1. Chemical Terrorism: Awareness

2. Chemicals as Weapons Historical attempts to poison enemy food supplies Scientific advances increase mass casualty potential Technical advancements New delivery methods National Institute for Occupational Safety and Health Image

3. Chemical Weapons on the Battlefield World War I use Chlorine and mustard agent World War II developments: Tabun, Sarin, and Soman by Germany VX by Great Britain Rocket delivery Worldwide outcry for chemical weapon treaties

4. 1980’s: reports of seizures of chemical stockpiles and arrests of individuals in possession of CW Covenant, Sword, and Arm of the Lord group Various Palestinian groups Growing Threat of Chemical Terrorism

5. 1990’s: Increasing use Iraq’s chemical weapons use: Against Iranian Soldiers Against own Kurdish population Aum Shinrikyo sarin attacks in Tokyo Growing Threat of Chemical Terrorism

6. CW: The Terrorist Risk Five levels of risk for terrorist use Threatened use, with no real capability Unsuccessful attempts to acquire CW Actual possession of CW Unsuccessful attempts to use CW The successful use of CW

7. CW: The Terrorist Risk Why haven’t we seen more use by terrorists? Groups seeking political legitimacy may fear severe backlash Bombs provide greater shock value and carnage for media coverage Most likely reason: Uncertainty

8. CW: Advantages Advantages Inexpensive Easy availability Long “shelf life” High level of control and containment Effect (death or disability) is immediate Destroys infrastructure Low risk of detection Lack of a “signature” allows anonymity

9. CW: Agents The military defines five types of agents Nerve Agents Sarin, Soman, Tabun and VX (organophosphates) Blister Agents Mustard, Lewisite “Blood” (Cyanide) Agents “Choking” Agents Chloride, Phosgene Incapacitating Agents Tear Gas, Pepper Spray,

10. Commercial Chemicals can also be used as weapons The FBI has a list of industrial chemicals that terrorists might use called the “Critical Agent List” Ammonia Arsine Chlorine Cyanides Hydrogen Sulfide Methyl Isocyanate Phosgene Phosphine Sulfur Dioxide Fluorine

11. CW: Availability Nerve Agents are a chemical of choice Formula and chemical process declassified information Easy to manufacture from readily available components For sale on the “black market”

12. CW: Availability Commercially available pesticides easily purchased or stolen Military and Law Enforcement agents may be stolen under the lax security State Sponsorship of terrorist groups: provision of labs & production facilities

13. CW: Toxicity Falls between conventional weapons and biological or nuclear weapons Environmental conditions are key factor Goal of the terrorist Harassment vs. death Determines type of agent used

14. CW: Toxicity Quantity required to produce heavy casualties within square-mile area under idealized conditions

15. Nerve Agents Are organophosphate chemicals Many commercial pesticides are very similar in composition Attack the body’s ability to send messages to the muscles Can be lethal in small quantities Are dangerous if inhaled or through skin contact

16. Blister Agents Military agents designed to cause casualties by destroying the victim’s skin Dangerous through inhalation and skin contact Often have symptoms that can be delayed up to 48 hours

17. “Blood” Agents and Commercial Cyanide Compounds Rapidly acting chemicals that effect a body’s ability to utilize oxygen within its cells. Highly toxic Many hundreds of thousands of tons of cyanides and cyanates are produced commercially every year Generally most dangerous through inhalation

18. “Choking” Agents and Civilian Chemicals Chlorine was the first chemical weapon used Chlorine is utilized in almost every community within the United States Millions of tons of these materials are manufactured and transported commercially every year Toxic through inhalation and irritating through skin contact

19. Incapacitating Chemicals These are chemicals designed to produce non-lethal effects in victims They can cause mass casualty events through panic The nightclub event in Chicago caused over two dozen fatalities due to panic causing a stampede with dozens of club patrons being trampled and crushed.

20. Other Commercial Chemicals Produced in huge quantities throughout the United States Often transported in bulk in railway cars and barges Offer tempting targets for terrorists A relatively small explosive charge could rupture a huge bulk transportation or storage container and produce a huge vapor cloud Depending upon product the effects may vary

21. CW: Delivery Environmental conditions Outdoor attacks vs. indoor attacks Dissemination problems increase logarithmically with increasing target size

22. CW: Delivery Municipal water systems attacks 4 billion gallon reservoir, community of 20,000, and each person consuming 16 oz of water Requires over 14 billion lethal doses to deliver one dose per person Fluoroacetates Requires 600 metric tons to achieve lethal dose

23. CW: Delivery Delivery by terrorists Covert contamination of selected foods and beverages Covert generation of volatile agent in enclosed space Covert dissemination of non-volatile agent in enclosed space Overt attack using “bursting” munitions or thermogenerators

24. CW: Defense Increasing defensive capabilities Deny terrorists access to weapons and chemicals needed for production Los Alamos National Laboratory Image

25. Your Role In the event of a mass casualty incident involving chemicals, either an accidental release or a terrorist attack everyone will be essential to successful response As a member of the healthcare team what will your role be in the event of a chemical emergency?

26. Know the Plan Be familiar with your facility’s emergency response plan Know what your job will be Know who to report to Be prepared to be flexible

27. Do not pass rumors Listen to the information provided through official sources Do not pass on rumors or hearsay If you have questions ask your supervisors If patients have questions seek correct information, even if it takes longer to get

28. Additional Training Many jobs will require additional training If your tasks during an emergency require direct patient care you will receive additional training on signs and symptoms of the various agents and on how to treat them If you might be exposed to agents you will be trained in the proper use of Personal Protective equipment

29. Summary Terrorist organizations have used chemical agents in the past and are seeking to gain them for use in the future The ability of the healthcare system in the United States to function in the event of a mass casualty event involving chemicals depends upon the everyone