Download Targets of Opportunity

Targets of Opportunity
Steven M Marcus
Medical Director
NJ Poison Information & Education System
New Jersey Medical School
Chemical Agents used during WWI include:
chlorine, phosgene, and nitrogen mustard
gases. These chemical lead to 100,000 deaths
and 1.2 million casualties.
Nazis killed millions of civilians with Zyklon B
gas (HCN) in WWII.
Agent Orange (a dioxin and defoliant) was
used in the Vietnam War, which may have lead
to skin cancer in our veterans.
Chemical Terrorist Events
• 1985 - Covenant Group found to
possess 33 gallons of cyanide
• 1992 - Police prevent Neo-Nazis from
using cyanide in synagogue
• 1994 - Aum Shinrikyo uses sarin in
Matsumoto – 7 dead, 280 injured
In 1995 in Tokyo, Sarin (very potent organophosphate nerve
gas) caused 12 deaths and 5,500 injuries.
More Chemical Terrorism
• Copycat attacks in Japan using cyanide,
phosgene, and pepper spray
• FBI thwarts possible sarin attack in
Disneyland
• 1997 - Sydney, Australia – chlorine
bombs in shopping centers injure 14 500 evacuated
Types - Chemical Agents
• Nerve Agents
Soman, VX
• Blood agents
•
•
•
•
Pulmonary Intoxicants
Miscellaneous
Vesicants
Riot Control
Spray
• Incapacitating Agents
Tabun, Sarin,
Hydrogen Cyanide,
Cyanogen Chloride
Phosgene, Chlorine
Ammonia
Mustard, Lewisite
Mace ®, Pepper
BZ
The Bhopal Disaster:
Twenty years ago an explosion at a
chemical factory sent 27 tons of
poisonous methyl isocyanate wafting
over the slumbering residents of
Bhopal, India. The aftermath was
apocalyptic. Between 7,000 and
10,000 people died in the three days
after the explosion and 15,000 more
have died since.
There is virtually no location in the
state of NJ beyond the range of
toxicity from an explosion in a
chemical storage or production
plant!
Top Ten Most Prevalent Hazardous
Chemicals in NJ
Ammonia
Hydrogen sulfide
Chlorine
Ozone
Difluoroethane
Pentane
Hydrogen chloride
Toluene diisocyanate
Hydrogen fluoride
Vinyl acetate
Chlorine
• Used in swimming
pools and
laboratories
• Industrial exposures
may produce large
numbers of
casualties
Chlorine - Civilian Uses
•
•
•
•
Chlorinated lime (bleaching powder)
Water purification
Disinfection
Synthesis of other compounds
– synthetic rubber
– plastics
– chlorinated hydrocarbons
• Don’t try this at home! (bleach + acid)
Historical Exposures
• 1996 Bethlehem, Pa 13 pool victims
• 1998 Rome, Italy 282 pool victims
• Diyarbakir, Turkey 2000 106 victims
leaking tanker car
Chlorine - Characteristics
• Properties
– Greenish-yellow gas, pungent odor
– Chlorine + water = HCl + Free O2 30x
more irritating to lungs than HCl
• Effects
– Eye irritation, cough, SOB, and wheezing
– delayed ARDS
Chlorine - Tissue Effects
• Topical rather than systemic
• In central airways - from HCl
– necrosis, sloughing
• In peripheral airways
– oxygen free radicals
– react with sulfhydryl groups, disulfide bonds
– damage to alveolar-capillary membrane
Chlorine - Clinical Effects
• Mild Exposure
–
–
–
–
suffocation, choking sensation
ocular, nasal irritation
chest tightness, cough
exertional dyspnea
• Moderate Exposure
– above sx + hoarseness, stridor
– pulmonary edema within 2-4 hours
Chlorine - Clinical Effects
• Severe Exposure
– severe dyspnea at rest
– may cause pulmonary edema within 30-60
min
– copious upper airway secretions
– sudden death may occur from
laryngospasm
Clinical Considerations
• These agents cause pulmonary edema
– damage alveolar-capillary membrane
• Latent Period
– symptom onset may be delayed hours to days
– objective signs appear later than symptoms
• Sudden Death may occur
– laryngeal obstruction (edema/spasm)
– bronchospasm
Clinical Considerations
• Infectious Bronchitis / Pneumonitis common
– usually occurs 3-5 days post-exposure
– fever, elevated WBC, infiltrates NOT always
infection
– prophylactic antibiotics NOT indicated
• Effects exacerbated by exertion
– compensatory mechanisms overwhelmed
– strict rest, even if asymptomatic
• No specific therapy exists
Ammonia
• Colorless, watersoluble, alkaline gas
• Pungent odor
• Wide industrial use
• Used to make
fertilizer, explosives,
dyes, and plastics
Ammonia - Characteristics
• Household ammonia pH <
12 - limited damage
• Anhydrous ammonia pH >
12 - severe damage
• Rapidly absorbed by
mucosal surfaces (eyes,
throat, and lungs)
• Corrosive produced when
combined with water Liquefaction necrosis
Ammonia - Clinical
Signs/Symptoms
• Eyes
– Burning, tearing,
severe pain -> injury of
the cornea and lens
• Lungs
– Cough, SOB, chest
pain, wheezing and
laryngitis with mild
exposure
– Hypoxia, chemical
pneumonia,
hemorrhage with
moderate - severe
exposures
Ammonia - Clinical
Signs/Symptoms
• Skin
– Pain, blister formation, deep burns
• Gastrointestinal (ingestion)
– Severe mouth pain, cough, and abdominal
pain
– Nausea and vomiting
– Edema to lips and mouth (leading to airway
obstruction)
– Esophageal strictures and perforation
Hydrogen flouride
• Production of electronic circuits
• Etching: glass, metal, stone and porcelain
• Cleaning products: wheel and chrome
cleaners
• Rust removers
Hydrogen fluoride
•
•
•
•
•
Dissolved in water as hydrofluoric acid
Weak acid
Volatizes easily
Local and systemic effects
Delayed symptoms
HF-clinical effects
• Local: pain out of proportion to apparent
injury
• Systemic: hypocalcemia,
hypomagnesemia and hyperkalemia
HF-therapy
•
•
•
•
Decontamination
Calcium compresses
Nebulized calcium?
Eye wash
Fluoride Release Leads to Evacuation of Texas Neighborhood
International Fluoride Information Network
July 10, 2003
Yesterday, July 9, an explosion occurred at a Texas oil refinery which resulted in
the release of an unspecified, but potentially large amount of hydrogen fluoride.
According to the article which appeared in today's Corpus Christi Caller Times, a
seven block area adjacent to the plant was soon evacuated after winds blew the
HF gas in its direction.
"The unpublicized usage of deadly hydrofluoric acid at half of all refineries is
endangering refinery communities...The environmental hazards of HF as
used at refineries have to do with the high volumes utilized, the potential for
high temperatures and pressures to be involved in a release, and the
tendency of HF, once released to the environment, to form deadly gas clouds
that do not easily diminish...This makes it an extremely dangerous material to
be utilized at refineries in highly populated areas. The danger posed is
thought by many experts to be as severe as the accident in Bhopal, India in
which thousands were killed at a Union Carbide chemical plant in 1984."
14 feared killed in refinery blast
Rescuers search for survivors at oil plant in Texas
Thursday, March 24, 2005
BY PAM EASTON
Associated Press
TEXAS CITY, Texas -- A thunderous explosion tore through a BP oil refinery
yesterday, shooting flames and billowing smoke into the sky and showering
the area with ash and chunks of charred metal. At least 14 were believed
dead and more than 100 were injured.