Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
thiosulfate which binds the cyanide from methemoglobin forming thiocyanate, a renally
excretable substrate. Sodium thiosulfate has a delayed onset of action, which is why the
methemoglobin inducers are used. The adverse effects associated with the administration of
both forms of nitrites include hypotension and methemoglobin formation.
The newer antidote is the one-step “Cyanokit®” which contains hydroxocobalamin. This
antidote has been in use in Europe for decades and was introduced in the US in 2006.
Hydroxocobalamin is administered intravenously and binds with cyanide to form
cyanocobalamin (i.e. vitamin B12) which is renally excretable. The dose is 5 grams
intravenously if the patient is symptomatic and 10 grams if the patient is suffering from cardiac
arrest. It has a fast onset of action and is associated with minor adverse effects such as red
discoloration of skin and urine. Because of its intense color, it can interfere with cooximeter
readings.
Fumigants are agents used in the home and numerous agricultural and industrial industries for
the extermination and control of a variety of pests (termites, fungi, nematodes, etc.). The four
most common fumigants regulated by the US Department of Agriculture are Vikane (sulfuryl
fluoride), methyl bromide, phosphine, and chloropicrin. Although fumigants are very toxic and
their distribution regulated, they remain surprisingly easy to obtain. While not generally
available, through retail locations or Internet ordering sites, these agents can be purchased
directly from chemical supply companies.
Popular for over 50 years in the extermination industry, Vikane (sulfuryl fluoride) is the most
frequently used fumigant in the United States. It is usually obtained in canisters and sprayed
into vacant buildings for the purposes of pest-control. Monitors are used to determine when it is
safe for occupants to return. Vikane has no warning properties as it is both colorless and
odorless. Exposure produces respiratory symptoms, seizures, coma, and death.
Methyl Bromide, being more toxic to humans, is less commonly used in the United States,
however, it remains popular in many foreign countries. It is both colorless and odorless. The
clinical effects can be delayed and may include: respiratory symptoms, seizures, and coma.
Seizures from methyl bromide are specifically associated with poor outcomes.
Phosphides, typically distributed in pellet form, are commonly used in agricultural settings for
the fumigation of grain. Pellets are mixed with water or an acid to produce phosphine gas.
Phosphine is colorless and has a fishy or sometimes garlicky odor. Clinical effects include
lethargy, coma, and lung injury.
All exposures to fumigants should be treated with immediate removal from source, thorough
skin and eye decontamination, oxygenation, supplemented by symptomatic and supportive
care. No specific antidote is available for any of these exposures.
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