf.

Jerome Hauer is former assistant secretary for Public Health Emergency Preparedness at the U.S. Department of Health and Human Services. He also served as director of Emergency Management for New York City, and as director of Emergency Medical Services and Fire Services for the State of Indiana. Hauer is CEO of The Hauer Group, a consulting firm whose clients include Meridian Medical Technologies.