US Army Medical Research Institute of Chemical Defense

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US Army Medical Research Institute of Chemical
Defense
U.S. Army Medical Research Institute of Chemical
Defense
MEDICAL CHEMICAL DEFENSE
Overview

• A presentation by
• Colonel Charles G. Hurst MC
• June, 1999

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THE CHEMICAL THREAT

• CW Terrorism
• Industrial accidents
• HAZardous MATerials
• Chemical Demilitarization

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WORLD WAR I CW CASUALTIES

• CW Casualties Fatal
• Germany 200,000 4.5
• France 190,000 4.2
• Britain 189,000 4.2
• U.S. 73,000 2.0
• Russia 475,000 11.8
• Kurds 5,000 ?100

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Riot Control Agents
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Lung Damaging Agents

• Chlorine
• Phosgene (CG)

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Pulmonary Agents

• Chlorine and Phosgene classic examples
• Gases at STP
• Mechanism pulmonary edema ARDS
• Treatment supportive

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Comparative Toxicity of Agents
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PHOSGENE - Case 2

• 42 y/o female
• 2 hrs post exposure
• rapidly inc. dyspnea
• PaO2 40 torr (room air)
• CXR infiltrates -
• perihilar
• fluffy
• diffuse interstitial
• death 6 hrs post exp.

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Blood Agents (Cyanide)

• Hydrogen Cyanide (AC)
• Cyanogen chloride (CK)

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Cyanide (Blood Agents)

• Hydrogen cyanide (AC), Cyanogen chloride (CK)
• Gas at STP, lighter than Air
• Mechanism blocks cell utilization of oxygen
• Treatment amyl or sodium nitrite sodium
  thiosulfate

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Comparative Toxicity of Agents
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Blister Agents (Vesicants)

• Sulfur Mustard (H,HD)
• Nitrogen Mustard (HN1, HN2, HN3)
• Lewisite chlorovinyldichloroarsine (L)
• Mustard / Lewisite mixtures (HL,HT,TL)
• Phosgene oxime (CX)

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Vesicants Sulfur Mustard

• Sulfur Mustard, Nitrogen Mustard, Lewisite,
• Oily liquid, heavier than air water, persistent
• Mechanism alkylating agent, DNA proteins most
  sensitive targets
• Treatment supportive

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Comparative Toxicity of Agents
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MUSTARD TOXICITY

• Liquid
• Blister 10ug
• Death 100 mg/kg
• 7 gm/70 kg (on skin surface)
• (350 mg absorbed)

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SULFUR MUSTARD

• CH2 - CH2 - Cl
• Mustard S
• CH2 - CH2 - Cl
• C H2 - CH2 - OH
• Thiodiglycol
  S
• C H2 - CH2 - OH

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MUSTARD EYE
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Nerve Agents (Anticholinesterases)

• Tabun (GA)
• Sarin (GB)
• Soman (GD)
• GF
• VX

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Nerve Agents

• Sarin (GB), VX (persistent)
• All liquids initially at STP
• Mechanism inhibits acetylcholinesterase,
  causes massive cholinergic crisis
• Treatment atropine, oxime, diazepam
  (pretreatment pyridostigmine with Soman (GD)

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Comparative Toxicity of Agents
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• Whether or not gas will be employed in future
  wars is a matter of conjecture, but . we can
  never afford to neglect the question.
• General John J. Pershing, 1919

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• When the drum beats to quarters is now a time
  of fearful expectation, and it is now the
  surgeons feels how much the nature of the wounds
  who might be brought to him ought to have
  occupied his mind in previous study.
• Sir Charles Bell, 1855