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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

1

Agricultural Chemicals of Concern

Module 4 for DHS Demonstration Cities 2015By the American College of Medical Toxicology


2Module Four – Agricultural Chemicals of Concern

Course Overview1. Introduction / Making Sense of Toxicology2. Why Toxic Industrial Chemicals?3. Inhalation of Toxic Industrial Gases4. Agricultural Chemicals of Concern5. Cyanide and Fumigants6. Psychological Consequences of Mass Exposure7. Risk Communication8. Neurotoxins9. Water, Food & Medication as Vectors10. Delayed-Onset Toxins11. Post-Event Medical Monitoring12. Tabletop Exercise www.acmt.net

http://www.acmt.net/



Please help us improve this course by filling out the module

evaluation.

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conclusion of this presentation.



Faculty Disclosure• Dr. McKay is the Vice-President of the American College of

Medical Toxicology, a professional association of physician toxicologists– Disclosures:

• Principal Investigator for clinical trial (Alere)• Member, Science Advisory Council, Environmental Health

Research Foundation

• Dr. McKay’s presentation should not be taken to represent the views, opinions, or policy of the U.S. Department of Homeland Security or the American College of Medical Toxicology, nor is it intended to promote any commercial product or service.



Participant Question:• How many people are in attendance at your site

(including yourself)?



Objectives

• List potential chemical hazards related to the agricultural sector

• Discuss explosive risks associated with agricultural compounds or processes

• Describe 2 distinct pesticide toxidromes



Potential Topics/Scope of Coverage• Food/Agricultural Sector• Chemicals with Agricultural Relevance

– Stored or used in Agriculture– Generated by Agriculture– Used in Transport

• Individuals Affected– Workers– Public/Consumers



• Representative Relevant Chemicals– Stored/used in Agriculture

• Ammonia• Chlorine• Pesticides/Fertilizers

– Generated by Agriculture• Hydrogen sulfide• Methane• Oxides of nitrogen

– Used in Transport• Refrigerants



Focus of This Module• Ammonium Nitrate• Hydrogen Sulfide• Rodenticides• Insecticides• Special Considerations

– Tapping Anhydrous Ammonia– Tracking unusual purchases



Fertilizer “Grade”

25-5-5

NitrogenPhosphorusPotash

Grading system represents guaranteed minimum percentage by weight

81-0-0

33-0-0

45-0-0



Anhydrous Ammonia Storage



Ammonium Nitrate• Component of explosive used in farming and mining• Major concern for diversion, accidental and/or

intentional triggering• Mixtures of ammonium nitrate and flammable

material or accelerants (e.g. ANFO)• Smoke components also include oxides of nitrogen• Ingestion of nitrates can lead to

methemoglobinemia and cyanosis– altered Hb cannot bind oxygen



https://www.youtube.com/watch?v=27qh44Ljmsg

https://www.youtube.com/watch?v=27qh44Ljmsg



Ammonium Nitrate Fuel Oil (ANFO)• Involved in a number of attacks by the IRA, Palestinian, and

Manila “Bojinko” plots of Ramzi Yousef• Oklahoma City (1995):168 deaths, >650 injured, 300

buildings damaged



West Fertilizer Storage & Distribution Center West, TX April 17, 2013

https://www.youtube.com/watch?v=Ba8jTkRWiwI

https://www.youtube.com/watch?v=Ba8jTkRWiwI



Not Just Fixed Facilities



Railway Explosion• Power cables touch rail cars loaded with ammonium nitrate fertilizer• Buildings for several hundred meters were totally flattened - 129 public buildings

destroyed or damaged including hospital, food processing plant, and college• Rescue workers described utter devastation with damage extending for 4 km and

thousands of homes damaged or destroyed



North Korean Railway IncidentApril 2004

• Death toll: 154, including 76 schoolchildren– A primary school had just ended when the explosion

happened– Some children were on their way home, while others were

trapped in the building– Most people were injured when they were trapped or

thrown from buildings.



Area Before Explosion



Area After Explosion



School After Explosion



Participant Question: What Does This Finding Indicate?

a) Somebody had an active backyard barbecueb) Hazardous Materials day at the local

dump/transfer stationc) Illicit methamphetamine

productiond) Color-coded valve

indicates these are helium tanks



Review

• Ammonia• Ammonium Nitrate

– ANFO– Oxides of nitrogen– Methemoglobinemia



Feedlot Waste Lagoon



Methane

• A farm worker notes heavy breathing and lightheadedness while cleaning a manure pit.

• He feels better on return to fresh air and is able to resume work.

Hydrogen Sulfide

• A farm worker notices a coworker down and unresponsive in a manure pit.

• He tries to lift the worker, but notices a strong “rotten egg” odor and eye irritation.

• The odor seems to dissipate, but this worker is overcome as well.



Pesticides: Insecticides• Organochlorine compounds• Organosulfur compounds (Metam Sodium)

– 1991 spill of 19,000 gallons (Sacramento River)– Breaks down into methylisothiocyanate, carbon

disulfide, and hydrogen sulfide• Methylisothiocyanate breaks down into methylamine and

CO2 with water contact

• Organophosphates and Carbamates• Pyrethroids• Fumigants

– Methyl bromide, Sulfuryl fluoride, phosphine, cyanide



Organophosphate or Nerve Agents –Toxidrome Recognition

• Cholinergic crisis– runny eyes and nose– nausea– dim vision secondary to miosis– bronchorrhea/bronchoconstriction– involuntary urination/defecation

• Fasciculations => Respiratory Failure• Seizures



Mnemonics: Cholinergic Crisis

• D• U• M• B• B• E• L• S

• S• L• O• B• B• E• R• E• D

iarrhearination

iosis

ronchorrhea

radycardiamesis

acrimation

alivation

pasms/ Salivation

acrimation

btundationronchorrhea

radycardia

mesis

educed vascular resistanceye findings (small pupil)

iarrhea

• S• L• U• D• G (GI)• E



Typical Organophosphate Overdose46 yo male consumes organophosphate provided

by wife• patient begins fighting w/wife who calls 911• patient, wife, police, and EMTs struggle• patient vomits, seizes and is transported to ED• wife, police, EMTs c/o nausea, dizziness• ED staff frightened, also c/o nausea• ED evacuation considered...



Aum Shinryko• Pseudo-Buddhist cult

– worldwide, based in Japan– Asahara’s brainwaves,...

• Matsumoto, July 1994– neighbors complain of odors, dying plants– attempted assassination of 3 judges who were to

rule against sect• Sarin disseminated by fan from van

– 7 killed, 280 injured



Aum Shinryko• Tokyo, March 20, 1995

– 5 bags of sarin punctured in 5 subway trains– ground zero: Tokyo Government Center

• 12 dead, 5500 “sick”• St. Luke’s Hospital (520 beds, 3km from stations)

– 1st patient arrived on foot ~30 minutes after event– 1st ambulance 50 minutes after event– 500 patients to ED in 1st hour– 640 visits 1st day– 111 admissions– 1410 related visits 1st week



Tokyo - Nerve Agent AttackIn following video, consider the following:• Initial notification• Initial conveyance• Initial decontamination• Toxidrome clues• Spread of symptoms• Logistics…and how these problems could be addressed in

your jurisdiction



520 bed hospital1st patient arrived on foot ~30 minutes after eventStory of people collapsing…fire…1st ambulance 50 minutes after event500 patients to ED in 1st hour



http://xnet.nextcentury.com/wiser/Chemmist/chemmist.htm




Participant Question: Which one of the following statements is true?

a) All insecticides cause a cholinergic crisisb) Most farm insecticide treatments use the same

chemicals found in hardware storesc) Metam sodium is the most dangerous

insecticide used in agricultured) Most organophosphate exposures can be

handled as an outpatiente) “Leaking from every opening” and small pupils

raises the possibility of a nerve agent exposure



Pesticides: Rodenticides• Red squill• Arsenicals• Thallium• Strychnine, Sodium monofluroacetate• Bromethalin• Phosphorus compounds, Para-Nitrophenylurea (Vacor)• Alpha-napthyl thiourea (ANTU)• Norbormide• Indanediones and Coumarin derivatives• Cholecalciferol



50 year old woman from group home• Severe headache• Rapid change in mental status

=> coma– intubated - some bleeding noted– bruises, hematuria, bloody stools

• CT scan:Further history: Occupational therapy includes putting out the rat poison...

Required 4 months of Vitamin K therapy



22 year old man to ED for second visit

• Continued back and leg pain– treated yesterday with muscle relaxants and pain

medication• Has been feeling nauseous, weak• Notes bloody urine• Now noting right arm swelling and discoloration of

trunk



Brodifacoum levels

050

100150200250300350400

9/21/0

5

9/28/0

5

10/5/

05

10/12

/05

10/19

/05

10/26

/05

11/2/

05

ng/m

l

Week: 0 1 2 3 4 5 6



Participant Question: Which of the following is a true statement

regarding rodenticides?

a) Most rodenticides are “knock down” agents, causing death within minutes of exposure

b) Rat poison in bait form is usually strychninec) Vitamin K is an effective treatment for

brodifacoum overdosed) The anticoagulant toxidrome presents within

hours of exposure



Other Special ConsiderationsBe aware of • Unusual purchases• Unusual patterns of injury (chemical burns, bruising)• Fires/Spills/Explosions• “Fence line” activities



Questions?• Please click on the “raise your hand” icon and the

host will unmute your phone line; or type your question into the “chat” box for the host to pass on to the presenter

• If you have registered for the course, you will receive an evaluation survey (SurveyMonkey) from [email protected]– Please complete the evaluation so we can continue to

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Next Webinar: September 9, 2015

Cyanide and Fumigants

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