Since Vapors And Gases Can Penetrate The Openings In Garments

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  • Since Vapors And Gases Can Penetrate The Openings In Garments

    1. 1. Chemical Agents as Terrorist Weapons
    2. 2. Acknowledgements <ul><li>South Carolina Area Health Education Consortium (AHEC) </li></ul><ul><ul><li>Funded by the Health Resources and Services Administration. </li></ul></ul><ul><ul><ul><li>Grant number: 1T01HP01418-01-00 </li></ul></ul></ul><ul><ul><li>P.I. : David Garr, MD, Executive Director AHEC </li></ul></ul><ul><ul><li>BT Project Director: Beth Kennedy, Associate Program Director AHEC </li></ul></ul><ul><ul><li>Core Team: </li></ul></ul><ul><ul><ul><li>BT Co-director: Ralph Shealy, MD </li></ul></ul></ul><ul><ul><ul><li>BT Project Manager: Deborah Stier Carson, PharmD </li></ul></ul></ul><ul><ul><ul><li>BT CME Director: William Simpson, MD </li></ul></ul></ul><ul><ul><ul><li>IT Coordinator: Liz Riccardone , MHS </li></ul></ul></ul><ul><ul><ul><li>Web Master: Mary Mauldin, PhD </li></ul></ul></ul><ul><ul><ul><li>P.R Coordinator: Nicole Brundage, MHA </li></ul></ul></ul><ul><ul><ul><li>Evaluation Specialist: Yvonne Michel, PhD </li></ul></ul></ul><ul><ul><ul><li>Financial Director: Donald Tyner, MBA </li></ul></ul></ul>
    3. 3. Acknowledgment This material has been prepared for SC AHEC Bioterrorism Training Network by Ralph M. Shealy, M.D., FACEP Co-Director of SC AHEC Bioterrorism Training Network Medical Director for Operations, Charleston County EMS Medical Director, Charleston County Rescue Squad
    4. 4. Objectives <ul><li>At the conclusion of this presentation, the participant will: </li></ul><ul><ul><li>Outline the historical frequency with which chemical agents have been used. </li></ul></ul><ul><ul><li>Describe common civilian situations in which a chemical community health emergency may occur. </li></ul></ul><ul><ul><li>Describe how the physical state of an agents influences its effectiveness. </li></ul></ul><ul><ul><li>List the six general classes of chemical agents. </li></ul></ul><ul><ul><li>Describe the signs, symptoms, mechanism of action, decontamination procedure, and clinical management of each class of chemical agents </li></ul></ul>
    5. 5. Regarding chemical weapons.. “ The effect is so deadly to the unprepared that we can never afford to neglect the question.” General John Pershing Commander of American Forces in Europe during World War I
    6. 6. World War I <ul><li>1915: Germans released 150 tons of chlorine gas from 600 cylinders in Belgium </li></ul><ul><li>British and French fielded cyanide to a limited extent during World War I. </li></ul><ul><li>1917: Germans deliver artillery shells containing sulfur mustard, causing 20,000 casualties. </li></ul><ul><li>Russia suffered 500,000 chemical casualties in World War I </li></ul>
    7. 7. Following World War I <ul><li>Britain used chemicals against Russians and mustard against the Afghans north of Khyber Pass. </li></ul><ul><li>Spain used mustard shells and bombs against the Riff tribes of Morocco. </li></ul><ul><li>Soviet Union used lung irritants against tribesmen in Kurdistan </li></ul><ul><li>Italy under Mussolini used mustard against Abyssinian tribesmen </li></ul><ul><li>Japan used chemicals against China. </li></ul>
    8. 8. World War II <ul><li>There was limited use of chemical weapons during the World War II </li></ul><ul><li>Germany used cyanide in the concentration camps. </li></ul><ul><li>In 1943, Germans bombed an American ship loaded with two thousand 100 pound mustard bombs in Bari Harbor, Italy, causing 600 military deaths and an unknown number of civilian casualties. </li></ul>
    9. 9. Recent Decades <ul><li>Egypt used mustard bombs against North Yemen royalists in 1963. </li></ul><ul><li>The United States used defoliants and riot control agents in Vietnam and Laos. </li></ul><ul><li>Chemicals were used against Cambodian refugees and Hmong tribesmen of Laos in 1970s and 1980s. </li></ul><ul><li>The Soviet Union used chemicals in its war against Afghanistan. </li></ul><ul><li>Iraq used mustard and nerve gas against Iran in the 1980s. </li></ul>
    10. 10. Why Tell This Story? <ul><li>Chemical weapons have been used frequently in the past. </li></ul><ul><li>There is every reason to believe they will be used again. </li></ul><ul><li>Chemical weapons give the underdog an advantage. </li></ul><ul><li>“ The effect is so deadly to the unprepared that we can never afford to neglect the question.” </li></ul>
    11. 11. Why would terrorist use chemical agents as weapons of terrorism? <ul><li>Chemical agents are: </li></ul><ul><ul><li>Cheap. </li></ul></ul><ul><ul><li>Readily available. </li></ul></ul><ul><ul><li>Do not require technological sophistication. </li></ul></ul><ul><ul><li>Do not require high tech delivery systems. </li></ul></ul><ul><ul><li>Cause fear and panic out of proportion to actual physical damage. </li></ul></ul>
    12. 12. Recent Japanese Experience <ul><li>In June 1994, a cult group spread Sarin nerve gas in the city of Matsumoto. Seven died and fifty-six required hospitalization </li></ul><ul><li>On March 20, 1995, the same group released Sarin in the Tokyo subway. Eleven died and 5,500 were injured. </li></ul><ul><li>In both incidents, health professionals were injured. </li></ul>
    13. 13. Why not do it the easy way? <ul><li>Dangerous chemicals are already available in our cities and towns. </li></ul><ul><li>A terrorist need only utilized chemicals that are already here. </li></ul><ul><li>Exotic chemical agents used as weapons are not necessary. </li></ul>
    14. 14. More Probable Events <ul><li>South Carolina health professionals are more likely to be confronted by: </li></ul><ul><ul><li>Industrial releases </li></ul></ul><ul><ul><li>Transportation accidents with leakage </li></ul></ul><ul><ul><li>Agricultural exposures </li></ul></ul>
    15. 15. The Bottom Line <ul><li>THIS REALLY CAN HAPPEN TO YOU! </li></ul>
    16. 16. Physical States of Chemical Agents <ul><li>Chemical agents in weapons are usually liquids. </li></ul><ul><li>Aerosols are very small particles of a solid or tiny droplets of a liquid suspended in the air. </li></ul><ul><li>Liquid agents evaporate to form a vapor. </li></ul><ul><li>Solids and liquids tend to be persistent, while vapors and aerosols are non-persistent. </li></ul>
    17. 17. Vapors and Gases <ul><li>Vapors and gases attack: </li></ul><ul><ul><li>the lungs </li></ul></ul><ul><ul><li>the tracheobronchial tree </li></ul></ul><ul><ul><li>mucous membranes, including the eyes </li></ul></ul><ul><li>Vapors and gases require special personal protective equipment. </li></ul>
    18. 18. Six Types of Chemical Agents <ul><li>Lung damaging agents </li></ul><ul><li>Cyanide (also called blood agents) </li></ul><ul><li>Vesicants (also called blister agents) </li></ul><ul><li>Nerve agents </li></ul><ul><li>Incapacitating agents </li></ul><ul><li>Riot-control agents </li></ul>
    19. 19. Toxidrome (Toxic Syndrome) <ul><li>A toxidrome is a set of clinical signs and symptoms by which a class of toxic agents can be recognized. Recognition of a toxidrome by clinicians can often lead to the identification of a causative agent faster and more effectively than can the analytical laboratory. </li></ul>
    20. 20. Pulmonary Agents <ul><li>Phosgene and chlorine. </li></ul><ul><li>Attack mucous membranes and respiratory system. </li></ul><ul><li>Odor of new mown hay. </li></ul><ul><li>Decontaminate with fresh air and copious water irrigation. </li></ul><ul><li>Supportive care. </li></ul>
    21. 21. Cyanide <ul><li>Hyperpnea with flushed skin. </li></ul><ul><li>Seizures. </li></ul><ul><li>Respiratory and cardiac arrest. </li></ul><ul><li>Odor of almonds. </li></ul><ul><li>Causes cellular asphyxia and profound metabolic acidosis. </li></ul><ul><li>Decontaminate with fresh air and copious water irrigation. </li></ul><ul><li>Use nitrates to liberate cyanide from hemoglobin and thiosulfate to facilitate excretion. </li></ul>
    22. 22. Vesicants <ul><li>Sodium mustard is the prototype blistering agents </li></ul><ul><li>Delayed onset of symptoms </li></ul><ul><li>Attacks skin, eyes, airway, lungs, GI tract, and bone marrow </li></ul><ul><li>Odor of onion, garlic, or mustard. </li></ul><ul><li>Immediately decontaminate with hypochlorite to prevent damage. </li></ul><ul><li>No specific therapy. </li></ul>
    23. 23. Vesicants <ul><li>Lewisite causes immediate pain on contact, which encourages immediate escape from exposure and decontamination. </li></ul><ul><li>Lewisite produce skin, eye, and respirator damage similar to mustard. </li></ul><ul><li>Lewisite causes systemic toxicity </li></ul><ul><li>BAL is the antidote </li></ul>
    24. 24. Nerve Agents <ul><li>May cause death within minutes. </li></ul><ul><li>Inhibit serum acetylcholinesterase. </li></ul><ul><li>Smooth muscles become hyperactive. </li></ul><ul><li>Striated muscle becomes flaccid. </li></ul><ul><li>Secretory glands become hyperactive. </li></ul><ul><li>Decontamination is with hypochlorite and fluid irrigation. </li></ul><ul><li>Atropine and pralidoxime are antidotes. </li></ul>
    25. 25. Incapacitating Agents <ul><li>Impair performance by CNS effects. </li></ul><ul><li>Anticholinergic agents that have opposite effects of nerve agents. </li></ul><ul><li>Cause decreased concentration, impaired memory, loss of judgment, and distortion of perceptions. </li></ul><ul><li>Physostigmine is a specific antidote. </li></ul>
    26. 26. Riot Control Agents <ul><li>Known as “tear gas”, “Mace”, and “pepper spray”. </li></ul><ul><li>Burning and pain on exposed mucous membranes and skin, eye pain and tearing, burning nostrils, and respiratory discomfort </li></ul><ul><li>Occasional deaths with prolonged exposure to high concentrations in a confined space. </li></ul><ul><li>Effects typically brief and self limiting. </li></ul>
    27. 27. Decontamination <ul><li>The reduction or removal of a chemical agent. </li></ul><ul><li>Achieved by physical means, such as washing, or by chemical neutralization or detoxification </li></ul><ul><li>The single most effective decontamination procedure is the removal of contaminated garments. </li></ul><ul><li>The most important and most effective decontamination is done within the first minute or two after exposure. </li></ul><ul><li>Effective early decontamination can mean the difference between survival and death. </li></ul>
    28. 28. Summary <ul><li>Chemical agents have frequently been used in warfare by many nations. </li></ul><ul><li>There are many civilian situations that may result in a chemical community health emergency. </li></ul><ul><li>There are six general classes of chemical agents, each with its own toxidrome, decontamination procedure, and clinical management. </li></ul><ul><li>Preparation is the best defense against a terrorist attack with chemical agents. </li></ul>
    29. 29. Acknowledgements <ul><li>This presentations borrows heavily from </li></ul><ul><ul><li>“ The Medical Management of Chemical Casualties Handbook,” Third Edition, produced by the U.S. Army Medical Research Institute of Chemical Defense. </li></ul></ul><ul><ul><li>Emergency Medicine , Fourth Edition, produced by the American College of Emergency Physicians and edited by Judith Tintinalli, M.D. </li></ul></ul>
    30. 30. <ul><li>Questions? </li></ul>

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