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APPENDIX C-2: CHEMICAL BIOTERRORISM AND INDUSTRIAL ACCIDENTS

CHEMICAL BIOTERRORISM AND INDUSTRIAL ACCIDENTS: INTRODUCTION

Chemical agents have been used as weapons on a large scale in World War I, in the Iraq-Iran War, by Iraq against Kurdish civilians, and in the Sarin attacks in Japan. Industrial hazardous materials (HAZMATs) produced in chemical plants could also be used as weapons in chemical terrorism.

Table C-2 lists potential agents for such attacks and the symptoms they elicit. Of these, the blistering agent sulfur mustard is one of the most likely agents to be used in a terrorist attack scenario, and it also induces skin lesions (see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4904a1.htm).

TABLE C-2Recognizing and Diagnosing Health Effects of Chemical Terrorism
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TABLE C-2 Recognizing and Diagnosing Health Effects of Chemical Terrorism
Agent Agent Name Unique Characteristics Initial Effects
Nerve

Cyclohexyl sarin (GF)

Sarin (GB)

Soman (GD)

Tabun (GA)

VX

Miosis (pinpoint pupils)

Copious secretions

Muscle twitching/fasciculations

Miosis (pinpoint pupils)

Blurred/dim vision

Headache

Nausea, vomiting, diarrhea

Copious secretions/sweating

Muscle twitching/fasciculations

Breathing difficulty

Seizures
Asphyxiant/blood

Arsine

Cyanogen chloride

Hydrogen cyanide

Possible cherry red skin

Possible cyanosis

Possible frostbitea

Confusion

Nausea

Patients may gasp for air, similar to asphyxiation but more abrupt onset

Seizures prior to death
Choking/pulmonary damage

Chlorine

Hydrogen chloride

Nitrogen oxides

Phosgene

Chlorine is a greenish yellow gas with pungent odor

Phosgene gas smells like newly mown hay or grass

Possible frostbitea

Eye and skin irritation

Airway irritation

Dyspnea, cough

Sore throat

Chest tightness
Blistering/vesicant

Mustard/Sulfur mustard (HD, H)

Mustard gas (H)

Nitrogen mustard (HN-1, HN-2, HN-3)

Lewisite (L)

Phosgene oxime (CX)

Mustard (HD) has an odor like burning garlic or horseradish

Lewisite (L) has an odor like penetrating geranium

Phosgene oxime (CX) has a pepperish or pungent odor

Severe irritation

Redness and blisters of the skin

Tearing, conjunctivitis, corneal damages

Mild respiratory distress to marked airway damage

May cause death

Dry mouth and skin
Incapacitating/behavior-altering Agent 15/BZ

May appear as mass drug intoxication with erratic behaviors, shared realistic and distinct hallucinations, disrobing and confusion

Hyperthermia

Mydriasis (dilated pupils)

Initial tachycardia

Altered consciousness, delusions, denial of illness, belligerence

Hyperthermia

Ataxia (lack of coordination)

Hallucinations

Mydriasis (dilated pupils)

aFrostbite may occur from skin contact with liquid arsine, cyanogen chloride, or phosgene.

Source: State of New York, Department of Health. https://www.health.ny.gov/environmental/emergency/chemical_terrorism/poster.htm

Following exposure and an asymptomatic latent period, erythema, pruritus, burning, and pain may present; initial blistering of the skin will start on the second day after exposure and will progress for up to 2 weeks. Vesicles coalesce, forming large blisters, and wound healing is considerably slower than for a comparable thermal burn. Differential diagnoses are thermal burn or scalding, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. (See also W R Heymann: Threats of biological and chemical warfare on civilian populations. J Am Acad Dermatol 2004, 51:452.)

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