II. Background: History
- Sparta in Peloponnesian War 423 BC
- Smoke from coals and sulfur pitch directed into fort
- Greeks: 7th Century AD directed Greek Fire
- Rosin, Sulfur, Pitch, Naphtha, Lime, Saltpeter
- Venice: 15-16th Centuries
- Loaded hollow mortar shells with poisons
- World War I: German use in Belgium
- Chlorine gas (1915)
- Sulfur Mustard (1917)
- Pre-World War II
- World War II
- Nazi Germany synthesized OrganophosphateNerve Agents
- Post-World War II
- 1963-1967 Egypt in Yemen War used mustard bombs
- Vietnam
- U.S. used defoliants and riot-control agents
- Afghanistan in 1970's and 1980's
- Soviet Union used Chemical Agents
- Iran-Iraq War and Operation Desert Shield and Storm
- Iraq used Sulfur Mustard, Tabun, Sarin, Cyanide
- Stockpiles of Chemical Agents
- Russia and former Soviet Union
- France
- Libya
- United States (Sarin, Mustard)
- Chemical Precursors used in Manufacturing
- Terrorism
- Sarin use in Matsumoto, Tokyo 1994-5
III. Background: Hazardous Material Labeling (NFPA 704 Labeling System)
- Hazardous Materials in the United States are labeled with a 4 quadrant diamond (NFPA 704)
- Fire Hazard or Flammability (RED top quadrant)
- Flash Point 4: <73 degrees F
- Flash Point 3: <100 degrees F
- Flash Point 2: 100 to 200 degrees F
- Flash Point 1: >200 degrees F
- Flash Point 0: Does not burn
- Health Hazard (BLUE left quadrant)
- Hazard 4: Deadly
- Hazard 3: Extreme Danger
- Hazard 2: Hazardous
- Hazard 1: Slightly Hazardous
- Hazard 0: Normal Material
- Reactivity or Instability (YELLOW right quadrant)
- Reactivity 4: May detonate
- Reactivity 3: Shock and heat may detonate
- Reactivity 2: Violent chemical change
- Reactivity 1: Unstable if heated
- Reactivity 0: Stable
- Specific Hazard (WHITE bottom quadrant)
- Ox: Oxidizer
- ACID: Acid
- ALK: Alkali
- COR: Corrosive
- W: Use NO water
- Radioactive Symbol
- Resources
IV. Types: Chemical Agents and Syndromes
-
Pulmonary Intoxicants (Phosgene, Chlorine)
- Inflammation at alveoli causing Pulmonary Edema
-
Cyanide ("Blood Agents")
- Systemic, rapid diffuse tissue effects
-
Vesicants or Blister Agents (Sulfur Mustard, Lewisite)
- Local inflammation: Blisters, eye and airway effects
-
Nerve Agents (Tabun, Sarin, Soman, VX)
- Inhibits enzyme Acetylcholinesterase
-
Incapacitating Agents (BZ)
- Impairs performance usually via CNS effects
-
Riot Control Agents (Mace, Pepper Spray)
- Local irritants causing Lacrimation, cough
- Miscellaneous Agents
- See Occupational Illness
- Ammonia
- Chemical acid burns (e.g. Hydrochloric acid, hydrofluric acid, Hydrocarbon solvents)
- See Chemical Eye Injury
- Hydrofluoric Acid requires specific management (Calcium Gluconate)
- Decontaminate other acid burns with copious water (e.g. shower for 20-30 minutes)
- Solvent Exposures (e.g. paint thinners, methylene chloride, toluene)
- Organophosphate Poisoning
V. Differential Diagnosis
- See Biological Weapon (Bioterrorism)
- See Biological Neurotoxin
- Consider Panic Symptoms from those of agents
VI. Findings
- Hazardous exposure risk assessment
- Occupancy and location (e.g. labs, farms, factories)
- Container shape
- Markings and colors
- Diamond shaped transport labels (with risk numbers 0-minimal to 4-high)
- Health risks (blue, left quadrant)
- Flammability (red, top quadrant)
- Reactivity (yellow, right quadrant)
- Other (white, lower quadrant)
- Placards and labels
- Shipping papers
- Odors
- Recognition of chemical attack
- Chemical attack is typically immediately evident by signs of affected victims
- Unlike Bioterrorism, no Incubation Period (effects are immediate)
- Large number of initial victims
VII. Management
- See Contaminated Casualty Management
- See Decontamination
- See Decontamination in Children
- Children are more susceptible to chemical attacks
- Increased Minute Ventilation (greater inhalation of agents)
- Lower height (closer to ground level where gases may settle)
- Thin, more permeable skin (greater toxin absorption and injury)
- Often dependent on adults to escape exposure
- Antidote dosing is not well established in children
- Children also are more susceptible to exposure to household chemicals (cleaners, cosmetics)
- Acidic and alkaline substances may cause Chemical Burns of skin, eyes or the Gastrointestinal Tract if ingested
VIII. Resources
- US Army Medical Research Institute of Chemical Defense
IX. References
- Campana, Patel and Martin (2016) Crit Dec Emerg Med 30(2): 14-9
- Seeyave (2015) Crit Dec Emerg Med 29(5): 13-21
- Medical Response to Chemical Warfare and Terrorism
- US Army Medical Research Institute Chemical Defense
- Video-Teleconference: 4/20/00 to 4/22/99
- Video-Teleconference: 12/5/00 to 12/7/00
- Text: 3rd Edition, December 1998