Assessing Chemical Assessing Chemical Exposure:Exposure:
A Lab PerspectiveA Lab PerspectiveKevin Chao, Ph.D.Kevin Chao, Ph.D.
Department of Public HealthDepartment of Public HealthState of CaliforniaState of California
Topics CoveredTopics Covered
Introduction to All Hazards TerrorismIntroduction to All Hazards Terrorism Chemical Terrorism SpecificsChemical Terrorism Specifics Toxicology/Properties of likely agentsToxicology/Properties of likely agents Public Health/Laboratory responsePublic Health/Laboratory response Environmental and clinical sample Environmental and clinical sample
collectioncollection Environmental and clinical sample testingEnvironmental and clinical sample testing
All Hazards?All Hazards?
ChemicalChemical BiologicalBiological RadiologicalRadiological NuclearNuclear ExplosiveExplosive
Toxic Industrial ChemicalsToxic Industrial Chemicals
ChlorineChlorine Hydrogen CyanideHydrogen Cyanide AmmoniaAmmonia PhosgenePhosgene Methyl IsocyanateMethyl Isocyanate
Bhopal, IndiaBhopal, India
December 3, 1984December 3, 1984 40 Tons of MIC (methyl isocvanate)40 Tons of MIC (methyl isocvanate) 500,000 exposed (500,000 exposed (5-8 miles downwind5-8 miles downwind)) 11,000 disabled11,000 disabled 3,800 dead3,800 dead
Similar Chemical Incident in Similar Chemical Incident in California?California?
Metam SodiumMetam Sodium Where did it happen?Where did it happen? Lucky or what?Lucky or what?
Comparative ToxicityComparative Toxicity(lethal dose)(lethal dose)
Highly Toxic AgentsHighly Toxic AgentsDeveloped to Kill or DisableDeveloped to Kill or Disable
Advantages:Advantages: Small amounts neededSmall amounts needed Surreptitious useSurreptitious use Targeted useTargeted use
Disadvantages:Disadvantages: ““Harder” to obtainHarder” to obtain Nations?Nations? Cults?Cults? Lunatics?Lunatics?
Some Overt Exposure ScenariosSome Overt Exposure Scenarios
Blast, leakBlast, leak Ventilation ductsVentilation ducts Closed spaces:Closed spaces:
• • subway carssubway cars• • planesplanes
Vehicular releases:Vehicular releases:• • drive-bydrive-by• • crop dustingcrop dusting
Some Covert Exposure ScenariosSome Covert Exposure Scenarios
Food, tobacco, alcoholFood, tobacco, alcohol Medications, blood productsMedications, blood products Cosmetics and personal hygieneCosmetics and personal hygiene productsproducts Surfaces (door knobs, utensils):Surfaces (door knobs, utensils):
hand-to-mouthhand-to-mouth Fixed distribution systems: water,Fixed distribution systems: water, natural gasnatural gas
Respiratory Irritant GasesRespiratory Irritant Gases
ChlorineChlorine PhosgenePhosgene Oxides of nitrogenOxides of nitrogen AmmoniaAmmonia Hydrogen chlorideHydrogen chloride FormaldehydeFormaldehyde AcroleinAcrolein
Respiratory Irritant GasesRespiratory Irritant Gases
Direct chemical reaction withDirect chemical reaction withtissuestissues
pH, redox, addition, substitutionpH, redox, addition, substitutionreactionsreactions
structural lipids and proteinsstructural lipids and proteinsdenatured or degradeddenatured or degraded
Induced inflammatory reactionInduced inflammatory reaction
Metabolic ToxicantsMetabolic Toxicants
CyanidesCyanides AzidesAzides SulfidesSulfides Carbon monoxideCarbon monoxide FluoroacetatesFluoroacetates Dinitrophenol, pentachlorophenolDinitrophenol, pentachlorophenol Many othersMany others
Cyanide: ToxicologicalCyanide: ToxicologicalMode of ActionMode of Action
Blocks electron transport in Blocks electron transport in mitochondriamitochondria
Binds to Fe+3 in cytochrome oxidaseBinds to Fe+3 in cytochrome oxidase Prevents electron transfer to oxygenPrevents electron transfer to oxygen Oxygen-rich red venous bloodOxygen-rich red venous blood
Carbon MonoxideCarbon Monoxide
#1 chemical cause of acute toxic death#1 chemical cause of acute toxic death #2 rank air pollutant after CO2#2 rank air pollutant after CO2 Vehicular, coal/oil burning, industrialVehicular, coal/oil burning, industrial Invisible, odorlessInvisible, odorless Affinity for Hgb 220x greater than that of O2Affinity for Hgb 220x greater than that of O2 Forms carboxyhemoglobinForms carboxyhemoglobin Proportionately decreases oxygen carryingProportionately decreases oxygen carrying
capacitycapacity Red venous bloodRed venous blood
Vesicant AgentsVesicant Agents(Blister Agents)(Blister Agents)
Mustard agentsMustard agents• • Sulfur (military use)Sulfur (military use)• • Nitrogen (chemotherapy)Nitrogen (chemotherapy)
LewisiteLewisite(2-chlorovinyl dichloroarsine)(2-chlorovinyl dichloroarsine)
Mustard: TargetsMustard: Targets
Nerve AgentsNerve Agents
A family of agents that kill byA family of agents that kill bydestroying acetyl cholinesterase, andestroying acetyl cholinesterase, anenzyme essential for proper nerveenzyme essential for proper nervefunctionfunction
Physical PropertiesPhysical Properties
Liquids at room temperature - not gasesLiquids at room temperature - not gases Soluble in fat and waterSoluble in fat and water Absorbed through respiratory tract, skin,Absorbed through respiratory tract, skin,
eyeseyes Phosphonate estersPhosphonate esters Tabun (GA) - most unavailableTabun (GA) - most unavailable Sarin (GB) - most volatileSarin (GB) - most volatile Soman (GD) - fastest “aging”Soman (GD) - fastest “aging” VX - most potent and persistentVX - most potent and persistent Other nerve agentsOther nerve agents
Symptoms of Nerve AgentsSymptoms of Nerve Agents
““DUMBELS”DUMBELS” D - DiarrheaD - Diarrhea U - UrinationU - Urination M - MiosisM - Miosis B - Bronchoconstriction, BronchorrheaB - Bronchoconstriction, Bronchorrhea E - EmesisE - Emesis L - LacrimationL - Lacrimation S - SalivationS - Salivation
What plant is this?What plant is this?
Public Health AimsPublic Health Aimsin a Chemical Eventin a Chemical Event
Identify the agent or causeIdentify the agent or cause Circumstance, intelligence, clinical Circumstance, intelligence, clinical
syndromesyndrome Environmental or biological fluids assayEnvironmental or biological fluids assay Determine temporal or geographicalDetermine temporal or geographical
distribution of exposuredistribution of exposure Determine relative (high/low) exposuresDetermine relative (high/low) exposures
Public Health AimsPublic Health Aimsin a Chemical Event (cont.)in a Chemical Event (cont.)
Evaluate health implicationsEvaluate health implications Provide medical and public healthProvide medical and public health
guidance and supportguidance and support Provide continued surveillance andProvide continued surveillance and
preventionprevention
After a CT IncidentAfter a CT IncidentEnvironmental Samples:Environmental Samples:
Identify chemical agent on sceneIdentify chemical agent on scene Define contamination zoneDefine contamination zone Check for effectiveCheck for effective
decontaminationdecontamination Determine when to allow re-entryDetermine when to allow re-entry
Who collects the environmental Who collects the environmental samples?samples?
Hazmat TeamHazmat Team CST Team, request through State OESCST Team, request through State OES FBI Team FBI Team Standard procedures for collecting these Standard procedures for collecting these
samples as described in HAZMAT samples as described in HAZMAT handbook with proper PPE and handbook with proper PPE and precautionprecaution
What types of samples are needed?What types of samples are needed?
Sample types: solid, liquid, wipes and airSample types: solid, liquid, wipes and air
Who is going to test them for Who is going to test them for you?you?
Agencies may test them for you:Agencies may test them for you: -Cal EPA (DTSC)-Cal EPA (DTSC) -US EPA-US EPA -LLNL for warfare agents-LLNL for warfare agents -CDHS could also help-CDHS could also help
After a CT IncidentAfter a CT IncidentClinical Samples:Clinical Samples:
Confirm agent IDConfirm agent ID Assist in medical treatmentAssist in medical treatment Separate exposed from “WorriedSeparate exposed from “Worried
Well”Well” Support health effect studiesSupport health effect studies
Continues:Continues:
Predicting levels of toxicants inPredicting levels of toxicants inpeople using environmentalpeople using environmentalmonitoring is very difficult andmonitoring is very difficult andincludes many assumptions…includes many assumptions…
Bio-monitoring- MeasuringBio-monitoring- MeasuringChemicals in PeopleChemicals in People
California has the funding to start a bio-California has the funding to start a bio-monitoring program as a tool to assess monitoring program as a tool to assess human exposure to toxic chemicals in human exposure to toxic chemicals in CaliforniaCalifornia
Your Plan for Human SpecimensYour Plan for Human Specimens
Local HAZMAT/first respondersLocal HAZMAT/first respondersidentify or suspect incidentidentify or suspect incident
Jurisdiction or FBI notifies CDHS/CDCJurisdiction or FBI notifies CDHS/CDC
Who collects the clinical Who collects the clinical samples?samples?
Attending physicians at ED to order the Attending physicians at ED to order the collection of clinical specimens (three collection of clinical specimens (three purple, one green and 25 cc urine for purple, one green and 25 cc urine for adults; urine only for infants and young adults; urine only for infants and young children) to be collectedchildren) to be collected
PH Labs as a hub to collect and ship PH Labs as a hub to collect and ship initial samples to CDHS/CDC pending initial samples to CDHS/CDC pending discussiondiscussion
What does CDC do with the first 40 What does CDC do with the first 40 samples?samples?
CDC performs PCR and “Rapid ToxicCDC performs PCR and “Rapid ToxicScreen” on initial samplesScreen” on initial samples
CDC provides guidance to LRN forCDC provides guidance to LRN foranalysis of remaining samplesanalysis of remaining samples
Rapid Toxic ScreenRapid Toxic Screen
Analysis of 40 samples for 150Analysis of 40 samples for 150agents or metabolites within 36 hrsagents or metabolites within 36 hrs
CDC has greater “screening”CDC has greater “screening”capability than currently available atcapability than currently available atany city or state public health labany city or state public health lab
Collecting Clinical Specimens:Collecting Clinical Specimens:
Protocols for collecting and shippingProtocols for collecting and shippingblood (3 purple and 1 green) and urine blood (3 purple and 1 green) and urine (25 mL) (2 blank tubes and cups are (25 mL) (2 blank tubes and cups are required) posted onrequired) posted onCDC’s website:CDC’s website:http://www.bt.cdc.gov/labissues/http://www.bt.cdc.gov/labissues/pdf/chemspecimencollection.pdfpdf/chemspecimencollection.pdf
Collecting Clinical Specimens:Collecting Clinical Specimens:
Clinical specimens will beClinical specimens will becollected at hospitalscollected at hospitals
Local Public Health Lab should continue Local Public Health Lab should continue train hospital staff (ED nurse managers train hospital staff (ED nurse managers especially) on what clinical samples especially) on what clinical samples should be collected.should be collected.
Call Kevin Chao for resources may be Call Kevin Chao for resources may be able to test the samples at 510-377-3435able to test the samples at 510-377-3435..