Module One Toxic Warfare: Looking Beyond Conventional Chemical ...

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Module One Toxic Warfare: Looking Beyond Conventional Chemical ...

Chemical Agents of Opportunity for Terrorism: TICs & TIMs!Module OneToxic Warfare: Looking Beyond ConventionalChemical WeaponsTraining Support Package1


Chemical Agents of Opportunity for Terrorism:TICs & TIMsCourse Overview• Why “Agents of Opportunity?”• Neurotoxicology• Gases• Cyanide and Fumigants• Food/Water/Medications• Delayed Onset Toxins• Radiation• Psychological AspectsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons2


Chemical Agents of Opportunity for Terrorism:TICs & TIMsLearning Objectives• Define TICs and TIMs• Describe the goals of toxic terrorism• Discuss prioritization and community response tochemicals of concern• Introduce the concept of using clinical findings toidentify a terrorist chemical agent and event• Review historical examples of toxic terrorismModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons3


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons5


Chemical Agents of Opportunity for Terrorism:TICs & TIMsAudience ResponseWhich of the following best describes who you workfor?1. Federal Government (incl. Military)2. State Government3. Local Government (incl. Police, Fire, EMS)4. Educational (University, High School,…)5. Hospital or Medical Facility6. Corporation7. Consulting Firm8. OtherModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons6


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons7


Chemical Agents of Opportunity for Terrorism:TICs & TIMsOfficial “Battlefield”Chemical Warfare Agents• Purpose Designed WarfareAgents• Dual Use IndustrialChemicals– Nerve (eg. Sarin, VX)– Blister (eg. Mustard)– Blood (eg. CN)– Choking (eg.Phosgene)– 1° focus of chemical defenseprograms in past– Less emphasis on industrialchemicals as a military threatModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons8


Chemical Agents of Opportunity for Terrorism:TICs & TIMsTICs and TIMs• TIC = Toxic Industrial Chemical• TIM = Toxic Industrial Material• Chemical substance that in sufficient availablequantity produces a toxic effect through inhalation,ingestion, or other route of absorptionModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons9


Chemical Agents of Opportunity for Terrorism:TICs & TIMsAudience ResponseWhich of the following would best be characterized asa toxic industrial compound?1. Ammonia2. Anthrax3. Sarin4. Mustard Gas5. WaterModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons10


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons11


Chemical Agents of Opportunity for Terrorism:TICs & TIMsImportance of DOSE“All substances are poisons: there is none which is not a poison.The right dose differentiates a poison and a remedy."Paracelsus (1493-1541)Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons12


Chemical Agents of Opportunity for Terrorism:TICs & TIMsSources of TICs and TIMs (1)Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons13


Chemical Agents of Opportunity for Terrorism:TICs & TIMsSources of TICs and TIMs (2)Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons14


Chemical Agents of Opportunity for Terrorism:TICs & TIMsChemical Terrorism• Definition – the use of chemicals to harm or alter thebehavior of an adversary• Utilizes existing stored chemicals – exploitingweapons of opportunity• Who’s at risk– Civilians in U.S.• Wide availability of toxic materials throughout U.S.• Proximity of industrial operations to large urban centers– Military abroadModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons15


Chemical Agents of Opportunity for Terrorism:TICs & TIMsGoals of Toxic Terrorism• Health Effects– Incapacitating vs killing• Damage / contamination of infrastructure• Psychological effects resulting from actual orthreatened use of toxic substances - terrorizing– Asymmetrical– Create uncertainty, fear, and panic– Uncertainties provide tactical and/or psychologicaladvantagesModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons16


Chemical Agents of Opportunity for Terrorism:TICs & TIMsAudience ResponseThe goal of toxic terrorism is best accomplished bywhich of the following scenarios or releases?1. Immediately lethal agent release in restaurant2. Disruption of a transportation corridor3. Creating fear leading to incapacity4. Occult insertion of a carcinogen5. Targeting a single factory componentModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons17


Chemical Agents of Opportunity for Terrorism: TICs & TIMs!Questions For Intro ModuleTraining Support Package18


Chemical Agents of Opportunity for Terrorism:TICs & TIMsScenarios• Large-scale outdoor release of toxic gas or fumes,and/or an explosion, from an attack on a mobile orfixed tank or vessel• Targeted release of a toxic gas into a confinedspace (e.g. a subway, theater, or building) or againstspecific individuals or groups• Acute or delayed poisoning by contamination offood, water, or a highly trafficked venueModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons19


Chemical Agents of Opportunity for Terrorism:TICs & TIMsWhy Use Industrial Chemicals?Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons20


Chemical Agents of Opportunity for Terrorism:TICs & TIMsLimitations with Purpose:Aum Shinrikyo – Matsumoto1994, Tokyo 1995 (Sarin)• Spent ~$30 million on chemicalweapons research• Employed many scientists• Killed only 19• Problems with– Production– Effective Delivery SystemDesigned WMDModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons21


Chemical Agents of Opportunity for Terrorism:TICs & TIMsMore Effective: Bhopal (1984)• Methyl isocyanate• > 2,500 deaths• 60,000 injuriesModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons22


Chemical Agents of Opportunity for Terrorism:TICs & TIMsShould We Worry?• ~ 850,000 U.S. businesses use, produce, or storeTICs• EPA report – 123 chemical plants across US haveenough toxic chemicals to kill/injure 1 million peoplein terrorist attack• 750 other plants have enough chemicals to kill/injureat least 100,000 people in an attack• U.S. army study - terrorist attack on chemical plantin densely populated area could result in 2.4 millionfatalities or injuriesModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons23


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons24


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons26


Chemical Agents of Opportunity for Terrorism:TICs & TIMsUS Legislative Response to MajorChemical Accidents• Emergency Planning and Community Right-to-KnowAct (EPCRA) 1986• Clean Air Act Amendments of 1990– Occupational Safety & Health Administration’s (OSHA)Process Safety Management (PSM)– Environmental Protection Agency’s (EPA) RiskManagement Program (RMP) 1996Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons27


Chemical Agents of Opportunity for Terrorism:TICs & TIMsEmergency Planning & CommunityRight-to-Know Act (EPCRA)• Required chemical facilities to provide– Information necessary for emergency planning to Local EmergencyPlanning Committees (LEPCs)– annual hazardous chemical inventories to State Emergency ResponseCommissions (SERCs), LEPCs and local fire departments.• Required SERCs & LERCs to prepare emergency responseplans for chemical accidents.• Established Toxics Release Inventory (TRI), which requiresfacilities to annually report quantities of their emissions oftoxic chemicals to TRI database.Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons28


Chemical Agents of Opportunity for Terrorism:TICs & TIMsRisk Management Programs(61 CFR 31667, 06/20/96)• Hazard vulnerability assessment• Accident prevention program• Emergency response program• Specified facility information• Make info available to: EPA, state & localgovernments, FD & publicModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons30


Chemical Agents of Opportunity for Terrorism:TICs & TIMsWorst-Case Scenario:Likelihood of Occurrence?• WCS are considered unlikely because:– assume a very large release occurring during worst-caseatmospheric conditions– does not include active release mitigation such as waterdeluge systems and automatic shutoff valves• passive mitigation efforts included, such as containment dikes andbuilding enclosures• However, with terrorist attack, more than oneprocess likely to be affectedModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons31


Chemical Agents of Opportunity for Terrorism:TICs & TIMsAEGL PlumesAcute Exposure Guideline Levels (AEGL): www.epa.gov/oppt/aegl/Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons32


Chemical Agents of Opportunity for Terrorism:TICs & TIMsReductions in Hazards &VulnerabilitiesSafe Hometown GuideModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons33


Chemical Agents of Opportunity for Terrorism:TICs & TIMshttp://www.ncseonline.org/nle/crsreports/03Feb/RL31530.pdfModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons34


Chemical Agents of Opportunity for Terrorism:TICs & TIMsNot Just Fixed FacilitiesModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons35


Chemical Agents of Opportunity for Terrorism:TICs & TIMsRail links transporting chemical tankercars travel through or near major citiesModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons "36


Chemical Agents of Opportunity for Terrorism:TICs & TIMsRailway Explosion• Power cables touch rail cars loaded with ammonium nitrate fertilizer• Buildings for several hundred meters were totally flattened• 129 public buildings destroyed or damaged including hospital, food processingplant, and college.• Rescue workers described utter devastation with damage extending for 4 kmModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons37


Chemical Agents of Opportunity for Terrorism:TICs & TIMsArea Before ExplosionModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons38


Chemical Agents of Opportunity for Terrorism:TICs & TIMsArea After ExplosionModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons39


Chemical Agents of Opportunity for Terrorism:TICs & TIMsNorth Korean Railway Incident• Death toll: 154, including 76 schoolchildren– A primary school had just ended when the explosionhappened– Some children were on their way home, while others weretrapped in the building– Most people were injured when they were trapped orthrown from buildings.Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons40


Chemical Agents of Opportunity for Terrorism:TICs & TIMsSchool After ExplosionModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons41


Chemical Agents of Opportunity for Terrorism:TICs & TIMsPrioritizing Chemicals of Concern: NATOITF-25 Definition of TICs – 1996• High Production Volume Chemicals (HPVs)– produced in quantities > 30 tons (60,000 pounds) in a single facility• High Toxicity– LCt50 by inhalation < 100,000 mg/min/M3• Appreciable vapor pressure at 20°C– Thus, airborne hazards only• Hazard Index = {(toxicity)x(state)x(distribution)x(producers)}– maximum value of 625Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons42


Chemical Agents of Opportunity for Terrorism:TICs & TIMsNATO ITF-25: High Hazard TICs• Tissue Irritants– ammonia– boron trichloride– chlorine– fluorine– formaldehyde– hydrogen bromide– hydrogen chloride– phosgene– phosphorus trichloride– nitric acid– sulfur dioxide– sulfuric acid• Systemic Poisons– arsine– boron trifluoride– carbon disulfide– cyanide– diborane– ethylene oxide– hydrogen fluoride– hydrogen sulfide– tungsten hexafluorideModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons43


Chemical Agents of Opportunity for Terrorism:TICs & TIMsUSACHPPM – 2002 Reevaluation• Also evaluated - corrosiveness, reactivity,flammability, less volatile chemicalsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons44


Chemical Agents of Opportunity for Terrorism:TICs & TIMsRisk AssessmentCHEMICAL HAZARD PROBABILITY RISKHydrogen Cyanide Catastrophic Occasional HighSulfuric Acid Catastrophic Likely ExtremeAcetylene Catastrophic Frequent ExtremeNitromethane Catastrophic Seldom HighPhosgene Critical Occasional HighMethanol Critical Occasional HighModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons45


Chemical Agents of Opportunity for Terrorism:TICs & TIMsUnusual but Easily Available AgentsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons46


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons47


Chemical Agents of Opportunity for Terrorism:TICs & TIMsOsmium TetroxideModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons48


Chemical Agents of Opportunity for Terrorism:TICs & TIMsAudience ResponseWhich of the following is not a component of a hazardscore or ranking?1. Toxicity of a chemical2. Amount of a chemical on site3. Volatility of chemical4. Wind direction at time of release5. History of use in prior terrorist eventModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons49


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons50


Chemical Agents of Opportunity for Terrorism:TICs & TIMsChemical Agents Employed by Terrorists• Corrosives - Acid / alkalis• Metals• Cyanide• Rodenticides• Pesticides• Poison gasMonterey Institute Database, 2002Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons51


Chemical Agents of Opportunity for Terrorism:TICs & TIMs“Terrorists can make the 'unlikely' happen.”Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons52


Chemical Agents of Opportunity for Terrorism:TICs & TIMsMethods Used by Terrorists forDelivery of Chemical (N=126)• Casual/direct contact 33 (30%)• Aerosol/spray 21 (19%)• Food/drink 13 (12%)• Unknown 12 (11%)• Product tampering 10 (9%)• Explosive 6 (5%)• Water supply 5 (4%)• Jug/jar/canister 1 (1%)• Mail/letter 4 (3%)• Reaction device 3 (2%)• Injection/projectile 1 (1%)Module OneToxic Warfare: Looking Beyond Conventional Chemical WeaponsMonterey Institute Database, 200053


Chemical Agents of Opportunity for Terrorism:TICs & TIMsTerrorism PreparednessModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons54


Chemical Agents of Opportunity for Terrorism:TICs & TIMsUnusual Agents of Historic ImportanceModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons55


Chemical Agents of Opportunity for Terrorism:TICs & TIMsModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons56


Chemical Agents of Opportunity for Terrorism:TICs & TIMsUnusual Agents: Characteristic ToxidromesModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons57


Chemical Agents of Opportunity for Terrorism:TICs & TIMsIt Doesn’t Even Have to Be Real:Fear and Economic TerrorHoax - 1989 - Chilean grapes imported intothe US alleged to contain CyanideModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons58


Chemical Agents of Opportunity for Terrorism:TICs & TIMsChallenges of Chemical AgentIdentification• Symptoms similar to common disease (gastroenteritis)• Immediate symptoms might be mild or nonexistent• Staggered reports over long periods / different locations• Mixed clinical presentations• Health care providers may be less familiar with certainchemical induced presentationsMMWR 10/3/03Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons59


Chemical Agents of Opportunity for Terrorism:TICs & TIMsClues to Chemical Exposure• Unusual number seeking care for chemical-relatedillness• Unexplained deaths among young, healthy people,plants, animals• Clusters of illness with common source (e.g. water)– Surveillance methods including PCC, pharmacy sales• Presence of a clinical pattern or toxidromeModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons60


Chemical Agents of Opportunity for Terrorism:TICs & TIMsSelected Toxidromes and PotentialChemical EtiologiesCategory Clinical Syndrome Potential ChemicalEtiologySevere gastroenteritisCholinergic crisisCellular hypoxiaPeripheral neuropathyMouth pain / ulcerationsMMWR 10/3/03Abdominal pain, emesisprofuse diarrhea, shockSLUDGE symptoms,Fasciculations, weaknessN/V, headache, AMS, shock,seizures, dec pHMuscle weakness, sensorylossLip / mouth / pharyngealulcerations; burning painArsenic, Ricin, ColchicineOP insecticides, nicotineCN, SMFA, CO, AzideHg, As, Thallium, Lead,Paraquat / diquat; caustics,HgModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons61


Chemical Agents of Opportunity for Terrorism:TICs & TIMsA Case49 yo man suddenly develops leg pain while walking• Day 1 - fever, nausea, vomiting• Day 2 - tachycardia, lymph node swelling and shock• Day 3 - kidney failure, vomited blood, heart block• Day 4 - death• Presumed Cause of Death – Septic ShockModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons62


Chemical Agents of Opportunity for Terrorism:TICs & TIMsSelected Toxidromes and PotentialChemical EtiologiesCategory Clinical Syndrome Potential ChemicalEtiologySevere gastroenteritisCholinergic crisisCellular hypoxiaPeripheral neuropathyMouth pain / ulcerationsMMWR 10/3/03Abdominal pain, emesisprofuse diarrhea, shockSLUDGE symptoms,Fasciculations, weaknessN/V, headache, AMS, shock,seizures, dec pHMuscle weakness, sensorylossLip / mouth / pharyngealulcerations; burning painArsenic, Ricin, ColchicineOP insecticides, nicotineCN, SMFA, CO, AzideHg, As, Thallium, Lead,Paraquat / diquat; caustics,HgModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons63


Chemical Agents of Opportunity for Terrorism:TICs & TIMsRicin PoisoningModule OneToxic Warfare: Looking Beyond Conventional Chemical Weapons64


Chemical Agents of Opportunity for Terrorism:TICs & TIMsQUESTIONS?Module OneToxic Warfare: Looking Beyond Conventional Chemical Weapons65

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