Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 31 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Cyanide: Missing Cyanide (2004) • 15-gallon drum of sodium cyanide was lost from a delivery truck • Located after 1 -week search in N. Dakota – Was being hauled for delivery to beekeepers – Used to fumigate and kill excess bees – Not legally registered for this use • Became a multi -state investigation Module Four – Cyanide & Fumigants 31 In 2004 in North Dakota a 15 gallon drum of cyanide was “lost” from a delivery truck, and was found almost 2 weeks later. It was being transported to be used in beekeeping, which is not a registered use of cyanide. Obviously this was a concern to DHS and FBI given the possible use of this chemical against a population, and it became a multistate investigation. But this really demostrates just how easy it is to get, and to lose, cyanide. The case first came to light on Sept. 30, 2004, when passing motorists found two drums of sodium cyanide along ND Highway 1, north of Lakota, North Dakota. A trucker admitted that three barrels had fallen off his vehicle, and a search was launched to find the missing barrel. The missing barrel was found October 12 th , in a water-filled ditch along Highway 1 near Brocket, ND. The case initially drew the attention of the U.S. Department of Homeland Security and the FBI. After it was learned that the chemical was intended for beekeeping, it became an agricultural regulatory matter and NDDA took the lead role. Since the incident was first reported, NDDA investigators determined that 54 containers of sodium cyanide had been sold in North Dakota over the past two years. All have been traced to the same offender: EnviroKem. Eleven locations in North Dakota and six locations in other states were involved. Sodium cyanide is legally used in extracting precious metals, case-hardening steel and electroplating. It has no registered agricultural use. December 2008 Version 2.0 Page 218
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 32 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Prehospital Care Cyanide: Treatment • Safely remove victims from source • Restore or maintain airway patency • Maximize oxygenation – 100% NRBM or BVM • Cardiopulmonary support to maintain VS – IVF and/or dopamine, norepinephrine • Decontamination Module Four – Cyanide & Fumigants 32 Given all these potential sources and nefarious uses of cyanide, let’s look at some treatment issues. In any setting with multiple people incapacitated or “found down”, one should always consider the surroundings potentially hazardous. After removal from the scene (with appropriate attention to rescuer safety), the treatment of cyanide poisoning starts with oxygenation and supportive care. Intubation and manual ventilation are often required to provide an airway and oxygenation. Specific antidotes exist and need to be given as soon as possible after exposure in order to save lives. Currently two different antidote kits are available in the US: the traditional 3-step (“Eli Lilly” or Taylor) kit or the more recently approved one-step Cyanokit® (Merck). We will discuss these in the next few slides. Once the patient has been stabilized decontamination procedures may be initiated, if indicated (more appropriate for ingested cyanogenic compounds or dermal contact with powder or liquid). December 2008 Version 2.0 Page 219
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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