Chemical warfare agents

Fact Sheet 1: Overview of Chemicals Defined as Chemical Weapons

What are chemical weapons?

The Chemical Weapons Convention considers chemical weapons to include both the toxic chemicals that are used in warfare, and the munitions and equipment used to disperse them. Toxic chemicals are defined as "any chemical which through its chemical action on life processes can cause death, temporary incapacitation or permanent harm to humans or animals. This includes all such chemicals, regardless of their origin or of their method of production and regardless of whether they are produced in facilities, in munitions or elsewhere." Today, thousands of poisonous substances are known but only a few are considered suitable for chemical warfare. About 70 different chemicals have been used or stockpiled as CW agents during the 20th century. Today, only a few of these are considered of interest because: A presumptive agent must not only be highly toxic but also "suitably highly toxic" so that it is not too difficult to handle. The substance must be capable of being stored for long periods without degradation and without corroding the packaging material. It must be relatively resistant to atmospheric water and oxygen so that it does not lose effect when dispersed. It must also withstand the heat developed when dispersed by explosion. The World Health Organization has listed 17 chemical weapons which are grouped as: NERVE AGENTS, for example tabun, sarin and soman. VESICANTS (blister gases), for example "mustard gas" and other. CHOKING AGENTS (lung irritants), for example phosgene and chloropicrin BLOOD GASES, for example hydrogen TEAR GASES and other disabling chemicals cyanide War gases" are seldom gases The CW agents used today are only exceptionally gases. Normally they are liquids or solids, often dispersed in the air in so-called aerosols. An aerosol can penetrate the body through the respiratory organs in the same way as a gas. In order to achieve good ground coverage when dispersed from a high altitude with persistent CW agents the dispersed droplets must be sufficiently large to ensure that they fall within the target area. This can be achieved by dissolving polymers (e.g., polystyrene or rubber products) in the CW agent to make the product highly-viscous or thickened. The result will be that the persistence time and adhesive ability increase which thus complicates decontamination. ROUTES OF EXPOSURE SKIN: Systemic poisoning may result from inhalation, dermal exposure and ingestion. Some CW agents can penetrate the skin. This mainly concerns liquids but in some cases also gases and aerosols. Solid substances penetrate the skin slowly unless they happen to be mixed with a suitable solvent. Local damage to the skin may promote absorption. INHALATION: Chemical agents may be inhaled, or ingested (e.g. through contaminated food or water). The respiratory system is affected by inhalation. EYES: The eyes are particularly sensitive to chemical agents and may cause the development of symptoms very quickly. Psychological stress may itself mimic some of the effects of chemical weapons.

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Fact Sheet 12: Chemical Warfare Agents, Properties, Diagnosis and First Aid
CHEMICAL AGENTS Nerve agents G agent (e.g. Sarin) (non persistent) VX agent (persistent) CHARACTERISTICS Colourless gas and colourless to pale yellow liquid. CLINICAL EFFECTS Tightness of chest; headache; rhinorrhea and salivation; persistent miosis and dimming of vision if liquid or vapour come into direct contact with eyes. Nausea and vomiting; sweating; convulsions; dyspnoea; respiratory failure, coma, apnoea, cardiac arrhythmia SELF-AID Autoinjectors with Atropine (and oximes). Repeat twice at 15 min interval if symptoms persist. Decontamination of skin exposed to agent. FIRST-AID Repeat atropine twice at 15 min intervals if symptoms persist. Administer oximes. Decontamination of casualty and resuscitation. Artificial ventilation Anticonvulsant (Diazepam) Initial symptoms may be delayed. REMARKS Speed is vital in treating casualties. Atropine must be given as soon as possible. Blood sampling for Acetylcholinesterases. (RBC CE activity).

Lung gases Phosgene

Chlorine Colourless gas which may form white cloud. Smell of newmown hay. Colourless gas or volatile liquid. Smell of bitter almonds.

Systemic or blood agents Hydrogen cyanide

Lacrimation; coughing choking; tightness in the chest with pain, conjunctivitis. Nausea and vomiting. Latent period 30 mins to 24 hrs followed by signs and symptoms of pulmonary oedema. Anoxia, circulatory collapse. Steroid inhaler Mild cases; headache, nausea and vertigo. Higher concentrations; in addition, convulsions and coma. High concentrations: respiratory arrest, coma; within minutes

Steroid inhaler I/V. Artificial respiration. Warmth, strict rest and oxygen.

Vesicant ("blister") agents Sulphur mustard

Yperite Arsenical vesicants

Lewisite Colourless to amber oily liquid or colourless gas. Smell of garlic. Lewisite has geranium-like smell.

Artificial respiration In severe cases death is (positive pressure, fast. Speed in treatment oxygen). is most urgent. Blood Amylnitrite, sodium sample for CN detection. nitrite + sodium thiosulphate, hydroxocobalamine. Correction of acidosis. Eyes. Delayed effects after 1 hr or more: lacrimation, Following Antidotes for Lewisite: severe conjunctivitis with pain, photophobia, irrigation of eyes, DMSA, DMPS and BAL blepharospasm and oedema. Temporary, rarely use antibiotics Secondary respiratory permanent blindness and local and skin infection. Skin. Delayed effects. Erythema followed by vesication anaesthetics. Ocular keratitis. and blistering. Vapour particularly affects moist areas. Treat skin Special protective Respiratory tract. blisters as for clothing required. Symptoms after 10-24 hours with rhinorrhoea followed thermal burns. Lewisite produces similar by hoarseness and cough, bronchitis, Treat respiratory effects to those of bronchopneumonia, nasal haemorrhage symptoms sulphur mustard, but is Contact produces immediate pain in the eyes or skin. symptomatically. absorbed more quickly Erythema, blisters and eye injury develop rapidly. Use steroid and acts more rapidly. Effects of arsenical poisoning may be produced. inhaler even in Treatment must be Remove agent from eyes. Irrigate with water absence of immediate. immediately. Use steroid inhaler even in absence of respiratory respiratory symptoms. symptoms and I/V steroids. Source: IPCS, WHO, Geneva "Fact Sheets on Chemical Warfare Agents, SDE/SEARO, World Health Organization, New Delhi, India"

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Fact Sheet 2 : Preparedness for a Chemical Threat Acquire antidotes and specialized chemical protective equipment masks, goggles, suits, aprons, etc), pharmaceuticals, decontamination material, medical equipment (e.g. respirators), other specialised material. Antidotes must be very quickly available! Give consideration to stockpiling and distribution plans. Identify specialised information sources and of specialists on hazardous materials, treatment protocols and preparation of public health response plans Train rescue and health personnel on the initial recognition and management of chemical casualties, barrier nursing, triage, decontamination, sample handling, handling of mass-casualty, rehabilitation and follow-up. Identify and ensure analytical support as an early identification of the chemical warfare agent is essential to determine the risk to the population and the types of actions required to minimize casualties. Define triage criteria: a medical decision process is required to place casualties in priority order as to ensure the most effective use of limited medical resources and minimize morbidity and mortality. Prepare for supportive and antidotal treatment. Few specific antidotes to chemical weapons are available. Poison centres are a good source of information and advice, and either hold or know of stocks of antidotes (see www.intox.org). Prepare for decontamination: In general, large quantities of water are required. Workers caring for victims at hospitals should remove clothing before the casualty is treated. Many chemical weapons evaporate readily and can be hazardous in enclosed rooms or shelters. RESPONSE TO A DELIBERATE CHEMICAL RELEASE In principle, it is usually safer for people to remain in their own home or shelters. Proceed to closing and sealing all doors, windows, chimneys and other possible routes of entry against a chemical weapon, storing sufficient quantities of uncontaminated food and water for survival. If evacuation is necessary, it should be done in a controlled manner. If a chemical weapon attack has actually occurred, relief and health personnel should protect themselves immediately and follow the response steps: 1. Apply techniques for the detection of the chemicals 2. Evaluate the nature and magnitude of the release 3. Contact the specialists and/or reference centres 4. Assess the current and delayed mass casualty needs 5. Obtain the antidotes, if available 6. Inform the population 7. Protect the first responders 8. Establish the hot-zone 9. Conduct immediate decontamination 10. Implement the triage system 11. Ensure medical care 12. Ensure the evacuation of victims 13. Conduct the decontamination 14. Require local, national or international resources 15. Monitor the residual hazard level

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Fact Sheet 3: Exposure to Chemical Agents
NERVE AGENTS Sarin, VX, Tabun, and Soman, are highly toxic chemicals, effective at very low concentrations and virtually odourless. Most were originally used as pesticides. They produce salivation, bronchoconstriction, myosis, and paralysis of the respiratory muscles. In liquid or vapour state, these organophosphate nerve agents rapidly penetrate all normal clothing and mucous surfaces including the cornea, and the vapour is quickly absorbed by upper and lower respiratory tracts. Exposure to high concentrations causes irregular shallow breathing, bradycardia, convulsions and death within a few minutes. Smaller doses cause nausea and vomiting, constriction of the pupils, tightness of the chest and a runny nose. Effective life support is vital. Antidotes are available. Three main groups of drugs can be used: atropine, oximes and diazepam. Pre-treatment with pyridostigmine may be beneficial. Toxicological analysis can most readily be performed by measuring the level of red cell cholinesterase activity VESICANTS OR SKIN-BLISTERING AGENTS Mustard HD, Lewisite. Mustards do not immediately cause pain or irritation or warn of their presence, they are detected by their garlic odour and by automatic electronic detectors. Mustards readily penetrate ordinary clothing, leather and skin. After a latent period of several hours the effects become apparent on the skin, eyes, respiratory and gastro-intestinal tracts. Eye inflammation may develop in one hour and skin blisters form about 12 hours after exposure. All lesions are susceptible to infection and damaged tissue are slow to heal (risk of permanent eye damage, bronchopneumonia, chronic bronchitis). Systemic effects on bone marrow and lymphatic system resemble the effects of ionizing radiation. There is no specific therapy. Treatment is only symptomatic and supportive. Skin decontamination should be carried out immediately with copious amounts of soap and water, and the eyes should be thoroughly irrigated with water. Mustards have been shown to be mutagenic, carcinogenic and teratogenic. Lewisite is a vesicant liquid with similar affects to the mustards but has a more immediate action as it rapidly penetrates rubber, plastic and skin, causing immediate and severe pain with rapid incapacitation, and deeper necrosis. It hydrolyses rapidly and is thus less persistent in moist climates. Decontamination should be carried out immediately (as above). Symptomatic and supportive treatment is required. The specific therapy for Lewisite include: DMSA, DMPS, DMPA and dimercaprol British Anti-Lewisite, BAL. LUNG GASES, CHOKING OR ASPHYXIANTS Phosgene, Chlorine is irritants: severe pulmonary oedema occurs after a latent period of up to 48 hours. Painful coughing, bronchial hypersecretion, vomiting, dyspnoea occurs. Patients suffer distress and fear. They die from cardiac failure or asphyxia 24 to 28 hours after exposure, or later, from secondary infection. If the eyes are contaminated, intense irritation and severe pain and corneal lesions may lead to permanent blindness. No antidote exists and treatment is essentially symptomatic and supportive, using mechanical ventilation and steroids. There is no specific therapy. Skin and eye decontamination should be carried out immediately. SYSTEMIC AGENTS OR BLOOD GASES Hydrogen cyanide is a volatile liquid (boiling point at 26C) that produces a gas which is lighter than air and disperses very rapidly. It acts extremely fast, and it is difficult to protect against because it can be absorbed by inhalation and ingestion (and through the skin in case of liquid hydrogen cyanide). However, it is difficult to maintain effective concentrations and so is unlikely to be useful for large civilian attacks. Once the cloud has dissipated, people who are still alive will most probably recover. Later sequelae are rare. Cyanogen halides cause lacrimation and possibly eye injury, and irritation of respiratory tract similar to lung damaging agents. Rapid and effective life support care is vital: assisted ventilation, cardiovascular resuscitation and correction of metabolic acidosis. Several antidotes are available: dicobalt edetate, amylnitrite, sodium nitrate and sodium thiosulfate in combination, hydroxocobalamin and also oxygen.

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Fact Sheet 4: Nerve Agent Sarin - GB (Isopropylmethylphosphonofluoridate) Description: Sarin was developed in 1938 in Germany as a pesticide. Sarin is a colorless gas and colourless to pale yellow liquid. The released vapor, because it is slightly heavier than air, hovers close to the ground. Under wet and humid weather conditions, Sarin degrades swiftly, but as the temperature rises up to a certain point, Sarin's lethal duration increases, despite the humidity. Sarin is a lethal cholinesterase inhibitor. Very small doses are needed to kill humans. Signs and Symptoms: Symptoms of overexposure may occur within minutes or hours, depending upon the dose. They include: miosis (constriction of pupils) and visual effects, headaches and pressure sensation, runny nose and nasal congestion, salivation, tightness in the chest, nausea, vomiting, giddiness, anxiety, difficulty in thinking, difficulty sleeping, muscle twitches, tremors, abdominal cramps, diarrhea, involuntary urination and defecation, with severe exposure symptoms progressing to convulsions and respiratory failure. Treatment: Inhalation: Hold breath until respiratory protective mask is donned. If severe signs of agent exposure appear (chest tightens, pupil constriction, in coordination, etc.), immediately administer the antidote: 2 mg atropine. Injections may be repeated at 5 to 20 minute intervals if signs and symptoms are progressing until three series of injections have been administered. No more injections will be given unless directed by medical personnel. In addition, a record will be maintained of all injections given. If breathing has stopped, give artificial respiration. Mouth-to-mouth resuscitation should be used when mask-bag or oxygen delivery systems are not available. Do not use mouth-to-mouth resuscitation when facial contamination exists. If breathing is difficult, administer oxygen. Seek medical attention Immediately. Eye Contact: Immediately flush eyes with water for 10-15 minutes, then don respiratory protective mask. Although miosis (pinpointing of the pupils) may be an early sign of agent exposure, an injection will not be administered when miosis is the only sign present. Instead, the individual will be taken Immediately to a medical treatment facility for observation. Skin Contact: Seek medical attention Immediately. Don respiratory protective mask and remove contaminated clothing. Immediately wash contaminated skin with copious amounts of soap and water, 10% sodium carbonate solution, or 5% liquid household bleach. Rinse well with water to remove excess decontaminant. Administer nerve agent antidote only if local sweating and muscular twitching symptoms are observed. Ingestion: Seek medical attention Immediately. Do not induce vomiting. First symptoms are gastrointestinal. Immediately administer antidote.

Fact Sheet 8: Blister Agent Mustard HD(Bis- [2-Chloroethyl] sulfide) Description: First used in 1917 during World War I. Mustard (liquid) is colorless when pure, but is normally a brown oily substance. Mustard (vapor) has a slight garlic- or mustard-like odor. Mustard remains a health hazard for an extended period of time. Mustard is a toxic agent that is considered non-lethal. However, complications from mustard exposure can lead to death. Signs and Symptoms: An individual exposed to mustard will feel very little pain and will not notice symptoms for quite some time. However, the longer the exposure without removal of the mustard agent, the more severe will be the damage to affected areas of the body. Mustard is a blister agent that affects the eyes, lungs and skin. The eyes are very susceptible, reacting to very low concentrations from mustard. Exposure to mustard on the skin can range from redness and inflammation to severe blisters and extreme soreness. Inhalation of the agent will cause irritation of throat, tightness of chest, hoarseness and coughing. If medical treatment is not received in the early stages of contamination, severe bronchopneumonia with accompanying high fever can occur. Treatment: There is no known antidote for mustard exposure; the process of cellular destruction is irreversible. Therefore, it is very important to remove the mustard as quickly as possible. The best means of removal is by flushing with water and household bleach, or washing with soap and water after using an absorber of mustard, such as flour. Inhalation: Hold breath until respiratory protective mask is donned. Remove from the source. Immediately. If breathing is difficult, administer oxygen. If breathing has stopped, give artificial respiration. Mouth-to-mouth resuscitation should be used when approved mask-bag or oxygen delivery systems are not available. Do not use mouth-to-mouth resuscitation when facial contamination is present. Seek medical attention Immediately. Eye Contact: Speed in decontaminating the eyes is absolutely essential. Remove the person from the liquid source; flush the eyes Immediately with water for at least 15 minutes by tilting the head to the side, pulling the eyelids apart with the fingers and pouring water slowly into the eyes. Do not cover eyes with bandages but, if necessary, protect eyes by means of dark or opaque goggles. Transfer the patient to a medical facility Immediately. Skin Contact: Don respiratory protective mask. Remove the victim from agent sources Immediately. Immediately wash skin and clothes with 5% solution of sodium hypochlorite or liquid household bleach within one minute. Cut and remove contaminated clothing, flush contaminated skin area again with 5% sodium hypochlorite solution, then wash contaminated skin area with soap and water. Seek medical attention Immediately. Ingestion: Do not induce vomiting. Give victim milk to drink. Seek medical attention Immediately.