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CHEMICAL TERRORISM

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Chemical Terrorism: Assessing Threats and Responses Jonathan B. Tucker Center for Nonproliferation Studies Monterey Institute of International Studies Efforts to enhance the nation's ability to prevent and respond to acts of chemical terrorism are warranted by the fact that hazardous chemicals are ubiq- uitous in modern industrial society and hence are more accessible to terrorists than either biological or fissile materials. Four possible types of chemical terror- ism have been identified: 1. Release of a military-grade chemical warfare agent against a civilian target with the intent to inflict indiscriminate casualties; 2. Sabotage of a chemical manufacturing plant or storage facility (including a rail tank car) in which toxic materials are held in gaseous or liquid form, or as solids, which have the capability of reacting with air or water to release toxic gases or vapors; 3. Contamination of public water or food supplies with toxic agents; and 4. Targeted use of a chemical agent to assassinate specific individuals. Terrorists intent on acquiring chemical weapons have two options: buying or stealing them from existing national stockpiles, or manufacturing them inde- pendently. Because the synthesis of military-grade agents entails significant tech- nical hurdles and risks, the acquisition of toxic industrial chemicals is more likely. Although such chemicals are hundreds of times less lethal than nerve agents, they could still inflict significant casualties if released in an enclosed space or outdoors under optimal atmospheric conditions. This paper assesses the threat of chemical terrorism and examines strategies of prevention and response. 117

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118 HIGH-IMPACT TERRORISM CHEMICAL THREAT AGENTS Chemical warfare (COO) agents are poisonous, man-made gases, liquids, or powders that, when absorbed through the lungs or skin, have incapacitating or lethal effects on humans and animals. Although many CW agents are liquids, the explosion of a munition can transform a liquid agent into an aerosol (a fine mist of tiny droplets) and then a vapor. Most warfare agents fall into five broad categories: blister, nerve, choking, blood, and incapacitating. Beyond their dif- fering physiological effects, CW agents vary in their persistency and volatility, or tendency to evaporate. Nonpersistent agents dissipate within a few hours and pose mainly an inhalation threat, whereas persistent agents remain hazardous for as long as a month when deposited on terrain, vegetation, or objects, and pose primarily a skin contamination threat. Blister agents, such as sulfur mustard and lewisite, are liquids that cause chemical burns. When absorbed by direct contact with the skin or eyes or by inhalation of aerosol or vapor, sulfur mustard induces painful skin blisters, blind- ness, and severe damage to lung tissue after an asymptomatic "latent period" of from one to eight hours. Mustard exposure also has harmful effects on the blood- forming tissues of the bone marrow, the lining of the gastrointestinal tract, and the central nervous system. Lewisite causes skin blistering similar to that of mustard, but its effects are immediate rather than delayed. Historical evidence from World War I and the Iran-Iraq War suggests that blister agents can inflict large numbers of casualties, although less than 5 percent are generally fatal. No effective treatment is available. Nerve agents, such as sarin and VX, are the most lethal chemical poisons known: they disrupt the functioning of the human nervous system and can kill within minutes. Sarin is the most volatile of the nerve agents, evaporating at about the same rate as water. In an enclosed space with poor ventilation, the evaporation of few liters of sarin can generate a lethal concentration in the air. Outdoors, however, much larger quantities are required to offset the dispersive effects of wind and air turbulence. VX is an oily liquid that persists in the environment for days or weeks, depending on ambient temperature, and acts primarily by penetrating the skin. The lethal dose is about 10 ma. Because of the extreme hazards associated with handling and disseminating nerve agents, terrorists might seek to develop "binary" weapons, which are safer to produce, store, and transport. In a binary system, two relatively nontoxic ingredients are stored separately and mixed together before use to generate the lethal agent. Sarin, for example, can be produced in a binary system by reacting isopropanol (rubbing alcohol) with methylphosphonic difluoride (DF). Never- theless, the synthesis of DF is complex and difficult. Terrorists would also have to mix the precursor chemicals manually before use an extremely hazardous operation or attempt to design a remote-controlled device that would carry out the mixing and dispersal steps, a task requiring considerable technical expertise.

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CHEMICAL TERRORISM 119 Although nerve agents have by far the greatest lethality, terrorists might employ other classes of toxic chemicals effectively. For example, choking agents (e.g., chlorine, phosgene gas) and blood agents (hydrogen cyanide, cyanogen chloride) were used on a large scale during World War I. These chemicals dissi- pate rapidly outdoors, but they could potentially cause mass casualties if re- leased by terrorists in an enclosed space, such as a subway station or an indoor sports arena.1 THE CASE OF AUM SHINRIKYO Much of the current concern about chemical terrorism stems from the case of the Japanese cult Aum Shinrikyo, which conducted sarin attacks in Matsumo- to in 1994 and Tokyo in 1995. Founded in 1987, the quasi-Buddhist sect attract- ed young intellectuals in their late twenties and thirties who were disillusioned with mainstream society. Aum had some 40,000 members by 1995, most of them in Japan and Russia. The cult ran a variety of legitimate businesses and also engaged in land fraud, drug dealing, and other criminal activities, enabling it to accumulate a net worth of about $1 billion.2 Aum leader Shoko Asahara planned to use a large-scale chemical attack to trigger a major war between the United States and Japan that cult members would survive, enabling them to seize control of the Japanese government. In pursuit of this mad scheme, Aum aggres- sively recruited scientists and technicians from Japanese universities to work on the development and production of chemical weapons as part of a "chemical brigade" within the cult's "Ministry of Science and Technology."3 Aum chemists chose to manufacture sarin because of its relative ease of production compared with other nerve agents, its volatility, and the fact that the necessary ingredients could be obtained from commercial suppliers. The cult purchased a Swiss-made pilot plant with computerized process controls, normal- ly used by industry to prototype chemicals. Installed at Aum's headquarters near Mount Fuji, this plant produced some 30 kg of sarin over a two-year period. Cult members successfully tested the nerve agent on sheep at a remote ranch that the cult had purchased in Western Australia.4 Asahara planned to acquire a stockpile of 70 tons of sarin and then employ a Russian military helicopter to spray the deadly agent over downtown Tokyo. On June 27,1994, Aum staged a trial nerve gas attack in a residential area of Matsu- moto, a city about 125 miles northwest of Tokyo. The primary targets were three judges who were about to reach a verdict against the cult in a fraud case brought by local landowners. Aum members drove to Matsumoto in a truck that was equipped with an electric hot plate, which they used to vaporize drops of satin, and a fan and nozzle to vent the toxic fumes. Over a period of about 25 minutes, the team vaporized 3 liters of satin, generating a toxic cloud that drifted down- wind over a residential neighborhood. The Matsumoto attack killed seven and injured 144 others, including the three targeted judges. Initially, the police au-

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120 HIGH-IMPACT TERRORISM thorities did not suspect terrorism and blamed the incident on a local resident who was falsely accused of synthesizing pesticides in his backyard. For the subsequent terrorist attack on the Tokyo subway on March 20,1995, Aum chemists synthesized 24 liters of sarin on short notice. Asahara ordered the subway attack as a diversionary tactic in response to a tip from informants that the police were training for an imminent raid on Aum headquarters. Because the sarin was not distilled, it was only about 25 percent pure. The agent was also diluted with acetonitrile to reduce its volatility and thus give the perpetrators time to escape.5 This solution was poured into 11 two-ply nylon-polyester bags, which were then heat-sealed. During the morning rush hour on March 20, cult members boarded five different cars on three lines of the Tokyo subway system, carrying the sarin- filled plastic bags wrapped in newspapers. The trains were scheduled to arrive at the central Kasumigaseki Station within a few minutes of each other. At the appointed time, cult members placed the plastic bags on the floor, punctured them with sharpened umbrella tips, and quickly left the trains. The punctured bags released puddles of liquid sarin that slowly evaporated, generating toxic fumes. In addition to 12 fatalities, 17 victims were in critical condition requiring intensive care, 37 suffered from severe symptoms of nerve agent exposure such as miosis (pinpoint pupils), shortness of breath, muscular twitching, and gas- trointestinal problems; and 984 had miosis only.6 Had the sarin been purer and disseminated in aerosol form, the attack would have caused many more deaths. A few weeks later, on May 5, 1995, Aum staged another chemical attack in a Tokyo subway station, this time using a crude binary weapon. The device consisted of two plastic pouches, one containing 2 kg of sodium cyanide crystals and the other filled with 1.5 liters of dilute sulfuric acid. A primitive fusing system ignited the sodium-cyanide pouch after a time delay. The two pouches were arranged so that as the flames from the first spread to the second, the cyanide crystals would react with the sulfuric acid to form deadly hydrogen cyanide gas. Cult members placed the jury-rigged chemical bomb in the men's room at Shinjuku subway station, Tokyo's busiest, but the device malfunctioned. Although four subway workers who doused the flames were overcome by toxic fumes and hospitalized briefly, the station was evacuated before anyone else was hurt.7 Aum also employed nerve agents as an assassination weapon. In late 1993, cult hit squads used sarin in two failed attempts on the life of the leader of a rival religious sect. Then, in December 1994 and January 1995, the cult reportedly carried out three assassination attempts with VX, one of which was successful. In each case, a small amount of liquid agent was sprayed with a hypodermic syringe in the victim's face. The targeted individuals included an anti-sum at- torney and an old man who had harbored an Aum defector.8

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CHEMICAL TERRORISM ASSESSING THE THREAT OF CHEMICAL TERRORISM 121 Other than Aum Shinrikyo, relatively few terrorist groups have engaged in chemical terrorism. According to a database compiled by the Monterey Insti- tute's Center for Nonproliferation Studies, only 125 incidents were reported worldwide between January 1960 and May 2001 involving the politically or ideologically motivated use of toxic chemicals. Responsibility for these inci- dents was distributed among the following types of groups: nationalist-separatist (18~; religious (16~; single issue, such as antiabortion or animal rights (14~; lone actor (9~; left wing (10~; and right wing (4~. In the remaining 54 cases, press accounts did not identify the perpetrators. Of the 125 reported incidents, most were small scale: only 6 caused 10 or more fatalities, and 12 caused more than 10 injuries.9 One possible explanation for this historical pattern is that few terrorist orga- nizations are motivated to inflict indiscriminate casualties, particularly with weapons that are widely viewed as abhorrent. Staging a chemical attack would alienate a terrorist group's political constituency and bring down on the perpetra- tors the full repressive wrath of the government authorities.~ Nevertheless, ter- rorist groups lacking outside supporters, such as apocalyptic cults or religious fanatics who believe they are acting on divine commands, may be more inclined to employ indiscriminate weapons such as toxic chemicals. It is still too early to tell whether Aum Shinrikyo was a bizarre aberration or the harbinger of a new trend in terrorism. But Osama bin Laden has declared that it is his "religious duty" to acquire chemical and other nonconventional weapons for use against U.S. targets. In addition to the motivational side of the equation, technical impediments to the acquisition of military-grade CW agents, such as sarin and VX, seem likely to prevent the large majority of terrorist groups from producing and em- ploying these weapons. Synthesis of nerve agents requires the use of high tem- peratures and corrosive and dangerous chemicals, and would not be feasible for terrorists untrained in synthetic organic chemistry. Blister agents such as sulfur mustard could be produced more easily if the necessary ingredients were avail- able, but ordering large quantities of a key precursor chemical such as thiodigly- col from a commercial supplier would arouse suspicion and might lead the re- quested company to notify law enforcement authorities. In at least one known case, however, an individual with expertise in chemis- try managed to produce blister agents and other powerful poisons in a clandes- tine laboratory. Valery Borzov, a 40-year-old Russian chemist, was arrested in Moscow on August 6, 1998, for attempting to sell a sample of nitrogen mustard to an undercover police officer. After having been fired from the Moscow Scien- tific Research Institute of Reagents in 1997, Borzov set up a sophisticated chem- ical laboratory in his apartment and synthesized mustard agent and other unspec- ified poisons for sale to the Russian mafia and other criminal buyers, charging

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22 HIGH-IMPACT TERRORISM his customers $1,500 a vial. After his arrest, a police search of his apartment uncovered chemical equipment, 50 liters of "strong poisons," 400 ml of mustard agent, and a thick notebook containing recipes for the manufacture of toxic substances. Borzov was found mentally incompetent to stand trial, diagnosed with schizophrenia, and committed to a treatment facility. Even if chemical warfare agents can be produced successfully, they are difficult and hazardous to handle and deliver. "Weaponization" of a toxic chem- ical includes the addition of stabilizers to extend its shelf-life and the develop- ment of a system for delivering the agent to the target population by mechanical, pneumatic, or explosive means. The most effective but technically challenging delivery system is an aerosol generator, which disperses the agent as tiny drop- lets that float in the air and are inhaled by the victims. According to a report by the General Accounting Office, an analytical agency of the U.S. Congress, CW agents "must be released effectively as a vapor, or aerosol, for inhalation expo- sure, or they need to be in a spray of large droplets or liquid for skin penetration. To serve as terrorist weapons, chemical agents require high toxicity and volatili- ty . . . and need to maintain their strength during storage and release." For example, introducing sarin into the air-handling system of a large building to kill those inside would require a leak-proof container that was small enough to be easily carried by one person yet could deliver a high enough concentration of agent in aerosol or vapor form to inflict widespread casualties. A device possess- ing such characteristics would be technically complex, probably exceeding the design and manufacturing capabilities of most terrorist groups, even those that managed to attract university-trained scientists.~3 These hurdles might be over- come, however, by a wealthy terrorist organization that recruited military scien- tists and engineers who had been formerly employed in a state-level chemical weapons program. As an alternative to synthesizing military-grade CW agents, terrorists might acquire toxic household or industrial chemicals such as sulfur dioxide, ammonia, phosgene, arsenic compounds, hydrogen cyanide, or methyl isocyanate. Cya- nides, for example, are employed in a wide variety of industrial applications including electroplating, mineral extraction, dyeing, printing, photography, agri- culture, and the production of paper, textiles, and plastics. The United States alone produces 300,000 metric tons of cyanides a year for peaceful purposes.~4 In addition, tens of thousands of toxic organic chemicals are produced by the commercial chemical industry. According to one estimate, the number of organ- ophosphate compounds a category that includes nerve agents, pesticides, and fire retardants exceeds 50,000.~5 Thus, toxic industrial chemicals are widely accessible in a way that the materials needed to produce military-grade CW agents are not. The Monterey Institute database suggests that, historically, terrorists have tended to employ "off-the-shelf" chemicals that are readily available. Of the 125 chemical attacks reported worldwide between January 1960 and May 2001, the

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CHEMICAL TERRORISM 123 toxic weapon was identified in 86 cases. Of this total, only nine incidents most of them linked to Aum Shinrikyo involved the use of a military CW agent. Instead, the great majority of attacks were carried out with household or industri- al chemicals, such as cyanides (22), butyric acid (21), tear gas (19), insecticide or pesticide (6), sulfuric acid (3), rat poison (2), mercury and mercury com- pounds (2), arsenic compounds (1), and weed killer (1~.~6 The delivery system, when known, was often equally low-tech: direct con- tact with the target (34 cases), spray or aerosol (24), contamination of food or drink (15), consumer product tampering (10), explosive device (8), contamina- tion of the water supply (6), jug or jar (5), letter or package (4), injection or projectile (2), and insertion into a building ventilation system (1~.~7 Using a toxic chemical to poison a large urban reservoir would be difficult, because it would take impractically large quantities of agent to overcome the effects of dilution and filtration. Food and drink, however, are potentially more vulnerable. In 1999, for example, chickens in Belgium were unintentionally given animal feed that had been contaminated with a dioxin, a cancer-causing chemical. Because the contamination was not discovered for months, dioxin was probably present in chicken meat and eggs sold in Europe in early 1999.~8 This experience suggests that other toxic chemicals could be used to poison the food supply, by way of either animal feed, a food-processing facility, or direct product tampering. A terrorist incident involving the deliberate poisoning of a beverage took place in Dushanbe, the capital of the former Soviet republic of Tajikistan, on December 31, 1994. Six Russian peacekeeping soldiers, three civilians, and the wife of a Russian embassy worker died after drinking champagne that had been laced with a cyanide. The locally produced champagne had been sold at a kiosk near the Russian military compound. It is not known how many bottles were poisoned.~9 Sabotage of Chemical Industry Plants Another possible form of chemical terrorism is sabotage of a commercial industry plant engaged in the production, processing, or storage of a highly toxic chemical, causing its release and the exposure of a nearby populated area. Such an attack might involve penetration of the plant site by outside terrorists or an inside job by disgruntled plant workers. The deliberate release of a hazardous chemical could be brought about by detonating a conventional explosive to rup- ture a storage tank or, alternatively, by manipulating the manufacturing process to cause a runaway reaction. In the latter case, if no group claimed responsibility, it might be difficult for investigators to distinguish a terrorist attack from an industrial accident. Terrorists might also use an improvised explosive device to puncture a railroad tank car carrying a hazardous chemical. According to an estimate by the U.S. Environmental Protection Agency (EPA), approximately 15,000 facilities in the United States, many of them in

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24 HIGH-IMPACT TERRORISM urban areas, produce or store hazardous or extremely hazardous chemicals.20 Phosgene, for example, was used as a chemical warfare agent in World War I, yet today more than 1 billion pounds of phosgene are produced and consumed in the United States each year for the production of plastics.2i Another highly toxic industrial chemical, methyl isocyanate (MIC), is an intermediate in pesticide production and was responsible for the 1984 accident at a Union Carbide plant in Bhopal, India, that caused more than 2,500 deaths. The Bhopal disaster, alleged- ly the result of sabotage by a disgruntled employee, occurred just after midnight on December 3,1984. Over a period of a few hours, an estimated 30 to 40 metric tons of MIC in vapor and liquid form escaped from a holding tank at the plant, forming a toxic cloud that blanketed an area of more than 10 square miles, including densely populated shantytowns. An estimated 500 people died before getting treatment, 2000 more died within the first week, and roughly 60,000 people were seriously injured.22 An example of a toxic release in the United States resulting from deliberate sabotage took place on February 28, 2000, at a chemical plant near the town of Pleasant Hill, Missouri. At about 4:00 a.m., an unknown individual opened a valve in a storage tank, causing 200 gallons of anhydrous ammonia to leak out. The chemical formed a cloud of poisonous vapor that spread through the down- town area, forcing the evacuation of more than 250 residents. Although the perpetrator and motive remain unknown, the facility manager speculated that the individual might have wanted ammonia to produce methamphetamines.23 Ac- cording to the EPA, a toxic release from any of more than 2000 facilities in the United States could affect at least 100,000 people. PREVENTING CHEMICAL TERRORISM Government authorities can take a number of measures to reduce the risk of chemical terrorism. First, state and local emergency management officials should conduct vulnerability assessments of the chemical manufacturing plants within their jurisdictions and encourage the owners to improve security at sites that produce or store toxic chemicals. At the same time, the locations of these plants and the associated vulnerability assessments should not be made public because of the risk that such information could fall into the wrong hands. Second, the federal government should tighten restrictions on the sale by commercial suppliers to private individuals (either U.S. citizens or foreigners) of dual-use chemicals that can serve as precursors for chemical warfare agents. Although the United States controls the export of 54 precursor chemicals to countries of proliferation concern, domestic sales of these chemicals are not currently regulated. Third, federal law enforcement agencies such as the Federal Bureau of In- vestigation (FBI) and the Bureau of Alcohol, Tobacco, and Firearms (ATF) should enhance their cooperation with state and local law enforcement agencies.

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CHEMICAL TERRORISM 125 To this end, the FBI and the ATE should reassess the balance between securing classified information about unconventional terrorism and sharing it with state and local agencies when it is relevant to preventing an incipient attack. RESPONDING TO CHEMICAL TERRORISM Unlike biological agents, which have an incubation period of days to weeks before clinical symptoms appear, chemical agents induce incapacitating or lethal symptoms within minutes after exposure with the sole exception of sulfur mus- tard, whose clinical manifestations are delayed up to several hours. Whereas explosives generate instantaneous destructive forces that are difficult to defend against, the toxic effects of some classes of chemical agents can be reversed or mitigated through the prompt administration of antidotes and other drugs. Anti- dotes are available only for a few types of chemical agents, however, and the time window for effective treatment is limited. Although much of the historical experience with the emergency response to chemical terrorism derives from the 1995 Tokyo subway incident, one can also draw important lessons from industri- al accidents involving toxic chemicals. First Responders During the Tokyo sarin incident, the city fire department received the first call about a medical emergency in the subway within minutes of the attack. Additional calls flowed in from 15 subway stations in rapid succession, yet it took more than an hour before emergency dispatchers realized that a single event was responsible rather than a series of unrelated incidents. As the crisis mounted, police, firefight- ers, 131 ambulances, and 1364 emergency medical technicians (EMTs) were dis- patched to downtown subway stations on the three affected lines.24 They arrived to find a chaotic scene. Critically injured casualties littered the sidewalks and subway entrances, vomiting or convulsing, and scores of less seriously affected commuters stumbled about, vision impaired and struggling to breathe. EMTs sought to triage the victims and offer some medical assistance, but they did not administer anti- dotes, intubate serious cases at the scene, or attempt to decontaminate the victims or even remove their sarin-saturated clothes.25 The Tokyo subway incident demonstrated that first responders to an inci- dent of chemical terrorism who lack personal protective equipment (such as police, paramedics, and ordinary firefighters) are at considerable risk of becom- ing victims themselves.26 Indeed, some observers have called police officers "blue canaries" because they would probably succumb to the toxic agent shortly after arriving on the scene. Because of this vulnerability, first responders lacking gas masks and protective clothing must resist the initial instinct to run to the rescue. Instead they must stand back, upwind and uphill of the spreading toxic cloud, and use loudspeakers and public address systems to direct the victims to

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26 HIGH-IMPACT TERRORISM safety. The first group to enter the danger zone should be members of the local hazardous material (Hazmat) team, who are equipped with personal protective equipment. Most fire departments in major U.S. cities have well-trained Hazmat teams with extensive experience in handling spills of toxic industrial chemicals, such as chlorine and organophosphate pesticides. The first step in responding to an incident of chemical terrorism is for police and firefighters to establish a perimeter around the danger zone to prevent more people from becoming exposed. A complicating factor, however, is that the dan- ger zone can move. Although volatile gases such as chlorine or phosgene dissi- pate rapidly, more persistent agents such as sarin can form clouds that last for hours, drifting with the breeze to form an elongated plume downwind from the point of release. In an urban environment, the air turbulence generated by tall buildings can redistribute the agent plume into zones of high and low concentra- tion, creating "hot spots" in unexpected locations. Moreover, ventilation systems can spread a toxic gas throughout a building, and subway cars can force an agent cloud down tunnels, spreading it from one station to the next. Rapid detection and identification of the toxic agent are crucial to ensure the prompt medical treatment of those who have been exposed and to reassure those who have not. Most fire departments, however, lack the specialized equipment needed to detect and analyze chemical warfare agents. Thus, a sample of the agent itself highly toxic would have to be collected and sent to a chemical laboratory for analysis. In a small, isolated U.S. city, several hours might elapse before the agent could be identified. To address this problem, scientists at the U.S. National Laboratories are developing handheld detectors that first respond- ers could use to identify about a dozen different CW agents.27 Until the toxic agent has been identified, medical practitioners should treat exposed persons according to the resulting clinical syndrome (cluster of symptoms), such as chem- ical burns, pulmonary edema, cardiorespiratory failure, neurological damage, or shock.28 At the same time that first responders are treating the casualties of a chemi- cal attack, law enforcement officials will have to conduct a criminal investiga- tion in order to identify and arrest the perpetrators. Careful coordination among the FBI, state and local police, and other agencies will be necessary to avoid destroying valuable forensic evidence while delivering urgently needed medical care. Another key task for state and local emergency responders is to inform the public and the news media immediately and continuously after a chemical inci- dent has occurred, so as to prevent widespread confusion and panic. In particu- lar, the authorities must be prepared to explain the cause of the disaster, what the victims should do, how long the crisis will last, where to obtain help, and how people can avoid exposure.

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CHEMICAL TERRORISM 127 Decontamination After the local Hazmat team is in place, the next challenge for emergency workers is to decontaminate the victims before they are evacuated for treatment. If people have come in contact with liquid agent or concentrated vapor, they will carry traces of the toxic substance on their clothes and bodies. Accordingly, decontamination is needed not only to prevent further absorption of the toxic agent through the skin or by inhalation of vapor, but also to prevent the victims from contaminating other people and the interior of cars and ambulances. During the Tokyo subway incident, police were slow in establishing a pe- rimeter around the affected zone and did not decontaminate victims on-site. As a result, many cases of secondary exposure resulted from the off-gassing of sarin from patients in cramped ambulances and poorly ventilated hospital rooms. Of a total of 1364 EMTs who transported victims to hospitals by ambulance, 135 (10 percent) developed symptoms of sarin exposure and had to receive treatment themselves. Moreover, although many patients were directed to a shower upon arrival at a hospital and their contaminated clothes were removed and sealed in plastic bags, 110 hospital staff members (23 percent) complained of symptoms of sarin poisoning in a follow-up questionnaire.29 In general, water is the best decontamination solution, with soap recom- mended for oily or otherwise adherent chemicals.30 Decontaminating large crowds poses complex logistical challenges, however, and the various methods offer different strengths and weaknesses. The usual approach is to direct the victims to "decontamination corridors" where they strip off their outer clothing and shower. Even so, persuading a frightened and mixed-gender group of strang- ers many of them scared, sick, blinded, or choking to undress and leave their valuables behind could easily result in panic and chaos. Special decontamination trucks or trailers containing showers are commercially available, but this equip- ment is expensive and time-consuming to set up. Some cities plan to use ordi- nary fire hoses to spray victims, yet that approach would expose them to public view and, in winter, might cause hypothermia. Other approaches to decontami- nation problems include the use of protective tarpaulins, inflatable heated tents, and plans to commandeer the nearest large building equipped with showers, such as a high school or college.3i Medical Treatment Medical treatment for victims of chemical terrorism varies depending on the type of toxic agent involved. In general, the prompt onset of symptoms after chemical exposure puts a premium on rapid response. If a nerve agent is used, the administration of antidotes within several minutes to an hour can save lives. Although those exposed to a massive dose would probably die before they could be treated, victims on the periphery of the attack who received sublethal doses

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28 HIGH-IMPACT TERRORISM would benefit from receiving antidotes. The U.S. Army's nerve agent antidote kit contains atropine and an oxime (2-PAM [praloxidime] chloride), plus diaz- epam to prevent seizures. Such drugs may be in short supply: most ambulances carry atropine for treating heart attacks, but only in doses less than a tenth of what a nerve gas victim requires. Thus, each major U.S. city should acquire and maintain a stockpile of nerve agent antidotes. In the event of exposure to hydrogen cyanide, immediate treatment with antidotes that bind cyanide ions in the blood can accelerate detoxification. But no antidotes currently exist for exposure to choking or blister agents, which must be treated symptomatically. Inhalation of choking agents typically results in pul- monary edema, which can be managed by administering oxygen, cortisone, and a drug to widen the bronchial tubes. Mechanical ventilators may also be required to keep victims breathing while their damaged lungs recover, although such equipment is rare and expensive. Because the cost of stockpiling specialized antidotes and ventilators in quantities sufficient for a mass-casualty incident is too high for any city to bear, the U.S. Department of Health and Human Services has established a two-tiered stockpile system. At least in theory, enough materi- als for 5000 victims can be made ready within hours to be flown to the site of a terrorist attack, and more would be en route the following day. In a serious incident of chemical terrorism, the only option may be triage: giving priority to patients who have the best chance of survival in view of the resources available to treat them. For this reason, ambulatory patients should be among the first to be decontaminated and evacuated.32 If thousands of people are affected, rapid triage and holding sites may have to be established where patients are decontaminated and given initial treatment; seriously ill patients would then be evacuated to appropriate care facilities. Within the triage areas, medical staff would work in full protective clothing. Hospital Care The U.S. medical system is poorly equipped to treat the mass casualties that might arise from a chemical attack. In the age of "managed care," most urban hospitals are private-sector entities that are under strong pressure from insurance companies to contain costs and thus run at full or excess capacity even under normal conditions. As a result, they have little room to accept an influx of casu- alties from a terrorist attack. A survey of nearly 200 hospital emergency depart- ments conducted by the U.S. Public Health Service found that less than 20 per- cent had plans or equipment for dealing with even 50 victims of a nerve agent attack, such as an isolated decontamination unit. Only 29 percent of the hospitals surveyed had adequate supplies of atropine to treat 50 patients, and just 6 percent had all of the "minimum recommended physical resources" to deal with a release of sarin by terrorists. Urban hospitals were three times more likely than rural hospitals to have a plan for responding to chemical terrorism.33

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CHEMICAL TERRORISM 129 Given these statistics, it is likely that in the event of a major incident of chemical terrorism, the local supply of hospital beds would rapidly be exhausted. To avoid chaos and overcrowding, it is essential for cities to plan for satellite treatment areas in sports centers, schools, armories, and other public buildings equipped with central heating, hot and cold running water, and telephones. At these locations, medical personnel and equipment could be brought in and a large number of patients treated.34 Another problem would be finding enough health care personnel to care for the injured. Some cities are creating databases of doctors or nurses who have retired, moved into administrative jobs, or changed careers but could be called up in an emergency. Such systems may not be rapid enough, however, to cope with a major incident of chemical terrorism. To augment local medical response capabilities, the Metropolitan Medical Response System (MMRS) links federal emergency services with first respond- ers, public health officials, and private hospitals into an integrated community disaster plan. As part of this program, the Department of Health and Human Services (HHS) has provided 97 U.S. cities with an average of $600,000 each in seed money, although the cities must expend their own resources to continue training and exercising people and to maintain equipment. Another federal pro- gram managed by HHS, the National Disaster Medical System (NDMS), would be activated after a major incident of chemical terrorism. More than 70 Disaster Medical Assistance Teams (DMATs), each consisting of up to 100 medical per- sonnel, have volunteered to deploy to disasters ranging from earthquakes to terrorist attacks. These teams would probably take several hours to mobilize, however. NDMS can also transfer overflow patients, by medical airlift if neces- sary, to veterans' hospitals and 2000 participating private hospitals nationwide. Psychosocial Impact Another problem that will inevitably arise during an incident of chemical terrorism is that a large number of people will experience psychogenic symp- toms or extreme anxiety and self-report to hospitals and doctors' offices for treatment. During the 1995 Tokyo subway incident, roughly 80 percent of the casualties who arrived at hospitals (about 4000 people) had no chemical injuries but still demanded medical attention. This influx of "worried well" swamped the available medical resources. Thus, after a major incident of chemical terrorism, physicians and other health care providers will have to distinguish real from psychogenic casualties so as to deliver priority treatment to those most urgently . . . requ~nng it. It is also clear that in the event of a large-scale chemical attack, survivors of and responders to the incident will experience extreme psychological trauma. For more than a week after the Tokyo subway incident, dozens of city residents continued to arrive at local hospitals complaining of various symptoms. Even months later, survivors sought treatment for posttraumatic stress disorder

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130 HIGH-IMPACT TERRORISM (PTSD), including panic attacks and fear of riding the subway.35 Thus, psychia- trists, clinical psychologists, and social workers will have to treat the widespread incidence of PTSD and other psychological sequelae. ORGANIZATIONAL ISSUES Because of the short time window available for medical response, the most cost-effective way to address the threat of chemical terrorism is to enhance local capabilities that can be brought to bear during the first critical minutes and hours after an attack. City and state governments have an institutional infrastructure for responding to chemical incidents, such as Hazmat teams and public health departments, that can be leveraged for enhanced domestic preparedness against terrorism. But although Hazmat specialists deal routinely with spills and acci- dental releases of toxic industrial chemicals, they require additional training to safely contain military-grade agents and to decontaminate and treat large crowds of victims. The Defense Against Weapons of Mass Destruction Act of 1996, sponsored by Senators Sam Nunn, Richard Lugar, and Pete Domenici, tasked the Depart- ment of Defense (in conjunction with other federal agencies) with providing training, expert advice, and $300,000 worth of protective gear, detection, and decontamination equipment to emergency responders in the nation's 120 largest cities. This effort, known as the Domestic Preparedness Program, was designed to give each participating city a limited response capability and enable it to keep training after completion of the program. On October 1, 2000, lead responsibility was transferred from the Pentagon to the Department of Justice (DOJ), which has shifted the program's focus from the 120 cities to all 50 states. To be eligible for federal funds, each state must perform a comprehensive self-assessment to identify likely terrorist targets and threats, and must develop a three-year domes- tic preparedness plan. DOJ has also established a Center for Domestic Prepared- ness, based at the former U.S. Army chemical school in Anniston, Alabama, to give Hazmat specialists hands-on experience with military CW agents that might be used in a terrorist attack. In recent years, however, spending priorities have drifted away from the original intent of the Nunn-Lugar-Domenici legislation. Of the $1.4 billion allo- cated to terrorism preparedness programs in fiscal year 2000, only about $315 million (22 percent) went to first responders in the form of training, equipment grants, and planning assistance.36 With 46 different federal agencies seeking a piece of the counterterrorism pie, and eight congressional committees and seven subcommittees with jurisdiction over terrorism issues, the Domestic Prepared- ness Program has become a hodgepodge of overlapping and often duplicative programs. For example, a host of redundant federal response teams have been established, including the Marine Corps' Chemical/Biological Incident Response Force, the FBI's Hazardous Materials Response Unit, the Army's Chemical-

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CHEMICAL TERRORISM 131 Biological Rapid Response Team, the EPA's Emergency Response Team, HHS's National Medical Response Team, and the National Guard's Weapons of Mass Destruction Civil Support Teams, among others. Given the fact that most of these teams would take several hours to deploy to the scene of an incident of chemical terrorism in a small to medium-sized city, it makes little sense to invest a large proportion of domestic preparedness re- sources in such efforts.37 Instead, the federal government should return to its original strategy of leveraging existing state and local assets by training and equipping first responders, while giving those agencies that have technical ex- pertise in dealing with toxic chemicals, such as the U.S. Army and the EPA, a support role in the event of a massive attack. CONCLUSIONS The historical record indicates that most incidents of chemical terrorism have involved the use of household or industrial chemicals. Although such com- pounds are far less toxic than military-grade agents, the Bhopal disaster demon- strates the deadly potential that could result from the sabotage of a commercial chemical plant or a series of railroad tank cars. It therefore makes sense to devote more resources to addressing forms of chemical terrorism that would be less catastrophic but are more likely, such as industrial sabotage, rather than focusing exclusively on worst-case scenarios involving the large-scale release of a military nerve agent. Improving the security of chemical plants and the trans- portation infrastructure will require cooperative efforts by government and the private sector. With respect to consequence management of a chemical terrorist attack, great- er emphasis and funding should go to training and exercising local and state first responders, particularly Hazmat teams, and improving their capabilities for crowd decontamination, medical triage, and treatment of large numbers of casualties. At the same time, federal assets such as information hotlines, drug stockpiles, and rapid response teams should be better coordinated, rationalized, and streamlined, with the primary aim of providing support to state and local authorities. NOTES 1. Sidell, Fred. 1996. Testimony in Proceedings of the Seminar on Responding to the Conse- quences of Chemical and Biological Terrorism, July 11-14, 1995, sponsored by the U.S. Public Health Service, Office of Emergency Preparedness. Washington, D.C.: U.S. Government Printing Office, pp. 1-66. 2 Kaplan, David E. Aum Shinrikyo. 2000. Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons, Jonathan B. Tucker, ed. Cambridge, Mass.: MIT Press, pp. 208-210. 3. Murakami, Haruki. 2001. Underground: The Tokyo Gas Attack and the Japanese Psyche. New York: Vintage International, p. 118. 4. Kaplan, op. cit., p. 214.

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132 HIGH-IMPACT TERRORISM 5. Murakami, op. cit., p. 217. 6. Sidell testimony, p. 2-32. 7. U.S. Senate, October 21, 1995. Committee on Governmental Affairs, Permanent Subcom- mittee on Investigations. Staff Statement: Hearings on Global Proliferation of Weapons of Mass Destruction: A Case Study on Aum Shinrikyo. 8. Kaplan, op. cit., p. 222. 9. Monterey Institute of International Studies, Center for Nonproliferation Studies, WMD Ter- rorism Database, data as of May 7, 2001. 10. Tucker, Jonathan B. 2000. Chemical and biological terrorism: how real a threat? Current History 99(636):147-153. 11. Viktorov, Andrey, Stepan Krivosheyev. 1998. Moscow gangsters were preparing for chemi- cal war: mad genius devoted lifetime to chemical warfare development. Moskva Segodnya (in Rus- sian), September 11, 1998, p. 7; translated in FBIS document FTS19981001001057, October 1, 1998. See also Associated Press. September 11, 1998. Russian man arrested for manufacturing, selling chemical weapons. 12. U.S. General Accounting Office. 1999. Combating terrorism: observations on the threat of chemical and biological terrorism. Statement of Henry L. Hinton, Jr., Assistant Comptroller General, National Security and International Affairs Division Report No. GAO/T-NSIAD-00-50, October 20, 1999, p. 4. 13. Zilinskas, Raymond A. 1996. Aum Shinrikyo's chemical/biological terrorism as a para- digm? Politics and the Life Sciencesl5(2):238. 14. Schmid, Alex P. 2001. Chemical terrorism: precedents and prospects. OPCW Synthesis (Summer/June): 12. 15. Mullen, Robert K. 1978. Mass destruction and terrorism. Journal of International Affairs 32(1):69. 16. Monterey Institute of International Studies, Center for Nonproliferation Studies, WMD Ter- rorism Database, data as of May 7, 2001. 17. Ibid. 18. U.S. Centers for Disease Control and Prevention, Strategic Planning Workgroup. 2000. Chemical and biological terrorism: strategic plan for preparedness and response. Morbidity and Mortality Weekly Report 49(April 21):1-14. 19. Los Angeles Times. January 3, 1995. Poisoned champagne kills 10 in Tajikistan, p. A18. 20. Begley, Sharon. 2001. Chemical plants: go well beyond "well prepared." Newsweek, p. 33. 21. National Research Council. 1999. Chemical and Biological Terrorism: Research and Devel- opment to Improve Civilian Medical Response. Washington, D.C.: National Academy Press, p. 127. 22. Jackson, Richard, M.D., M.P.H., Director, National Center for Environmental Health. State- ment before the U.S. Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, June 2, 1998. 23. Reuters. February 28, 2000. Dozens flee deliberate poison cloud. 24. Smithson, Amy E., and Leslie-Anne Levy. 2000. Ataxia: The Chemical and Biological Terror- ism Threat and the U.S. Response. Washington: Henry L. Stimson Center, Report No. 35, pp. 91-102. 25. For vivid eyewitness descriptions of the Tokyo subway attack, see Murakami, op. cit. 26. U.S. Department of Health and Human Services. 1996. Planning Considerations for Health and Medical Services Response to Nuclear/Biological/Chemical Terrorism. Washington, D.C.: U.S. Department of Health and Human Services, p. 2. 27. U.S. Department of Energy, National Nuclear Security Administration, Office of Nonprolif- eration Research and Engineering. 2001. Chemical & Biological National Security Program, FY00 Annual Report DOE/NN-0015. Washington, D.C.: pp. 67-76. 28. U.S. Centers for Disease Control and Prevention, Strategic Planning Workgroup, op. cit. 29. National Research Council, op. cit., p. 102. 30. Ibid.,p.100.

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CHEMICAL TERRORISM 133 31. Freedberg, Sidney J., Jr. 2001. Feds prepare state, local governments for terrorist attacks. National Journal, March 15, 2001. On-line at www.govexec.com/dailyfed/0301/031501nj/htm. 32. National Research Council, op. cit., p. 108. 33. American Journal of Public Health 91 (May 2001):710-717. Cited in Reuters. May 1, 2001. Study: U.S. hospitals not prepared for bioterrorism. 34. Lorin, H.G., P.E.J. Kulling. 1986. The Bhopal tragedy what has Swedish disaster medicine planning learned from it? Journal of Emergency Medicine 4:311-316. 35. Smithson and Levy, op. cit., p. 101. 36. Ibid., p. 289. 37. Green, Joshua. 2001. Weapons of mass confusion: how pork trumps preparedness in the fight against terrorism. Washington Monthly (May 2001): 15-21.

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