Wednesday, September 3, 2008
Because of recent terrorist events many workers have expressed concern about the possibility of a terrorist attack involving blister agents. Blister agents have been used as chemical warfare agents, in World War I (1914-1918) and the Iran-Iraq war (1984-1988). The following frequently asked questions will help workers understand what blister agents are and how they may affect their health and safety.
General Information
What are blister agents?
Blister agents or "vesicants" are chemicals which have severely irritating properties that produce fluid filled pockets on the skin and damage to the eyes, lungs and other mucous membranes. Symptoms of exposure may be immediate or delayed until several hours after exposure.
What are the different forms of blister agents and their properties?
The three major categories of blister agents are: sulfur mustard (H,HD,HT), nitrogen mustard (HN-1, HN-2, HN-3), Lewisite (L), and halogenated oximes (CX). Sulfur mustards are clear to yellow or brown oily liquids with a slight garlic or mustard odor. Although volatility is low, vapors can reach hazardous levels during warm weather. Nitrogen mustards are colorless to yellow, oily liquids with variable odors. Lewisite contains arsenic and is a dark oily liquid with a slight odor of geraniums. Phosgene oxime, one of the most common halogenated oximes, is a colorless solid or liquid, with an intense irritating odor.
Why are we concerned about blister agents as a terrorist’s weapon?
There are large stockpiles of blister agents which, if obtained by terrorists, could be released using bombs, explosives, spray tanks, or rockets.
How long will blister agents persist in the environment?
When exposed to air, blister agents will break down but this may take several days. Nitrogen mustards and Lewisite should break down quickly in soil and water. Sulfur mustards, however, may persist for several days in soil and water. When exposed to air, phosgene oxime is broken down slowly, but in water or soil it is broken down more quickly. See the following table for more information:
Types and Characteristics Chemical AgentsGeneral Information
What are blister agents?
Blister agents or "vesicants" are chemicals which have severely irritating properties that produce fluid filled pockets on the skin and damage to the eyes, lungs and other mucous membranes. Symptoms of exposure may be immediate or delayed until several hours after exposure.
What are the different forms of blister agents and their properties?
The three major categories of blister agents are: sulfur mustard (H,HD,HT), nitrogen mustard (HN-1, HN-2, HN-3), Lewisite (L), and halogenated oximes (CX). Sulfur mustards are clear to yellow or brown oily liquids with a slight garlic or mustard odor. Although volatility is low, vapors can reach hazardous levels during warm weather. Nitrogen mustards are colorless to yellow, oily liquids with variable odors. Lewisite contains arsenic and is a dark oily liquid with a slight odor of geraniums. Phosgene oxime, one of the most common halogenated oximes, is a colorless solid or liquid, with an intense irritating odor.
Why are we concerned about blister agents as a terrorist’s weapon?
There are large stockpiles of blister agents which, if obtained by terrorists, could be released using bombs, explosives, spray tanks, or rockets.
How long will blister agents persist in the environment?
When exposed to air, blister agents will break down but this may take several days. Nitrogen mustards and Lewisite should break down quickly in soil and water. Sulfur mustards, however, may persist for several days in soil and water. When exposed to air, phosgene oxime is broken down slowly, but in water or soil it is broken down more quickly. See the following table for more information:
| PERSISTENCE | PERSISTENCE | ENTRANCE | ||||
| TYPE OF AGENT | SYMBOL | SUMMER | WINTER | RATE OF ACTION | VAPOR/AEROSOL | LIQUID |
| BLISTER | HD, HN | 3 days-1 wk | Weeks | Slow | Eyes, Skin, Lungs | Eyes, Skin |
| L, HL | 1-3 days | Weeks | Quick | Eyes, Skin, Lungs | Eyes, Skin, Mouth | |
| CX | Days | Days | Very Quick | Eyes, Lungs, Skin | Eyes, Skin, Mouth |
*ARMY FIELD MANUAL NO. 8-10-7. Health Service Support in a Nuclear, Biological, and Chemical Environment.
Health Effects
How do blister agents affect people?
Blister agents burn and blister the skin or any other part of the body they contact. Blister agents (whether as a gas, aerosol, or liquid) enter the body primarily through inhalation and dermal contact. They may act on the eyes, mucous membranes, lungs, and skin. Mustard agent symptoms are delayed - with little or no pain at the time of exposure. In some cases, signs of injury may not appear for several hours or days depending on the concentration. Mustard agents are also suspected carcinogens. Lewisite and phosgene oxime cause immediate, severe pain.
For additional information, see
How do blister agents affect people?
Blister agents burn and blister the skin or any other part of the body they contact. Blister agents (whether as a gas, aerosol, or liquid) enter the body primarily through inhalation and dermal contact. They may act on the eyes, mucous membranes, lungs, and skin. Mustard agent symptoms are delayed - with little or no pain at the time of exposure. In some cases, signs of injury may not appear for several hours or days depending on the concentration. Mustard agents are also suspected carcinogens. Lewisite and phosgene oxime cause immediate, severe pain.
For additional information, see
- Agents, Diseases, and Other Threats (A to Z list). Centers for Disease Control and Prevention (CDC) (2004, February 27).
Controls
How do I protect myself from blister agents?
If you are exposed to a blister agent attack, get away from the impacted area quickly without passing through the contaminated area, if possible. It may be necessary to “shelter-in-place” if you can’t get out of a building or if the nearest place with clean air is indoors.
If available, a good way to protect yourself from a from blister agents is to wear appropriate chemical protective clothing and respiratory protection. However, protective equipment does not always work against blister agents. The effectiveness is determined by the materials of construction, the type and level of exposure, and duration of exposure.
What does it mean to "shelter in place"?
"Shelter in place" means to go indoors, close up the building, and wait for the danger to pass. If you are advised to shelter in place, close all doors and windows; turn off fans, air conditioners, and forced-air heating units that bring in fresh air from the outside; only re-circulate air that is already in the building; move to an inner room or basement; and keep your radio turned to the emergency response network or local news to find out what else you need to do.
For additional information see the Shelter-in-Place Information Center.
What should I do if I have been exposed to a blister agent?
If you have been exposed to a blister agent, remove all clothing immediately and wash with copious amounts of soap and water. Seek emergency medical attention.
Is there any treatment for persons exposed to blister agents?
The military has many publications covering the treatment of personnel who have been exposed to blister agents. Examples are the US Army Medical Research Institute of Chemical Defense (USAMRICD) Medical Management of Chemical Casualties Handbook, Chapter 4, Vesicants and Field Manual 8-285, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries, Chapter 4, Blister Agents (Vesicants).
Has the federal government made recommendations to protect worker health?
OSHA has not set occupational exposure levels for exposure to blister agents. However, other government departments and agencies have published existing and proposed standards.
How do I protect myself from blister agents?
If you are exposed to a blister agent attack, get away from the impacted area quickly without passing through the contaminated area, if possible. It may be necessary to “shelter-in-place” if you can’t get out of a building or if the nearest place with clean air is indoors.
If available, a good way to protect yourself from a from blister agents is to wear appropriate chemical protective clothing and respiratory protection. However, protective equipment does not always work against blister agents. The effectiveness is determined by the materials of construction, the type and level of exposure, and duration of exposure.
What does it mean to "shelter in place"?
"Shelter in place" means to go indoors, close up the building, and wait for the danger to pass. If you are advised to shelter in place, close all doors and windows; turn off fans, air conditioners, and forced-air heating units that bring in fresh air from the outside; only re-circulate air that is already in the building; move to an inner room or basement; and keep your radio turned to the emergency response network or local news to find out what else you need to do.
For additional information see the Shelter-in-Place Information Center.
What should I do if I have been exposed to a blister agent?
If you have been exposed to a blister agent, remove all clothing immediately and wash with copious amounts of soap and water. Seek emergency medical attention.
Is there any treatment for persons exposed to blister agents?
The military has many publications covering the treatment of personnel who have been exposed to blister agents. Examples are the US Army Medical Research Institute of Chemical Defense (USAMRICD) Medical Management of Chemical Casualties Handbook, Chapter 4, Vesicants and Field Manual 8-285, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries, Chapter 4, Blister Agents (Vesicants).
Has the federal government made recommendations to protect worker health?
OSHA has not set occupational exposure levels for exposure to blister agents. However, other government departments and agencies have published existing and proposed standards.
- Summary of Chemical Agent Air Exposure Values Table 1. (2004, August 3), 87 KB PDF, 2 pages.
- Summary of Multi-Media Chemical Agent Toxicity and Exposure Values Table 2. (2004, August 3), 206 KB PDF, 2 pages.
- Lewisite. CDC Emergency Preparedness and Response (2003, December 22). This page includes Fact Sheets, an Emergency Response Card, Medical Management Guidelines, and FAQ's about Lewisite.
- Sulfur Mustard. CDC Emergency Preparedness and Response (2003, December 22). This page includes Fact Sheets, an Emergency Response Card, Medical Management Guidelines, and FAQ's about Sulfur Mustard.
- Nitrogen Mustard. CDC Emergency Preparedness and Response (2003, December 22). This page includes Fact Sheets, Emergency Response Card, Medical Management Guidelines, and FAQ's about Nitrogen Mustard.
- Phosgene Oxime. CDC Emergency Preparedness and Response (2003, December 22). This page includes Fact Sheets, Emergency Response Card, Medical Management Guidelines, and FAQ's about Phosgene Oxime.
First Responders
How should first responders prepare for a release of blister agents?
First responders should consider the possible impact of a release and potential exposure to blister agents and address this in their health and safety plan(HASP). The safety and health plan should include guidelines such as: monitoring, detection, awareness training, personal protective equipment, decontamination, and medical surveillance of acutely exposed workers.
What equipment can first responders use to detect if a blister agent is present?
The variety of devices are available to detect blister agent vapor and liquid. The most portable of the vapor detectors are the M256A1 card or ticket and the Chemical Agent Monitor (CAM). The simplest liquid detectors are the M8 and M9 papers. Direct reading instruments that are available include specialized gas chromatographs (Minicams) and ion mobility spectrometers such as the APD 2000. Since some of these detectors cannot adequately detect the agents at safe airborne levels, users should be trained in regards to the use and limitations of the detectors. Listed below is a table of military detection and monitoring equipment:
Military Detection and Monitoring EquipmentHow should first responders prepare for a release of blister agents?
First responders should consider the possible impact of a release and potential exposure to blister agents and address this in their health and safety plan(HASP). The safety and health plan should include guidelines such as: monitoring, detection, awareness training, personal protective equipment, decontamination, and medical surveillance of acutely exposed workers.
What equipment can first responders use to detect if a blister agent is present?
The variety of devices are available to detect blister agent vapor and liquid. The most portable of the vapor detectors are the M256A1 card or ticket and the Chemical Agent Monitor (CAM). The simplest liquid detectors are the M8 and M9 papers. Direct reading instruments that are available include specialized gas chromatographs (Minicams) and ion mobility spectrometers such as the APD 2000. Since some of these detectors cannot adequately detect the agents at safe airborne levels, users should be trained in regards to the use and limitations of the detectors. Listed below is a table of military detection and monitoring equipment:
| Equipment | Agent | Sensitivity | Time | Cost | Operations/ Maintenance/ Limits | Notes |
| M-8 Paper | Nerve-G Nerve-VX Mustard-H Liquids only | 100-µ drops 100-µ drops 100-µ drops | <=30 sec | $1 per book of 25 sheets | Disposable/ hand-held Dry, undamaged paper has indefinite shelf life | Chemical agent detector paper; 25 sheets/book and 50 booklets/box; potential for false positives. |
| M-9 Paper | Nerve-G Nerve-VX Mustard-H Liquids only | 100-µ drops 100-µ drops 100-µ drops | <=20 sec | $5 per 10-m roll | Disposable/ hand-held 3-year shelf life Carcinogen | Adhesive-backed dispenser roll or books. |
| M-18A2 Detector Kit | Nerve-GB Nerve-VX Mustard-H, HN, HD, HT Lewisite-L, ED, MD Phosgene-CG Blood-AC Liquid, vapor, aerosol | 0.1 mg/m3 0.1 mg/m3 0.5 mg/m3 10.0 mg/m3 12.0 mg/m3 8.0 mg/m3 | 2—3 min | $360 | Disposable tubes Hand-held | 25 tests per kit; Detector tubes, detector tickets, and M-8. |
| M-256A1 Detector Kit | Nerve-G and VX Mustard-HD Lewisite-L Phosgene oxime-CX Blood-AC, CK Vapor or liquid | 0.005 mg/m3 0.02 mg/m3 2.0 mg/m3 9.0 mg/m3 3.0 mg/m3 8.0 mg/m3 | 15 min Series is longer AC--25 min | $140 | Disposable/ Hand-held 5-year shelf life | Each kit contains 12 disposable plastic sampler-detectors and M-8 paper. |
| M-272 Water Test Kit | Nerve-G and VX Mustard-HD Lewisite Hydrogen cyanide | 0.02 mg/l 2.0 mg/l 2.0 mg/l 20.0 mg/l | 7 min 7 min 7 min 6 min | $189 | Portable/ lightweight 5-year shelf life USN, USMC | Used to test raw or treated water; Type I and II detector tubes, eel enzyme detector tickets; Kit conducts 25 tests for each agent. |
| CAM Chemical Agent Monitor | Nerve-GA, GB, VX Blister-HD and HN Vapor only | 0.03 mg/m3 0.1 mg/m3 | 30 sec <=1 min | $7,500 | Hand-held/portable battery operated 6—8 hours continuous use. Maintenance required. | Radioactive source. False alarms to perfume, exhaust paint, additives to diesel fuel. |
| ICAM Improved Chemical Agent Detector | Nerve-G and V Mustard-HD | 0.03 mg/m3 0.1 mg/m3 | 10 sec 10 sec | $7,500 | 4.5 pounds Minimal training | Alarm only; False positives common. |
| ICAM-APD Improved Chemical Agent Detector--Advanced Point Detector | Nerve-G Nerve-V Mustard-H Lewisite-L | 0.1 mg/m3 0.04 mg/m3 2.0 mg/m3 2.0 mg/m3 | 30 sec 30 sec 10 sec 10 sec | $15,000 | 12 pounds including batteries Low maintenance Minimal training | Audible and visual alarm. |
| ICAD Miniature Chemical Agent Detector | Nerve-G Mustard-HD Lewisite-C Cyanide-AC, CK Phosgene-CG | 0.2—0.5 mg/m3 10 mg/m3 10 mg/m3 50 mg/m3 25 mg/m3 | 2 min (30 sec for high levels) 2 min 15 sec | $2,800 | 8 oz pocket-mounted 4 months service No maintenance Minimal training | Audible and visual alarm; Marines; No radioactivity. |
| M-90 D1A Chemical Agent Detector | Nerve-G, V Mustard Lewisite Blood Vapor only | 0.02 mg/m3 0.2 mg/m3 0.8 mg/m3 N/A | 10 sec 10 sec 80 sec | $16,000 | 15 lb. with battery Radioactive source exempt from licensing. Minimal training | Ion mobility spectroscopy and metal conductivity technology can monitor up to 30 chemicals in parallel. Alarm only. |
| M-8A1 Alarm Automatic Chemical Agent Alarm | Nerve-GA, GB, GD Nerve-VX Mustard-HD Vapor only | 0.2 mg/m3 0.4 mg/m3 10 mg/m3 | <=2 min <=2 min <=2 min | $2,555 | Vehicle battery operated Maintenance required | Radioactive source (license required); Automatic unattended operation; Remote placement. |
| MM-1 Mobile Mass Spectrometry Gas Chromatograph | 20—30 CWA Vapor | <10>2 of surface area | <=45 sec | $300,000 military $100,000 civilian | Heater volatizes surface contaminants. | German "Fuchs" (FOX Recon System/Vehicle) |
| RSCAAL M-21 | Nerve-G Mustard-H Lewisite-L Vapor | 90 mg/m3 2,300 mg/m3 500 mg/m3 | $110,000 | Line-of-sight dependent 10 year shelf life 2-person portable tripod | Passive infrared energy detector 3 miles; Visual/ audible warning from 400 meters | |
| SAW Mini-CAD | Nerve-GB Nerve-GD Mustard-HD Vapor | 1.0 mg/m3 0.12 mg/m3 0.6 mg/m3 | 1 min 1 min 1 min 1 pound No calibration | $5,500 | Minimal training Field use | Alarm only; False alarms from gasoline vapor, glass cleaner. |
| ACADA (XM22) | Nerve-G Mustard-HD Lewisite Vapor | 0.1 mg/m3 2 mg/m3 -- | 30 sec 30 sec -- | $8,000 | Vehicle mounted, battery powered Radioactive source (license required) Minimal training | Audible alarm; Bargraph display--low, high, very high. |
| Field Mini-CAMs | Nerve-G, V Mustard-H Lewisite-L | <0.0001>3 <0.003>3 <0.003>3 | <5 min <5 min <5> | $34,000 | Designed for field industry monitoring (10 lb.) 8 hours training 24 hour/7 day operations | Plug-in modules increase versatility; Threshold lower than AEL. |
| Viking Spectratrak GC/MS | Nerve-G, V Mustard-HD Many others | <0.0001>3 <0.003>3 | <10 min <10> | $100,000 | Field use, but 85 pounds Needs 120v AC, helium 40 hours training | Lab quality analysis; Library of 62,000 chemical signatures. |
| HP 6890 GC with flame photometric detector | Nerve-G, V Mustard-HD Many others | <0.0001>3 <0.0006>3 | <10 min <10> | $50,000 | Not designed for field use Gas, air, 220v AC 40 hours training | State-of- the-art gas chromatograph; Used by CWC treaty lab. |
Reference from National Research Council’s Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response.
- Guide for the Selection of Chemical Agent and Toxic Industrial Material Detection Equipment for Emergency First Responders. National Institute of Justice Guide 100-00 (Volumes I and II) (2000, June). This guide for emergency first responders provides information about detecting chemical agents and toxic industrial materials and selecting equipment for different applications. Volume II Appendices B, C, D, E have specific equipment information including manufacturers.
- Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Institute of Medicine and Board on Environmental Studies and Toxicology Commission on Life Sciences, National Research Council (1999).
What personal protective equipment (PPE) should first responders use?
When an active release is occurring, or the release has stopped but there is no information about the duration of the release or the airborne concentration of nerve agents, don level A protection. The requirement of OSHA’s Hazardous Waste Operations and Emergency Response (HAZWOPER) standard (29 CFR 1910.120(q)) provides additional information for responding to hazardous substance releases, including blister agents.
For additional information see CBRN Personal Protective Equipment Selection Matrix for Emergency Responders - Blister Agents.
Healthcare Workers
How should healthcare workers prepare to respond to a blister agent release?
Healthcare facilities should have a health and safety plan in place that addresses the possibility of receiving patients exposed to blister agents from a terrorism event. The document "OSHA Best Practices for Hospital-Based First Receivers of Victims" contains practical information for developing an emergency management plan and includes victim decontamination, personal protective equipment, and employee training.
How do I decontaminate a patient?
Healthcare professionals should don appropriate gloves and respiratory protection and then remove contaminated clothing from victim and thoroughly wash exposed area with soap and water. Healthcare professionals should also wash hands after removing any protective gloves and any other potentially exposed body surfaces.
When an active release is occurring, or the release has stopped but there is no information about the duration of the release or the airborne concentration of nerve agents, don level A protection. The requirement of OSHA’s Hazardous Waste Operations and Emergency Response (HAZWOPER) standard (29 CFR 1910.120(q)) provides additional information for responding to hazardous substance releases, including blister agents.
For additional information see CBRN Personal Protective Equipment Selection Matrix for Emergency Responders - Blister Agents.
Healthcare Workers
How should healthcare workers prepare to respond to a blister agent release?
Healthcare facilities should have a health and safety plan in place that addresses the possibility of receiving patients exposed to blister agents from a terrorism event. The document "OSHA Best Practices for Hospital-Based First Receivers of Victims" contains practical information for developing an emergency management plan and includes victim decontamination, personal protective equipment, and employee training.
How do I decontaminate a patient?
Healthcare professionals should don appropriate gloves and respiratory protection and then remove contaminated clothing from victim and thoroughly wash exposed area with soap and water. Healthcare professionals should also wash hands after removing any protective gloves and any other potentially exposed body surfaces.
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