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

2. GAO 1999 zChemical terrorism likely to be a crime of opportunity. The GAO notes that: y“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.” y“Terrorists do not need sophisticated knowledge or dissemination methods to use toxic industrial chemicals.”

3. Aum Shirikyo Sarin zMatsumoto incident (judges ruling on sect) y20 kg released as aerosol y253 sought attention y58 hospitalized or died

4. Aum Shirikyo Sarin zTokyo subway incident: 1994 ymanufactured from precursor chemicals prior day y20 kg put in 5 subway trains in plastic bags yfirst victims arrived on foot y5510 patients seen

5. Aum Shirikyo Sarin zTokyo subway incident: 1994 y85% of those reporting concerned but not exposed yAntidote available y10% of immediate responders and hospital staff mildly exposed y54 patients severely affected or died

6. Aum Shirikyo Lessons to be learned zPrepare ahead of time: yprotocols/training yprepare for mass casualties zTriage: majority of those going to hospital may be concerned, not exposed zMust plan for decontamination at exposure site zFirst responders and ER personnel at some risk zMultiple events possible

7. Organophosphates zInitial Symptoms : yconstricted pupils yasthmatic response ymuscular tremors and paralysis zPersistent and delayed effects: yneuropathy yanoxic brain damage

8. Pulmonary Toxicants Effects zimmediate Laryngospasm or asthmatic response zPulmonary edema in 2-24 hours zLong term: yasthma and emphysema yanoxic brain effects

9. Pulmonary Toxicants Sulfur Dioxide zHighly irritating to both the upper and lower airways: forms sulfurous acid when contacts moist surfaces zHigh level “puff” exposure more damaging than same dose spread over hours zImmediate effects: ybronchoconstriction ylaryngospasm

10. Pulmonary Toxicants Sulfur Dioxide zDelayed effects (2-24 hrs): ypulmonary edema ylaryngeal edema ybronchoconstriction zLong-term effects: ybronchiolitis obliterans (irreversible small airway obstruction) 2-3 weeks after exposure yincreased asthma severity for as long as 18 months yinduction of non-specific airway reactivity (non- allergic asthma) yemphysema

11. Toxins Ricin zExperimental antineoplastic agent zreadily available: made from castor beans zHas been used for political assassination zConsidered as low risk as terrorist agent (GAO)

12. Toxins Ricin zDelayed effects (8-36 hours) zWith inhalation (primary route of concern) see: ybronchitis ynecrotizing pneumonia ypulmonary edema zNo available antidotes though effective, 1 shot, immunization

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