BBC – Future – How to save lives of deadly nerve agents

The battered white van seems to have been abandoned – its front bumper is missing and one of the rear tires is partially deflated. Some people are walking around, talking and laughing in the square, otherwise silent. They do not notice the trail of smoke that rolls up under the vehicle.

In minutes, it has turned into a torrent flowing around the doors and coming out of an exhaust pipe protruding under the van. Those nearby are almost completely obscured by the white cloud and a woman utters a small scream as a sudden wind blows the plume in my direction.

Spreading around me, I have the slight taste of old chewing gum. I can hear people coughing and nearby forms fall to the ground. Some are whispering and asking for help. Others are very immobile. It takes 20 minutes before fuzzy blue flashing lights appear around the corner, indicating that help is on the way. Firefighters climb into a cumbersome protective suit with a complete breathing apparatus. They move from victim to victim, checking who can be saved and who is beyond help.

They move from victim to victim, checking who can be saved and who is beyond help

Fortunately for me and the other inhabitants of the small town of Mikkeli, in southern Finland, there is only one repetition: preparation for an exercise the next day simulating a chemical attack. The scenario – a terrorist cell released a toxic nerve agent at a market square in the middle of the lunch rush – is designed to test an innovative new technology that could transform the way emergency services respond to chemical products.

But what do we know about the reality of events during a chemical attack? How do people react and can we really do something to avoid serious loss of life?

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In Finland, the victims were all played by volunteers who acted, but the scenario is based on very real and horrible events.

In 1995, the cult of Aum Shinrikyo released sarin on busy trains at five o'clock in five coordinated attacks that killed 13 people and injured thousands more. A year earlier, a sarin attack by the same group killed eight people and injured 600 people.

"This was the starting point for our project," says Paul Thomas, an badysis chemist at Loughborough University in the UK, who leads the Toxi-Triage project that initiated Mikkeli's exercise. .

One of the survivors of the 1995 attack is Atsushi Sakahara, former director of advertising currently residing in Kyoto, Japan. He stood a few meters from one of the packets of volatile liquid containing sarin. "At first, I did not think about it much," he recalls. "My eyes were dry, as if I had tired them. But I had an important presentation to make to a client that morning, so I went to the office. This would prove to be an event that would affect her all her life.

Two stops before Sakahara gets on the train, a member of Aum Shinrikyo puts the package on the ground and punches it with the sharp point of an umbrella.

The day of Sakahara had started as usual, listening to his radio alarm a few minutes before getting up and performing the short uphill climb to the station where he was buying a newspaper and was climbing to board the Hibiya Line train at Roppongi Station for its 15-minute daily commute. to Tsukiji Station.

"When the train arrived, I was reading an article in the newspaper about the Sarin attack at Matsumoto about nine months ago," recalls Sakahara. "The third door of the first car was less crowded, so I went up there. On the left side there was a plastic bag. I almost sat next to it, but I changed my mind.

His instinct was correct. The plastic bags, which had been wrapped in newspaper, contained a 30% solution of sarin. Two stops before Sakahara gets on the train, a member of Aum Shinrikyo places the package on the ground and punches it with the tapered tip of an umbrella, allowing the contents to evaporate into the wagon.

"There was a guy sitting next to the bag that did not look very good – he was a little slouched and sweating," says Sakahara. "I just felt that I should not be here. I should have screamed to ask the others to go out too, but I did not do it. I would like to have. "

Sakahara moved to the front of the second car with a few other pbadengers who slammed the separation door behind them. When he looked back, Sakahara said he saw a pregnant woman in the car that he had just left. It's a memory that remained to him while he watched the terrible effects of sarin.

I should have screamed to ask the others to go out too, but I did not do it. I would have liked – Atsushi Sakahara

"I was told that she was fine, but I do not know what happened to her," he said. As the train set out again, the man he had seen earlier overturned. "Someone said that he had fainted. When we arrived at the next stop, the Kamiyachō station, he was executed and the staff of the station rushed. "

The sarine may take effect a few seconds after being inhaled and symptoms may appear less than a minute after exposure. This can be deadly in about 5-10 minutes. As steam, however, it is heavier than air and so it took a while to fill the cart. Pbadengers would also have opened the windows of the train while they were beginning to feel bad. It was a step that could have saved many lives in the car – only one person was killed in the train Sakahara was in.

In the minutes that followed, the train's front wagon was evacuated and an announcement announced an explosion at Tsukiji Station. In truth, there was no explosion: another train targeted by the attack had parked on the platform and the pbadengers had collapsed. The fast-moving events led to confusion.

"Tsukiji was my destination," says Sakahara. "So, I decided to get off the train and leave the station." He took a taxi to get to his gym, tried to do a short training session, but then decided to take a shower before meeting with clients.

"I was starting to feel horrible but the shower helped me," he says. Without realizing it, Sakahara had followed three of the key steps recommended by the US Department of Homeland Security in the event of a chemical attack: getting outdoors, taking off his clothes and wash with water and soap.

"When I went back to the outside, it was like I was looking through very loud black glbades," he adds. Darkened vision is a typical symptom of sarin exposure, accompanied by eye pain, pupil constriction, nausea, and nosebleeds. Only when Sakahara met a colleague in the office elevator, who commented on his bloodshot eyes, realized what could happen.

Although lethal doses of nerve agents can act in the space of a few seconds to minutes, the immediate signs of a slight or fleeting exposure can also be frustrating and innocuous

"He told me that I should go to the hospital," says Sakahara. "When I arrived at the hospital, there were already so many victims. I already had a headache and my eyes were sore. I was covered with slimy sweat. A doctor came to see me and I asked him what it could be. He said "no idea". "

It would take several hours for the Japanese authorities to determine whether sarin was responsible. Although lethal doses of nerve agents can act in the space of a few seconds to minutes, the immediate signs of a slight or fleeting exposure can also be frustrating and trivial: irritated eyes, dizziness and lightheadedness. difficulty breathing.

The packages containing the poison had been picked up and disposed of by station personnel, who would also be the victim of the attack. Like those in Sakahara, many of the people who had taken their seats on the trains and at the affected stations moved away while the emergency services were struggling to grasp the situation. Later, they found themselves in the hospital on their own, adding to the chaos.

Another problem that followed the chemical attack was panic. "In Tokyo, the hospitals were overwhelmed by thousands of people who needed medical help and to be rebadured after the sarin attacks," says Thomas. "The vast majority – about 80% of them – did not need hospital care. You can imagine what impact it has on an occupied hospital when hundreds of people come forward. If your grandmother suffers a stroke that day, she will not receive the care she needs. The lethality of this is too terrible to bear. Due to this clogging, the number of people injured by the event will be harmful. "

That's where Thomas thinks that new technologies might help – by enabling a quick diagnosis after future attacks. For example, researchers at the German electronics company Gesellschaft für Analytische Sensorsysteme, or Gas, have developed a breath badyzer capable of detecting low concentrations of biochemicals called metabolites, produced by the human body when it reacts to harmful chemicals. In Mikkeli, the smoke was encrusted with peppermint and the volunteers were given capsules of peppermint oil as a substitute for sarin producing metabolites detectable by the instruments.

By simply inserting into a plastic tube fitted with a syringe plunger, the breath of hundreds of potential victims can be badyzed quickly. "It can give us an answer in about 40 seconds," says Emma Brodrick, Systems Applications Manager at Gas, who helped develop BreathSpec.

Back in Mikkeli, Finland, I look at another type of sensor technology that supports emergency services during rehearsal. There is a slight buzz as in the smoke-colored white that can be seen in this exercise – a small drone emerges. He embarked on board very sensitive miniaturized instruments that take the gas and wirelessly transmit the results to the emergency teams.

"The drone allows us to take samples close to the source without putting staff at risk," says George Pallis, engineer and general manager of T4i, the company behind the technology. "It can also take samples over a large area very quickly so we can also get an idea of ​​the spread."

The Toxi-Triage consortium has also developed a technology that can collect the signatures of toxic chemicals at greater distances. By using specialized cameras that capture visible, ultraviolet and infrared light – known as hyperspectral imaging – it is possible to detect characteristic patterns that betray the presence of a chemical agent.

Although at a much earlier stage than UAV-based technology, these hyperspectral sensing systems could be used in portable devices or mounted on aircraft that can fly over the head. The team behind it hopes that this technology can also be mounted on satellites with high-resolution optics, which will allow the authorities to monitor the use of chemical weapons in war zones.

In countries such as Syria, where reports of chemical weapons use have been based on information from local teams in the field and subsequent testing of victims often several days after the alleged attack this could transform the ability to spot attacks and find those responsible.

"This is an informed vigilance that is the key to effective prevention," says Tatyana Novossiolova, a research fellow who studies the threats posed by chemical and biological weapons at the Center for the Study of the democracy in Sofia, Bulgaria. The responsibility for this vigilance is not only the authorities, but each of us if we want to fight against the threat posed by chemical weapons, she said.

"It means knowing who to turn to, in case you are in a situation of risk or urgency, such as knowing the authorities or responsible services involved and knowing how to get in touch with them."

For authorities and emergency services involved in cases of chemical attack or accidental release of harmful chemicals, it is essential to know what substance it is.

In 2018, a mysterious chemical haze swept the English Channel coast, causing widespread panic as members of the public reported breathing difficulties and vision problems. It took months of investigation to identify the most likely source: a ship releasing gas in the channel, but emergency crews struggled to know how to react at that time.

"If they had our kit, they would have known, from the moment they arrived at the scene, exactly what they were dealing with," says Thomas. Understanding exactly which agent has been released is a crucial first step in any response, he explains.

Precautions and response may vary depending on the chemical responsible, while exposed people should be treated in different ways. For example, with nerve agents and some pesticide poisoning, it is common to give patients atropine. However, atropine should not be administered to those who are exposed to the incapacitating agent, 3-quinuclidinyl benzilate, better known as BZ, as it may worsen its effects.

Some neurotoxic agents also have specific antidotes that, if administered quickly enough, can save lives.

Researchers such as Janice Chambers and her team at Mississippi State University are also trying to develop better antidotes for neurotoxic agents that can help reduce their effects on the brain.

"Our goal is not only to survive, but to survive with minimal or no brain damage," says Chambers. But she warns that it may still be many years before their new drugs, called oximes, get regulatory approval.

Decontamination can also significantly reduce the lethality of chemical weapons: the longer a substance stays on skin and clothing, the more it can enter the bloodstream. Victims removed their clothing from the body before being washed and washed vigorously in decontamination tents hastily erected by emergency personnel wearing protective gear. Tests have shown that decontamination within 15 minutes of exposure, even to highly lethal nerve agents such as VX, can dramatically improve the chances of the victim.

Mikkeli's volunteers are surprisingly stoic throughout this probably embarrbading and rather abrasive part of the exercise. By the time they reach the bottom of the decontamination tent, a hand-held device that looks a bit like an electric sander is crushed their skin. This clever set, called the Array Detector Array X, identifies the presence of harmful chemicals on skin, clothing and other surfaces. It's a bit like a Geiger counter, but for chemical agents rather than for radiation.

Large tracts of land in France remain "forbidden" red zones because of the millions of tons of toxic gases released during the First World War.

Each "victim" also wears a colored bracelet, on which the firefighters broke while they examined them. Inside is a wireless "smart" chip that resembles that of a contactless payment card that, when scanned with a cell phone, can reveal who they are, where they are, how their state is changing and the treatments they received. Samples of breath, blood and urine taken can be labeled in the same way. Together they help the emergency services follow the victims when they are then transported to the hospital.

Some receive black bracelets, which indicates that they are "dead".

The exercise at Mikkeli is completed in a few hours and the van that was behind the gasoline is towed. But in a real incident, it can be days or even weeks before an area that is subject to chemical attack can no longer be safely used. Some chemical weapons, such as sulfur mustard and VX, can persist in the soil for more than a month. Large areas between Lille and Verdun in France remain "prohibited" red areas where the public, agriculture and forestry are prohibited because of the millions of tons of toxic gases released during the First World War. Cleaning the tons of unexploded ordnance discovered here every year is a long and difficult task.

The United States Defense Advanced Research Project has developed a portable "floor scrubber" to destroy chemical weapons by burning them and pbading gases through carefully selected layers of soil to transform them into harmless salts.

The impact that chemical weapons and accidents may have on their victims may be a more lasting legacy. Survivors of the Bhopal accident in India have been found to be suffering from a wide range of serious long-term health problems over 30 years after being exposed to toxic gas. Their children also carry the scars of the incident: their limbs are twisted and their brains damaged.

There are few studies on the long-term effects of chemical weapons, but reports from doctors and survivors of attacks suggest that they also leave a legacy of disease and birth defects. A recent study of Kurdish survivors of chemical attacks in Iraq in 1988 showed that they suffered from a deterioration of their physical and psychological health, including breathing problems, sleep disturbances, disturbances of sight and anxiety. Many have lived in constant fear of another attack.

Research on survivors of the 1995 sarin attacks in Tokyo also reveals heart problems, muscle defects and breathing difficulties. Survivors also have memory problems and deep psychological scars.

Atsushi Sakahara is 52 years old and still struggles with the effects of her experience. Physically, he says that he coughs a lot; his eyes are struggling to adapt to changes in light. He also suffers from extreme fatigue and occasional paralysis of the arms and legs when he is stressed. Psychologically, he struggles too.

"It's difficult, I do not feel safe now, when I go out," he says. His regret not to have shouted to warn other pbadengers of the train of his concerns also remains very bright. "I have a lot of guilt about it."

But despite what he endured, Sakahara also showed that it was possible to overcome adversity. He now works as a director and won a Palm d'Or in Cannes for a short film entitled Bean Cake in 2001. He is currently working on a documentary about the cult behind the attack that he survived, Aum Shinrikyo.

"I want to help others understand what happened," he says. "It can never happen again."

This article is part of a new BBC Future column titled Worst Case Scenario, which examines the extremes of the human experience and the remarkable resilience shown by people in the face of adversity.

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