[Chemical and biological terrorism: psychological aspects, and guidelines for psychiatric preparedness]

Chemical or biological terror may cause mass casualties, but the major damage of such a threat is related mainly to psychological terror. Anxiety and panic that accompany chemical or biological threat, may affect mass populations, disrupt their lives, and enormously increase the demands from the medical systems. In the case of real attack, such an increased demands may be critical, especially to the functional ability of hospitals. The Israeli experience, during the Persian Gulf war, concerning preparations to chemical attacks at the national level, was unique in its nature. In addition, the Scud missiles attacks, accompanied with non-conventional threat, supplied valuable information on the populations behavior, and on the needed preparations for similar threats. In the case of chemical or biological threat or attack, the main task of the psychiatrist is to treat stress and anxiety casualties. At the same time, he should be aware of the possibility that the psychological & behavioral symptoms may reflect organic brain damage due to the pathogenic agent, and that such a differential diagnosis may be life saving for the patient. Stress casualties will be referred from the ER, and treated by the mental health team, at a specifically designed "center for stress casualties". In addition, the psychiatrist will consult the medical teams, or sometimes directly intervene, with combined casualties, at other locations of the hospital. At the regional or community level, one should plane and exercise deployment and activation of multi-professional teams, including mental health, in existing installations designed for screening, treatment, and temporary containment of casualties. It is recommended that the head of the local authority, will be responsible for the preparations and activation of this formation. A planned and rational usage of the media may have a critical influence on the ability of the authorities to manage the crisis situation and on shaping the behavior of the population. In certain scenarios, the media may even serve as the main tool for calming and instructing the people being isolated at their homes.