Chemical Agents of Warfare and Terrorism

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Chemical Agents of Warfare and Terrorism

• Glenn Paulson

Funding provided by the NJ Department of Health
and Senior Services, through the CDC Public
Health Preparedness and Response for Bioterrorism
Program.
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Use of Chemical Warfare Agents (The Early Years)

• Chemical Agents used 2000 BC in wars between
  India and China dried red peppers in rice paper
  burned and thrown at enemy (incapacitating, not
  lethal)
• 423 BC the Spartan allies took an Athenian fort
  by directing smoke into the fort through a
  hollowed out beam.
• 600AD Greek Fire, a liquid which auto-ignited
  when exposed to air, was develope by the
  Byzantine Empire, helping to keep them in power
  for 500 years.

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Use of Chemical Warfare Agents (The Coming of Age)

• WWI Germans released 150 tons of chlorine gas at
  Ypres, Belgium
• 800 troops died
• Many more casualties
• Two years later, same location, the Germans used
  a new agent, mustard.
• 20,00 Casualties
• 1917 phosgene used by Germans on battlefield at
  Verdun

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Use of Chemical Warfare Agents

• Soviets dismantled German production facilities
  and began production of nerve agents in 1946
• Since 1915, use of mustard produced large scale
  casualties (400,000 casualties in WWI, Ethiopia
  in 1935, China, 1937-1944, and Iran-Iraq war,
  1982-88)

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Recent CWA Terrorist Events

• 1995 Aum Shinrikyo sect released Sarin vapor
  into Tokyo subway system
• 12 deaths, 5,500 casualties (4,000 w/o clinical
  manifestation of injury)
• 1993 World Trade Center Bombing
• Van contained sufficient cyanide to contaminate
  entire building with potentially lethal
  concentrations
• Cyanide destroyed in blast

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Preparing for potential chemical attacks

• Enhance awareness of potential chemical terrorism
  among physicians, nurses, public health
  officials, emergency medical service personnel,
  police officers, firefighters, and others.
• Enhance epidemiologic capacity for detecting and
  responding to chemical attacks.
• Stockpile chemical antidotes.
• Develop and provide means to detect and diagnosis
  chemical injuries.
• Prepare educational materials to inform the
  public during and after a chemical attack

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Chemical Agents

• Range from warfare agents to toxic chemicals
  commonly used in industry.
• Criteria for determining priority chemical agents
  include
• chemical agents already known to be used as
  weaponry
• availability of chemical agents to potential
  terrorists
• chemical agents likely to cause major morbidity
  or mortality
• potential of agents for causing public panic and
  social disruption
• agents that require special action for public
  health preparedness

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Potential Terrorism Risks from Chemical Agents

• Detonation of CWA-containing munitions
• Atmospheric Dispersal
• Contamination of Food Supplies
• Contamination of Water Supplies
• Product Tampering
• Shared Feature Low Probability/High Consequence
  Event

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Sources of CW Agents

• Foreign governments
• Internet recipes
• Crime and corruption in former Soviet Union
• U.S. industrial facilities (e.g., chlorine,
  phosgene, etc.)
• U.S. military stockpile
• About 30,600 tons of nerve agents and vesicants
  at 8 sites across U.S.
• 1985 law directed DoD destroy stockpile by 1994
  extended to 2004)
• U.S. Military non-stockpile
• Outdated CWA and recovered weaponsburied at 215
  sites

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Key CWA Characteristics

• Volatility
• Tendency to evaporate from liquid to gas form
• Greater volatility shorter persistence
• Vapor Density
• Weight of the vapor or mist relative to air
• All CWAs (except HCN) heavier than air
• Persistence
• Most evaporate gt 24 hours
• Present increased risk for skin exposure to
  victims and risk to responders

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Toxicity of CWAs

• Potential to cause injury in biologic systems
• LD50 single dose causing death in 50 of
  animals
• ED50 dose where 50 of exposed population will
  exhibit signs or symptoms
• LD50 and ED50 limited use for toxicity of agents
  inhaled or absorbed across mucous membranes
• Concentration-time (C-T) used for CWAs
• Concentration in air x time exposed
• Represented as milligrams/minute/cubic meter
• Latency time delay between exposure and
  clinical signs/symptoms (sulfur mustard and
  pulmonary have longestnerve agents and cyanides
  shortest)

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Classes of Chemical Agents

• Nerve Agents
• Inhibit acetylcholinesterase (AChE) causing Ach
  accumulation and excessive cholinergic
  stimulation
• Incapacitating Agents
• Irritation and extreme pain to affected organs
• Pulmonary Agents
• Impair ability to function- not permanent
• Vesicants and Blistering Agents
• Extensive irreversible tissue damage
• Blood Agents
• Interfere with cellular respiration

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Nerve Agents

• Tabun (GA)
• Sarin (GB)
• Soman(GD)
• VE
• VG
• V-Gas
• VM
• VX

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Health Effects of Nerve Agents

• Toxic by inhalation, absorption or ingestion in
  very small amounts
• Effects after dermal exposure may be delayed for
  as long as 18 hours.
• Effects - runny nose, chest tightness, pinpoint
  pupils, shortness of breath, excessive salivation
  and sweating, nausea, vomiting, abdominal cramps,
  involuntary defecation and urination, muscle
  twitching, confusion, seizures, paralysis, coma,
  respiratory paralysis, and death.

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Nerve Agents, Continued

• Incapacitating effects occur within 1 to 10
  minutes and fatal effects can occur within 1 to
  10 minutes for GA, GB, and GD, and within 4 to 42
  hours for VX.
• Fatigue, irritability, nervousness, and memory
  defects may persist for as long as 6 weeks after
  recovery from an exposure episode.
• Longer-term effects, if any, not well known.

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Incapacitating Agents

• Riot Control/Tear
• Bromobenzylcyanide Chloroacetophenone
• Chloropicrin
• CNB - (CN in Benzene and Carbon Tetrachloride)
• CNC - (CN in Chloroform)
• CNS - (CN and Chloropicrin in Chloroform)

• Vomiting
• Adamsite (DM)
• Diphenylchloroarsine (DA)
• Diphenylcyanoarsine (DC)
• Other
• Agent 15
• BZ
• Canniboids
• Fentanyls
• LSD
• Phenothiazines

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Potential Health Effects of Incapacitating Agents

• Short Duration of Action
• Irritation and extreme pain
• Eyes, nose, respiratory tract
• Occasionally vomiting follows exposure
• Sometimes esophageal or laryngeal constriction
• Hallucinogenic

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Pulmonary Agents

• Chlorine (CL)
• Diphosgene (DP)
• Cyanide
• Nitrogen oxide (NO)
• Perflurorisobutylene (PHIB)
• Phosgene (CG)
• Red phosphorous (RP)
• Sulfur trioxide-dhlorosulfonic Acid (FS)
• Teflon and perflurorisobutylene (PHIB)
• Titanium tetrachloride (FM)
• Zinc oxide (HC)

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Health Effects of Pulmonary Agents

• Inhalation primary route of entry
• Variety of upper respiratory and pulmonary
  effects
• Variable latency (water solubility impacts) from
  minutes to 72 hours
• Latency decreased with length of exposure and
  physical activity
• Shallow breathing, chest tightness, cough
• Laryngeal spasm, airway obstruction, pulmonary
  edema (2-6 hours post-exposure)

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Blister/Vesicant Agents

• Distilled mustard (HD)
• Lewisite (L)
• Mustard gas (H) (Sulfur mustard)
• Nitrogen mustard (HN-2)
• Phosgene oxime (CX)
• Ethyldichloroarsine (ED)
• Methyldichloroarsine (MD)
• Mustard/Lewisite (HL)
• Mustard (H)

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Acute Effects of Sulfur Mustard Exposure

• 5 Fatality. Low or no garlic-like odor.
• Symptoms delayed 2 to 24 hours.
• Skin redness and itching of the skin may occur 2
  to 48 hours after exposure and change eventually
  to yellow blistering of the skin.
• Eyes irritation, pain, swelling, and tearing may
  occur within 3 to 12 hours of a mild to moderate
  exposure. A severe exposure may cause symptoms
  within 1 to 2 hours and may include the symptoms
  of a mild or moderate exposure plus light
  sensitivity, severe pain, or blindness (lasting
  up to 10 days).

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Acute Effects of Sulfur Mustard Exposure-continued

• Respiratory tract runny nose, sneezing,
  hoarseness, bloody nose, sinus pain, shortness of
  breath, and cough within 12 to 24 hours of a mild
  exposure and within 2 to 4 hours of a severe
  exposure.
• Digestive tract abdominal pain, diarrhea, fever,
  nausea, and vomiting.

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Chronic Effects of Mustard

• Exposure to sulfur mustard liquid is more likely
  to produce second- and third- degree burns and
  later scarring than is exposure to sulfur mustard
  vapor. Extensive skin burning can be fatal.
• Extensive breathing in of the vapors can cause
  chronic respiratory disease, repeated respiratory
  infections, or death.
• Extensive eye exposure can cause permanent
  blindness.
• Exposure to sulfur mustard may increase a
  persons risk for lung and respiratory cancer.

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Blood Agents

• Arsine (SA)
• Cyanogen Chloride (CK)
• Hydrogen Chloride
• Hydrogen Cyanide (AC)

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Health Effects of Blood Agents

• Immediate signs and symptoms of cyanide exposure
• Rapid breathing
• Restlessness
• Dizziness
• Weakness
• Headache
• Nausea and vomiting
• Rapid heart rate

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Health Effects of Blood Agents-continued

• Convulsions
• Low blood pressure
• Slow heart rate
• Loss of consciousness
• Lung injury
• Respiratory failure leading to death
• Survivors of serious cyanide poisoning may
  develop heart and brain damage.

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Sources of Information
www.bt.cdc.gov/agent/agentlistchem-category.asp
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Sources of Information
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Sources of Information
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Sources of Information
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Clues suggesting release of a chemical agent

• An unusual increase in the number of patients
  seeking care for potential chemical-release-relate
  d illness
• Unexplained deaths among young or healthy persons
• Emission of unexplained odors by patients
• Clusters of illness in persons who have common
  characteristics, such as drinking water from the
  same source
• Rapid onset of symptoms after an exposure to a
  potentially contaminated medium (e.g.,
  paresthesias and vomiting within minutes of
  eating a meal)

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Clues suggesting release of a chemical
agent--continued

• Unexplained death of plants, fish, or animals
  (domestic or wild)
• Syndrome (i.e., a constellation of clinical signs
  and symptoms in patients) suggesting a disease
  associated commonly with a known chemical
  exposure (e.g., neurologic signs or pinpoint
  pupils in eyes of patients with a
  gastroenteritis-like syndrome or acidosis in
  patients with altered mental status)

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General Treatment Guidelines

• Nerve Agents
• Atropine, pralidoxime chloride (2-PAMCl), or
  diazepam
• Incapacitating Agents
• Remove to fresh air, decon w/water, 6bicarbonate
  solution
• Pulmonary Agents
• Supplemental oxygen, restrict physical activity,
  medical attention
• Vessicants/Blister Agents
• Remove to fresh air, remove clothing,
  decontaminate skin, supplemental oxygen,
  hospitalization, extensive irrigation of eyes
• Blood Agents
• Amyl nitrate, sodium nitrate, sodiumthiosulfate

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Patient Management and Treatment

• Focus on Airway, Breathing, Circulation (ABCs)
• Personal Protective Equipment (respiratory, skin)
• Clothing Removal
• Decontamination of Patient
• Copious water w/any liquid soap
• 0.5-2 bleach solution (controversial)
• Soft sponges (no abrasive cleaners)
• Plain water or normal saline for eyes
• Do not delay irrigation

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Chemical Warfare Agent Detection

• Ionization Instruments
• Flame Ionization Detectors (FID)
• Poor range of detection
• Not selective
• Photo Ionization Detectors (PID)
• Good range of detection
• Not Selective

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Chemical Warfare Agent Detection

• Ionization Instruments
• Ion Mobility Spectrometry (IMS)
• Excellent range of detection
• Moderately selective

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Chemical Warfare Agent Detection

• Surface Acoustic Wave (SAW)
• Very Good range of detection
• Fairly Selective
• Filter Based Infrared Spectroscopy(FBIS) or
  Non-Dispersive Infrared (NDIR)
• Very Good range of detection
• Fairly Selective

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Chemical Warfare Agent Detection

• Colorimetric Tubes
• Very good range of detection
• Fairly Selective
• Electrochemical Sensors
• Poor range of detection

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Sources of Information

• CDC
• US Military Sources
• The New Jersey Center for Public Health
  Preparedness at UMDNJ, www.njcphp.org
• The speaker Glenn Paulson, Director, NJCPHP,
  phone [phone], paulsogl_at_umdnj