First aid

April 18, 2003

The Survival Guide: What to Do in a Biological, Chemical, or Nuclear Emergency. By Angelo Acquista. Random House, 288 pp., $12.95.

As I write this review, the possibility of a chemical or biological attack on U.S.  forces in Iraq is very much on the minds of both military leaders and American citizens. The possibility of such an attack occurring on U.S. soil is also a matter of concern for many. How prepared are we for such an act of aggression, and what should we do were it to happen?

Angelo Acquista, cited as the "pro bono medical director of the New York City Mayor's Office of Emergency Management," addresses precisely these concerns. (His survival guide has its own Web site at

Our first response to suspected exposure to biological and chemical agents should be--when no respiratory mask is available--to "cover mouth and nose with fabric (wet if possible)." Acquista emphasizes the importance of washing and showering as soon as possible. Every adult would be well advised to read the chapter "Creating an Emergency Action Plan," as well as the chapter "Preparedness and Response Supplies."

Most of the contents, however, constitute a reference book to be used in the midst of emergencies rather than digested before the fact. The book has a first-rate index that will serve the reader well in tracking down specific precautions, symptoms and treatments. It also supplies information necessary for making intelligent decisions on such matters as whether or not to receive a smallpox vaccination. (On the last point, a recent survey by the Harvard School of Public Health published in the New England Journal of Medicine revealed that 25 percent of Americans believe they would be likely to die from the side effects of smallpox vaccine. In fact, the most recent estimate predicts that fewer than three persons per million would die, although recent reports of heart attacks that may be vaccine-related have in­creased the public anxiety.)

Not everything the author has said to the press has been as rigorous as the advice in his book. Acquista told the Knight Ridder Newspapers on March 19 that biological weapons were unlikely to kill more than a handful of people and "that the only weapon of mass destruction is a nuclear detonation." Yet in the book Acquista refers to all the terrorist threats that he discusses in his guide as "weapons of mass destruction," and throughout the text he is forthright about the terrible dangers posed by bio-weapons.

As a military historian and medical writer who has studied these issues at great length over many years, I trust Acquista the author more than Acquista the interviewee. I agree with the 1998 statement by John Holum, director of the U.S. Arms Control and Disarmament Agency under President Clinton, who remarked, "For 20 years, biological weapons have been regarded in the same way as chemical weapons. In fact, they are much closer to nuclear weapons in terms of their destructive power."

Though bio-weapons and nuclear weapons are indeed comparable in their ability to kill, there is no comparison in cost of production. The resources of a nation-state are necessary for manufacturing nuclear weapons, but not for waging germ warfare. The Washington Post confirmed this fact when it reported on March 23 that "al-Qaeda leaders, long known to covet biological and chemical weapons, have reached at least the threshold of production. They may already have manufactured some, according to a newly obtained cache of documentary evidence and interrogations recently conducted by the U.S. government."

Perhaps Acquista errs on the side of optimism because he wants to quell incipient panic. In any case, his book is inadequate in providing psychological advice, though he does include a useful section titled "What to Tell Children/Helping Them Cope." Un­characteristically, he even suggests that especially frightened children may require the services of "a member of the clergy." So may adults!

For the most part, churches and synagogues are lagging in their response to the clear and present dangers of weapons of mass destruction. This and other books should convince religious leaders to join with the secular disaster-preparedness groups in developing emergency plans for congregations.

The need for volunteers will persist, since federal and local preparations may well prove inadequate. As the New York Times put it on March 19, "President Bush promised help--$3.5 billion for first responders [to terrorist attacks] in localities across the nation--but [the aid] has remained mostly unfinanced. It may get ever more difficult to be heard while both sides of Pennsylvania Avenue are looking at an initial bill of tens of billions of dollars to attack Iraq and then begin rebuilding it."

During the decline of the Roman Empire, the church eagerly served the needs of people, especially the sick, children, the elderly and the poor. As the empire's institutions became less and less capable of caring for local needs, the church stepped in to fill the gap. Our spiritual heritage commands us to do likewise.

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