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Chemical Terrorism

Chemical Terrorism. Woodhall Stopford, MD, MSPH Community & Family Medicine Occupational & Environmental Medicine. GAO 1999. Chemical terrorism likely to be a crime of opportunity. The GAO notes that:

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Chemical Terrorism

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  1. Chemical Terrorism Woodhall Stopford, MD, MSPH Community & Family Medicine Occupational & Environmental Medicine

  2. GAO 1999 • Chemical terrorism likely to be a crime of opportunity. The GAO notes that: • “The ease or difficulty for terrorists to cause mass casualties with an improvised chemical or biological weapon or device depends on the chemical or biological agent selected.” • “Terrorists do not need sophisticated knowledge or dissemination methods to use toxic industrial chemicals.”

  3. Aum ShirikyoSarin • Matsumoto incident (judges ruling on sect) • 20 kg released as aerosol • 253 sought attention • 58 hospitalized or died

  4. Aum ShirikyoSarin • Tokyo subway incident: 1994 • manufactured from precursor chemicals prior day • 20 kg put in 5 subway trains in plastic bags • first victims arrived on foot • 5510 patients seen

  5. Aum ShirikyoSarin • Tokyo subway incident: 1994 • 85% of those reporting concerned but not exposed • Antidote available • 10% of immediate responders and hospital staff mildly exposed • 54 patients severely affected or died

  6. Aum ShirikyoLessons to be learned • Prepare ahead of time: • protocols/training • prepare for mass casualties • Triage: majority of those going to hospital may be concerned, not exposed • Must plan for decontamination at exposure site • First responders and ER personnel at some risk • Multiple events possible

  7. Organophosphates • Initial Symptoms: • constricted pupils • asthmatic response • muscular tremors and paralysis • Persistent and delayed effects: • neuropathy • anoxic brain damage

  8. Pulmonary ToxicantsEffects • immediate Laryngospasm or asthmatic response • Pulmonary edema in 2-24 hours • Long term: • asthma and emphysema • anoxic brain effects

  9. Pulmonary ToxicantsSulfur Dioxide • Highly irritating to both the upper and lower airways: forms sulfurous acid when contacts moist surfaces • High level “puff” exposure more damaging than same dose spread over hours • Immediate effects: • bronchoconstriction • laryngospasm

  10. Pulmonary ToxicantsSulfur Dioxide • Delayed effects (2-24 hrs): • pulmonary edema • laryngeal edema • bronchoconstriction • Long-term effects: • bronchiolitis obliterans (irreversible small airway obstruction) 2-3 weeks after exposure • increased asthma severity for as long as 18 months • induction of non-specific airway reactivity (non-allergic asthma) • emphysema

  11. ToxinsRicin • Experimental antineoplastic agent • readily available: made from castor beans • Has been used for political assassination • Considered as low risk as terrorist agent (GAO)

  12. ToxinsRicin • Delayed effects (8-36 hours) • With inhalation (primary route of concern) see: • bronchitis • necrotizing pneumonia • pulmonary edema • No available antidotes though effective, 1 shot, immunization

  13. Summary • Chemical terrorism in the U.S. is likely to be a crime of opportunity: use of war gases is unlikely • Most chemicals would need to be dispensed in large volumes to offer risk • Major technical difficulties limit risks associated with liquid or solid chemicals or toxins • Most events likely to be limited in time and place: keep in doors until plume passes

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