Sarin Attack Research Articles

Chemical Warfare Agent: Toxicity and Health Effects of Sarin Gas (GB)

Chemical warfare agents (CWAs) are toxic substances used to cause harm, injury, or incapacitation to an adversary in the context of warfare and related military activities. Sarin stands as an exemplar among agents, embodying some of the most potent compounds ever developed. This strength originates from its ability to permanently inhibit the acetylcholinesterase (AChE) enzyme, leading to the accumulation of acetylcholine (ACh) at synaptic junctions, which, in turn, induces stimulation of muscarinic and nicotinic receptors. The main objective of the current article is to summarize the negative influence of sarin gas on health and its role in the incidence of several pathological conditions in people who’s exposed to the gas. From this point of view, the clinical features of sarin exposure (health effect and related diseases) and the influence of nerve agents on deactivation of cholinesterase were the main area covered in this article. Furthermore, and for better understanding of the gas behavior and its toxicity, it was important to discuss the features of the gas, discovery, mechanism of toxicity, and pharmacological management. Lately, various approaches have also been reported with esteem of sarin detection, destruction, attacks, and treatment approaches after sarin poisoning.

Optimizing Medical Care during a Nerve Agent Mass Casualty Incident Using Computer Simulation

IntroductionChemical mass casualty incidents (MCIs) pose a substantial threat to public health and safety, with the capacity to overwhelm healthcare infrastructure and create societal disorder. Computer simulation systems are becoming an established mechanism to validate these plans due to their versatility, cost-effectiveness and lower susceptibility to ethical problems.MethodsWe created a computer simulation model of an urban subway sarin attack analogous to the 1995 Tokyo sarin incident. We created and combined evacuation, dispersion and victim models with the SIMEDIS computer simulator. We analyzed the effect of several possible approaches such as evacuation policy (‘Scoop and Run’ vs. ‘Stay and Play’), three strategies (on-site decontamination and stabilization, off-site decontamination and stabilization, and on-site stabilization with off-site decontamination), preliminary triage, victim distribution methods, transport supervision skill level, and the effect of search and rescue capacity.ResultsOnly evacuation policy, strategy and preliminary triage show significant effects on mortality. The total average mortality ranges from 14.7 deaths in the combination of off-site decontamination and Scoop and Run policy with pretriage, to 24 in the combination of onsite decontamination with the Stay and Play and no pretriage.ConclusionOur findings suggest that in a simulated urban chemical MCI, a Stay and Play approach with on-site decontamination will lead to worse outcomes than a Scoop and Run approach with hospital-based decontamination. Quick transport of victims in combination with on-site antidote administration has the potential to save the most lives, due to faster hospital arrival for definitive care.

Comparing the top 100 attacks in the Global Terrorism Database: high injury rate versus high fatality rate attacks

Background Terrorist attacks have the potential to be mass casualty events, causing multiple injuries and deaths. High injury rate attacks will particularly place a high burden on emergency medical systems. This study aimed to assess if there is a difference between attacks with high injury rates and high fatality rates. Methods The top 100 terrorist events causing the highest number of fatalities versus the highest number of injuries were selected from the Global Terrorism Database. Analyses were performed on temporal factors, location, target type, attack and weapon type, and perpetrator type. Results The 9/11 attacks caused the highest number of both fatalities and injuries. With regards to injury rates, the sarin attacks in Tokyo, Japan ranked second. Events with high fatality rates were overrepresented in Sub-Saharan Africa, whereas events with high injury rates were predominant in the Middle East & North Africa. High fatality rates were most often associated with armed assaults and hostage takings. Bombings were responsible for the highest number of injuries. CBRN attacks were overrepresented in the top 100 injuries, and accounted for 11% of the incidents. Conclusion High injury rate incidents place a heavy burden on the health care system as the number of injuries is nearly ten times as high as the number of injuries in high fatality rate incidents. Epidemiological analysis of high impact terrorist events may contribute to counter-terrorism preparedness, to an increased focus on dealing with CBRN-events, and thus to a proper medical response to future terrorist events.

The Family Consequences of Terrorism: The Effects of the Tokyo Subway Sarin Attack on Marital Formation and Dissolution

Research on the effects of disruptive events on family-related decision making provides competing predictions with different channels, and the available evidence is mixed. This study focuses on the Tokyo subway sarin attack in 1995, the most disastrous terrorist attack in modern Japanese history. The findings indicate that in the years following the sarin attack, marriage and divorce rates decreased in areas served by the affected subway lines relative to areas not served by them within the Tokyo metropolis. The effects do not appear to be driven by a change in population compositions. The negative effects of the sarin attack on marriage and divorce are weaker in areas with higher social welfare expenditures. The findings are consistent with the perspective that the sarin attack triggered perceived uncertainty, such that people adhered to their status quo; with the availability of social welfare, they perceived the impact as less pervasive.

A Case of Dimethoate Poisoning Requiring Prolonged Skin Decontamination

Background Decontamination is a critical medical counter measure in reducing toxic exposure following poisoning. Little is known on the effectiveness of this procedure and its impact in the context of preventing secondary exposure of healthcare workers and secondary contamination of facilities. Presented here is a case of dimethoate poisoning that required a prolonged period of skin decontamination to remove residual skin contamination. Case Report A young gardener consumed dimethoate at the workplace witnessed by a colleague who called the emergency services immediately. Paramedics noted the patient to be drowsy with stable vital signs and 100% oxygen saturation. En-route to the hospital the patient vomited multiple times and was drenched in vomitus with a pungent odour. Upon arrival at the emergency department (ED), vital signs remained stable with a Glasgow Coma Scale (GCS) of 10. Due to gross external contamination from the vomitus and pungent odours emanating suggestive of chemical fumes off-gassing, the hospital decontamination shower was activated for patient decontamination. Staff donned protective suits and proceeded to disrobe and bag all the patient’s clothing before showering the patient for 10-minutes using soap and water. Post-decontamination a chemical agent monitor (CAM) were used to screen for residual chemicals following the hospital’s decontamination protocol. The chemical alarm was triggered twice, first around the left mastoid region and again just below the left breast. This required targeted re-showering for a further 10-minutes before patient was finally cleared of contamination. Subsequently, the patient was given atropine (2.4 mg) and pralidoxime (1 g) followed by an infusion at the intensive care unit (ICU). The patient made an uneventful recovery and was discharged 5-days later. Conclusion This case of dimethoate poisoning is notable for the prolonged period of skin decontamination to remove residual skin contamination and illustrates potential implications to patient and health care worker safety. Past mass casualty incidents involving chemicals, such as the sarin attack in Tokyo, highlight the high incidence of secondary exposures amongst healthcare workers due to the lack of casualty decontamination. As a result, many hospitals have developed capacity to conduct rapid and timely decontamination at their premises to prevent further complications from secondary chemical exposure. However, the effectiveness of this process of decontamination needs further evaluation.

Social media video analysis methodology for sarin exposure

As social media becomes increasingly ubiquitous, many events are recorded and released on social media platforms, including chemical weapon attacks. We develop an objective tool in order to evaluate brief and unstructured social media videos for analysing sarin exposure from a civilian medical pathology perspective. We developed and validated this new questionnaire using a standardized procedure that includes content domain specification, item pool generation, content validity evaluation, a pilot study, and assessment of reliability and validity. In total, 51 sarin attacks and 48 matched videos were analysed. Cronbach’s α for all 20 items was 0.75, which indicates adequate internal reliability. The test–retest reliability was 0.96, which indicates good internal reliability. The inter-observer intraclass correlation coefficient was 0.97. After verifying sampling adequacy with the Kaiser–Meyer–Olkin measure and the factorability of the items with Barlett’s test of sphericity, a factor analysis was performed. According to the principal axis factoring, a six-factor solution explained 51.86% of the total variance. The receiver-operating characteristic curve analysis showed that the Video Score Questionnaire has a sensitivity of 0.817, a specificity of 0.478, and an efficiency of 65.3. Therefore, the Video Score Questionnaire is reliable and valid for evaluating sarin attacks from brief and unstructured social media videos. Key points Chemical weapons are still used as a method of warfare. Social media videos are an important source of information. We developed a validated scale which can analyse sarin exposure in short and unstructured videos.

No promising antidote 25years after the Tokyo subway sarin attack: A review.

On the battlefields of Syria, many innocent civilians have been killed or injured by sarin poisoning. In Malaysia in February 2017, a North Korean man was assassinated with VX at Kuala Lumpur International Airport. In the face of such threats, a more effective antidote against organophosphonate acetylcholinesterase (AChE) inhibitors is needed, one that can freely penetrate into the central nervous system (CNS) through the blood-brain barrier (BBB). In the 1995 Tokyo subway sarin attack, which produced more than 6,000 victims, 2-pyridinealdoxime methiodide was the most commonly used antidote in hospitals, but it was unable to prevent CNS damage and no other oximes have been approved for use in Japan. Ultimately, 12 people died, and many victims had severe neurological injuries or sequelae. Although more than 25years have passed since the incident, progress has been slow in the development of a new antidote that can penetrate the BBB, restore AChE activity in the CNS, and definitely prevent brain injury. From the perspectives of countering terrorism and protecting innocent people from nerve agent attacks, the search for nerve agent antidotes should be accelerated with the goals of improving both survival and quality of life. This review gives an overview of a series of our studies on the development of a new antidote since the Tokyo subway sarin attack and emphasizes that there is unfortunately still no promising antidote for saving the CNS in Japan.

The Tokyo subway sarin attack has long-term effects on survivors: A 10-year study started 5 years after the terrorist incident.

ObjectivesThe Tokyo subway sarin attack in 1995 was an unprecedented act of terrorism that killed 13 people and sickened more than 6,000. The long-term somatic and psychological effects on its victims remain unknown.MethodsWe conducted analyses on the self-rating questionnaire collected annually by the Recovery Support Center (RSC) during the period from 2000 to 2009. The RSC is the only organization that has large-scale follow-up data about sarin attack victims. The prevalence of self-reported symptoms was calculated over 10 years. We also evaluated the prevalence of posttraumatic stress response (PTSR), defined as a score ≥ 25 on the Japanese-language version of the Impact of Event Scale–Revised. The multivariate Poisson regression model was applied to estimate the risk ratios of age, gender, and year factor on the prevalence of PTSR.ResultsSubjects were 747 survivors (12% of the total) who responded to the annual questionnaire once or more during the study period. The prevalence of somatic symptoms, especially eye symptoms, was 60–80% and has not decreased. PTSR prevalence was 35.1%, and again there was no change with time. The multivariate Poisson regression model results revealed “old age” and “female” as independent risk factors, but the passage of time did not decrease the risk of PTSR.ConclusionsAlthough symptoms in most victims of the Tokyo subway sarin were transient, this large-scale follow-up data analysis revealed that survivors have been suffering from somatic and psychological long-term effects.

Proposal for Reforming Prehospital Response to Chemical Terrorism Disasters in Japan: Going Back to the Basics of Saving the Lives of the Injured by Securing the Safety of the Rescue Team.

Having experienced the Tokyo subway sarin attack in 1995, Japan has established extremely strict rules on handling injured victims before they are sent to a hospital. As a result, it takes a long time before rescue actions are taken. This report aims to propose a reform to change the system that focuses on saving lives. First, the issues in firefighting on sites that currently present problems in Japan were identified. Then, Japanese guidelines were compared with those that were considered in other countries. Based on this, an ideal way of running rescue operations was examined, and a proposal to save many lives was made. This research was conducted with funding from the Ministry of Health, Labour, and Welfare of Japan (MHLW; Chiyoda, Tokyo, Japan). In addition to preventing secondary injuries, the temporal aspect of rescuing people early with the clear goal of saving many lives was emphasized. Priority was given to measures against nerve agents to prevent secondary injuries, which put the rescuers' lives at risk. Possible decontamination methods were pursued before choosing the one that was most appropriate. A linear algorithm was used to determine which decontamination method could be started immediately, and then the gradual use of equipment was recommended. Even if Level A personal protective equipment (PPE) and other dedicated equipment and materials cannot be procured, the possibility of starting rescue activities under certain condition using regular equipment was pointed out. The need for a system for possible victims who would require support, such as foreigners, the handicapped, and elderly people, was also identified. Japan limits the scope of activities that can be undertaken by emergency medical technicians (EMTs) on-site. The way in which on-site medical care can be provided with future legal revisions in mind was also discussed. There is an urgent need to build a framework in which rescue activities can take place so that the number of deaths would not rise, even if sarin and other poisons are scattered.

Discursive opportunities and the transnational diffusion of ideas: ‘brainwashing’ and ‘mind control’ in Japan after the Aum Affair

A case study in the sociology of ideas, this article refines the theory of 'discursive opportunities' to examine how intellectual claims cross national and linguistic boundaries to achieve public prominence despite lacking academic credibility. Theories of 'brainwashing' and 'mind control' originally began in the United States in the 1960s as a response to the growth of new religious movements. Decades later in Japan, claims that so-called 'cults' 'brainwashed' or 'mind controlled' their followers became prominent after March 1995, when new religion Aum Shinrikyō gassed the Tokyo subway using sarin, killing thirteen. Since then, brainwashing/mind control have both remained central in public discourse surrounding the 'Aum Affair' despite their disputed status within academic discourse. This article advances two arguments. Firstly, the transnational diffusion of brainwashing/mind control from the US to Japan occurred as a direct result of the 1995 Tokyo sarin attack, which acted as a 'discursive opportunity' for activists to successfully disseminate the theories in public debate. Secondly, brainwashing/mind control became successful in Japanese public discourse primarily for their normative content, as the theories identified 'brainwashing/mind controlling cults' as evil, violent and profane threats to civil society.

Medical Measurement Against the Mega-Disaster: The Necessity of Systematization of the Disaster Medicine or the Disaster Medicine Compendium

Introduction:The large number of casualties during major or mega-disasters are a global problem.Aim:The role of medicine against mega-disasters is analyzed from a worldwide perspective.Methods:Chernobyl incident, the Tokyo Subway Sarin Attack, the 9-11 attack, the Indian Ocean earthquake/tsunami, Hurricane Katrina, the Flu pandemic, the Higashi Nihon Earthquake followed by the Fukushima nuclear plant incident, etc. are critically analyzed, based on the actual medical experiences.Results:These mega-disasters often have a wide, severe negative influence. Linked catastrophes often form catastrophic circulus vitiosus (CCV) or malignant cycles on a global scale. The typical example is the Chernobyl incident which caused not only many deaths by radiation exposure/thyroid cancer and world anxiety, but also is considered to have contributed to the end of the Eastern European Communism system in 1989 (East Germany) and 1991 (ESSR).Discussion:Many roles of medical doctors and staff were requested, including creating preventive life-saving systems, in addition to the prevention of mega-disaster measurement to minimize the unhappiness. Moreover, medical ethics and philosophy are important, which were often overlooked. It is necessary for medical care and support to have a broad perspective. Although the classical philosophy of utilitarianism is often accepted without suspicion, it comes with the risk of disregarding vulnerable/weak people. The concept of justice according to John Rawls (USA) and the Minimal Unhappiness Theory by Naoto Kan (Japanese politician) should be considered, too. From such viewpoints, it is our conclusion to urge the establishment of systematic disaster medicine or to compile a disaster medicine compendium. Although the tentative first version was compiled with 22 volumes in 2005, only one-fourth was available in English. The English part increased up to nearly three-fourths by adding several new versions in which the nuclear/biological/chemical hazard version, tsunami measurement, and psychological care version are included at the moment.

A review of CBRN topics related to military and civilian patient exposure and decontamination.

Chemical and biological (CB) warfare have long been practiced, and although these types of warfare are not acceptable in modern times, this does not prevent them from occurring. This makes it important for societies to be able to appropriately respond to these events, including the best way to decontaminate victims to keep them and emergency responders safe. Decontamination methods such as chemical, physical, wet, and dry methods are discussed, as well as their downsides. Secondary contamination, which played a significant role in the Tokyo sarin attacks, has long been noted by anecdotal evidence, although it has been little studied. Biological agents cause more problems after infection has taken place, and thus preventing the spread of infection is the largest concern. There are many differences between military and civilian populations, and the response to mass casualty attacks differs accordingly. There are several emerging technologies that can make this process easier on all parties, such as bioscavengers, antitoxins, and color changing bleach for visualization. A reliable way to quantify decontamination is also needed, which would allow for better care of victims both in normal hospital situations, as well as during aeromedical transport. In addition, several gaps were identified, such as the lack of scientific basis for 90 percent reduction during decontamination, a way to quantify decontamination, and the lack of studies on toxic industrial chemicals and secondary contamination.

Going Underground with Murakami Haruki: storytelling, oral history and “the japanese psyche” after Tokyo subway sarin attack

On doit à Haruki Murakami, l’un des écrivains japonais les plus connus dans le monde, le principal texte explorant les effets sociaux de l’attaque au gaz sarin dans le métro de Tokyo en 1995. Cet article revient sur le rôle de Murakami en tant que narrateur, historien et commentateur culturel de cet attentat, en même temps qu’il interroge l’importance qui a été accordée de par le monde à la production littéraire et culturelle d’un écrivain, au détriment d’une multiplicité de voix japonaises.

Nerve agents: A clear and present danger to mankind

This editorial is written on the occasion of the 25th anniversary of the infamous sarin and VX terrorist attacks in Japan, in order to increase the awareness of the potential terrorist use of nerve agents and to urge the preparedness to cope with its consequences. Nerve agents are extremely toxic organophosphorus acetylcholinesterase inhibitors, divided in three known groups: G-, Vand A-agents. G-agents tabun, sarin and soman were synthesised in Nazi Germany (1938-1944), V-agents including VX by the British in the 1950s and A-agents or Novichok agents between 1971 and 1993 in the Soviet Union. The use or alleged use of tabun and sarin was mentioned in connection with the Iraq-Iran war (1980-1988) and the Syrian conflict in 2013 and 2017. Sarin and VX were used for terrorist purposes by the Japanese religious sect AUM Shinrikyo in 1994 and 1995. The assassination of Kim Jong NAM with VX took place in Kuala Lumpur, Malesia in 2017, while the 2018 Salisbury and Amesbury poisonings in the UK were ascribed to the so-called Novichok agent A234. Milder cases of poisoning with nerve agents is accompanied by predominantly muscarinic symptomatology and more massive intoxications with mainly nicotinic and central symptoms. Treatment consists of use of atropine, oximes and anticonvulsants.

Victims of chemical terrorism, a family of four who were exposed to sulfur mustard

Sulfur mustard (SM) was responsible for more than 80% of all documented chemical casualties during the Great War. Recent literature on clinic picture of SM exposure remained so limited with the sporadic cases who were accidentally exposed to SM especially either in Western Europe or China. We reported a Syrian family of four who became victims of chemical terrorism due to SM exposure and we described the detailed clinical course of the family including the medical history, initial symptomatology, clinical examination, hematological data, and initial treatment in the first 48 hours after exposure at Kilis State Hospital, Turkey. The principles of our therapeutic approaches were designed according to the total affected body surface area, severity of cutaneous and respiratory lesions, and existing hematological disorders. SM is still considered as a critical vesicant agent and a current threat because of its ease of synthesis. Chemical terrorist attacks of non-state actors or terrorist organizations with “home-made” SM is likely such a threat which is targeting health systems of developed and developing countries. Except sarin attacks in Japan, the literature depends on real incidents of chemical terrorism is so rare and for this reason we have gaps and challanges in the prepardness of medical response system against chemical terrorism. Medical management could be performed adequetly only if the response system is well planned, well equipped, and well prepared for overburdened medical facilities filled with SM contaminated casualties after a chemical terrorist attack.

Posttraumatic Stress Symptoms in Victims of the Tokyo Subway Sarin Attack: Twenty Years Later

Introduction: Previous studies found that about 10–30% of terrorist attack survivors suffer mental disorders such as posttraumatic stress disorder (PTSD) which persist up to 10 years. However, little is known about whether the effects of terrorism on mental health could last for a longer period or whether physical symptoms and secondary victimization are associated with the persistence of mental disorders. Method: A questionnaire survey was conducted with the victims of the Tokyo subway sarin attack in March 1995 (N = 299). Victims’ physical and ophthalmic symptoms, secondary victimization, and posttraumatic stress symptoms were surveyed. For comparison, those who have experienced a stressful event were surveyed with the same instruments as of victims’ survey except secondary victimization. Results: Results indicated that 21.3% of the male and 36.1% of the female victims were in the high-risk group for posttraumatic stress symptoms (PTSS), which did not differ from those of the comparison group. However, victims had physical and ophthalmic symptoms of greater severity than the comparison group. Moreover, we found that PTSS was strongly associated with physical symptoms and secondary victimization. Discussion: There is a need to develop a support system that would be helpful in reducing mental health suffering of terrorist victims. Providing regular physical checkups and building support for those who experience life changes caused by victimization are suggested.

Latency Through Uncertainty: the 1994 Matsumoto Sarin Incident as a Delayed Cultural Trauma

Cultural trauma theory has emphasised the role of social groups in narrating, and thereby attributing moral significance to, highly disruptive events. In contrast, this article draws attention to professions such as the police and the media, which act as “fact-finders” to establish the factual circumstances of events from which trauma narratives are created. The article offers a case study of the June 1994 Matsumoto Sarin Incident in Japan, a terrorist attack in which members of religious movement Aum Shinrikyō gassed residential streets using sarin. Factual uncertainties surrounding the attack, in combination with institutional failings by fact-finders that resulted in a false accusation, meant that carrier groups did not identify the event as one that brought a collectivity’s underlying values into question; in other words, cultural trauma as a discourse did not develop. It was only after Aum’s second sarin attack on the Tokyo subway in March 1995, when the true perpetrators and motives were finally uncovered, that Matsumoto belatedly became recognised as a traumatic assault on Japan’s civic values. This article suggests that a collaborative approach combining science and technology studies (STS) with collective memory studies could provide a fruitful avenue of further research.

Should Helicopters Transport Patients Who Become Sick After a Chemical, Biological, Radiological, Nuclear, and Explosive Attack?

The local fire department executed a training simulation for chemical and explosive incidents at a large sports facility. In this training simulation, a physician-staffed helicopter arrived at the request of the fire department and landed just outside the cold zone in the parking area. The doctor and nurse of the helicopter were escorted to a red area in the cold zone, which was selected based on the results of postdecontamination triage. After the patients had been treated, they were air medically evacuated to the base hospital. In the Tokyo subway sarin attack in 1995, St Luke's International Hospital admitted over 600 victims. During this incident, 23.2% of medical staff suffered secondary injury from sarin exposure. If air medial crews respond with subsequent postexposure effects during flight, an affected pilot could lose control of the helicopter, resulting in a fatal crash. Based on potential safety concerns for air medical and ground personnel, our recommendation would be that air medical helicopters not be dispatched to sites of chemical, biological, radiological, nuclear, and explosive incidents.

Essential Lessons in a Potential Sarin Attack Disaster Plan for a Resource-Constrained Environment.

Sarin is a potent nerve agent chemical weapon that was originally designed for military purposes as a fast-acting anti-personnel weapon that would kill or disable large numbers of enemy troops. Its potent toxicity, ease of deployment, and rapid degradation allow for rapid deployment by an attacking force, who can safely enter the area of deployment a short while after its release. Sarin has been produced and stockpiled by a number of countries, and large quantities of it still exist despite collective agreements to cease manufacture and destroy stockpiles. Sarin's ease of synthesis, which is easily disseminated across the Internet, increases the risk that terrorist organizations may use sarin to attack civilians. Sarin has been used in a number of terrorist attacks in Japan, and more recently in attacks in the Middle East, where nonmilitary organizations have led much of the disaster relief and provision of medical care. In the present article, we examine and discuss the available literature on sarin's historical use, delivery methods, chemical properties, mechanism of action, decontamination process, and treatment. We present a management guideline to assist with the recognition of an attack and management of victims by medical professionals and disaster relief organizations, specifically in resource-constrained and austere environments. (Disaster Med Public Health Preparedness. 2018;12:249-256).

TLAMs in Syria

The United States' Tomahawk cruise-missile strikes on the Syrian regime's Shayrat Air Base in retaliation for the regime's sarin attack are unlikely to advance peace in Syria. The regime and its main supporters, Russia and Iran, remain defiant, and the Trump administration appears inclined to frame the strikes as a relatively narrow deterrent against chemical weapons attacks and keep counter-terrorism its main priority in Syria for now.