Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 8 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Case 1: Mass Psychogenic Illness or Toxic Exposure • 5 health care staff hospitalized – ED nurse hospitalized for 9 days developed chronic severe headaches, fatigue, dyspnea • A psychiatrist insisted it was an organic cause – ED physician hospitalized in ICU for 2 weeks requiring mechanical ventilation • 3 months in a wheelchair • Avascular necrosis of knees requiring 20 operations Module One – Observed Behaviors during Mass Chemical Exposures 8 Two medical providers had significant hospitalizations, with ensuing chronic health issues - one with somewhat non-specific symptoms; the other with a more recognizable medical condition. These are serious health effects – but are they attributable to an original toxic exposure, consequences of medical interventions, or some combination thereof If the former, this would be strong evidence for a toxic exposure. If these effects are “just” adverse events based on physiologic and psychological responses to a frightening event and/or iatrogenic complications of procedures or medications, it underlines the importance of intervening in this process early. December 2008 Version 2.0 Page 434
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 9 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Case 1: Three Investigations • Coroner – Patient died from cervical cancer – Fumes that sickened hospital workers were just the “smell of death ” • Cal-OSHA – No safety violations – Three employees had “involuntary psychological reaction to some agents” while the rest suffered from mass hysteria • California Dept of Health Services (CDC) – “An outbreak of mass sociogenic illness perhaps triggered by an o dor” – Also possible that a few staff members were exposed to unknown toxic chemical Module One – Observed Behaviors during Mass Chemical Exposures 9 The coroner’s report determined the cause of death to be cervical cancer, but found no chemicals that might account for the event. That report speculated that others were overcome by “the smell of death”. The official opinion of Cal-OSHA (state Occupational Safety and Health Administration) is that, while some of the staff may have been affected by hysteria, at least three people had a genuine reaction to some kind of toxin or agent. They also found no safety violations – meaning no methamphetamine laboratory in the hospital. The State Dept. of Health Services report said that most people (eventually over 30) who reported feeling ill were suffering from stress reactions, but that six staff who were felled may have been affected by either hysteria or a toxic agent. The Riverside Dept. of Health says that they now believe that the chief resident, a respiratory technician and a nurse with prolonged patient contact were not suffering from hysteria. Lawrence Livermore Lab released a report hypothesizing that dimethyl sulfate (an industrial gas with some irritant features and severe systemic effects) could have been produced from a dimethyl sulfoxide (DMSO) exposure or ingestion; and was the cause of toxic symptoms in some people. December 2008 Version 2.0 Page 435
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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