With the exception of chlorine’s early use in World War I, none of these gases has a military application or designation.Īn act of sabotage on a tanker or tank truck in the downtown area of a middle-American city rapidly could discharge tons of potentially lethal vapors. 2 The devastation of Bhopal, India, from the accidental release of toxic methyl isocyanate gas on an unprepared civilian population has been well chronicled. Releases of ammonia and chlorine in the civilian world have forced evacuation of hundreds of families in recent times. There is a wide range of chemicals that the military considers "unsuitable" for use as a chemical warfare agent that have significant application as agents of terrorism. 1Įqually likely is the use of precursors or industrial chemicals as improvised chemical warfare agents. Modern pesticide-producing plants can manufacture nerve agents, while ethylene and sulfurated petrochemicals may be combined in the Levinstein process to produce sulfur mustard gas. These agents often are either production chemicals or first derivatives of chemicals used to produce plastics, pesticides, and fabrics. In proper form, these agents can persist for long periods and could deny use of airports, water supplies, bridges, or even highways. Mustard gas and nerve agents have a high enough lethality and could be employed in a small enough package to interest the terrorist. With a high volatility, compounds such as phosgene, chlorine, hydrogen sulfide, and hydrogen cyanide could be used in a confined area such as a subway or building. The chemical tragedy that killed more than 2,000 people at Bhopal, India, in 1984 should convince any reluctant emergency physician that preparedness is necessary, even when no terrorists are involved.Īlthough a wide range of chemical weapons has been used in prior conflicts, only a small number of these compounds developed by the military is likely to be used by an aggressor or terrorist.
In addition, chemical plants recently have been listed as potential targets for terrorist attacks. The recent use of toxic chemical agents in the Tokyo and other Japanese subways mandate preparedness by civilian medical providers.
Chemical warfare agents easily are synthesized from readily available chemicals, and terrorist operations, such as Aum Shinriko, can simply make their own. It also is possible that a "state" sponsor could supply some terrorist groups with these weapons. Even though the military has control of the agents in most countries, it is quite possible that terrorist groups could gain access to these agents. More important to the civilian physician and the poison control center is the possibility that these agents might be employed by a terrorist group. It is quite unlikely that the civilian emergency physician will see these chemical warfare agents employed in wartime. Part II will address nerve agents and blood agents.
#Choking after effects series
Part I of this series will cover choking agents, vesicants, and halogenated oximes. What are the predominant agents? What injuries do they cause? What is the prognosis for their victims? These are questions that both military and civilian physicians alike should understand. As General Pershing warned after World War I, "the effect is so deadly to the unprepared that we can never afford to neglect the question." Indeed, Iraq and Iran already have used chemical weapons against each other and against the Kurdish population.Ĭhemical warfare is not a popular topic, but the potential of chemical warfare agents should be of overwhelming concern to civilian emergency physicians and prehospital providers. In 1997, Secretary of Defense William Cohen identified Libya, Iraq, Iran, and Syria as countries that aggressively were seeking nuclear, biological, and chemical weapons. For these terrorists, the possibility of chemical weapons is close at hand. 11, 2001, and others have studied in-depth the possibilities of using chemical agents to wreak havoc on the innocent. The terrorists involved in attacks of Sept. Now, the current war with Iraq and concerns about potential terrorism make chemical warfare agents and weapons of mass destruction important concerns. The spread of anthrax through the postal system in 2001 brought home the threat of bioterrorism. Medical Center Assistant Professor of Medicine, Harvard Medical School, Massachusetts Memorial Medical Center, Worcester, MA Jonathan L.īurstein, MD, FACEP, Director of Disaster Medicine, Beth Israel Deaconess Of Emergency Medicine, Director, Clinical Toxicology Services, University of Aaron, MD, FACMT, FACEP, Associate Professor Stewart, MD, FACEP, Emergency Physician, Colorado Part I: Choking Agents, Vesicants, and Halogenated OximesĪuthor: Charles E.
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