Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Module Four Cyanide & Fumigants - Administration Page Cyanide and fumigants constitute a threat to the general population because they are easily weaponized, highly toxic when inhaled, and widely available due to their extensive use in the agriculture and pest-control industries. While accidental exposure is not uncommon, there is significant concern about their potential use as weapons of mass destruction. Though public attention has focused on past incidents of drug tampering, a more substantial danger is these agents’ suitability for dispersal as a gas through ventilation systems. Duration 45 minutes Scope Statement This module reviews commercial applications, characteristics, and treatment guidelines relating to hydrogen cyanide gas and to the three most common fumigants regulated by the US Department of Agriculture: Vikane (sulfuryl fluoride), methyl bromide, and phosphine. Terminal Learning Objective (TLO) • Recognize and provide appropriate initial therapy for individuals exposed to cyanide and to fumigant gases. Enabling Learning Objectives (ELO) Resources • Indicate the sources and uses of cyanide and fumigants • Describe therapies used to treat cyanide poisoning • List the four most common fumigant gases • Describe the clinical effects of exposure to these gases • Explain how to treat victims exposed to these gases Each of the eight course modules is deployed as an interactive, instructor-lead, MS PowerPoint presentation containing didactic content, historical examples, and selected case studies. All presentations are included in a printed participant guide (PG) containing the modules’ overview, scope statement, terminal and enabling learning objectives, PowerPoint slide handouts, and a summary section. Instructor to Participant Ratio [Enter the instructor to participant ratio(e.g., 1:25).] Reference List 1. Sperry P. Al-Qaida terrorists to gas US subways DHS memo warns of device that uses cyanide to asphyxiate its victims. WorldNetDaily, 25 November 2003. December 2008 Version 2.0 Page 182
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide 2. Baud FJ, Barriot P, Toffis V, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. NEJM 1991;325:1761- 1766. 3. BBC News. Romania’s poison dump. May 19 2000. Accessed Dec 2008 from: http://news.bbc.co.uk/1/hi/programmes/correspondent/755780.stm 4. Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J. 2006 Jan;23(1):e3. 5. Burgess JL. Phosphine exposure from a methamphetamine laboratory investigation. J Toxicol Clin Toxicol. 2001;39(2):165-8. 6. Burgess JL, Morissey B, Robertson WO. Fumigant related illnesses: Washington State’s five year experience. J Toxicol Clin Toxicol 1998: 36(5):465 (abstract). 7. Burkhart K. Methyl Bromide and Other Fumigants, in Goldfrank’s Toxicological Emergencies; Goldfrank LR, Flomenbaum N, Hoffman RS, et al (eds.) McGraw-Hill Professional, 8th edition, 2006. 8. Centers for Disease Control and Prevention. Epidemiologic Notes and Reports Fatalities Resulting From Sulfuryl Fluoride Exposure After Home Fumigation—Virginia. MMWR 1987;36(36):602-604,609-611. 9. Centers for Disease Control and Prevention: National Institute for Occupational Safety and Health. NIOSH Alert: preventing phosphine poisonings and explosions during fumigation. NIOSH Publication No. 99-126;1999. Accessed Dec 2008 from: http://cdc.gov/niosh/99- 126.html 10. Centers for Disease Control and Prevention: Agency for Toxic Substances and Disease Registry. Medical Management Guidelines for Phosphine. Accessed Dec 2008 from: http://www.atsdr.cdc.gov/mhmi/mmg177.html 11. Centers for Disease Control and Prevention: National Institute for Occupational Safety and Health. Acetonitrile. NIOSH Pocket Guide to Chemical Hazards. Accessed Dec 2008 from: http://www.cdc.gov/niosh/npg/npgd0006.html 12. Centers for Disease Control and Prevention: National Institute for Occupational Safety and Health. Acrylonitrile. NIOSH Pocket Guide to Chemical Hazards. Accessed Dec 2008 from: http://www.cdc.gov/niosh/npg/npgd0014.html 13. Centers for Disease Control and Prevention: National Institute for Occupational Safety and Health. Cyanogen Chloride The Emergency Response Safety and Health Database. Accessed Dec 2008 from: http://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_2975003 9.html 14. Centers for Disease Control and Prevention: National Institute for Occupational Safety and Health. NIOSH Pocket Guide to Chemical Hazards: Sulfuryl fluoride. 2005. Accessed Dec 2008 from: http://www.cdc.gov/niosh/npg/npgd0581.html December 2008 Version 2.0 Page 183
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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