“If falling into desperation worked to make things better, then I would say, ‘Let’s all jump into despair’. But it doesn’t help. The only way to truly find meaning and fulfillment is to look at the disaster, the pain, the difficulty, and know with complete certainty that good can come from this”-Yehuda Berg

In the current and past climate of war, conflict and asymmetric threats, the global community has experienced the use of both toxic industrial chemicals (TICs) and militarized chemical warfare agents (CWAs) as an expression of political violence, terrorism and extreme conflict. In Iraq and Syria, the intentional use of an industrial chemical, also with both historical and recent use as a CWA, chlorine, was used against non-combatant populations. The vivid images resulting from the heinous use of the nerve agent, sarin, against the civilian population by the Assad regime in the Ghouta region of Damascus, remain as tragic and stark reminders of the perversion of chemical and physiological knowledge to inflict mass death and disability.

chlorineThe existence of chemical weapon stockpiles and the demilitarization and decommissioning of these CWAs and delivery systems present their own inherent dangers to personnel and communities, in the U.S. and abroad. During the conflict in Kosovo, it was not uncommon for troops and non-combatants to encounter abandoned industrial chemical manufacturing facilities and hazardous waste sites which posed unique challenges in an already war-torn area of the world.

In an area of the US, known as the “most dangerous two-miles in the US”, a large chlorine manufacturing facility exists that is vulnerable to terrorist action and an accidental airborne release. A U.S. Army study has revealed that a catastrophic release could generate as many as 2.5 million casualties. Similarly, and globally, deteriorating critical infrastructure combined with hazardous technologies and practices generate environmental and public health hazards, with many situations generating fires, explosions and highly toxic by-products released into the environment.

At approximately 12:44 p.m., Saturday, 10 July, 1976, a chemical disaster occurred in the town of Seveso, Italy after a valve broke at the Industrie Chimiche Meda Societa Azionaria chemical plant in Meda, releasing a cloud of chemicals containing dioxin that wafted an estimated 50 meters into the sky. Carried southeast by the wind, the toxic cloud enshrouded the municipality of Seveso and other communities in the area. Approximately 3,000 kg of chemicals became airborne, among them was 2,4,5 trichlorophenol, used in the manufacture of herbicides, and anywhere from about 100 grams to 20kg of dioxin (TCDD), one of the most toxic compounds known to humanity .

Reconstruction of this event and utilizing both environmental modeling and biological sampling, including some original blood samples taken from exposed victims, have yielded extraordinary data on the health effects of dioxin, its retention time in the body ,and modeling that can be extrapolated to predict behavior and consequences of other accidental or intentional releases of hazardous materials, as well as emergency actions, such as emergency notifications, risk communications, evacuations vs. sheltering-in-place and resource planning.

BhopalThe premier defining moment in community-wide and industrial emergency planning for hazardous materials events was the tragedy that unfolded in Bhopal, India in 1984, where over 40 metric tons of product was released into the atmosphere as a result of a runaway exothermic reaction caused by water incursion into a reaction vessel containing methyl isocyanate (MIC), a potent respiratory toxicant, as well as the release of the World War I military war gas, phosgene, also a potent lung-damaging agent. Phosgene is also a TIC that is used in various industrial processes, and that can be released from the pyrolysis of chlorinated hydrocarbons. This sentinel event occurred at the former Union Carbide Sevin (carbaryl) pesticide manufacturing facility.

No emergency action plans had been established to cope with an event of this magnitude. This included not informing local authorities of the dangers of chemicals used and manufactured at the Bhopal facility. At the time of the event, the MIC tank refrigeration unit was disabled to save money, with some of the coolant being diverted elsewhere. The gas scrubber was on stand-by status, and therefore did not attempt to clean escaping gases with sodium hydroxide (caustic soda), which may have brought the concentration down to a safe level. The water curtain that may have reduced the concentration of the gas was only set to ~13 m and did not reach the gas, and the flare tower used to incinerate gases before they are allowed to escape was inoperable and pending repairs. The external auditory warning system had been engaged, however, quickly silenced to avoid panic among the at-risk population.

Approximately, 8,000 people died within 72 hours of the gas leaking into the air, with approximately 15,000 people succumbing to the long-term effects of gas exposure. According to Amnesty International, 100,000 people continue to suffer from chronic and debilitating illnesses related to toxic gas exposure for which treatment is largely ineffective. More than 500,000 people in Bhopal suffered some damage, injury or trauma as a consequence of this large scale industrial chemical disaster. The Bhopal tragedy led to landmark environmental legislation and regulations and changes in the safety culture of the chemical industry.

We know that such catastrophic industrial releases can be intentional events with broad consequences, therefore accidental releases generate data useful for planning for and response to chemical-sector attacks. We may also extrapolate data useful in planning and response to other hazardous technological operations gone awry in the nuclear power sector, such as the explosions and massive radionuclide releases in Chernobyl and Fukishima. Similarly, radiological accidents such as the mass exposures derived from an abandoned cancer radiotherapy unit in Goiana, Brazil and the intentional Polonium-210 poisoning of Russian journalist, Alexander “Sasha” Litvienko, provide emergency planners, public health authorities and emergency responders with data that may be applied to planning, mitigation, response and recovery phases relevant to radiological terrorism.

We have gained much knowledge from the releases of various radionuclides into environmental media and the exposure pathways leading to incorporation and health effects of radionuclides from nuclear weapons testing, environmental contamination from military and industrial nuclear-radiological operations, and the unfortunate human experimentation during the Cold War utilizing radionuclides. Case studies in epidemiology are rife with hundreds of examples that can be extrapolated to CBRN events, such as accidental or indiscriminate contamination of food and water by biological pathogens, heavy metals, industrial chemicals, radionuclides and other substances.

First and foremost, CBRN agents are hazardous materials. CBRN agents may exist as solids, liquids or gases/vapors, and aerosols and are subject to chemical and physical laws, such as temperature, pressure, gravity and water solubility. Examples of some similarities or analogies that may be drawn between CBRN agents and TICS/TIMs would include militarized vesicants such as sulfur mustard (HD) or Lewisite (L), and “toxic caustics”, such as strong acids (corrosives), or organophosphate pesticides, such as Malathion and militarized nerve agents, e.g. sarin (GB).

Can we learn from a non-intentional outbreak of botulinum toxicity, model and extrapolate to an intentional dissemination of the deadly toxin? The obvious answer is of course.

Have we learned from natural outbreaks of infectious diseases, emerging pathogens or otherwise, and use the data to plan, prepare, mitigate, respond to and recover from bioterrorism events? Yes, and we continue to do so.

AccidentMilitarized agents, such as sarin and VX, are profoundly more toxic than a plethora of TICs and TIMs, however, nations are dotted with what US President Barak Obama has called “stationary WMDs”, i.e., chemical manufacturing plants that utilize hazardous processes, store, produce and dispose of highly toxic, corrosive, flammable and explosive materials and by-products, have lax security and often have been found with serious safety violations.

In addition, conventional hazardous materials are imported and exported regularly and transported via vulnerable transportation systems, such as rail, trucks and barges often through highly congested population areas. Essentially, militarized (unitary or binary) and field expedient CWAs utilizing TICs and TIMs, can both be utilized to generate mass casualty events with inherent warfare, or criminal, terroristic aspects attached to the event. An intentional event may also be masqueraded as an accidental event, and forensic and criminal investigations of accidental hazardous materials releases are concurrently conducted alongside accident investigations.

The operational aspects of a conventional HAZMAT response are applicable to the CBRN response, albeit the confirmed CBRN release and subsequent response possesses terrorism -specific hazards and actions such as render-safe operations for secondary devices, crime scene management and evidence collection and preservation. There is still much to learn from our technological follies and slip-ups that have profound meaning to CBRN planning and response.

There is no doubt that technological failures and disasters will continue to occur, and that the real or threatened use of militarize

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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 .