What You Should Know about the Emotional Impact of Chemical Terrorism
Chemical terrorism is the intentional use of a toxic chemical agent to cause physical and psychological damage to an adversary's population. The terrorist seeks to attack the basic sense of well being of the general public through inflicting physical injury, loss of life, and destruction of property. A chemical attack may be overt, with the terrorist announcing the release, or it may be covert, where the attack becomes clear only after people become ill and require emergency care.
Chemical agents are poisonous substances that are toxic to people, animals, and plants. The main types of chemical agents are those that affect (1) the nervous system (nerve agents), (2) the respiratory system (choking agents), (3) the circulation system (blood agents), or (4) the skin (blister agents). Chemical agents are absorbed into the body by inhalation (being breathed), by exposure to the eyes or skin, or--less commonly--by the intake of food or water. Unlike some biological agents, chemical effects are not contagious and do not result in an epidemic. The effects are, however, quite rapid, typically occurring in just minutes.
Chemical agents can take the form of a vapor, aerosol, liquid, or solid, depending upon the temperature and pressure. Some, like the nerve agent sarin, are odorless, while others, like cyanide, have a distinctive smell. Chemicals agents, which potentially could be used by terrorists, include common household chemicals like chlorine, industrial chemicals like cyanide, or nerve agents like those once produced for military use.
Chemical agents could be sprayed from aircraft, combined with a conventional explosive, or dispersed in a liquid form. As the chemical enters the lungs, a range of effects, from mild illness to death, can follow very quickly. The ability of these invisible agents to cause injury vary widely and may last from a few seconds to hours, depending upon the type of agent, the manner of release, and the degree of exposure.
Chemical agents are classified as either "persistent" or "non-persistent," determined by how long they are thought to be a health risk. Persistent agents are liquids that evaporate about as easily as motor oil and remain a hazard for more than twenty-four hours. Non-persistent agents, such as sarin, are liquids that evaporate easily, like water. When a nerve agent evaporates, it can form a cloud of vapor that can be deadly if inhaled. While chemical agents can be lethal, they are not easy to produce or deliver to large numbers of people in a lethal concentration. They are easily dissipated outdoors.
The incident that first highlighted the mental health impact of terrorism on an entire population, took place in Tokyo in 1995. The religious cult, Aum Shinrikyo, released the nerve agent sarin simultaneously in five subway stations near the hub of the Japanese government. About 1,000 people required hospitalization and twelve died, however some 5,000 people sought treatment in Tokyo's emergency rooms immediately after the attack. The fact that about 4,000 of these people-who had no exposure and were not at medical risk--sought emergency medical treatment, led to the term "the worried well." This term now refers to people who have no health problems, but are convinced that they are ill. "Worried well" was an unfortunate and inaccurate term to use at the time, since these Tokyo residents, though not exposed to sarin, were exposed to terrifying media images. As their fears were understandable, given the lack of general knowledge of chemical agents and their effects at the time, the use of the term "well" hardly seems appropriate.
The response of the citizens of Tokyo illustrates the profound psychological impact of chemical agents, which are unfamiliar, terrifying, and potentially lethal. Up until recently, the public, emergency responders, and health care professionals were relatively uninformed about the nature of chemical terrorism and ill prepared to manage potentially large numbers of victims. Lack of knowledge can be made worse by repeated media images and reports that state, "There is enough sarin on one penny to kill many thousands of people." As there is evidence that people tend to overestimate their personal risk from unknown threats, such language does not help individuals or parents gauge the actual risk to themselves or their families.
The choice and effectiveness of a particular chemical agent as a weapon of terrorism depend upon a variety of factors. Can the agent easily be "weaponized"? Is the agent highly lethal? Are many individuals likely to die after being exposed to the particular chemical? Are the agents easily obtainable, manufactured, or transported to the target country? How quickly available are the range of effective treatments and can the exposed population be decontaminated against the agent?
The primary emergency response strategy is to remove individuals from contact with the toxic chemicals and decontaminate them. Decontamination is a highly effective strategy in which contaminated clothing is removed and the chemical residue is washed from the skin with water. After exposed individuals are decontaminated, medical care is given as needed. Children are of special concern because their higher breathing rates and proximity to the ground-where many agents are more concentrated--make them more vulnerable to chemical agents. They may also be at increased risk from the hypothermia that can result from the decontamination process.
The goals of terrorists are only accomplished if (1) they succeed in undermining a nation's confidence in its ability to protect its citizens and (2) if citizens change their behavior and daily life in response to fears. Our state, local, and federal agencies are making strides toward reducing the threat of chemical terrorism. US government resources, including the Metropolitan Medical Response System and HRSA (Health Resources and Services Administration), the Hospital Preparedness Program, and the Centers for Disease Control and Prevention (CDC), along with the American Red Cross and others, are working to improve the capacity of first responders and emergency response agencies to respond to chemical terrorism. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 has resulted in funding to help states build their local public health departments and hospitals, the largest public health and emergency medical care investment in our history.
For more information on chemical agents, click here to access the CDC's Emergency Preparedness & Response.