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Chemical Attack General Guidance

Be alert to the following:

  • Groups of individuals becoming ill around the same time

  • Sudden increase of illness in previously healthy individuals

  • Sudden increase in the following non-syndromes:

    • Sudden unexplained weakness in previously healthy individuals

    • Dimmed or blurred vision

    • Hypersecretion syndromes (like drooling, tearing, and diarrhea)

    • Inhalation syndromes (eye, nose, throat, chest irritation; shortness of breath)

    • Burn-like skin syndromes (redness, blistering, itching, sloughing)

  • Unusual temporal or geographic clustering of illness (for example, patients who attended the same public event, live in the same part of town, etc.)

Understanding exposure. Exposure may occur from vapor or liquid droplets and, less likely, contamination of food or water.

Chemical effects are dependent on:

  • volatility and amount of chemical

  • water solubility (higher solubility leads to more mucosal and less deep lung deposition and toxicity)

  • increased fat solubility and smaller molecular size increase skin absorption

Decontamination Considerations

  • Chemical warfare agents usually require removal of clothing and decontamination of the patient with soap and water.

  • Treating contaminated patients in the emergency department before decontamination may contaminate the facility.

Nerve Agents

  • Symptom Onset:

    • vapor: seconds

    • Liquid: minutes to hours

  • Symptoms

    • Moderate exposure: diffuse muscle cramping, runny nose, difficulty breathing, eye pain, dimming of vision, sweating, diarrhea

    • High exposure: all of the above plus sudden loss of consciousness, flaccid paralysis, seizures

  • Decontamination: rapid disrobing, water wash with soap and shampoo


  • Symptom Onset: seconds to minutes

  • Symptoms: almond-like smell

    • Moderate exposure: dizziness, nausea, headache, eye irritation

    • High exposure: loss of consciousness

  • Decontamination: clothing removal

Sulfur Mustard (blister agent)

  • Symptom Onset: 2 to 48 hours

  • Symptoms: skin erythema, blistering, conjunctivitis and lid swelling, upper airways sloughing, pulmonary edema, marrow suppression with hymphocytopenia

  • Decontamination: clothing removal, Large amounts of water

Phosgene (Pulmonary Agent)

  • Symptom Onset: 1 to 24 hours (rarely up to 72 hours)

  • Symptoms: shortness of breath, chest tightness, wheezing, mucosal and dermal irritation and redness

  • Decontamination: none usually needed

Ricin (castor bean toxin)

  • Symptom Onset: 18 to 24 hours

  • Ingestion: nausea, diarrhea, vomiting, fever, abdominal pain

  • Inhalation: chest tightness, coughing, weakness, nausea, fever

  • Decontamination: clothing removal, water rinse

T-2 (mycotoxin)

  • Symptom Onset: 2 to 4 hours

  • Symptoms: dermaland mucosal irritation, blistering, necrosis, blurred vision, eye irritation, nausea, vomiting and diarrhea, altaxia, coughing and dyspnea

  • Decontamination: clothing removal, water rinse

This is a scaled down version
of our main environmental health site. For more detailed information please visit our main site at http://www.doh.state.fl.us/chd/volusia/EH/index.html