sign in sign up
<<
Home , Methyl isocyanate

9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Module Two: Toxic Industrial Gases

Mark Su, MD

1

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Course Overview

1. Introduction – Why Toxic Industrial Chemicals? 2. Inhalation of Toxic Industrial Gases 3. Neurotoxins 4. Agricultural Chemicals of Concern 5. Cyanide and Fumigants 6. , Food & Medication as Vectors 7. Delayed-Onset Toxins 8. Psychological Consequences of Mass Chemical Exposure 9. Tabletop Exercise

Module Two: Inhalation of Toxic Industrial Gases 2

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Faculty Disclosure

• Faculty: Mark Su, MD – Relationships with commercial interests: none – Speakers Bureau/Honoraria: none – Consulting Fees: none – Other: none

Module Two: Inhalation of Toxic Industrial Gases 3

1 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Please help us improve this course by filling out the module evaluation.

You will receive an email with instructions following the conclusion of this presentation.

Module Two: Inhalation of Toxic Industrial Gases 4

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Learning Objectives

• Review history of important industrial gas exposures and regulatory response • Identify major industrial gases of interest • Understand the clinical picture created by the gases and be able to relate this to their physical properties and • Address methods to decrease likelihood of exposure and illness

Module Two: Inhalation of Toxic Industrial Gases 5

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Key Learning Points

• Legislation to regulate TICs/TIMs generated by toxic gas concerns • Releases of large volumes of gas most likely TIC/TIM scenario • Toxicity of a gas is determined by – Dose – Inherent toxicity – Water solubility – Warning properties

Module Two: Inhalation of Toxic Industrial Gases 6

2 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Participant Question

• Which of the following events resulted in the largest number of casualties? A. The sinking of the Titanic, 1912 B. The , 1984 C. The release from Lake Nyos, 1986 D. Terrorist attacks of September 11th, 2001

Module Two: Inhalation of Toxic Industrial Gases 7

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

The Bhopal Disaster (1984)

• Best example of large scale toxic industrial gas release • More casualties and from this event than any terrorist event to date. • Methyl (MIC) release

Module Two: Inhalation of Toxic Industrial Gases 8

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Bhopal Disaster (1984)

• Occurred in middle of the night • Staffing levels low / Plant was shutting down • Water entered a tank believed to be empty – 57,000L of Methyl isocyanate – Accident vs. sabotage • Exothermic (heat releasing) reaction • 40+ tons of methyl isocyanate released – Some combustion products

Module Two: Inhalation of Toxic Industrial Gases 9

3 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Bhopal Disaster • Safety system failures – Unreliable pressure gauges – Nonfunctional refrigeration – Inoperable gas scrubber – Alarm failure – Inadequate spray “knock-down”

http://www.lenntech.com/environmental-disasters.htm

Module Two: Inhalation of Toxic Industrial Gases 10

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Bhopal

Module Two: Inhalation of Toxic Industrial Gases 11

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Bhopal Disaster

• Plume drifted over shanty-town – 250,000 people exposed – Blinding fog at night • Temperature inversion trapped plume • No actual measurements of the Methyl isocyanate concentration – Modeled mean methylisocyanate conc: 27 ppm (0.1-86 ppm) with a median concentration of 1.8 ppm • Concerning gas levels as AEGL3 only 0.40 ppm – Acute Exposure Guideline Level -3 is concentration at which the general population is expected to experience threatening health effects. Level 3 = highest level (NNN)

Module Two: Inhalation of Toxic Industrial Gases 12

4 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Bhopal Disaster • Unprecedented human toll – 2500 fatalities within 1 week (pulmonary) – Thousands more died weeks-months later – Chronic disability for > 100,000+ • Chronic pulmonary complaints • Ocular inflammation

Dhara et al, Arch Environ Health 2002; 57:391-404

Module Two: Inhalation of Toxic Industrial Gases 13

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Methyl Isocyanate (MIC): • Chemical intermediary – Insecticides, polyurethane foam and some plastics • Used in large industrial amounts • Properties – Colorless, flammable liquid at room temperature – Easily vaporizes – Boiling point 39.5 ºC – Has a pungent but not enough to provide warning – Water soluble, but releases heat with water – Heavier than air (Vapor density: 1.4) • It is not cyanide and does not produce cyanide*

Module Two: Inhalation of Toxic Industrial Gases 14

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Methyl Isocyanate: Clinical Effects

• Ocular/Dermal – Blindness/unable to escape exposure – Irritation and ulceration • Respiratory – Irritation upper and lower respiratory tract – Life-threatening pulmonary edema – Residual chronic lung disease • Reactive Airways Dysfunction Syndrome (RADS) – Asthmatic condition following large exposure to certain irritants – Non-immunologic

Module Two: Inhalation of Toxic Industrial Gases 15

5 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Reactive Airways Dysfunction Syndrome (RADS) • A form of chemically induced • Syndrome Diagnosis requires: – No prior chronic respiratory illness (including asthma) – Documented significant exposure to chemical irritant – Symptom onset (cough, dyspnea, wheezing) within 24 hours and persistence for >3 months – Bronchial hyper-responsiveness on pulmonary function testing – Lack of another competing pulmonary diagnosis

Module Two: Inhalation of Toxic Industrial Gases 16

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

SARA • Reponses to tragedy US Congress passed several laws • SARA Title III-Emergency Planning and Community Right-to-Know Act (1986) – State Emergency Response Commission – Local Emergency Planning Committees – Chemical facilities required to submit annual hazardous chemicals inventory reports • Law focus on accidental releases

http://www.access.gpo.gov/nara/cfr/waisidx_04/40cfr372_04.html Module Two: Inhalation of Toxic Industrial Gases 17

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Clean Air Act Amendments of 1990: Risk Management Plans (RMP) • Regulated businesses required to prepare RMP – Greater than threshold amounts present of 77 toxic or 63 flammable substances • RMP must include – Type and amounts of hazardous materials – Accident history during past 5 years* – Hazards associated with chemical processes – Process controls, passive mitigation, detection systems • Off-site consequence analysis (OCA) – Accidental release scenario

Module Two: Inhalation of Toxic Industrial Gases 18

6 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Chemical Facility Anti-Terrorism Standards (CFATS, 2014) • Certain chemical facility covered by act – Risk based focus (Consequence, capability) – Security vulnerability assessments – Site security plans – Audits and inspections • Penalties for non-compliance/ facility shut down • Recognition of need to coordinate but also protection of sensitive information from public disclosure

Module Two: Inhalation of Toxic Industrial Gases 19

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Chemical Accidents (not explosive) in US Industry under RMP for 2000-2015 Anhydrous 965 (16) Chlorine 548 (3) 175 (0) 137 (4) Ammonia (>20%) 121 (15) 89 (2) 63 (2) 58 (0) Fuming Sulfuric acid 57 (2) 1,3 Butadiene 54 (4) Propylene oxide 54 (1) Carbon Disulfide 50 (1) Number of accidents with Chlorine Dioxide 47 (1) number of fatalities in Vinyl Chloride 47 (5) parenthesis 36 (0*)

Module Two: Inhalation of Toxic Industrial Gases 20

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Inhalational Exposure: Determinants of Toxicity • Dose = Respiratory rate x tidal volume • Exposure circumstances – Concentration – Duration • Health of Individual exposed • Properties of Agent – Water solubility – pH – Volatility/Vapor density – Mixtures and particle size

Module Two: Inhalation of Toxic Industrial Gases 21

7 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Clinical Effects Based on Properties of Agent High water Low water Solubility Solubility

Onset of Symptoms Rapid Delayed

Warning Properties Good Poor

Airway Upper with Lower with lung Injury irritation injury

Module Two: Inhalation of Toxic Industrial Gases 22

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Comparative Toxicity Of Likely Terrorist Industrial Gases

Ammonia > Phosgene • Ammonia AEGL3 = 1600 ppm

Phosgene > Ammonia • Phosgene AEGL3 = 1.5 ppm

Module Two: Inhalation of Toxic Industrial Gases 23

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Railway Accident: Minot, ND 2002

• Derailment of 31 cars • Immediate release of ~150,000 gallons of anhydrous ammonia • 5 cars released • One car airborne ¼ mile striking a house • Plume 300 feet high spreading 5 miles downwind

Module Two: Inhalation of Toxic Industrial Gases 24

8 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Video Derailment

Module Two: Inhalation of Toxic Industrial Gases 25

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Minot ND Ammonia Leak • Even though lighter than air, this release resulted in significant ground-level [NH3] • The visible fog represents significant hazard to: – Contact – Upper airway – Inhalation hazard • Highly water soluble gas • Sheltering in place was the appropriate response to this event – In home or in vehicle

Module Two: Inhalation of Toxic Industrial Gases 26

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Response and Outcomes

• Shelter-in-place order • Difficulty with communication (no overnight TV crew) • Exposed population: 11,600 • Minor symptoms: 322 • Serious symptoms: 11 • Fatal: 1

Module Two: Inhalation of Toxic Industrial Gases 27

9 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Anhydrous Ammonia (NH3)

• Third highest production volume chemical in U.S. – ~9 million metric tons • Manufacture of fertilizer as source (>80%) • Other uses: plastics, fibers and resins, explosives, cleaning disinfectants, refrigeration • Transported as liquefied gas under pressure via pipeline, railcar, tanker truck, and refrigerated barge

Module Two: Inhalation of Toxic Industrial Gases 28

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Ammonia: Physical Properties • Colorless gas with pungent odor • Low odor threshold; good warning properties – Odor threshold 25 ppm <<< IDLH 500 ppm • Highly water soluble • Boiling point – 33º C – Requires high pressures/low temperature storage • Vapor density 0.6 (lighter than air*) • Combustible in narrow range • Highly reactive gas

Module Two: Inhalation of Toxic Industrial Gases 29

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Clinical Effects

• Damage from alkali burn and thermal reaction (frost) NH3 + H2O Æ NH4OH Hydroxide

• Low concentration: irritant to nose, throat, upper respiratory tract • Higher concentrations or more prolonged contact cause skin burns • Lower airway inflammation with pneumonitis and pulmonary edema

Module Two: Inhalation of Toxic Industrial Gases 30

10 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Anhydrous Ammonia

• Concentration x duration determines clinical effect – Minor irritation to blindness with extensive scar formation • Center picture shows fluorescein uptake indicating diffuse corneal injury

Module Two: Inhalation of Toxic Industrial Gases 31

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Homemade WWI Warfare Agent

• 29 yr old man with acute respiratory distress after cleaning toilet with mixture he made • RR 36/min, HR 128/min, BP 148/76 • Lip and throat swelling • Diffuse wheezing • Required intubation and positive pressure ventilation • Hypoxia with CXR

Module Two: Inhalation of Toxic Industrial Gases 32

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Participant Question

• What chemical agent was made? A. Anhydrous Ammonia B. Chlorine C. Phosgene D. Sulfur Mustard

Module Two: Inhalation of Toxic Industrial Gases 33

11 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chlorine

Non-cardiogenic pulmonary edema

Module Two: Inhalation of Toxic Industrial Gases 34

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Dangerous combination

Module Two: Inhalation of Toxic Industrial Gases 35

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chlorine Gas

• Multiple Uses – Manufacturing chemicals – Pulp and paper industry – Commercial & household bleaching agents – Water purification & waste treatment • 1998 US production > 14 million tons – One of most produced chemicals – Shipped as liquefied compressed gas

Module Two: Inhalation of Toxic Industrial Gases 36

12 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chlorine: Physical Properties

• Green-yellow, pungent gas • Low odor threshold; – Moderate warning properties (≈3ppm) • Intermediate water solubility

– Less than NH3, more than phosgene • Boiling point –34 ºC • Vapor density 2.5 (heavier than air) • Reacts explosively with many http://www.amazingrust.com/ compounds Experimentshow_to/Images/ Module Two: Inhalation of Toxic Industrial Gases Chlorine_gas.jpg 37

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chlorine: Clinical Effects • Intermediate water-solubility • Low concentrations: Cl2 + H2O ↔ HCl + HOCl – irritant to eyes, nose, throat, upper respiratory tract – May not be detected so the victim remains in environment • Higher concentrations: – Acute pulmonary edema – Chemical pneumonitis • Chronic sequelae: – RADS http://www.aliciapatterson.org/APF1403/Borg/Borg04.jpg Module Two: Inhalation of Toxic Industrial Gases 38

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Chlorine: 1st Successful Chemical Warfare Agent, WW I

Wind-borne Chlorine Attack, WWI

Battle of Ypres-168 tons of Cl2 released from 5700 canisters; 50% mortality Chlorine Gas Respirators Module Two: Inhalation of Toxic Industrial Gases 39

13 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Chlorine from Train Accident (Graniteville, SC; Jan 6, 2005 02:40)

One 90 ton tanker ruptured, releasing gas for ¼ - ½ mile

http://www.hazmatteam.com Module Two: Inhalation of Toxic Industrial Gases 40

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Consequences Graniteville Train Accident • 9 deaths – 1 train engineer – 6 mill workers – 1 in home – 1 in truck • 529 sought medical care • 69 hospitalized, 11 critical • 18 were treated at area physicians’ offices • 5,400 evacuated in 1 mile radius of crash • Initial report : "sodium nitrate" • Chlorine was not reported to ED for 1 hour Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit ---South Carolina, 2005; Selected States, 1999-2004. MMWR 54(3):64-67. http://sav-cdn.com/sites/default/files/imagecache/superphoto/editorial/images/savannah/mdControlled/cms/2006/07/18/24773370.jpg Module Two: Inhalation of Toxic Industrial Gases 41

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chlorine Transport in the US

Rail transportation of chlorine and other toxic gases is common in highly populated cities.

photo: Jim Dougherty July 9, 2004

Module Two: Inhalation of Toxic Industrial Gases 42

14 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Chlorine Gas used in terrorism • Reports of chlorine gas being used in Syria and by ISIS – Partial augmentation in IED weapon lethality – Also using just the gas • Transient breathing problems most common.

http://www.bbc.com/news/world-middle-east-31847427 Module Two: Inhalation of Toxic Industrial Gases 43

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chlorine Bombs

Module Two: Inhalation of Toxic Industrial Gases 44

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene • Used in the manufacture of – Organic chemicals: dyestuffs, – Plastics – Insecticides – Pharmaceuticals • 80% used for isocyanate production • US production: estimated 1 million tons/year • Also formed as a combustion product when chlorine-containing compounds are burned

• Formula Cl2C=O; Not same as

Module Two: Inhalation of Toxic Industrial Gases http://www.newworldencyclopedia.org/entry/Phosgene 45

15 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene: History

• Synthesized in 1812 • 1st used in WWI, Ypres, Belgium (December 1915) – Germans shelled British with 88 tons of phosgene – 1100 casualties, 120 deaths

Module Two: Inhalation of Toxic Industrial Gases 46

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Phosgene: Community Threat Assessment • 99.9% of production is “used on-site” • Storage and transport as liquefied compressed gas

http://www.chemicaldesign.com/Phosgene.htm

Module Two: Inhalation of Toxic Industrial Gases 47

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene

• BASF Plant Ascension Parish, LA • 1981: Plant operator killed • 1982: 28 workers injured • 1986: Phosgene plume over unpopulated parts of http://commons.wikimedia.org/wiki/ Ascension Parish Image:Map_of_Louisiana_highlighting_Ascen sion_Parish.svg – Only chemical releases considered

Module Two: Inhalation of Toxic Industrial Gases 48

16 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene: Physical Characteristics

• Colorless gas (Odor of musty hay) • Low water solubility • Higher odor threshold; poor warning properties • Vapor density 3.5 (heavier than air) • Boiling point 8.3 ºC – Can be stored in pressurized cylinders

Module Two: Inhalation of Toxic Industrial Gases 49

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Video

Module Two: Inhalation of Toxic Industrial Gases 50

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

• Odor threshold: Phosgene 0.5 - 1.5 ppm – Olfactory fatigue • 10 min AEGL-2: 0.60 ppm – Severe symptoms • 10 min AEGL-3: 3.6 ppm – Life threatening symptoms

(AEGL= Acute Exposure Guideline Level; 3=NNN) Module Two: Inhalation of Toxic Industrial Gases 51

17 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene: Clinical Effects

• Limited initial symptoms – Eyes, nose, upper airways irritation – Airway spasm with high concentration • Low water solubility – delayed onset • Slow hydrolysis to HCl

Module Two: Inhalation of Toxic Industrial Gases 52

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene: Clinical Effects

• Latent development of pulmonary edema – Onset 1 to 24 hours after exposure – Pulmonary function abnormalities – May be fatal • Chronic airway disease • Other possible mechanism of damage include linking together and making acid.

COCl2 + 2 R-NH2 Æ CO(NH-R)2 + 2HCl

Module Two: Inhalation of Toxic Industrial Gases 53

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Phosgene: Delayed Lung Injury

6 hrs post-exposure 10 hrs post-exposure

Module Two: Inhalation of Toxic Industrial Gases 54

18 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Hydrofluoric Acid

• Known as HF • Used in # industrial processes/consumer products: – Catalyst in oil refineries – Manufacture of silicon semiconductor chips – Separating uranium isotopes – Etching glass or enamel – Cleaning brass, crystal and as a rust remover (dilute) • Production in U.S. is < 1 million tons/year • Transported as pressurized anhydrous liquid by rail

Module Two: Inhalation of Toxic Industrial Gases http://www.viewimages.com/Search.aspx?mid=1307009&epmid=1&partner=Google 55

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

HF: Physical Properties

• Colorless, non-flammable- irritating odor • Fuming liquid or gas • Highly water soluble • Low odor threshold; good warning property • Weak acid (does not mean unable to harm!) – Penetrates tissue well • Boiling point 20 ºC • Vapor density 0.7 (less than air)

Module Two: Inhalation of Toxic Industrial Gases 56

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

HF: Clinical Effects

• Corrosive (concentration dependent): Irritating • Onset of pain and skin changes may be delayed for hours with dilute (<20%) solutions – Near instant/immediate injury with 50%+ solutions • Release of fluoride ion results in binding to calcium and magnesium – Unique and severe systemic effects – Tissue necrosis – Hypocalcemia, hypomagnesemia, hyperkalemia – Cardiac dysrhythmia and death • Small burns with concentrated HF can be fatal Module Two: Inhalation of Toxic Industrial Gases 57

19 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Texas City, TX Industrial Accident Releasing HF (October 31, 1987) • ~30,000 pounds of hydrofluoric acid leaked from an HF alkylation reactor drum – Convection unit was dropped on the vessel • Estimate of critical levels (AEGL3) ~3/4 mile away – ~4000 residents evacuated for 3 days – >1000 people to hospital with skin, eye, nose/throat irritation and pulmonary symptoms • No fatalities

Module Two: Inhalation of Toxic Industrial Gases 58

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Prevention • Importance of plant security/ Hardening • Plant used to store 500,000 lbs HF

Module Two: Inhalation of Toxic Industrial Gases 59

Chemical Agents of Opportunity for Terrorism: TICs & TIMs Prevention • Proximity to Oakland coliseum

Module Two: Inhalation of Toxic Industrial Gases 60

20 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Gas Summary

AGENT PHYSICAL PROPERTIES EXPECTED CLINICAL EFFECTS

H2O Odor / Vapor Mucosal / Lower Systemic Solubility Warning Density Upper Airway Airway MIC High Pungent / 1.4 Yes Possible No Inadequate methylisocyanate NH High Pungent / 0.5 Yes Possible No 3 Good Ammonia Pungent / Fair Cl2 Interm. 2.5 Yes Yes No Chlorine COCl Low Mown Hay/ 3.5 Unlikely Yes No 2 Inadequate Phosgene HF High Pungent / 0.7 Yes Possible Electrolyte & Good Cardiac Hydrofluoric Rhythm

Module Two: Inhalation of Toxic Industrial Gases 61

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Participant Question

• Which chemical agent has the lowest water solubility and often the longest symptom onset time? A. Anhydrous Ammonia B. Chorine C. Hydrofluoric Acid D. Phosgene

Module Two: Inhalation of Toxic Industrial Gases 62

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Treatment for Irritant Gas Exposure

• Remove from exposure • Irrigation of eyes or skin if involved – Extensive decontamination usually not necessary unless liquid exposure – Delays can impede care and have other negative effects • Oxygen • Nebulized beta-agonists (e.g. albuterol) for wheezing or dyspnea

Module Two: Inhalation of Toxic Industrial Gases 63

21 9/11/15

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

• National planning guidance available about decon • Recommendations based on available (minimal) evidence

http://www.dhs.gov/publication/mass-decontamination-guidance Module Two: Inhalation of Toxic Industrial Gases 64

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Treatment for Irritant Gas Exposure

• Consider adding sodium bicarbonate to nebulizer in chlorine gas exposures • Intravenous and inhaled calcium gluconate, and continuous cardiac monitoring are important for hydrogen fluoride exposure • Observe patients for late pulmonary effects, particularly in those with severe early symptoms • Concern for late pulmonary effects for agents with low water solubility agents

Module Two: Inhalation of Toxic Industrial Gases 65

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Questions?

Module Two: Inhalation of Toxic Industrial Gases 66

22