Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Module Two Summary
The Central Nervous System is a unique target organ for chemical terrorism. Despite its
complexity, the brain really only displays its dysfunction in a limited number of ways. This
includes CNS depression (sedation), CNS excitation (seizure) and possibly altered thoughts, as
with hallucinations. Therefore, the use of certain chemicals as agents of terrorism will result in a
limited number of acute clinical consequences. Management is generally symptomatic although
“antidotes” may be available for certain agents.
The normal state of the brain is maintained by balancing both excitation and inhibition, each
mediated by a unique set of chemicals called neurotransmitters. We alter our neurotransmitters
under normal conditions to suit our needs. For example, in order to sleep we increase inhibition
and reduce excitations. Other neurotransmitters play a role in our functional abilities, or our
ability to process information smoothly. For example, Serotonin and Acetylcholine serve as
modulators of our thought processes. Chemical (drugs) typically cause sedation or coma by
enhancing our inhibitory tone, not by reducing excitation. Chemicals (drugs) typically cause
seizures by enhancing excitation or reducing inhibition. The alteration of the flow of information
in our brain results in hallucinations. Sensory input is unfiltered resulting in sensory overload,
causing hallucinations.
Sedatives have the potential to be used by terrorists. The Moscow theater hostage crisis was
the seizure of a crowded Moscow theatre on October 23, 2002 by about 40 armed Chechen
militants. They took 850 hostages and demanded the withdrawal of Russian forces from
Chechnya and an end to the Second Chechen War. After a two-and-a-half day siege, Russian
special forces pumped weaponized Fentanyl (maybe carfentanil)- into the building's ventilation
system and raided it. Officially, 39 of the terrorists were killed by Russian forces, along with at
least 129 of the hostages. Some estimates have put the civilian death toll at more than 200
people.
Most central nervous system depressants are associated with some degree of respiratory
depression. Some like the opioids are associated with profound respiratory depression,
explaining the high fatality rate in the Moscow theater. The opioid toxidrome (toxicological
syndrome) is relatively easy to recognize, particularly for medical personnel, since it is
commonly noted in heroin users. Treatment involves administration of an antidote called
naloxone (Narcan). Ventilatory support may be necessary and for extended periods of time.
The use of toxic convulsants creates another clinical syndrome that may appear convulsions or
seizure. The term seizure refers to the underlying brain activity whereas convulsion is what you
see when you look at the patient; the movement. Some convulsant toxins are not seizure
inducing, such as strychnine.
Tetramine (rat poisoning) has been reportedly used several times in epidemic poisoning in
China. Other convulsant poisons that are relatively easy to access include organophosphorus
and carbamate insecticides, along with nicotine, hydrazines, camphor, and organochlorines and
strychnine.. Their use in an act of terrorism is a distinct possibility. The clinical management of
seizures attempts to balance the loss of inhibitory tone by supplying a sedative that enhances
inhibitory tone.
Hallucinogens. Although the actual mechanisms by which hallucinogens act on our brain vary,
the clinical syndrome produced is qualitatively similar. We lose the ability to interpret and
interact with our environment. Hallucinogens may be used by terrorists as incapacitating agents.
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