Welcome to AACC's Expert Access Live Online Program

Dr. Steven I. Baskin is our January 2002 expert hosting this session on, Chemical Terrorism.

We would like to extend our most sincere thanks to the Bayer Corporation for making this program possible.

What are the latest developments in the kind of precautions the army taken to ensure the safety of soldiers in the field?
Washington, DC

Dr. Steven I. Baskin: Many developments and checks are being examined. I am scientist working in only one of the many programs. For a more complete answer, you should go to someone who has a more complete view of policy vs science. Scientifically, Many in vitro and in vivo experiements are being accomplished. The lieterature is constantly being probed, analyzed and reviewed. Interactions take place with members of this agency and other agencies as well as with academia, the private sector and others. many searchs are done as recccently as this morning. Standard and advanced toxicology is being performed. ADME studies are performed to address FDA concerns and all rules/ regulation are complied with to address safety. Meeting such as Bioscience Review and others are well attended and the safety discussed. Consider examining the publications of the DOD agencies to see the pharmacology/toxicology of the latest developments.

1. Besides RBC-ChE, what other retrospective tests/methods are there for the clinician to assess for nerve agent exposure? 2. What materials can civilian institutions use for decontamination?
Boston, MA

Dr. Steven I. Baskin: In addition to RBC-ChE one could look at upregulation or downregulation of multiple muscarinic sites. These tests are available commercially. Measurement of cholesterol esterase also appear to be sensitive to low levels of OP's. Benschop as well as others have measured adducts of OP's (MS). The methodology of decontamination is readily available. go to WWW site and follow instructions. One of the sites I believe is: ccc.apgea.army.mil The concentrations of hypochlorite are provided, for example, with many other sources of information. If this site doesn't work for you call 410-436-2230.

I would like to know something about psychotropics and psychiatric disturbances that could be made, espetialy mass psychoses or similar BEOGRAD

Dr. Steven I. Baskin: Thank you very much for asking. As a group effort, we wrote a review as a special issue for Military Psychology covering many threat areas in chemical terrorism. It will appear in the March- April time frame and is edited by J. King and J. Romano. Rockwood and myself wrote the chaper on cyanide for example. Organophosphonate is well covered.

Does CDC have the laboratory capacity to respond to a chemical terrorist incident or should local/state health department laboratories develop biominitoring capabilities for chemical warfare agents. Or should the local/state efforts be towards analyzing environmental samples for these agents
Austin, Tx

Dr. Steven I. Baskin: Since I am a scientist at DOD and not a Policy person it is not clear if I am the best person to answer your question. DOD currently has the technology and personnel to do such assays. I have heard that CDC is working on the Benschop adduct to cholinesterase assay but I am not sure if they have worked it out. From experience in a local/state lab that had a healthy load of assays, it might be preferable to utilize a central technical lab that does these assays and has fresh standards at hand. The idea of spreading soman standards across the country may bring out angry folks and a security problem that we can't imagine.

I am aware of chemical detection devices being installed in underground subways. How effective are these devices? If an agent is detected, will there be ample time to evacuate?
Cincinnati, Ohio

Dr. Steven I. Baskin: There are many different types of devices. Paper strips to Mass specs. The specificity and sensitivity varies from product to product. Also the time constant varies (time it takes to assess sample) with the individual product. The czech detector appears to exhibit a different response than the American one for example. Some of the detectors which are surprisingly simple are surisingly good and sensitive. Some are less so. It depends on which one you are talking about. In terms of time to evacuate. It depends on the agent and its concentration and other physical chemical factors (remember PV=nRT). In general, leave the area as soon as you can.

Please comment on the options for decontamination of patients, specimens, and laboratory personnel and equipment in a chemical weapon attack.
Baltimore, MD

Dr. Steven I. Baskin: Oh where do I start. The Army's chemical casualty Division of USAMRICD at APG, MD has done a very good job outlining this information. They have issued a CD ROM, a book and have a web site that as taxpayers we should be proud of. Since I am not in that division, it doesn't impart directly on me. Their phone is 410-436-2230. I listed the web site in an answer to another question (see above). It is a suggestion to look the decon chapter over. It is written in a very straight forward, cookbook manner. It describes methods well with illistrations. You might want to look at the F. Sidell articles as well. He is very knowledgeble. The best option is probably to use a well thought out and already described method. It will save a lot of time and effort. More importantly it should save lives and provide a coordinated plan in advance. Also....PRACTICE!!

What chemical agents do you see as the most likely to be used for bioterrorism? Are clinical laboratory tests readily available to detect these agents?
Rochester, Minnesota

Dr. Steven I. Baskin: As I don't directly communicate with terrorist or hope I am not, this information is provided from agencies such as DDC, DOD, or other agencies. Organophosphates, cyanide, sulfur mustard, phosgene, ricin, antrax, bot tox, and arsenicals are only some of the agents listed. The lists vary from time to time. There are many available chapters that cover the "usual" suspects. Mass spec, AA, UV and a host of specific tests are available. For organophosphates there is a commercially available cholesterase assay kit, for example. For cyanide there is the dragger metter or some cyanide assays. (not the ion specific electrode). (interferences). For sulfur mustard one can assay for thiodiglycol. There are metters and assays devices available.

Does the ineffectiveness of Atropine at nicotinic receptors present any complications for exposed individuals? Thanks!
Milwaukee, WI

Dr. Steven I. Baskin: Organophosphates and organophosphonates (military) act at concentrations well below at the muscarinic sites than the nicotinic sites. Approximately, one needs 7x the phosphonate to act at the nicotinic site. Actually, atropine at high high concentrations will act at "nicotinic" sites i.e., ganglionic. In controlled experiments in animals, it has been found that nicotinic antagonists can help shift and antagonise the organophosphonate response. In reality, Pyridostigmine, for example, can help for CNS and cardiac problems. anticonvulsants such as valium are also thought to help is administrered soon enough and at adequate does. Look in a special issue on chemical terrorism in Military Psychology that should come out in March - April or in the CRC book edited by Somani and Romano.

How prepared do you think the military is to protect and treat and actual chemical attack? When do you think they will be 100% ready?
Nashville, TN

Dr. Steven I. Baskin: One great thing about America is that following 9/11, there was, despite the pain, a call of cooperation to call to suggest to try to help scientifically. I and my fellow scientists received many calls of useful suggestions. Some we had thought of, some probably won't work. It isn't only the military's fight but all our people to protect our family, our freinds, our people against chemical terrorism. It is an ongoing effort. Just like trying to protect people againt heart attacks. We are getting better and better but not 100%. With heart attacks, We have digoxin, antiarrthmics, statins, CPR, codes, defribrillation paddles, endotraceal absorbtion of drugs when iv access is not available, etc. but not yet 100%. We are making progress. Similar incremental improvement.

Should all laboratories and hospitals have facilities available for decomtamination? Who will pay for such major changes?
Chicago, IL

Dr. Steven I. Baskin: Labs and hospitals designated should have available facilites for decon. Even simple items as hypochlorite is inexpensive. I would not like your family members going to an emergency room in a small hospital in your home town only to find that that there is no anticyanide or anticholinesterase kit available. Homeland defenese act passed by congress may help or local legislation. Has it been determined that basic help is so expensive? What is the cost for atropine [It is rather cheap], anticyanide kit [rather cheap], hypochlorite [cheap].

Please comment on the status of globally co-ordinated effort on chemical terrorism.
Milwaukee, WI

Dr. Steven I. Baskin: Different areas of chemical terrorism is actually coordinated on many levels. It is coordinated across threat area for example. having worked many years in antidotes for cyanide, I can say I know many of the cyanide scientists. We see each other at meetings and talk about the latest information on cyanide accidents, cyanide mechanisms, treatments and methods. Similar coordination occur for sulfur mustard, phosgene, organophosphonates etc. This is not surprising. There is interchange at meetings, seminars in the literature which takes many formal and informal sites. There are also specialized meetings or sessions within meetings. Scientific friendships can on occasion overtake the place of politics. I can remember a session several years ago at IUTOX (International Union of Toxicology) in Paris where there was a good exchange and meeting of scientists from about 15 or more countries. It was super. If run in good spirit by open scientists, many barriers to communication can be broken. We need fore of this.

Dr. Baskin, I recognize that your presentation was on nerve agents, but would you comment generally on the level of morbidity associated with vesicant agents?
Broward County, FL

Dr. Steven I. Baskin: One of the lessions learned in World War I was the fact that Sulfur mustard would tie up a huge amount of medical resources. Thus a portion of the problem was not morbidity it self but the constant care and the manpower needed to maintain the afflicted soldiers. Several of the acute morbidity studies between WWI and WWII showed that sulfur mustards were notably toxic to the lymphatics. The canine studies were not completely understood in terms of mechanisms sad to say. In terms of long term toxicity, DNA appears to play a role. mustard appears to act primarily a a guanosine site. The same is said for the thiosulfate antidote. We hope to present another session on mustards and cyanide sometime in the future. At that time they will be discussed.They are in general less toxic than the organophosphonates but more toxic than cyanide.

I suspect that a number of new tests to detect chemical terrorism are on the horizon. Do you see a role for the Department of Defense in test approval or should the FDA continue to be the sole approving body.
Amherst, MA

Dr. Steven I. Baskin: As a scientist and not an administrator, I see FDA still being a approving body. I do see other agencies developing metters for the various threat agents. We are working on several benificial new tests.

Your presentation says VX is the most toxic molecule known to medicine. Are the agencies charged with implementing safety measure against chemical terrorism focusing more on the VX agent?
San Diego, California

Dr. Steven I. Baskin: Some scientists for multiple reasons are focusing on thiolate like agents. VX appears to has more of its effect on acetylcholinesterase instead of others as some that can effect acetylcholinesterase as well as affecting other esterases. Bot tox A is mentioned as being very toxic. The presentation is trying to compare various chemical vs biological agents and provide an overview in relative terms of toxicity.

For the first responders, there are screening kits such as color tests and paper tests for chemical terrorism agents. PLease comment on sensitivity and specificity. Further, are there " fast and easy " immunoassays being developed for routine clinical screening/testing? Milwaukee, WI

Dr. Steven I. Baskin: I am aware that many attempts have been made to develop antibodies to various organophosphorus agents and sulfur mustard. I am not aware that any of them are commercially availabe or "fast and easy". You may try to contact Dr. Yacob Ashani at IIBR (Israel Institute of Biological Research) in Israel who was working on butyrylcholinesterase as a target therapy. There is a assay kit available in this country but it is colorimetric in nature designed for humans. It is the testmate mfg by EQM in Cincinatti, Ohio. For cyanide there is a rapid test paper. You can buy it from a supplier in New York. There are many cyanide meters available The Compur, STM, Dragger that can be used by the first responder.

I hope you enjoyed this timely session of Expert Access Live-on-Line session. The questions and answers from today's session, and all previous sessions, are archived on our website and serve as a continuing source of education.

We hope you will join us for the February 5 Expert program when Drs. Paula Santrach and Greg Nuttall from the Mayo Clinic will host the session on Ecarin Clotting Time: A New Tool for Management of Heparin Induced Thrombocytopenia in Cardiac Surgery.

Again, thank you to the Bayer Corporation for making this educational program possible.