Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

exposures (Table 5.3). For an in-depth discussion of principles in managing such toxic
injuries, see Osterhoudt, et al., 2005, and Erickson, 2004.
Community Preparedness
In the aftermath of September 11, 2001, many agencies are collaborating to ensure
coordinated care of pediatric victims (see Chapter 2, Systems Issues). All pediatricians
are encouraged to participate in disaster management training. The need to stock
appropriate antidotes, practice decontamination strategies, and learn the use of PPE is
apparent. Although perhaps not every practicing pediatrician needs to be competent in all
aspects of disaster response, all in the community should work together to optimize the
overall capacity for providing disaster care to chemically exposed children.
Successful planning and response to events involving chemical terrorism require strong
collaboration and integrated functioning of many agencies and facilities, both
governmental and nongovernmental, including local treatment facilities, local and State
health departments, and Federal agencies (CDC, FEMA, FBI, etc.).
Nerve Agents
Nerve agents are organophosphorous compounds similar to the organophosphate
insecticides used in agriculture or industry but far more toxic. Four compounds are
currently regarded as nerve agents: tabun, sarin, soman, and VX (“Venom X”). All of
these agents are hazardous by ingestion, inhalation, or cutaneous absorption, the latter
being particularly true for VX. The toxic effects of nerve agent vapors depend on the
concentration of the agent inhaled and on the time exposed to the agent. The toxicity of
nerve agent liquid depends on the time exposed and the bodily site of exposure. Nerve
agents exist as liquids at standard temperatures and pressures. In gaseous form, they are
denser than air and vary in volatility, with some (e.g., VX) being more persistent than
others (e.g., sarin).
Background
The Iran-Iraq War of the 1980s reportedly resulted in more than 100,000 casualties from
chemical weapons. Iranian sources reported that the number of casualties caused by nerve
agents was far greater than the number of casualties caused by mustard agent. Many
nerve agent casualties that were only mildly to moderately affected were not counted.
A chemical warfare campaign by the Iraqi military on Kurdish civilians in the late 1980s
caused thousands of deaths. The exact agents are not definitively known, but Iraq is
known to have stockpiled tabun, sarin, and VX.
A Japanese religious cult that manufactured sarin deployed it in 1994 in attacks on a
residential neighborhood of Matsumoto and again in 1995, in the Tokyo subway.
Immediate mortality was low, but thousands of individuals arrived at emergency rooms.
The lack of a decontamination process resulted in significant morbidity to health care
personnel. The sarin was released by a relatively primitive method (punctured plastic
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