2. Introduction
2.1 The Expert Group on Management of Chemical Casualties Caused by Terrorist Activity (EGMCCT) was established in September 2002 on an ad hoc basis to provide advice to the Chief Medical Officer. The Group was asked to provide advice on the clinical management of patients exposed to toxic chemicals as a result of terrorist activity. An initial list of chemicals of concern to the Department of Health was drawn up by officials and considered by the Members of the Group.
2.2 Members accepted that detailed advice was required and, further, that this should be based as far as possible on a systematic examination of the relevant evidence. It was noted that though much relevant information was available in the unclassified literature, some classified material would need to be examined. The Group agreed that it was likely and desirable that their reports would not contain classified material and argued that the reports should be published in such a way that as large an audience as possible could be provided with the Group's views.
2.3 It was accepted that a rapid response was needed and Members were encouraged to use their expert judgement in coming to a considered view based on the available literature. Some problems have been studied in depth in many countries and both the classified and unclassified literature is extensive; other problems have received comparatively little attention, at least little appears to have been published. This and the need for a rapid response has led to the short reports not being identical in format: some are presented as a series of key points with limited discussion, others in a comparatively discursive format.
2.4 In discussing ways of working, Members felt that publication of short reports on the Department of Health website (www.doh.gov.uk) would be appropriate. Where possible, more detailed reports giving as much supporting evidence as possible should be published in the peer-reviewed literature. This approach has been followed and a detailed review of oximes is currently being prepared for publication.
2.5 Members have been asked to advise on further compounds and problems that need to be addressed. Ricin and irritant incapacitants have been suggested and will be considered in the next report. Advice on the provision of oxygen and respiratory support as rapidly as possible after exposure to toxic substances will also be provided. A small working group to look at this has been established.
2.6 Members have also been asked to advise on what research is needed to support their recommendations regarding the medical management protocols. These recommendations are included in the accounts of individual problems and collated at the end of the report.
2.7 The Department of Health is grateful to Members of the Expert Group for the effort they have put into preparing this first report in such a short time.
