There are many nerve agents available to terrorist or subverise organizations. They may include:
TABUN (GA)
Tabun is an organophosphate type compound that was developed between WWI & II. It can be easily absorbed through the skin, by means of inhalation, or ingestion. The symptoms of the poisoning are similar , regardless of the route of introduction. Upon inhalation, for instance, the symptoms (in order of occurance) include;
a. Runny nose
b. Bronchial secretions
c. Tightness in the chest
d. Dimming of vision
e. Pin-Point Pupils
f. Drooling
g. Excessive perspiration
h. Nausea, Vomiting
i. involuntary defecation, urination
j. muscle tremors, convulsions
k. Coma
l. Death
Primary treatment for Tabun and several other nerve agents is Atropine Sulfate. It is commonly carried in auto- injectors by military personnel in dosages of 1-2 mgs. However, in many cases, massive doses may be necessary to reverse the effects of the anticholinesterase agents. Frequently, 20-40 mgs. of atropine may be necessary.
The second drug that is used in the treatment of "nerve gas" poisoning is Pralidoxime chloride (3-PAMC1). It is used to reactivate the the acetylcholinestrase that is bound by the nerve agent. 3-PAMC1 is not as effective against Soman (GD). The dosage for 3-PAMC1 is normally 600mg per injection and that it may have to be given repeatedly. Therapeutic levels may also include 1 or more grams of Pralidoxime to be given by intervenous administration over an eight hour period.
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Sarin (GB)
Also a nerve agent in the organophosphate family. Has similar symptoms and is generally "non-persistent" (as is Tabun); is dispersed in an droplet or mist form. GB is also a cholinesterase inhibitor, as are all of the "G" agents. It is treated in a similar manner as Tabun with Atropine and 3-PAMC1.
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Soman (GD)
Again; a compound of the organophosphate family, but more difficult to treat than the other "G" agents. Pralidoxime does not work as well with GD, due to the fact that it's reactivation of acetylcholinesterase must be accomplished within moments of exposure to be at all effective. Normally dispersed like the other "G" agents.
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(VX)
VX is an organophosphate-like compound, but comes in an oily liquid form that is persistent for weeks or longer in the environment. It is commonly used to deny access to a given area and thus stop or slow an enemy ground advance. It can be treated by the same methods that are used for the "G" agents, but must be decontaminated in a different manner than the other agents; alcohol, ether, or acetate can be used to wash the oily liquid from the skin.
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OTHER AGENTS AND INFORMATION OF CONCERN:
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CYANIDES
(AC- Hydrogen cyanide HCN)
(CK- Cyanogen chloride CNCL)
The cyanides can be delivered by artillery, rockets, bombs, or released from upwind cannisters. The symptoms of cyanide poisoning include:
a. Dryness and burning of the throat
b. Dyspnea, shortness of breath
c. Hyperpnea, rapid shallow breathing
d. Apnea, lack of breathing
e. Convulsion & coma
f. Cardiovascular collapse
These agents act by binding the iron (FE) component of the cytochrome c oxidase system, which controls the cellular respiration and exchange of oxygen. The treatment of this agent includes the administration of oxygen and nitrates. Standard military treatment includes administration of 10cc of 3% solution of Sodium nitrate followed by sodium thiosulfate (50cc of 25% solution) by intravenous. Some other medical authorities recommend the use of Amyal Nitrate crushable ampules followed by the nitrates listed above.
Others recommend using Vitamin B12, EDTA, and/or hyperbaric oxygen (High Compression oxygen chamber). Due to the fact that "field" conditions do not allow the use of such extensive equipment, or inconsistent treatment methods; the military method is recommended for the near future.
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DECONTAMINATION:
Generally, protected ( i.e. Gloves, Respirators/SCBA, non- permeable clothing) medical and rescue personnel must wash the victim with soap and water at the scene. Wash water should be properly disposed of in drums or containers that can be properly destroyed. Victims of VX and other non- soluble agents should be cleaned with the alcohol and/or the agents described above. This must be accomplished as soon as possible, and the specific antidotes listed above then be administered. "Dirty" patients should not be transported to the hospital.
(Ed. Note/Disclaimer: This article contains commonly accepted practices in the treatment of those exposed to toxic gases. It should be understood that these recommendations may not be in keeping with local medical practice or EMS standing medical protocals. All practitioners should follow those guidelines that are deemed acceptable within the system that they work. If you have questions, refer to your local system policy.)
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CONCLUSIONS
Nerve agents are thought to be in the stockpiles of several extremist nations and terrorist organizations, including Iran, Iraq, Libya, Lebanon, and Syria. Tthey are also said to have access to a "Mustard Gas" type agent, which can cause extensive skin and respiratory system burns. Reportedly, Iraq used "Mustard" type agents in past attacks on the Kurdish tribemen in their own country. The consequences of letting the "Chemical Genie out of the bottle" have been demonstrated by the chemical release in the Tokyo subway system. Numerous terrorists have vowed to use whatever means are available to them to strike out against the United States or any of her allies; we must be prepared.
By Clark Staten, EMT-P I/C
Former Chairman, National Society of EMS Administrators
Member, NFPA Standard #473 Committee-EMS/Haz-Mat Operations
Asst. Chief Paramedic, Chicago Fire Department, (Retired)
Executive Director, Emergency Response & Research Institute
