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

Sulfur mustard is stockpiled both in the United States and in several other countries as
well. It is not difficult to manufacture, making it even more favorable for use by
terrorists. In addition to its accessibility and ease of production, several other factors
enhance its suitability as a terrorist or warfare agent. Although mortality associated with
sulfur mustard is considerably lower than that caused by other chemical weapons such as
nerve agents, sulfur mustard exposure results in significant and prolonged morbidity that
may potentially overwhelm health care resources. The risk of direct contamination either
from patient contact or from the agent’s persistence in the environment may force health
care providers to wear bulky protective gear, which makes it difficult to administer care,
particularly to children. Although tissue damage occurs within minutes of exposure,
clinical symptoms are delayed for hours, potentially rendering the victim ignorant of
exposure until the opportunity for effective decontamination has passed. Lastly, unlike
the case for lewisite, there is no known antidote for sulfur mustard exposure.
Characteristics
Sulfur mustard is an alkylating agent that is highly toxic to rapidly reproducing and
poorly differentiated cells. Under normal environmental conditions, it is an oily liquid
that varies in color from yellow to brown, depending on amounts and types of impurities.
Its odor has been described as similar to garlic or to mustard itself. In warmer climates,
mustard vapor is a particular concern due to its low volatility, while at lower
temperatures (