Chemical Toxin

Aka: Chemical Toxin, Chemical Burn, Chemical Weapon, Toxic Chemical Syndrome, Chemical Warfare Agents, Chemical Hazard Release, Chemical Terrorism, Hazardous Material, Hazardous Substance, Hazmat, NFPA 704

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II. Background: History

  1. Sparta in Peloponnesian War 423 BC
    1. Smoke from coals and sulfur pitch directed into fort
  2. Greeks: 7th Century AD directed Greek Fire
    1. Rosin, Sulfur, Pitch, Naphtha, Lime, Saltpeter
  3. Venice: 15-16th Centuries
    1. Loaded hollow mortar shells with poisons
  4. World War I: German use in Belgium
    1. Chlorine gas (1915)
    2. Sulfur Mustard (1917)
  5. Pre-World War II
    1. Great Britain
      1. Chemicals against Russians
      2. Mustards against Afghans at Khyber Pass, Spain
    2. Spain
      1. Mustard against Riff tribes in Morocco
    3. Soviet Union
      1. Lung Irritants against Kurdistan tribesman
    4. Italy
      1. Tear Gas, mustard against Abyssinia
  6. World War II
    1. Nazi Germany synthesized OrganophosphateNerve Agents
      1. Tabun (GA)
      2. Sarin (GB)
  7. Post-World War II
    1. 1963-1967 Egypt in Yemen War used mustard bombs
  8. Vietnam
    1. U.S. used defoliants and riot-control agents
  9. Afghanistan in 1970's and 1980's
    1. Soviet Union used Chemical Agents
  10. Iran-Iraq War and Operation Desert Shield and Storm
    1. Iraq used Sulfur Mustard, Tabun, Sarin, Cyanide
  11. Stockpiles of Chemical Agents
    1. Russia and former Soviet Union
    2. France
    3. Libya
    4. United States (Sarin, Mustard)
  12. Chemical Precursors used in Manufacturing
    1. Phosgene
  13. Terrorism
    1. Sarin use in Matsumoto, Tokyo 1994-5

III. Background: Hazardous Material Labeling (NFPA 704 Labeling System)

  1. Hazardous Materials in the United States are labeled with a 4 quadrant diamond (NFPA 704)
  2. Fire Hazard or Flammability (RED top quadrant)
    1. Flash Point 4: <73 degrees F
    2. Flash Point 3: <100 degrees F
    3. Flash Point 2: 100 to 200 degrees F
    4. Flash Point 1: >200 degrees F
    5. Flash Point 0: Does not burn
  3. Health Hazard (BLUE left quadrant)
    1. Hazard 4: Deadly
    2. Hazard 3: Extreme Danger
    3. Hazard 2: Hazardous
    4. Hazard 1: Slightly Hazardous
    5. Hazard 0: Normal Material
  4. Reactivity or Instability (YELLOW right quadrant)
    1. Reactivity 4: May detonate
    2. Reactivity 3: Shock and heat may detonate
    3. Reactivity 2: Violent chemical change
    4. Reactivity 1: Unstable if heated
    5. Reactivity 0: Stable
  5. Specific Hazard (WHITE bottom quadrant)
    1. Ox: Oxidizer
    2. ACID: Acid
    3. ALK: Alkali
    4. COR: Corrosive
    5. W: Use NO water
    6. Radioactive Symbol
  6. Resources
    1. https://www.nfpa.org/Assets/files/AboutTheCodes/704/704_FAQs.pdf

IV. Types: Chemical Agents and Syndromes

  1. Pulmonary Intoxicants (Phosgene, Chlorine)
    1. Inflammation at alveoli causing Pulmonary Edema
  2. Cyanide ("Blood Agents")
    1. Systemic, rapid diffuse tissue effects
  3. Vesicants or Blister Agents (Sulfur Mustard, Lewisite)
    1. Local inflammation: Blisters, eye and airway effects
  4. Nerve Agents (Tabun, Sarin, Soman, VX)
    1. Inhibits enzyme Acetylcholinesterase
  5. Incapacitating Agents (BZ)
    1. Impairs performance usually via CNS effects
  6. Riot Control Agents (Mace, Pepper Spray)
    1. Local irritants causing Lacrimation, cough
  7. Miscellaneous Agents
    1. See Occupational Illness
    2. Ammonia
    3. Chemical acid burns (e.g. Hydrochloric acid, hydrofluric acid, Hydrocarbon solvents)
      1. See Chemical Eye Injury
      2. Hydrofluoric Acid requires specific management (Calcium Gluconate)
      3. Decontaminate other acid burns with copious water (e.g. shower for 20-30 minutes)
    4. Solvent Exposures (e.g. paint thinners, methylene chloride, toluene)
    5. Organophosphate Poisoning

V. Differential Diagnosis

  1. See Biological Weapon (Bioterrorism)
  2. See Biological Neurotoxin
  3. Consider Panic Symptoms from those of agents

VI. Findings

  1. Hazardous exposure risk assessment
    1. Occupancy and location (e.g. labs, farms, factories)
    2. Container shape
    3. Markings and colors
      1. Diamond shaped transport labels (with risk numbers 0-minimal to 4-high)
      2. Health risks (blue, left quadrant)
      3. Flammability (red, top quadrant)
      4. Reactivity (yellow, right quadrant)
      5. Other (white, lower quadrant)
    4. Placards and labels
    5. Shipping papers
    6. Odors
  2. Recognition of chemical attack
    1. Chemical attack is typically immediately evident by signs of affected victims
    2. Unlike Bioterrorism, no Incubation Period (effects are immediate)
    3. Large number of initial victims

VII. Management

  1. See Contaminated Casualty Management
  2. See Decontamination
  3. See Decontamination in Children
  4. Children are more susceptible to chemical attacks
    1. Increased Minute Ventilation (greater inhalation of agents)
    2. Lower height (closer to ground level where gases may settle)
    3. Thin, more permeable skin (greater toxin absorption and injury)
    4. Often dependent on adults to escape exposure
    5. Antidote dosing is not well established in children
  5. Children also are more susceptible to exposure to household chemicals (cleaners, cosmetics)
    1. Acidic and alkaline substances may cause Chemical Burns of skin, eyes or the Gastrointestinal Tract if ingested

VIII. Resources

  1. US Army Medical Research Institute of Chemical Defense
    1. http://WWW.CW-MED.ORG

IX. References

  1. Campana, Patel and Martin (2016) Crit Dec Emerg Med 30(2): 14-9
  2. Seeyave (2015) Crit Dec Emerg Med 29(5): 13-21
  3. Medical Response to Chemical Warfare and Terrorism
    1. US Army Medical Research Institute Chemical Defense
    2. Video-Teleconference: 4/20/00 to 4/22/99
    3. Video-Teleconference: 12/5/00 to 12/7/00
    4. Text: 3rd Edition, December 1998

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