Chemical Agent Use in Terrorist Events: A Gathering Storm Requiring Enhanced Civilian Preparedness

Abstract

Background: The use of chemical weapons in terrorist attacks, though rare, remains a significant challenge and concern due to their ability to inflict mass casualties. Chemical attacks remain a topic of interest for Disaster Medicine (DM) and Counter-Terrorism Medicine (CTM) specialists and are clearly an area in need of enhanced preparedness. This study aims to provide an epidemiological description of all terrorism-related attacks using chemical agents as a primary weapon, sustained from 1970 - 2019. These data will be useful in the development of education programs in CTM and provide an insight into how best to prepare for potential attacks in the future. Methods: Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all events using chemical weapons as a primary attack method from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. The GTD also details the specific chemical used, when known, in the summary of incidents. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Results: A total of 292 terrorist attacks involving chemical agents as a primary attack method were recorded from 1970 - 2019, registering 284 deaths and 13,267 injuries. Acid (52) was the most commonly used chemical agent, followed by “unspecified poison” (43), “unknown chemical agents” (29), “unspecified gas” (27), tear gas (27), chlorine gas (24), cyanide (21), mercury (9), pepper spray or mace (9), mustard gas (8), insecticide or 1080 (8), diphenylamine chloroarsine (7), phosphate or phosphorous (3), sodium hydroxide or corrosive liquid (3), sarin (2), “unspecified drugs” (2), VX nerve gas and other nerve gas (2), pesticides (2), cleaning chemicals/paint thinner (2), ammonia (2), anesthesia agent (1), arsenic (1), chlorine and mustard gas mix (1), phenarsazine chloride (1), rat poison (1), unknown irritative gas (1), hydrochloric acid and sodium cyanide mix (1), unknown white powder (1), antiseptic dye (1), and chlorine gas and white phosphorous mix (1). Conclusion: The use of chemical weapons in warfare, though prohibited by the Chemical Weapons Convention (CWC), remains a rare but concerning terrorist attack methodology. In recent years, there have been more instances where potentially deadly chemicals have been used in civilian settings. Dual use industrial chemicals, in particular, pose a significant concern. Acid was the most commonly used chemical weapon in 52 attacks. Tear gas, chlorine, and cyanide were each used in over 20 attacks. Both DM and CTM specialists advocate for better preparedness and response training for intentional events in civilian settings.

Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War

“…During more recent stages of the war, to develop practical hands-on skill stations and drills, we reviewed potential chemical, biological, and radiologic weapons historically produced and used by the Russian Federation (or its allies) 6 to identify plausible risks to Ukraine military personnel and civilians. 13 We also prioritized preparedness, rapid assessment, and treatment guidelines to recognize and manage these acute exposures in wartime settings. Evaluating a potential CBRNE exposure should also emphasize (1) immediate life-saving interventions and resuscitation (2), evacuation from the exposure (3), diagnosis of syndromic symptoms or toxidromes, and (4) supportive care and antidote therapy, as described in Figure 2).…”

Terrorism-Related Attacks in East Asia from 1970 through 2020

“…3,4,16,17 Nerve agents have also 19,20 These findings are in line with previous research that the use of chemical weapons in terrorist attacks, although rare, remains a significant challenge and concern because of their ability to inflict massive numbers of casualties. 21 Previous literature has determined that among global chemical terror attacks from 1970 through 2017, the most common routes of exposure were dermal-mucosal (43.8%), inhalational (37.2%), enteral (16.9%), parenteral (1.7%), and multiple (0.4%). 22 The most frequent terrorist attack weapon type in East Asia was explosives.…”

A Descriptive Analysis of the Use of Chemical, Biological, Radiological, and Nuclear Weapons by Violent Non-State Actors and the Modern-Day Environment of Threat

“…16 Tin, Cheng, Shin, et al Also, VNSAs need not go to the trouble of manufacturing agents at all, as powerful pharmaceuticals such as fentanyl, remifentanil, carfentanyl, or halothane are readily available on the dark web, and commonly used industrial chemical agents such as chlorine gas can be deployed for nefarious purposes. 3,17,18 The use of drones by terrorist groups is well-known; drones are used to gather intelligence on secure areas using visual, thermal, and infrared technology, thereby circumventing conventional defenses. Modifying the drone to carry a small payload (chemical, biological, or radiological) and a specialized dissemination device is possible and plausible.…”

“…1,2 Deadly chemicals are readily available in the industrial sector and home-made bioweapons are increasingly plausible as biotechnologies advance. [3][4][5] In addition, the threat of artificial intelligence (AI) looms as a tool to create innovative chemical weapons that might not otherwise have been conceived of. 6 Further, radiation sources used commonly in the medical sector are vulnerable to theft and modifications and then used to create dirty bombs, and nuclear plants are vulnerable to both cyber hacks and physical damage, which could lead to meltdowns and wide-spread human, structural, and environmental devastation.…”