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Module 10: Delayed Onset Toxins

Chemical Agents of Opportunity for Terrorism: Toxic Industrial Chemicals (TICs) & Toxic Industrial Materials (TIMs)

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. 

Chemical Agents of Opportunity for Terrorism Complete Course Description 

Course Target Audience

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. 

Module 10: 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.

Module Objectives

By the end of this module, participants will be able to:

  • Recognize that exposure to some chemical agents results in delayed onset of symptoms
  • Describe chemical agents that may cause delayed toxic syndromes
  • Describe toxidromes caused by chemicals with delayed-onset syndromes


Michael Beuhler, MDMichael Beuhler, MD, FACMT
Director, Carolinas Poison Center
Carolinas Medical Center
Charlotte, NC
Dr. Beuhler is the Medical Director for the Carolinas Poison Center (the North Carolina Poison Center) and has been for 11 years. He is also an Attending physician at Carolinas Medical Center where there is an active in- and outpatient Medical Toxicology service. He completed his Medical Toxicology fellowship training at Good Samaritan Regional Medical Center in Phoenix, AZ and his Emergency Medicine Residency at North Shore University Hospital in Manhasset, NY. He has authored several papers that have utilized poison center data and participates in the development and conducting of toxicological public health surveillance programs.He has presented research and academic materials at several national forums as well as authoring chapters in several medical toxicology textbooks. His current research interests include bio-surveillance/public health, poison center triage criteria, mushrooms, “bath salts”, copperhead envenomations, and new antidotes.  

Module Recording and Materials

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