Some carry gas masks in their trunks. Some have antidotes in their glove compartments. They've been through drill after drill. Are they ready?

They are the M*A*S*H unit for Doomsday.

They are the military doctors, nurses and medics who, when the inevitable biological or chemical attack comes, are going to be responsible for the injured, who'll have to keep their wits amid chaos, who'll have to fight a deadly, unseen, sometimes unknown, enemy.

One hundred of them - volunteers all - have crammed into classrooms at Maryland's Edgewood Arsenal and Fort Detrick for the first medical class to address all three weapons of mass destruction - chemical, biological, nuclear. Or a combination. They all have reasons to volunteer, and they all face a common enemy: fear.

One is a doctor who listened helplessly from his ship to TV reports of a terrorist attack on the Japanese subway traveled by his wife and children.

Another is a nurse whose father helped radiation victims in postwar Japan.

A third is in charge of mobilizing a bone-marrow transplant bank that could be the only hope for soldiers gassed with mustard. In case of war, one of the first victims may be her husband, a military medic.

Sooner or later these medical experts will enter a battlefield untested on a mass scale. It could be botulism dripped into a restaurant salad bar. The dusting of an American embassy with anthrax. A pox among U.S. soldiers in the Saudi desert. Who knows how many people will die before these volunteers can return medical fire? Only this is sure: Hundreds, perhaps thousands, of lives will be in their hands.

"This is your fate," they are told. "You'll be regarded as a savior ... or as the people who made a mistake."

In a simple brick classroom at Edgewood Arsenal, the old U.S. chemical weapons depot on the edge of Aberdeen Proving Ground north of Baltimore, Lt. Col. James M. Madsen, 46, hurls Lifesavers at rows of soldiers foggy from travel. It's his opening salvo in the military's Berlitz-style class earlier this year in the next frontier of medicine.

His smile, like his energy, is broad and deep.

"EXXX-cel-lent!" he yells, jumping up, waving his arms excitedly, when somebody calls out a correct answer.

His exuberance suits his boyish face, parted crew cut, turned-out ears, polished shoes. "Mister Rogers on Speed" one student dubs him. His high is natural. Even coffee is barred by his Mormon faith.

A pathologist, Madsen is as intimate with the nuances of death as he is obsessed with preventing it. Washington tapped him to teach the Doomsday squad after the 1991 gulf war, when he took it upon himself, as a battalion physician, to convince reluctant soldiers to take a controversial, untested pill against nerve gas.

Watching Madsen in the classroom, one sees why people take a leap of faith with him. What Madsen preaches most ardently is this: Information is the antidote for fear.

His preparation for this class began five years ago when Madsen, newly assigned to the Edgewood chemical team, educated himself by writing up 21 single-spaced pages of notes on the military and terrorist use of chemical agents from 3000 B.C. to the present.

These he distributes to the "students," along with 11 pounds of special gear - jacket, pants, boots, belt, gloves and gas masks.

The monster-bug look of the breathing mask hasn't changed from World War II. It still uses a charcoal filter to keep out poison but now it's fine enough to allow the wearer to speak, hear and drink clean water through a straw attached to a thermos at the hip.

"Try it," Madsen urges. In the desert, he had slept in it rather than take it on and off each time the siren sounded.

The mask is surprisingly light. The other surprise is that it lops off a sizable chunk of vision.

And it's so much work to breathe that the initial reaction is to rip off the mask to get some air. The mask and military gear raise the body's temperature 15 degrees. Madsen's commander grew so hot on his third bus trip through the desert that he nearly pulled it off, despite the risk of being doused with a deadly chemical. "Just let them throw it," he said. "I don't care."

Every soldier will be tempted to pull off the mask, the class is told, but only one or two people in hundreds of thousands develop mask phobias. The rest will learn to live in this rubber monster, sleep in it, work in it. Otherwise they could become victims of airborne terror like the Kurdish woman in the photograph Madsen flashes before the class time and again.

The image was taken by journalists in the late 1980s after Iraq reportedly cleared villages of Iraqi Kurds with cyanide. The woman was climbing the steps with her swaddled baby when she fell, face down, on the concrete. Her arm remains gripped around her infant. The baby's face, tilted to the sky, is calm, as if in sleep. His mouth is open in a tiny halo. A thin line of blood drips from his lips.

"It's a dramatic way to die," Madsen says. Cyanide, favored by assassins, attaches itself to an enzyme, the powerhouse of the cell, smothering it and preventing the cell from taking in oxygen from the blood. With oxygen overcrowding the blood, the victim hyperventilates. Convulsions follow, paralysis set in, and death comes five to eight minutes later.

The antidotes, sodium nitrate and sodium thiosulfate, must be delivered intravenously within five minutes. Soldiers could survive if somebody can open the bulky 15-by-6-inch boxes of druet a needle through protective gear and into a vein in time.

"Who gets the kits?" calls out a hospital medic destined for the front line.

"You'll have some kits available," Madsen replies, "but not enough."

By the fourth time Madsen flashes the mother and child, one of the students sees his own wife and child.

Leader in decontamination

Steve Temerlin, a Navy flight surgeon and director of the emergency room in the Navy's Medical Center in San Diego, has sat quietly, purposefully, in a back row, taking in Madsen's tips without expression.

His face, toughened by five-hour stints on a ship's deck in 100-degree weather, is uncannily calm, but like everyone here, he says, he is terrified.

It is not his own death he fears, but being unprepared to stop the dying around him. He knows what it's like to be helpless.

"This is all very real to me," he begins. In March 1995 he was stationed on the U.S. Independent off Japan when he heard reports on CNN that terrorists had poisoned the subway in Tokyo with Sarin and thousands of people had been hurt.

He recognized the subway. It was the line his wife and daughters took when they left the military base and traveled an hour and a half into Tokyo to a religious school each week. And it was the day and hour they would be on it.

The ship's captain announced that no Americans were known to be among the casualties, but Temerlin couldn't be sure. Upward of 5,000 people flooded hospitals and doctors' offices seeking help.

Three days passed with no word before his ship landed and he learned that his youngest daughter had been sick the day of the attack so his wife decided against taking her to school.

Afterward, determined to never again feel helpless in the face of terror, he volunteered to set up the chem-bio decontamination team on the Navy's 1,000-bed West Coast hospital ship, Mercy.

His wartime assignment will be to decontaminate casualties who arrive by helicopter and to keep infections like smallpox and plague from getting past the deck of the ship. Should a terrorist strike San Diego, he would direct the civilian medical response. He set that up, too.

By now he has mastered his fear.

"At least as far as chemical weapons are concerned, they do not threaten me at all," he says. The protective gear works. The sensing equipment works. Advance notice is likely - anyone can test the grass with a strip of paper in his pocket.

"... I don't think the risk I am taking if I would ever be in a real-life situation is that great. I don't think it compares with a carrier pilot who lands on a ship at night ... I have never seen anything in my life more complicated ..."

Those first 15 seconds

In the ladies' room, a tall, thin woman adjusts the collar of her camouflage jacket, refreshes her lipstick and runs a comb through her blond hair. Her fingers reveal a gold wedding band. Schmidt is the name sewn on her pocket. Major Schmidt. Margaret.

As a child she heard her father, an Army colonel, tell stories of helping radiation victims in post-World War II Nagasaki.

Seven years ago, when her youngest child reached first grade, the nurse anesthetist enlisted in the Air Force Reserve. She's assigned to board a C-141 medical transport plane at Andrews Air Force Base within hours of an attack on U.S. forces abroad. This military posting, and the fact that her civilian job at Providence Hospital in Washington, is close to the Capitol, an obvious target for terrorists, make her among those likely to treat victims of modern chemical or biological weapons.

"It's not if, but when," she says. "I want to be prepared."

Think about it, she says: It costs $2,000 to kill everybody in one square mile using conventional weapons. The same area could be covered with nuclear weapons for $800, by a chemical like Sarin for $600 and by biologicals for a dollar.

"This is the battlefield of the future," she says.

She keeps rations in her basement.

"The threat is escalating," she says.

Once or twice a day in class, the doctors and nurses get a signal to jump from their chairs, rip out their gear and push a mask over their faces.

With only 15 seconds to protect their lungs from an airborne toxin, the hands that tighten straps and pull rubber coverings over necks in these exercises often shake.

Anything can go wrong.

Midweek in the Edgewood gym, when an alarm signals a full-scale simulated disaster, Nancy Beecher, 46, an operating-room nurse from Colorado Springs, fits her gas mask to her face in a nano-second. She's done it numerous times. This time, her goggles steam up, blinding her and as she tries to shut off the outside air, she fumbles.

A buddy runs over. Then another. The clock ticks: 10. 11. 12. 15 seconds. Six hands pull on the straps at the back of her head, adjusting the mask until it hugs her like a suction cup. As her vision clears, Beecher thinks about what could have interfered: In her rush when she got dressed this morning, she pinned up her waist-length braid slightly higher than usual.

"If I get called, I'm cutting off all my hair," she stammers, pulling off her mask.

The gym exercise is the closest Beecher and her classmates get to the actual physiological and psychological drain of treating patients in modern warfare. Everything about it is a challenge:

Sweltering in their gear, working harder for each breath, they are forced to bend over to hear patients, to identify injuries obscured by protective gear, and to scribble diagnoses in fingers thickened by rubber.

As the "victims" (drama students) convulse, writhe, groan, even wander away, the doctors and nurses sort through them, trying to identify the injured from the terrified. Most will be psych cases - the reversal of what happens in conventional war, when most people seeking medical attention are injured.

The terrorist attack on the Japanese subway illustrates yet another extraordinary medical challenge associated with biological or chemical strikes: The death toll in Tokyo was 12, and 900 others suffered temporary eye pain. But 5,000 people, the so-called "walking worried," flooded hospitals. Their problem was fear.

Old weapons, new delivery

At midweek, the class moves to Fort Detrick, to the U.S. Army Medical Institute of Infectious Diseases in Frederick. Madsen stays behind, yielding the floor to experts in biological warfare - the scariest of possibilities.

Unlike chemicals, biological weapons give no warning. Days go by before symptoms show up and, by then, the incubation period is over and it is too late to save the victim. The terrorists, meanwhile, are safely back home soaking their feet in front of the television.

The only way to prevent a vast human tragedy is for these doctors to spot "disconnects" - symptoms that don't make medical sense. A flu epidemic on a military base in summer, for instance.

So the remainder of the week is spent discussing how to spot the proverbial canary by positing scenario after scenario. Inexplicable deaths in cities around the country three days after the victims visited Disneyworld (anthrax). A cluster of strange flu-like cases in a doctor's office (smallpox).

"The tough part of biological warfare is to suspect it in the first place," says Ted Cieslak, chief lecturer.

In a city of 1 million attacked at night by five SCUDS carrying anthrax, assuming the worst conditions for the bacteria, 100,000 to 200,000 people would die - a situation akin to the casualties from nuclear weapons.

The possibility of such devastation in a battlefield convinced the secretary of defense to begin vaccinating the 2.5 million-member military against anthrax this year.

But given the risk, it's probably not worth vaccinating 300 million people. "Better to hope for a canary," Cieslak says.

The government expects that someone will succeed at a domestic attack in the next five years. It could be state-sponsored terrorism or the work of individuals.

The fact is, people have tried to use biological toxins for centuries, with limited success. Now a technological and information explosion makes it easier to get and deliver these weapons. The biological weapon of choice - and the one involved in hoaxes - is anthrax, an ancient bacteria passed from animal to humans through wool or blood. It causes lesions covered by large, black scabs - hence its name, Greek for black coal.

Anthrax is easily harvested from dead animals in the American Southwest. Smallpox and plague, both highly contagious when inhaled, and botulinus toxins are easy to manufacture. Cieslak says the Iraqis bought their collection from a type-culture company in Rockville; they are harder to get now - "you have to sign for them."

At the coffee pot, an ear-and-nose specialist is shaking. He would only fill in on a military base in wartime and doesn't expect to see action himself. Until he took this class, he wasn't concerned. Now he's scared to death. "It's fine for me," he says. "I got the gear, the vaccine. But what about my wife and kids?"

Ready to fight fear

At week's end, Madsen drives over from Edgewood in the early-morning hours. "I missed you," he tells the class.

He's giving a pre-exam review, a needed break from his latest assignment: finding a way to decontaminate soldiers felled in biological warfare so they can be returned home for burial. (The only sure way to kill off the deadly germs, known to live on for 40 years, is to burn the bodies, but fearing a public relations disaster, President Bush forbade it.)

The harder Madsen works for this class, though, the fewer bodies he has to worry about how to bring home later.

This is his last chance to prepare them. He knows how fear can motivate - a red scar runs down his neck, reminding him.

Not too long ago, a tumor was removed. It had metastasized in a nearby lymph node. The soldier-doctor spent months researching vascular cancer. Though his doctors predicted this rare form of the disease might not develop for 20 to 30 years, Madsen convinced surgeons to cut out the carotid artery and replace it with a vein from his leg. The surgeons feared a high risk for stroke if a blood clot should form on scar tissue. But Madsen figured that 30 years from now, researchers are more likely to perfect ways to monitor the blood flow to his brain than to find a cure for cancer.

Preparation is the antidote for fear.

A pocket-sized military handbook on how to recognize victims of biological weapons went into its third edition last month.

A film version of what military doctors learned in Maryland will be offered to civilian doctors beginning this fall, through the Centers for Disease Control and Prevention. The goal is to quadruple the number of American doctors trained to recognize an outbreak of biological warfare and to treat injuries from all instruments of mass destruction.

The experts on biological war in Frederick are urging Congress to stockpile antidotes and antibiotics in local hospitals.

And on stage, Madsen joins other doctor-soldiers to hand out diplomas. He shakes hands with each graduate as he reads out grades - 100, 98, 90, 92. ... He's smiling: They, like Madsen, are now prepared to fight fear with their wits.

Pub Date: 7/30/98