“24” is Fiction, but Chemical Nerve Agent Threat is Real

For five seasons of Fox’s hit television show “24,” lead character Jack Bauer and his colleagues at the Counter Terrorism Unit have struggled to protect the United States from threats ranging from bio-terrorism to nuclear attack. This makes for great entertainment, but it also reflects real threats that we face in the world today.

The plotline for this season’s “24” focused largely on a terrorist threat involving a chemical nerve agent. While not considered as high impact as a nuclear device or biological agent, a chemical nerve agent is a much more probable weapon of choice.

Unlike nuclear or biological weapons, chemical nerve agents are relatively easy and inexpensive to produce and deploy. These poisons, which include organophosphorous insecticides such as malathion, parathion and diazinon, are readily available in our communities, and travel via road and rail through our cities every day.

Chemical nerve agents already have been used successfully in terrorist attacks. In 1995, members of the Japanese cult Aum Shinrikyo released the nerve agent sarin into a Tokyo subway, killing 12 and injuring 5,500 others. The year before, members of the same cult released sarin into a residential apartment building in Matsumoto, Japan, killing seven and injuring more than 200.

A 2004 Homeland Security Council report outlined a terrorist attack scenario in which a chemical nerve agent release in three large office buildings could kill 95 percent of the occupants, the equivalent of nearly 6,000 people. The report estimates that first responders would arrive on the scene in 10-15 minutes. The response is likely to be too little, too late, given the rapidity of nerve agent poisoning symptom onset, and the logistical challenges of providing immediate medical assistance to large numbers of victims.

In the event of a chemical nerve agent attack on a public transit system, indoor stadium, amusement park or office building, individuals who have been poisoned may have only minutes to receive the antidote. Emergency responders in the U.S. have access to auto-injectors that contain the antidotes for chemical nerve agent poisoning. The problem is that in many cities, emergency responders may have only enough antidotes to treat themselves, and will not be able to treat victims in time.

The Hurricane Katrina disaster underscored that local emergency responders must be prepared to manage a disaster for 24 to 72 hours before federal assistance arrives. Unfortunately, most state and local emergency management agencies do not have a standardized protocol to guide their response to a chemical nerve agent attack. Most are depending on federal government stockpiles of antidotes, but those caches will not be immediately available and may not be delivered for 12 or more hours. And most do not have adequate supplies of infant and pediatric dosages.

Even before the tragedy of 9/11, New York City implemented a layered inventory and response system. Every ambulance in the city carries an inventory of chemical nerve agent antidote kits as standard equipment. Victims who are most severely affected by a nerve agent would receive their initial antidote treatment from the first ambulances on scene. Logistical Support Units represent the next layer of logistical support followed by pre-positioned caches of antidotes. These local layers of reinforcement would be utilized before federal assets, such as chem-packs supplied by the Centers for Disease Control and Prevention, are required.

State and local emergency response agencies have the opportunity to purchase chemical nerve agent antidote kits through federal Office of Domestic Preparedness grants, at no cost to them. It is important for agency leaders to partner with other state and local government officials to assess their risk for a chemical nerve agent emergency, and develop standard response protocols similar to those in place in New York City. During an emergency is not the time to realize you don’t have a plan. And Hollywood heroes like “24”s Bauer won’t be there to protect you.

For more information on first responder grants, visit the Department of Homeland Security web site at www.dhs.gov/dhspublic/interapp/editorial/editorial_0356.xml.

Jerome Hauer
Former Director, New York City Office of Emergency Management
Former Assistant Secretary, Department of Health and Human Services, Office of Public Health Emergency Preparedness