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Chemical Agents of Opportunity for Terrorism: Toxic Industrial Chemicals (TICs) and Toxic Industrial Materials (TIMs) - LIVE Course

Saturday, September 12, 2015 | 8:00am - 4:30pm

Course Location

The Morrelly Homeland Security Center
510 Grumman Road W.
Bethpage, NY 11714

Course Description

The Department of Homeland Security (DHS) Office of Health Affairs (OHA) Chemical Defense Program (CDP) in collaboration with the Nassau County Fire Marshal’s Office and the American College of Medical Toxicology (ACMT) will hold a one-day Federal Emergency Management Agency (FEMA) approved awareness level training course addressing the medical and psychological impact of industrial chemicals used as terrorist weapons.

This training will utilize a symptom-based clinical approach to describe the medical impact of various chemical poisons. It will provide a framework to enhance recognition of the common health effects of apparently disparate chemical toxins, describe the risk to various healthcare workers, and introduce clinical and public health management strategies.

Target Audience

The training is targeted towards local first responders, EMTs, paramedics, emergency physicians, emergency response coordinators, public health officials, industrial hygienists, hazardous materials personnel, nurses, and others involved with chemical terrorism preparedness and response.

Course Objectives

By attending this one-day course, the participant will be able to:

  • Understand the concept of chemical agents of opportunity, TICs and TIMs, and appreciate the basis for increased public health preparedness.
  • Identify chemical agents of opportunity that could be used by terrorists.
  • Discuss the past use of these chemicals in mass exposure situations.
  • Describe the major health effects of TICs, TIMs and other important non-volatile chemical agents that could be used by terrorists.
  • Identify the primary modalities available to assess and treat victims of such chemical exposures.
  • Understand the psychological impact of mass chemical exposures.

Agenda / Course Syllabus

7:45-8:00am - Sign-In* & Welcome 

8:00-8:45am - Introduction - Why Toxic Industrial Chemicals?

This module provides a framework to understand and apply with confidence important toxicology principles (exposure pathway, dose-response, toxidromes, association vs. causation). TICs/TIMs are defined and the concept of “agents of opportunity” is introduced, distinguishing these agents from purpose-derived chemical warfare agents. Historic events and hazard ranking systems are discussed.

Charles McKay, MD, FACMT


8:45-9:30am - Inhalation of Toxic Industrial Gases

Five industrial gases are described in this module (Methyl Isocyanate, Ammonia, Chlorine, Phosgene, and Hydrofluoric Acid). The important features of vapor density, water solubility, odor threshold; respiratory, and systemic effects are discussed. Examples of mass exposures resulting from industrial accidents or acts of terrorism are portrayed.

9:30-10:15am - Neurotoxins

This module portrays the complexities of the central nervous system as a balance between excitatory, inhibitory, and thought modulating neuro-transmitters. The ways in which chemicals alter this balance are described (calmatives, convulsants, hallucinogens) with examples of mass poisonings and attacks.

10:15-10:30am - Break

10:30-11:15am - Agricultural Chemicals of Concern

The Food/Agricultural Sector is a critical infrastructure and constitutes nearly 20% of the U.S. economy. In addition, there are a number of chemicals transported, stored, or used onsite that have the potential for intentional or accidental misuse. This module will focus on agents of explosive concern and pesticides, including some insecticides and rodenticides.

11:15-12:00pm - Cyanide and Fumigants

This module reviews commercial applications, characteristics, and treatment guidelines relating to cyanide and three common fumigants: Vikane (sulfuryl fluoride), methyl bromide, and phosphine.

12:00-1:20pm - Lunch Break

1:20-2:00pm - Water, Food & Medication as Vectors

This module explores the complexity and vulnerabilities of the water, food, and medication production and distribution systems. Historical examples of tampering are used to exemplify methods to identify and interdict chemical terrorism. 

2:00-2:45pm - Delayed-Onset Toxins

Using historic examples, the clinical presentation and psychological impact of delayed-onset toxins such as thallium, mercury, dioxins, and polybrominated biphenyls are described in this module.

2:45-3:00pm - Break

3:00-3:45pm - Psychological Consequences of Mass Exposure

The normal physiologic response to fear and the difficulty in distinguishing these responses from those of true chemical exposures, are discussed in this module. The importance of planning for patients presenting “just to get checked out” and with misinterpreted physiologic responses is emphasized. 

3:45-4:15pm - Table Top Exercise

4:15-4:30pm - Closing Remarks


KirkM125w.jpgMark Kirk
Department of Homeland Security, Office of Health Affairs
Washington, DC
Dr. Kirk is an emergency physician and medical toxicologist. He is the Director of the Department of Homeland Security's Chemical Defense Program. He is on faculty at the University of Virginia's Department of Emergency Medicine. He is a nationally recognized expert in chemical incident emergency response and community-based planning.
Lee_DavidDavid Lee, MD
North Shore-LIJ Hofstra Medical School
Hempstead, NY
Dr. Lee is a Professor of Emergency Medicine at the North Shore-LIJ Hofstra Medical School.  He is also the Associate Chairman of Emergency Medicine at North Shore Manhasset Hospital and the Chief of Medical Toxicology at the North Shore LIJ.
Chuck_McKay.jpgCharles McKay, MD
University of Connecticut School of Medicine
Hartford, CT
After graduating from both Dartmouth College and Medical School, Dr. McKay completed an internship and residency in Internal Medicine at Rhode Island Hospital. He completed his residency in Emergency Medicine at Denver General Hospital, and completed practice pathway preceptorships in Medical Toxicology at the Rocky Mountain and New York Poison Control Centers. 

Dr. McKay is a medical toxicologist at Hartford Hospital and the University of Connecticut School of Medicine, where he is an Associate Professor of Emergency Medicine. He is a diplomat of the ABMT and the ABMS Toxicology Subboard. He is the Associate Medical Director of the Connecticut Poison Control Center and the Director of the Toxicology Fellowship at UConn. Dr. McKay also directs a toxicology consult service at Hartford Hospital and Connecticut Children’s Medical Center (CCMC). As Medical Director of Occupational Health Services for Hartford Hospital and CCMC, he also evaluates questions of workplace safety and toxic exposure for 9,000 employees. 

He has served on the ACMT Board of Directors since 2007 and is the Past Chair of the ACMT Practice Committee. Dr. McKay is active in biopreparedness efforts at the local and state level and has helped lead ACMT’s participation in the Department of Homeland Security’s Chemical Terrorism Risk Assessment (CTRA) process. Dr. McKay is also the National Coordinator of the ACMT-ATSDR Regional Consultation Network.
Dr. McKay seeks “to develop sustainable practice opportunities for medical toxicologists.” His interests lie in clinical patient care, occupational and environmental toxicology, biopreparedness, and training of residents and fellows. He also enjoys scuba diving and distance running. 
Lewis_Nelson.jpgLewis Nelson, MD, FACMT
New York University School of Medicine
New York, NY
Dr. Nelson is currently a Professor of Emergency Medicine at New York University School of Medicine, and is an attending physician at both NYU Medical Center and Bellevue Hospital. He is the Director of the Fellowship in Medical Toxicology at New York University School of Medicine and the New York City Poison Control Center. He is a former President of the American College of Medical Toxicology and has served in various consultative roles with FDA, CDC, and DHS. He is an editor of Goldfrank’s Toxicologic Emergencies, now in its 10th Edition, a major textbook in the field of medical toxicology. He has published over 130 peer-reviewed publications and book chapters, and presents frequently at national and international meetings. The focus of his publications and presentations are medication-related adverse effects, chemical terrorism, and toxicity of abused drugs.
 Schwartz_125.jpgMichael Schwartz, MD
 Department of Homeland Security, Office of Health Affairs
 Washington, DC
Dr. Schwartz is an emergency physician and medical toxicologist.  Currently he serves as the Deputy Director of the Chemical Defense Program at the Department of Homeland Security's Office of Health Affairs. Previously Dr. Schwartz spent 12 years at the Centers for Disease Control and Prevention's National Center for Environmental Health as a medical officer. Dr. Schwartz is a Captain in the US Public Health Service.
Su_125.jpgMark Su, MD
New York City Poison Control Center
New York, NY
Dr. Su is currently the Director of the New York City Poison Control Center and an attending physician in the NYU/Bellevue Hospital Center Emergency Department. He is a graduate of the State University of New York Downstate Medical Center and Columbia University Mailman School of Public Health. He completed his Emergency Medicine training at SUNY-Downstate Medical Center/Kings County Hospital Center in Brooklyn, NY and Fellowship Training in Medical Toxicology at the New York City Poison Control Center. His current research interests focus mostly on synthetic cannabinoids and the epidemiology of poisoning.