Jeffrey L Arnold, MD, FACEP
Suzanne White, MD
Francisco Talavera, PharmD, PhD
Raymond J Roberge, MD, MPH, FAAEM, FACMT
Risk of Exposure
Injury from chemical weapon agents, known as CWAs, may result from industrial accidents, military stockpiling, war, or a terrorist attack.
Industrial accidents are a significant potential source of exposure to chemical agents. Chemicals such as phosgene, cyanide, anhydrous ammonia, and chlorine are used widely. These chemicals are frequently transported by industry. The accidental release of a methylisocyanate cloud (composed of phosgene and isocyanate) was implicated in the Bhopal, India, disaster in 1984.
Although a number of international treaties have banned the development, production, and stockpiling of chemical weapons, these agents reportedly are still being produced or stockpiled in several countries.
Within the last decade, terrorists deployed chemical weapons against civilian populations for the first time in history. The release of sarin in Matsumoto, Japan, in June 1994 by the extremist Aum Shinrikyo cult left 7 dead and 280 injured. The following year, the Aum Shinrikyo cult released sarin vapor in the Tokyo subway system during morning rush hour, leaving 12 dead and sending more than 5,000 casualties to local hospitals.
Several characteristics of chemical weapon agents lend themselves to terrorist use.
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This article is for managers who prepare hospital operational plans, for leaders responsible for response activities within a hospital, and for hospital health care providers.