In recent years, there has been growing concern that many of the most likely threats of chemical terrorism involve so-called “agents of opportunity.” Both common and unusual industrial agents may pose a considerable threat as potential terrorist weapons. While an understanding of the traditional military chemical weapons (e.g. nerve agents) remains essential, an appreciation of the myriad of other potential toxic chemicals readily available in our society is crucial if we are to optimally prepare, identify and defend against chemical threats. Many toxic industrial chemicals are easily obtainable from multiple sources in our communities and pose a serious threat to health if accidentally released or intentionally disseminated.
The American College of Medical Toxicology (ACMT) created a Federal Emergency Management Agency (FEMA)-approved awareness-level training course addressing the medical and psychological impact of industrial chemicals used as terrorist weapons. With sponsorship by the US Department of Homeland Security (DHS) Office of Health Affairs (OHA) Chemical Defense Program, ACMT is pleased to present this expanded course in a webinar format to the response communities participating in the OHA Demonstration Projects.
This course 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. The traditional military warfare chemical agents will not be covered in these lectures because information on these agents is readily accessible through a number of other forums.
The information presented will be of interest to state and local first responders, EMTs, paramedics, emergency physicians, emergency response coordinators, public health officials, industrial hygienists and others involved with chemical terrorism preparedness and response. Our topic selection for each course is intended to prepare the response community for their upcoming OHA Demonstration Project Tabletop exercise.
By attending this course, the participant will be able to:
This module provides a framework to understand and apply with confidence important toxicology principles (exposure pathway, dose-response, toxidromes, association vs. causation). CHEMM-IST (http://chemm.nlm.nih.gov/chemmist.htm), a tool to assist the medical care provider and emergency planner in identifying the chemical class responsible for a given clinical presentation is introduced.
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This module defines TICs/TIMs and introduces the concept of “agents of opportunity”, distinguishing them from purpose-derived chemical warfare agents. Historic events and hazard ranking systems are discussed, as well as ongoing efforts such as Chemical Terrorism Risk Assessment.
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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.
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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.
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This module reviews commercial applications, characteristics, and treatment guidelines relating to cyanide and three common fumigants: Vikane (sulfuryl fluoride), methyl bromide, and phosphine.
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Part 1 | Module 6: 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.
Part 2 | Module 7: Risk Communication
This module reviews some of the major tenets of communication in a disaster or stressful situation, emphasizing synthesis of the key components of risk assessment (hazard identification, exposure pathway, modifying factors, toxicity assessment) into effective messaging. There will be an opportunity for participants to assess their own communication styles and to formulate critical message maps.
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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.
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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.
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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.
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The process and goals of medical monitoring (clinical and/or laboratory studies) are described and applied to potential chemical terrorism or mass chemical exposure scenarios in this module.
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The objectives of the Chemical Agents of Opportunity series will be reviewed, followed by a moderated discussion about how this new knowledge can be applied in the field.
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