“Doctor, doctor please listen …My brain is scattered … You can be Alice , I’ll be the mad hatter”… – lyrics from “Mad Hatter”, Melanie Martin

In a modest Japanese farming and fishing village in the 1950s, an unprecedented drama unfolded as one of the starkest and most vivid mass toxic exposure events of the 20th Century afflicted the townspeople of Minamata, Japan.

Minamata is located on the Western coast of Kyushu, Japan’s southernmost island.

In Minamata, shellfish and fish have been the protein mainstays of the area, and the backbone of the area’s economy for generations.

In 1932, the Chisso Corporation began to manufacture acetylaldehyde, used to produce plastics. In post -World War Minamata, the production of acetylaldehyde utilizing mercury, a neurotoxic and fetotoxic heavy metal, accelerated as the need for plastic products accelerated.

Wastewater containing mercury  from the production process was spilled into Minamata Bay where aquatic microorganisms assisted in the transformation of inorganic mercury into methyl mercury; an organic form that is capable of entry and biomagnification in the food chain.

The closed -loop ecosystem of Minamata, and the high consumption of shellfish and fish contaminated with concentrated amounts of methyl mercury evolved into a formula for a tragic environmental disaster that would leave a legacy of human disease and unfathomable suffering.

Threat1

The consumption of contaminated shellfish and fish from Minamata Bay led to neurological damage and developmental disabilities, such as a form of cerebral palsy and mental retardation, as mercury transcends the placental barrier and concentrates in fetal cells.

The contamination of Minamata Bay with mercury and the neurological and neurobehavioral manifestations of widespread mercury intoxication, continues to serve as a poignant example of environmental injustice and a principal case study in environmental public health and toxicology.

In addition, this sentinel event demonstrates the possible behavior and consequences of an intentional widespread toxic heavy metal release into the environment as the result of a terroristic or criminal act.

The mere spillage of a small amount of mercury in a laboratory setting, for example, is enough for a HAZMAT emergency response.

The recent example of widespread lead poisoning in Flint, Michigan serves as a profound and egregious example of water contamination by a toxic heavy metal, stemming not from a terrorist act, but from a crumbling water distribution infrastructure coupled with official indifference and inadequate local and state governmental response.

While this a case of gross environmental and public health negligence resulting in elevated blood lead levels and adverse health effects, especially neurological damage and developmental and learning disabilities in children ,it is also a lesson learned in the realm of toxic terrorism.

Environmental and biomedical monitoring and modeling involving environmental  contamination with heavy metals due to industrial accidents and  releases into waterways or onto soil and vegetation, as point or area sources and the indiscriminate dumping of hazardous wastes can be utilized and extrapolated for planning, mitigation and response to toxic terrorism utilizing heavy metals.

Toxic terrorism utilizing heavy metals such as mercury, lead, arsenic and cadmium as Weapons of Opportunity and Convenience/Weapons of Mass Effect is a distinct possibility.

A toxic heavy metal is any relatively dense metal or metalloid that is noted for its potential toxicity, especially in environmental contexts. The term is particularly appropriate for lead, mercury, arsenic and cadmium, all of which are listed in the World Health Organization’s (WHO) list of 10 chemicals of major public concern. Other examples include manganese, chromium, cobalt, nickel, copper, zinc, selenium, silver, antimony and thallium.

Hands

Intentional dissemination of toxic heavy metals or their by-products into agricultural operations, including milk production and distribution, water distribution systems , open salad bar restaurants or HVAC systems utilizing respirable metallic particles and fumes, eg. nickel carbonyl , a potent lung-damaging waste gas of nickel production .

Toxic metals such as arsenic and thallium have been used in homicides and political assassinations.

A cluster of intentional thallium poisoning occurred in Baghdad Iraq in 2008 when a group of individuals consumed contaminated cake and developed severe gastrointestinal symptoms, hair loss, ascending muscular weakness, peripheral neuropathy, cardinal signs of thallium toxicity.

Moreover, some metals are highly reactive to mechanical shock and/or combustible acting as energetic materials capable of being used as explosive or incendiary weapons, eg. sodium metal and magnesium.

Heavy metals are also utilized in other toxic industrial materials such as pesticides and rodenticides.

Depleted uranium (DU) utilized in armor piercing ammunition and widely deployed in the Middle Eastern theatre of operations, is unique, as it poses both radiological and chemical toxicity hazards.

Respirable particles containing DU can be inhaled, ingested and shrapnel fragments can be injected and systemically absorbed causing neprotoxicity and renal impairment, as well as irradiate body tissue as an incorporated radiological hazard.

Cobalt-60 and radio-cesium (Cs-137) are also readily available to incorporate into a Radiological Dispersal Device (RDD).  In essence these are radiotoxic metals which can create a significant radiological hazard.

Metal

Secondary consequences of other terrorism events that cause structural collapse, for example, can generate toxic aerosols, dusts and fumes involving toxic metallic agents, such as the heavy metals found due to destruction of electronic components and construction materials in the aftermath of the World Trade Center attacks in 2001.

In subsequent clean-up and recovery operations, toxic metal particles can be re-suspended and made airborne.

Varying levels of lead and cadmium were found in environmental and medical monitoring efforts of rescue and recovery workers at the WTC site.

Toxic heavy metals are readily available to be used as a weapons of terror, as are other toxic industrial materials.

Emergency preparedness for toxic terrorism must include scenarios involving mass heavy metal exposures and targeted medical countermeasures such as chelation therapies utilizing decorporation agents, eg. Prussian blue for thallium and cesium toxicity, must be integrated into health and medical response.

The ready availability of toxicological and environmental health expertise as integral components of incident response is mission-critical.

In addition, a robust protective countermeasures program such as appropriate PPE and high efficiency air filtration systems must be in place.

The threat of toxic terrorism utilizing toxic metals is a credible, opportunistic and ubiquitous reality.

It is true: all that glitters is not gold…It is deadly.

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Frank G. Rando possesses over 30 years of real world experience as a public safety professional,clinician, educator ,emergency and crisis manager ,author and consultant in the areas of tactical ,disaster and operational medicine, weapons and tactics, law enforcement /criminal investigations ,counterterrorism, hazardous materials management and emergency response ,toxicology, environmental safety and health,and health care and public health emergency management .