Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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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. December 2008 Version 2.0 Page 248
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Module Five Chemical Contamination of Food, Water, & Medication - Administration Page Safe food and water are among the basic necessities of life. Pharmaceuticals are widely used and generally considered safe in the United States. However, as past domestic and foreign crises have demonstrated, modern centralized production and distribution systems for these critical resources provide a tempting target to would-be terrorists. Duration 45 minutes Scope Statement This module provides an overview of US food, drug, and water production systems with a view towards identifying potential threats and vulnerabilities. Past incidents are discussed and used to contextualize existing preventive measures and regulations. Terminal Learning Objective (TLO) • Identify potential vulnerabilities in relation to the properties of selected chemical agents in our water, food, and drug supply systems. Enabling Learning Objectives (ELO) Resources • Describe how US drinking water is produced and protected • Identify system vulnerabilities and potential chemical agents of concern, using past incidents of water, food, and drug contamination or terrorism • Describe significant episodes of water, food, and medication contamination that have resulted in system-wide changes or legislation • Identify resources detailing measures used to protect the US water, food, and drug supplies 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 1:8 (minimum) to 1:25 (maximum) December 2008 Version 2.0 Page 249
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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