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Terrorism Involving Cyanide: The Prospect of Improving Preparedness in the Prehospital Setting

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  28 June 2012

Mark E. Keim
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Abstract

The potential for domestic or international terrorism involving cyanide has not diminished and in fact may have increased in recent years. This paper discusses cyanide as a terrorist weapon and the current state of readiness for a cyanide attack in the United States. Many of the factors that render cyanide appealing to terrorists are difficult to modify sufficiently to decrease the probability of a cyanide attack. For example, the relative ease with which cyanide can be used as a weapon without special training, its versatile means of delivery to intended victims, and to a large degree, its ready availability cannot be significantly modified through preparedness efforts. On the other hand, the impact of an attack can be mitigated through preparedness measures designed to minimize the physical, psychological, and social consequences of cyanide exposure. Although the nation remains ill-equipped to manage a cyanide disaster, significant progress is being realized in some aspects of preparedness. Hydroxocobalamin—a cyanide antidote that may be appropriate for use in the prehospital setting for presumptive cases of cyanide poisoning—currently is under development for potential introduction in the US. If it becomes available in the US, hydroxocobalamin could enhance the role of the prehospital emergency responder in providing care to victims of a cyanide disaster. Additional progress is required in the areas of ensuring local and regional availability of antidotal treatment and supportive interventions, educating emergency healthcare providers about cyanide poisoning and its management, and raising public awareness of the potential for a cyanide attack and how to respond.

Keywords

Cyanide Antidote Kitcyanide poisoningpreparednessterrorism
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 21 , supplement S2: Cyanide Intoxication: Pathophysiology, Diagnosis, and Treatment: Invited Papers , April 2006 , pp. s56 - s60
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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