Fatal sarin poisoning in Syria 2013: forensic verification within an international laboratory network

John, Harald; Schans, M.J. van der; Koller, Marianne; Spruit, Helma; Worek, Franz; Thiermann, Horst; Noort, Daan

doi:10.1007/s11419-017-0376-7

Cited by 188 publications

(149 citation statements)

References 16 publications

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“…Emergencies caused by hazardous toxicological/chemical materials may result from "inadvertent residential, industrial, occupational or transportation mishaps; natural disasters; and hazardous-substance releases that are intended to cause harm" [5]. Beyond such risks, the use of hazardous materials may be intentionally directed by humans to cause mass devastation, as part of political or military conflicts or wars, as was displayed in the Syrian civilian war [5,11,12]. Mass casualty incidents that involve hazardous materials may be detrimental to the functional continuity of emergency departments (EDs), leading to chaos, confusion, miscommunication, lack of coordination, and misinformation [13,14].…”

Section: Characteristics Of Toxicological/chemical Threatsmentioning

confidence: 99%

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

Siman‐Tov

Davidson

Adini

2020

IJERPH

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Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F (1,20) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.

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Section: Characteristics Of Toxicological/chemical Threatsmentioning

confidence: 99%

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

Siman‐Tov

Davidson

Adini

2020

IJERPH

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“…86 Sarin was deployed as a terrorist weapon in the 1995 Tokyo subway attack 15 and has been used in military conflicts against civilian populations in Iraq and Syria. 13,14 Nerve agents were also used in the widely publicized assassination attempts in Malaysia in 2017 and the United Kingdom in 2018. 11,12 The incident in the United Kingdom highlighted fourth-generation agents, also known as Novichok agents.…”

Section: Cholinergic Agentsmentioning

confidence: 99%

Hazardous Chemical Emergencies and Poisonings

2019

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H azardous chemical emergencies and related poisonings result from various exposures, including inadvertent residential, industrial, occupational, or transportation mishaps; natural disasters; and hazardoussubstance releases that are intended to cause harm. 1-3 Up to 100,000 industrial chemicals are used each day in the United States, 4 and federal authorities estimate that more than 10,000 potentially consequential releases of hazardous substances occur annually. 4,5 In addition, numerous compounds have been developed primarily as military weapons, with exceedingly high toxicity. 6-8 Both toxic industrial chemicals and military chemical weapons are capable of causing mass casualties in a substantive release and may be deployed intentionally in the context of chemical terrorism, 8-10 targeted assassination attempts, 8,11,12 or wartime attacks on civilian populations, as tragically shown in the current Syrian war. 13,14 A toxidrome-based, emergency medical systems (EMS) approach to chemical weapons attacks was presented recently by Ciottone in the Journal. 8 (Toxidromes are constellations of clinical signs, particularly vital signs, mental status, and ocular, respiratory, neurologic, and skin findings, that are characteristic of general classes of poison.) A similar approach is useful for the myriad possible entities in nonintentional hazardous chemical incidents. We review the toxicology and hospital-based management of acute poisonings caused principally by dermal and inhalational exposure to several representative chemical-agent classes in incidents involving the release of hazardous substances or chemical attacks (Table 1). Cyanide and organophosphate poisonings are emphasized, since they can also affect individual patients in the more familiar contexts of occupational and residential exposures or ingestions with suicidal intent and since specific emergency antidotal therapy is crucial for good outcomes. Ov erv iew of Hospita l-Ba sed Emergenc y M a nagement Incidents involving the release of hazardous chemicals may result in widespread chaos and confusion, affecting the EMS response and emergency department (ED) care. 2,8 A rapid influx of multiple critically ill victims with unfamiliar illnesses, as well as numerous low-risk but understandably anxious patients, potentially far outnumbering the seriously ill, 1 poses significant challenges to hospital-based emergency care providers. Patients may bypass prehospital care and arrive at the hospital unaware of or misinformed regarding the cause of their symptoms, with the potential to chemically contaminate bystanders and staff. 2,15-17 Thus, prompt recognition of the chemical event is important so that ED staff and hospital emergency management personnel can secure hospital entrances and decontaminate contami

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“…This was explained by the different incubation times but also by the lower reactivity of soman to HuBuChE because of its higher steric hindrance. Compared to the standards approaches that have been used for the analysis of sarin in plasma [48], this on-line method allows a fast, sensitive and specific analysis. The extraction step of OPNA-HuBuChE adducts by anti-HuBuChE antibodies, that is usually performed in 2 h with the use of immunomagnetic beads (7) was here performed in less than 20 min, leading to high recovery and high specificity.…”

Section: Analysis Of Plasma Spiked With Sarin and Soman By The On-linmentioning

confidence: 99%

Online coupling of immunoextraction, digestion, and microliquid chromatography-tandem mass spectrometry for the analysis of sarin and soman-butyrylcholinesterase adducts in human plasma

et al. 2017

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Organophosphorus nerve agent (OPNA) adducts formed with human butyrylcholinesterase (HuBuChE) can be used as biomarker of OPNA exposure. Indeed, intoxication by OPNAs can be confirmed by the LC/MS analysis of a specific HuBuChE nonapeptide on which OPNAs covalently bind. A fast, selective, and highly sensitive online method was developed to detect sarin and soman adducts in plasma, including immunoextraction by anti-HuBuChE antibodies, pepsin digestion on immobilized enzyme reactors (IMER), and microLC/MS analysis of the OPNA adducts. The potential of three different monoclonal antibodies, covalently grafted on sepharose, was compared for the extraction of HuBuChE. The online method developed with the most promising antibodies allowed the extraction of up to 100% of HuBuChE contained in plasma and the digestion of 45% of it in less than 40 min. Moreover, OPNA-HuBuChE adducts, aged OPNA adducts, and unadducted HuBuChE could be detected (with S/N > 2000), even in plasma spiked with a low concentration of OPNA (10 ng mL). Finally, the potential of this method was compared to approaches involving other affinity sorbents, already described for HuBuChE extraction. Graphical abstract Online coupling of immunoextraction, digestion, and microliquid chromatography-tandem mass spectrometry for the analysis of organophosphorous nerve agent adducts formed with human butyrylcholinesterase.

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Fatal sarin poisoning in Syria 2013: forensic verification within an international laboratory network

Cited by 188 publications

References 16 publications

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

Hazardous Chemical Emergencies and Poisonings

Online coupling of immunoextraction, digestion, and microliquid chromatography-tandem mass spectrometry for the analysis of sarin and soman-butyrylcholinesterase adducts in human plasma

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