chemical terrorism


Summary: The use of chemical agents in TERRORISM. This includes the malevolent use of nerve agents, blood agents, blister agents, and choking agents (NOXAE).

Top Publications

  1. Lawrence D, Kirk M. Chemical terrorism attacks: update on antidotes. Emerg Med Clin North Am. 2007;25:567-95; abstract xi pubmed
    ..This article is meant to introduce the clinician to several such agents, along with the antidotes useful in the management of exposure to these. It covers the indications, administration, and precautions for using these antidotes...
  2. Hoffman R, Mercurio Zappala M, Bouchard N, Ravikumar P, Goldfrank L. Preparing for chemical terrorism: a study of the stability of expired pralidoxime (2-PAM). Disaster Med Public Health Prep. 2012;6:20-5 pubmed publisher
    ..Because 2-PAM is often dosed empirically, clinical improvement does not guarantee pharmacological stability. We therefore chose to analyze the chemical stability of expired 2-PAM...
  3. Varney S, Hirshon J, Dischinger P, Mackenzie C. Extending injury prevention methodology to chemical terrorism preparedness: the Haddon Matrix and sarin. Am J Disaster Med. 2006;1:18-27 pubmed
    ..Nineteen city, state, federal, and military agencies responded to the Haddon Matrix chemical terrorism preparedness exercise and offered feedback in the data review session...
  4. Phelps S. Mission failure: emergency medical services response to chemical, biological, radiological, nuclear, and explosive events. Prehosp Disaster Med. 2007;22:293-6 pubmed
    ..Results indicate that EMS responders are not prepared to safely respond to MTCWAs, which may result in a significant loss of life of victims and responders. ..
  5. Vale A. What lessons can we learn from the Japanese sarin attacks?. Przegl Lek. 2005;62:528-32 pubmed
    ..Analysis of the events reveals a number of important lessons for authorities as well as physicians to consider when preparing for such incidents. ..
  6. Myhrer T. Neuronal structures involved in the induction and propagation of seizures caused by nerve agents: implications for medical treatment. Toxicology. 2007;239:1-14 pubmed
    ..Studies of radiolabeled ligands to map subreceptors may provide specification of wanted drug properties to guide the choice among existing agents or to synthesize novel ones. ..
  7. Tokuda Y, Kikuchi M, Takahashi O, Stein G. Prehospital management of sarin nerve gas terrorism in urban settings: 10 years of progress after the Tokyo subway sarin attack. Resuscitation. 2006;68:193-202 pubmed
    ..To help minimize the possible catastrophic impact on the public, we make several recommendations based on analysis of the Tokyo subway sarin attack and systematically review the current scientific literature. ..
  8. Liebelt E. Old antidotes, new antidotes, and a 'universal antidote': what should we be using for pediatric poisoning?. Curr Opin Pediatr. 2007;19:199-200 pubmed
  9. Rodgers G, Condurache C. Antidotes and treatments for chemical warfare/terrorism agents: an evidence-based review. Clin Pharmacol Ther. 2010;88:318-27 pubmed publisher
    ..The strength of evidence for most antidotes is weak, highlighting the need for additional research in this area. ..

More Information


  1. Grugle N, Kleiner B. Effects of chemical protective equipment on team process performance in small unit rescue operations. Appl Ergon. 2007;38:591-600 pubmed
    ..This article discusses the implications of these results with respect to the study design and the limitations of using an event-based team performance measurement methodology. ..
  2. McInerney J, Richter A. Strengthening hospital preparedness for chemical, biological, radiological, nuclear, and explosive events: clinicians' opinions regarding physician/physician assistant response and training. Am J Disaster Med. 2011;6:73-87 pubmed
  3. Prockop L. Weapons of mass destruction: Overview of the CBRNEs (Chemical, Biological, Radiological, Nuclear, and Explosives). J Neurol Sci. 2006;249:50-4 pubmed
    ..Neurological complications of chemical, biological and explosive weapons which have or may be used by terrorists are reviewed by international experts in this publication. Management and treatment profiles are outlined. ..
  4. Anderson P. Emergency management of chemical weapons injuries. J Pharm Pract. 2012;25:61-8 pubmed publisher
    ..Blood agents include cyanide. The mechanism of toxicity for cyanide is blocking oxidative phosphorylation. Toxic industrial chemicals include agents such as formaldehyde, hydrofluoric acid, and ammonia. ..
  5. Stull J. New and improved responder ensembles. Occup Health Saf. 2006;75:61-2, 64, 66 passim pubmed
  6. Eisenkraft A, Dushnitsky T. Toxic industrial compounds--the threat is out there. Isr Med Assoc J. 2007;9:676 pubmed
  7. Gronvall G, Matheny J, Smith B, Mair M, Chamberlain A, Deitch S, et al. Flexible defenses roundtable meeting: promoting the strategic innovation of medical countermeasures. Biosecur Bioterror. 2007;5:271-7 pubmed
  8. Krauss B, Heightman A. 15-second triage tool. The use of capnography for the rapid assessment & triage of critically injured patients & victims of chemical terrorism. JEMS. 2006;31:60-2, 64-6, 68 pubmed
  9. Yokoyama K. Our recent experiences with sarin poisoning cases in Japan and pesticide users with references to some selected chemicals. Neurotoxicology. 2007;28:364-73 pubmed
    ..In addition, non-neurological effects of pesticides and other chemicals are presented, in relation to genetic polymorphism and oxidative stress. ..
  10. Moores L. Threat credibility and weapons of mass destruction. Neurosurg Focus. 2002;12:E1 pubmed
    ..The psychological ramifications, it should be noted, the permutations of which have not yet been defined, will be much longer lasting. In this paper the author discusses these and other characteristics of the current threat. ..
  11. Lim S, Ma K, Jeong J, Kim G, Lee K, Jeong J, et al. In situ gas sensing using a remotely detectable probe with replaceable insert. Opt Express. 2012;20:1727-32 pubmed publisher
    ..The remote sensing probe, we believe, has much potential for detecting gases in hazardous environments. ..
  12. Devaney D. Updating hospital bio-terrorism and chemical preparedness procedures. J Healthc Prot Manage. 2005;21:40-8 pubmed
    ..This article is designed as a generic guide and checklist that will be helpful to hospital security departments in updating their procedures for responding to bio-terrorism and chemical terrorist incidents. ..
  13. Beer S, Muller G, Wöllenstein J. Development and characterization of an electrostatic particle sampling system for the selective collection of trace explosives. Talanta. 2012;89:441-7 pubmed publisher
    ..The selectivity of this particle collection and separation process is demonstrated and a full-chain demonstration of a DNT detection experiment is presented (DNT: di-nitro-toluene). ..
  14. Baker D, Murray V, Carli P. A pan-European study of capabilities to manage mass casualties from the release of chemical agents: the MASH project. Am J Disaster Med. 2013;8:13-23 pubmed publisher
    ..A program of specialized training and action are required to apply the findings revealed by the MASH study into a unified cross-border emergency medical response. ..
  15. Fuse A, Okumura T, Hagiwara J, Tanabe T, Fukuda R, Masuno T, et al. New information technology tools for a medical command system for mass decontamination. Prehosp Disaster Med. 2013;28:298-300 pubmed publisher
  16. Pumera M. Analysis of explosives via microchip electrophoresis and conventional capillary electrophoresis: a review. Electrophoresis. 2006;27:244-56 pubmed
    ..This article overviews the microchip and conventional capillary electrophoretic techniques for analysis of a wide variety of explosive compounds and mixtures. ..
  17. Williams B, Magsumbol M. Emergency preparedness among people living near US army chemical weapons sites after September 11, 2001. Am J Public Health. 2007;97:1601-6 pubmed
    ..Compliance with procedures during emergencies could be seriously limited, putting residents in these sites at higher levels of risk of exposure to chemical hazards than nonresidents. ..
  18. Rosman Y, Makarovsky I, Bentur Y, Shrot S, Dushnistky T, Krivoy A. Carbamate poisoning: treatment recommendations in the setting of a mass casualties event. Am J Emerg Med. 2009;27:1117-24 pubmed publisher
    ..We speculate that in a mass casualties event, the benefits of using oximes outweigh the low level of potential risk. ..
  19. Barrett A, Adams P. Chlorine truck attack consequences and mitigation. Risk Anal. 2011;31:1243-59 pubmed publisher
    ..Measures such as sheltering in place, evacuation, and use of security barriers and cryogenic storage can reduce fatalities, sometimes by 50% or more, depending on response speed and other factors. ..
  20. Teran Maciver M, Larson K. Implications of chemical biological terrorist events for children and pregnant women. MCN Am J Matern Child Nurs. 2008;33:224-32; quiz 233-4 pubmed publisher
  21. Chalela J, Burnett T. Chemical terrorism for the intensivist. Mil Med. 2012;177:495-500 pubmed
    ..For obvious reasons, the critical care literature on chemical terrorism is scarce...
  22. Hrobak P. Nerve agents: implications for anesthesia providers. AANA J. 2008;76:95-7 pubmed
    ..This article also reviews the physiology of the neuromuscular junction and the autonomic nervous system receptors that nerve agent toxicity affects. ..
  23. Pennell P, Antenucci A, Brennan L, Burhans R, Ostrowski S. Functional assessment of hospital laboratory packaging and shipping preparedness in New York State. Clin Lab Sci. 2008;21:199-204 pubmed
    ..acute care hospital facilities (statewide, excluding New York City) that submit suspect bioterrorism (BT), chemical terrorism (CT), and/or pandemic influenza (Pan Flu) clinical specimens to the NYS Department of Health (DOH) Wadsworth ..
  24. Barelli A, Biondi I, Soave M, Tafani C, Bononi F. The comprehensive medical preparedness in chemical emergencies: 'the chain of chemical survival'. Eur J Emerg Med. 2008;15:110-8 pubmed publisher
    ..This paper addresses the medical priority when approaching victims of chemical emergencies. The priority actually is to establish a chain of chemical survival in which antidote administration is one out of several links. ..
  25. Yanagisawa N. [The nerve agent sarin: history, clinical manifestations, and treatment]. Brain Nerve. 2014;66:561-9 pubmed
    ..Posttraumatic stress disorder (PTSD) was observed in several of the victims in the 5-year follow up, irrespective of the severity of poisoning at Matsumoto. Psychological symptoms continue in victims of both incidents. ..
  26. Cosar A, Kenar L. An anesthesiological approach to nerve agent victims. Mil Med. 2006;171:7-11 pubmed
  27. Krauss B. Capnography as a rapid assessment and triage tool for chemical terrorism. Pediatr Emerg Care. 2005;21:493-7 pubmed
    The assessment and triage of victims of chemical terrorism in the emergency department and the prehospital setting has become an important priority...
  28. Pennell P, Brennan L, Burhans R, Ostrowski S. Packaging and shipping capabilities of New York State hospital laboratories: a 3-year drill assessment. Clin Lab Sci. 2011;24:14-21 pubmed
    ..the ability of NYS acute care hospital facilities to recognize and respond to a suspected bioterrorism, chemical terrorism or pandemic flu emergency specimen submission event...
  29. Schobitz E, Schmidt J, Poirier M. Biologic and chemical terrorism in children: an assessment of residents' knowledge. Clin Pediatr (Phila). 2008;47:267-70 pubmed
    ..medicine residents at a single institution in the medical management of pediatric victims of biologic and chemical terrorism. A test covering essential content was developed and validated by experts...
  30. Okumura T, Kondo H, Nagayama H, Makino T, Yoshioka T, Yamamoto Y. Simple triage and rapid decontamination of mass casualties with colored clothes pegs (STARDOM-CCP) system against chemical releases. Prehosp Disaster Med. 2007;22:233-6 pubmed
    ..It is recommended that this system should be adopted internationally and used for both drills and actual events. ..
  31. Subbarao I, Bond W, Johnson C, Hsu E, Wasser T. Using innovative simulation modalities for civilian-based, chemical, biological, radiological, nuclear, and explosive training in the acute management of terrorist victims: A pilot study. Prehosp Disaster Med. 2006;21:272-5 pubmed
    ..Future studies should be conducted to determine the educational and cost-effectiveness of the use of these modalities. ..
  32. Schumacher J, Weidelt L, Gray S, Brinker A. Evaluation of bag-valve-mask ventilation by paramedics in simulated chemical, biological, radiological, or nuclear environments. Prehosp Disaster Med. 2009;24:398-401 pubmed
    ..This delay in refilling may have resulted in a reduced achievable minute volume. The range of maximum minute volumes observed in both groups highlights the need for continuous BVM ventilator training. ..
  33. Sandilands E, Good A, Bateman D. The use of atropine in a nerve agent response with specific reference to children: are current guidelines too cautious?. Emerg Med J. 2009;26:690-4 pubmed publisher
    ..This review examines the issues currently surrounding the use of atropine in children following a nerve agent attack and propose strategies for treating exposed children. ..
  34. Cannard K. The acute treatment of nerve agent exposure. J Neurol Sci. 2006;249:86-94 pubmed
    ..This article reviews the properties of NAs and how to recognize the clinical features of NA intoxication, employ the needed drugs properly, and screen out anxious patients who mistakenly believe they have been exposed. ..
  35. Seto Y. [Analytical and on-site detection methods for chemical warfare agents]. Yakugaku Zasshi. 2006;126:1279-99 pubmed
  36. Jett D. Neurological aspects of chemical terrorism. Ann Neurol. 2007;61:9-13 pubmed
  37. Freyberg C, Arquilla B, Fertel B, Tunik M, Cooper A, Heon D, et al. Disaster preparedness: hospital decontamination and the pediatric patient--guidelines for hospitals and emergency planners. Prehosp Disaster Med. 2008;23:166-73 pubmed
    ..These guidelines must be utilized, studied, and modified to increase the likelihood that they will work during an emergency situation. ..
  38. Makarovsky I, Markel G, Dushnitsky T, Eisenkraft A. Hydrazine--the space era agent. Isr Med Assoc J. 2008;10:302-6 pubmed
    ..Finally, medical teams should also be equipped with the proper protection measures (appropriate suits, gloves and breathing apparatuses) in order to avoid secondary exposure of themselves and others. ..
  39. Vayre P. [Session: on the subject: "Healthcare response to terrorism armed conflict excepted". Introduction]. Bull Acad Natl Med. 2007;191:967-9 pubmed
  40. Aleksandrov V, Bogolubov E, Bochkarev O, Korytko L, Nazarov V, Polkanov Y, et al. Application of neutron generators for high explosives, toxic agents and fissile material detection. Appl Radiat Isot. 2005;63:537-43 pubmed
  41. Eason M. Sarin exposure: a simulation case scenario. South Med J. 2013;106:55-62 pubmed publisher
    ..b>Chemical terrorism, specifically the use of nerve agents, has occurred in other nations...
  42. Edwards N, Caldicott D, Eliseo T, Pearce A. Truth hurts--hard lessons from Australia's largest mass casualty exercise with contaminated patients. Emerg Med Australas. 2006;18:185-95 pubmed
  43. Rabinowitz P, Wiley J, Odofin L, Wilcox M, Dein F. Animals as sentinels of chemical terrorism agents: an evidence-based review. Clin Toxicol (Phila). 2008;46:93-100 pubmed publisher
    ..of this systematic review was to identify evidence that animals could serve as sentinels of an attack with a chemical terrorism agent...
  44. Talmor D. Nonconventional terror--the anesthesiologist's role in a nerve agent event. Anesthesiol Clin. 2007;25:189-99, xi pubmed
    ..The multiple casualties that may be expected present additional logistical and organizational problems. The specific skills of anesthesiologists will make them invaluable members of the care team in such a chemical mass casualty event. ..
  45. Fry D. Chemical threats. Surg Clin North Am. 2006;86:637-47 pubmed
    ..This reality makes it necessary for civilian disaster-planning strategies to incorporate an understanding of chemical agents, their effects, and the necessary treatment. ..
  46. Michael W S, Julia A M. Chemical-biological terrorism and its impact on children. Pediatrics. 2006;118:1267-78 pubmed
  47. Schaper A, Desel H, Wyke S, Orford R, Griffiths M, Edwards N, et al. Countering health threats by chemicals with a potential terrorist background--creating a rapid alert system for Europe. Eur J Intern Med. 2012;23:e63-6 pubmed publisher
    ..Poisons centres receive a large number of enquiries and could be important sentinels in this field of toxicovigilance. ..
  48. Baez A, Sztajnkrycer M, Giráldez E, Comprés H. Weapons of mass destruction preparedness and response for the XIV Pan-American Games, Santo Domingo, 2003. Prehosp Disaster Med. 2006;21:256-60 pubmed
    ..Syndromic surveillance was performed by means of direct communications between the hospitals and units, as well as use of an electronic, Web-based surveillance tool. ..
  49. Saladi R, Smith E, Persaud A. Mustard: a potential agent of chemical warfare and terrorism. Clin Exp Dermatol. 2006;31:1-5 pubmed
    ..Prevention and management of mustard exposure are briefly discussed. The need for awareness and preparedness in the dermatological community regarding mustard exposure is emphasized. ..
  50. Izake E. Forensic and homeland security applications of modern portable Raman spectroscopy. Forensic Sci Int. 2010;202:1-8 pubmed publisher
    ..On the other hand, spatially offset Raman spectroscopy proved to be very valuable for non-invasive chemical analysis of hazards concealed within non-transparent containers and packaging. ..
  51. Babakhanian R, Bushuev E. [Forensic-medical assessment of terroristic chemical attacks]. Sud Med Ekspert. 2005;48:18-21 pubmed
    By potential damage, chemical terroristic attacks are much more dangerous than terroristic bombing. To fight chemical terrorism it is necessary to create the system of medical-environmental defense of the population...
  52. Hauschild V, Watson A. Exposure levels for chemical threat compounds: information to facilitate chemical incident response. J Emerg Manag. 2013;11:355-84 pubmed
    ..Rapid selection of the most appropriate chemical exposure criteria is recommended to avoid such problems and expedite all phases of chemical incident response and recovery. ..
  53. Weerasekera G, Smith K, Needham L, Barr D. A rapid, cost-effective method for analyzing organophosphorus pesticide metabolites in human urine for counter-terrorism response. J Anal Toxicol. 2008;32:106-15 pubmed
    ..Because this method is lower in cost, it may be a more viable option for equipping multiple laboratories with chemical-terrorism response capabilities. ..