Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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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. December 2008 Version 2.0 Page 118
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide The anticholinergic hallucinogens have a long history of use, and drugs such as scopolamine are in current use as transdermal patches. A common occurrence on cruise ships is an elderly passenger who is using a transdermal scopolamine patch who begins hallucinating due to excessive absorption through their thin skin. The treatment for hallucinations is generally supportive with the additional use of sedatives (enhancing inhibition) to allow the drug to be eliminated. In conclusion, The CNS is a unique target organ for terrorism yet there are a limited number of acute clinical consequences that may result from the deliberate exposure to toxins. Management is generally symptomatic although “antidotes” may be available for certain agents. December 2008 Version 2.0 Page 119
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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