Emergency Preparedness & Response

Arsenic is a naturally occurring element widely distributed in the earth's crust. In the environment, arsenic is combined with oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds. Inorganic arsenic compounds are mainly used to preserve wood. Organic arsenic compounds are used as pesticides, primarily on cotton plants.

What happens to arsenic when it enters the environment?

Arsenic cannot be destroyed in the environment. It can only change its form. Arsenic in air will settle to the ground or is washed out of the air by rain. Many arsenic compounds can dissolve in water. Fish and shellfish can accumulate arsenic, but the arsenic in fish is mostly in a form that is not harmful.

How might I be exposed to arsenic?

Eating food, drinking water, or breathing air containing arsenic. Breathing contaminated workplace air. Breathing sawdust or burning smoke from wood treated with arsenic. Living near uncontrolled hazardous waste sites containing arsenic. Living in areas with unusually high natural levels of arsenic in rock.

How can arsenic affect my health?

Breathing high levels of inorganic arsenic can give you a sore throat or irritated lungs. Ingesting high levels of inorganic arsenic can result in death. Lower levels of arsenic can cause nausea and vomiting, decreased production of red and white blood cells, abnormal heart rhythm, damage to blood vessels, and a sensation of "pins and needles" in hands and feet. Ingesting or breathing low levels of inorganic arsenic for a long time can cause a darkening of the skin and the appearance of small "corns" or "warts" on the palms, soles, and torso. Skin contact with inorganic arsenic may cause redness and swelling. Organic arsenic compounds are less toxic than inorganic arsenic compounds. Exposure to high levels of some organic arsenic compounds may cause similar effects as inorganic arsenic.

How likely is arsenic to cause cancer?

Several studies have shown that inorganic arsenic can increase the risk of lung cancer, skin cancer, bladder cancer, liver cancer, kidney cancer, and prostate cancer. The World Health Organization (WHO), the Department of Health and Human Services (DHHS), and the EPA have determined that inorganic arsenic is a human carcinogen.

How does arsenic affect children?

We do not know if exposure to arsenic will result in birth defects or other developmental effects in people. Birth defects have been observed in animals exposed to inorganic arsenic. It is likely that health effects seen in children exposed to high amounts of arsenic will be similar to the effects seen in adults.

How can families reduce the risk of exposure to arsenic?

f you use arsenic-treated wood in home projects, you should wear dust masks, gloves, and protective clothing to decrease exposure to sawdust. If you live in an area with high levels of arsenic in water or soil, you should use cleaner sources of water and limit contact with soil.

Is there a medical test to show whether I've been exposed to arsenic?

here are tests to measure the level of arsenic in blood, urine, hair, or fingernails. The urine test is the most reliable test for arsenic exposure within the last few days. Tests on hair and fingernails can measure exposure to high levels or arsenic over the past 6-12 months. These tests can determine if you have been exposed to above-average levels of arsenic. They cannot predict how the arsenic levels in your body will affect your health.

Chlorine

What chlorine is

Chlorine is an element used in industry and found in some household products. Chlorine is sometimes in the form of a poisonous gas. Chlorine gas can be pressurized and cooled to change it into a liquid so that it can be shipped and stored. When liquid chlorine is released, it quickly turns into a gas that stays close to the ground and spreads rapidly. Chlorine gas can be recognized by its pungent, irritating odor, which is like the odor of bleach. The strong smell may provide an adequate warning to people that they have been exposed. Chlorine gas appears to be yellow-green in color. Chlorine itself is not flammable, but it can react explosively or form explosive compounds with other chemicals such as turpentine and ammonia.

Where chlorine is found and how it is used

Chlorine was used during World War I as a choking (pulmonary) agent. Chlorine is one of the most commonly manufactured chemicals in the United States. Its most important use is as a bleach in the manufacture of paper and cloth, but it is also used to make pesticides (insect killers), rubber, and solvents. Chlorine is used in drinking water and swimming pool water to kill harmful bacteria. It is also as used as part of the sanitation process for industrial waste and sewage. Household chlorine bleach can release chlorine gas if it is mixed with other cleaning agents.

How people can be exposed to chlorine

People’s risk for exposure depends on how close they are to the place where the chlorine was released. If chlorine gas is released into the air, people may be exposed through skin contact or eye contact. They may also be exposed by breathing air that contains chlorine. If chlorine liquid is released into water, people may be exposed by touching or drinking water that contains chlorine. If chlorine liquid comes into contact with food, people may be exposed by eating the contaminated food. Chlorine gas is heavier than air, so it would settle in low-lying areas.

How chlorine works

The extent of poisoning caused by chlorine depends on the amount of chlorine a person is exposed to, how the person was exposed, and the length of time of the exposure. When chlorine gas comes into contact with moist tissues such as the eyes, throat, and lungs, an acid is produced that can damage these tissues.

Immediate signs and symptoms of chlorine exposure

During or immediately after exposure to dangerous concentrations of chlorine, the following signs and symptoms may develop:

Coughing
Chest tightness
Burning sensation in the nose, throat, and eyes
Watery eyes
Blurred vision
Nausea and vomiting
Burning pain, redness, and blisters on the skin if exposed to gas, skin injury similar to frostbite if exposed to liquid chlorine
Difficulty breathing or shortness of breath (may appear immediately if high concentrations of chlorine gas are inhaled, or may be delayed if low concentrations of chlorine gas are inhaled)
Fluid in the lungs (pulmonary edema) within 2 to 4 hours
Showing these signs or symptoms does not necessarily mean that a person has been exposed to chlorine.

What the long-term health effects are

Long-term complications from chlorine exposure are not found in people who survive a sudden exposure unless they suffer complications such as pneumonia during therapy. Chronic bronchitis may develop in people who develop pneumonia during therapy.

How people can protect themselves, and what they should do if they are exposed to chlorine

Leave the area where the chlorine was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing exposure to chlorine. If the chlorine release was outdoors, move away from the area where the chlorine was released. Go to the highest ground possible, because chlorine is heavier than air and will sink to low-lying areas. If the chlorine release was indoors, get out of the building. If you think you may have been exposed, remove your clothing, rapidly wash your entire body with soap and water, and get medical care as quickly as possible.Removing and disposing of clothing:

Quickly take off clothing that has liquid chlorine on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag. Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will help protect you and other people from any chemicals that might be on your clothes.
If you placed your clothes in plastic bags, inform either the local or state health department or emergency personnel upon their arrival. Do not handle the plastic bags.
If you are helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.

Washing the body

As quickly as possible, wash your entire body with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
If your eyes are burning or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If you wear contacts, remove them before rinsing your eyes, and place them in the bags with the contaminated clothing. Do not put the contacts back in your eyes. You should dispose of them even if you do not wear disposable contacts. If you wear eyeglasses, wash them with soap and water. You can put the eyeglasses back on after you wash them.
If you have ingested (swallowed) chlorine, do not induce vomiting or drink fluids.
Seek medical attention right away. Dial 911 and explain what has happened.

How chlorine exposure is treated

No antidote exists for chlorine exposure. Treatment consists of removing the chlorine from the body as soon as possible and providing supportive medical care in a hospital setting.

Cyanide

What cyanide is

Cyanide is a rapidly acting, potentially deadly chemical that can exist in various forms. Cyanide can be a colorless gas, such as hydrogen cyanide (HCN) or cyanogen chloride (CNCl), or a crystal form such as sodium cyanide (NaCN) or potassium cyanide (KCN). Cyanide sometimes is described as having a “bitter almond” smell, but it does not always give off an odor, and not everyone can detect this odor. Cyanide is also known by the military designations AN (for hydrogen cyanide) and CK (for cyanogen chloride).

Where cyanide is found and how it is used

Hydrogen cyanide, under the name Zyklon B, was used as a genocidal agent by the Germans in World War II. Reports have indicated that during the Iran-Iraq War in the 1980s, hydrogen cyanide gas may have been used along with other chemical agents against the inhabitants of the Kurdish city of Halabja in northern Iraq.

Cyanide is naturally present in some foods and in certain plants such as cassava. Cyanide is contained in cigarette smoke and the combustion products of synthetic materials such as plastics. Combustion products are substances given off when things burn. In manufacturing, cyanide is used to make paper, textiles, and plastics. It is present in the chemicals used to develop photographs. Cyanide salts are used in metallurgy for electroplating, metal cleaning, and removing gold from its ore. Cyanide gas is used to exterminate pests and vermin in ships and buildings. If accidentally ingested (swallowed), chemicals found in acetonitrile-based products that are used to remove artificial nails can produce cyanide.

How people can be exposed to cyanide

People may be exposed to cyanide by breathing air, drinking water, eating food, or touching soil that contains cyanide. Cyanide enters water, soil, or air as a result of both natural processes and industrial activities. In air, cyanide is present mainly as gaseous hydrogen cyanide. Smoking cigarettes is probably one of the major sources of cyanide exposure for people who do not work in cyanide-related industries.

How cyanide works

Poisoning caused by cyanide depends on the amount of cyanide a person is exposed to, the route of exposure, and the length of time that a person is exposed. Breathing cyanide gas causes the most harm, but ingesting cyanide can be toxic as well. Cyanide gas is most dangerous in enclosed places where the gas will be trapped. Cyanide gas evaporates and disperses quickly in open spaces, making it less harmful outdoors. Cyanide gas is less dense than air, so it will rise. Cyanide prevents the cells of the body from getting oxygen. When this happens, the cells die. Cyanide is more harmful to the heart and brain than to other organs because the heart and brain use a lot of oxygen.

Immediate signs and symptoms of cyanide exposure

People exposed to a small amount of cyanide by breathing it, absorbing it through their skin, or eating foods that contain it may have some or all of the following symptoms within minutes:

Rapid breathing
Restlessness
Dizziness
Weakness
Headache
Nausea and vomiting
Rapid heart rate
Exposure to a large amount of cyanide by any route may cause these other health effects as well:
Convulsions
Low blood pressure
Slow heart rate
Loss of consciousness
Lung injury
Respiratory failure leading to death
Showing these signs and symptoms does not necessarily mean that a person has been exposed to cyanide.

What the long-term health effects may be

Survivors of serious cyanide poisoning may develop heart and brain damage.

How people can protect themselves and what they should do if they are exposed to cyanide

First, get fresh air by leaving the area where the cyanide was released. Moving to an area with fresh air is a good way to reduce the possibility of death from exposure to cyanide gas. If the cyanide release was outside, move away from the area where the cyanide was released. If the cyanide release was indoors, get out of the building. If leaving the area that was exposed to cyanide is not an option, stay as low to the ground as possible. Remove any clothing that has liquid cyanide on it. If possible, seal the clothing in a plastic bag, and then seal that bag inside a second plastic bag. Removing and sealing the clothing in this way will help protect people from any chemicals that might be on their clothes. If clothes were placed in plastic bags, inform either the local or state health department or emergency coordinators upon their arrival. Do not handle the plastic bags. Rinse the eyes with plain water for 10 to 15 minutes if they are burning or vision is blurred. Wash any liquid cyanide from the skin thoroughly with soap and water. If cyanide is known to be ingested (swallowed), do not induce vomiting or give fluids to drink. Seek medical attention right away. Dial 911 and explain what has happened.

How cyanide poisoning is treated

Cyanide poisoning is treated with specific antidotes and supportive medical care in a hospital setting. The most important thing is for victims to seek medical treatment as soon as possible.

Lewisite

What lewisite is

Lewisite is a type of chemical warfare agent. This kind of agent is called a vesicant or blistering agent, because it causes blistering of the skin and mucous membranes on contact. Lewisite is an oily, colorless liquid in its pure form and can appear amber to black in its impure form. Lewisite has an odor like geraniums. Lewisite contains arsenic, a poisonous element. Lewisite is also known by its military designation, “L.”

Where lewisite is found and how it is used

Lewisite was produced in 1918 to be used in World War I, but its production was too late for it to be used in the war. Lewisite has been used only as a chemical warfare agent. It has no medical or other practical use. Lewisite is not found naturally in the environment.

How people can be exposed to lewisite

People’s risk for exposure depends on how close they are to the place where the lewisite was released. If lewisite gas is released into the air, people may be exposed through skin contact or eye contact. They may also be exposed by breathing air that contains lewisite. If lewisite liquid is released into water, people may be exposed by drinking water that contains lewisite or by getting the water on their bodies. If lewisite liquid comes into contact with food, people may be exposed by eating the contaminated food. People can be exposed by coming into direct contact with liquid lewisite. Lewisite vapor is heavier than air, so it will settle in low-lying areas. Lewisite remains a liquid under a wide range of environmental conditions, from below freezing to very hot temperatures. Therefore, it could last for a long time in the environment.

How lewisite works

Adverse health effects caused by lewisite depend on the amount people are exposed to, the route of exposure, and the length of time that people are exposed. Lewisite is a powerful irritant and blistering agent that immediately damages the skin, eyes, and respiratory (breathing) tract. Because it contains arsenic, lewisite has some effects that are similar to arsenic poisoning, including stomach ailments and low blood pressure.

Immediate signs and symptoms of lewisite exposure

Most information on the health effects of lewisite is based on animal studies. Signs and symptoms occur immediately following a lewisite exposure. Lewisite can have the following effects on specific parts of the body:

Skin: pain and irritation within seconds to minutes, redness within 15 to 30 minutes followed by blister formation within several hours. The blister begins as a small blister in the middle of the red areas and then expands to cover the entire reddened area of skin. The lesions (sores) from lewisite heal much faster than lesions caused by the other blistering agents, sulfur mustard and nitrogen mustards, and the discoloring of the skin that occurs later is much less noticeable.
Eyes: irritation, pain, swelling, and tearing may occur on contact.
Respiratory tract: runny nose, sneezing, hoarseness, bloody nose, sinus pain, shortness of breath, and cough
Digestive tract: diarrhea, nausea, and vomiting.
Cardiovascular: “Lewisite shock” or low blood pressure may occur
Showing these signs and symptoms does not necessarily mean that a person has been exposed to lewisite.

What the long-term health effects may be

Extensive skin burning, as seen with sulfur mustard, is less likely. Extensive breathing in of the vapors may cause chronic respiratory disease. Extensive eye exposure may cause permanent blindness. Unlike sulfur mustard, lewisite is not known to suppress the immune system.

How people can protect themselves and what they should do if they are exposed to lewisite

Leave the area where the lewisite was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to lewisite. If the lewisite release was outdoors, move away from the area where the lewisite was released. Go to the highest ground possible, because lewisite is heavier than air and will sink to low-lying areas. If the lewisite release was indoors, get out of the building. If you think you may have been exposed, remove your clothing, rapidly wash your entire body with soap and water, and get medical care as quickly as possible.
Removing and disposing of clothing:

Quickly take off clothing that has liquid lewisite on it. Any clothing that has to be pulled over the head
should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag.
Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will
help protect you and other people from any chemicals that might be on your clothes.
If you placed your clothes in plastic bags, inform either the local or state health department or emergency
personnel upon their arrival. Do not handle the plastic bags.
If you are helping other people remove their clothing, try to avoid touching any contaminated areas, and
remove the clothing as quickly as possible.

Washing the body:

As quickly as possible, wash any liquid lewisite from your skin with large amounts of soap and water. Washing
with soap and water will help protect people from any chemicals on their bodies.
If your eyes are burning or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If
you wear contacts, remove them and place them in the bags with the contaminated clothing. Do not put the
contacts back in your eyes. If you wear eyeglasses, wash them with soap and water. You can put the eyeglasses
back on after you wash them.
If you have ingested (swallowed) lewisite, do not induce vomiting or drink fluids.
Seek medical attention right away. Dial 911 and explain what has happened.

How lewisite exposure is treated

Treatment consists of removing lewisite from the body as soon as possible and providing supportive medical care in a hospital setting. An antidote for lewisite is available and is most useful if given as soon as possible after exposure.

Mustard Gas

What sulfur mustard is

Sulfur mustard is a type of chemical warfare agent. These kinds of agents are called vesicants or blistering agents, because they cause blistering of the skin and mucous membranes on contact. Sulfur mustard is also known as “mustard gas or mustard agent,” or by the military designations H, HD, and HT. Sulfur mustard sometimes smells like garlic, onions, or mustard and sometimes has no odor. It can be a vapor (the gaseous form of a liquid), an oily-textured liquid, or a solid. Sulfur mustard can be clear to yellow or brown when it is in liquid or solid form.

Where sulfur mustard is found and how it is used

Sulfur mustard is not found naturally in the environment. Sulfur mustard was introduced in World War I as a chemical warfare agent. Until recently, it was available for use in the treatment of a skin condition called psoriasis. Currently, it has no medical use.

How people can be exposed to sulfur mustard

If sulfur mustard is released into the air as a vapor, people can be exposed through skin contact, eye contact, or breathing. Sulfur mustard vapor can be carried long distances by wind. If sulfur mustard is released into water, people can be exposed by drinking the contaminated water or getting it on their skin. People can be exposed by coming in contact with liquid sulfur mustard. Sulfur mustard can last from 1 to 2 days in the environment under average weather conditions and from weeks to months under very cold conditions. Sulfur mustard breaks down slowly in the body, so repeated exposure may have a cumulative effect (that is, it can build up in the body).

How sulfur mustard works

dverse health effects caused by sulfur mustard depend on the amount people are exposed to, the route of exposure, and the length of time that people are exposed. Sulfur mustard is a powerful irritant and blistering agent that damages the skin, eyes, and respiratory (breathing) tract. It damages DNA, a vital component of cells in the body. Sulfur mustard vapor is heavier than air, so it will settle in low-lying areas.

Immediate signs and symptoms of sulfur mustard exposure

Exposure to sulfur mustard is usually not fatal. When sulfur mustard was used during World War I, it killed fewer than 5% of the people who were exposed and got medical care. People may not know right away that they have been exposed, because sulfur mustard often has no smell or has a smell that might not cause alarm. Typically, signs and symptoms do not occur immediately. Depending on the severity of the exposure, symptoms may not occur for 2 to 24 hours. Some people are more sensitive to sulfur mustard than are other people, and may have symptoms sooner. Sulfur mustard can have the following effects on specific parts of the body:

Skin: redness and itching of the skin may occur 2 to 48 hours after exposure and change eventually to yellow blistering of the skin.
Eyes: irritation, pain, swelling, and tearing may occur within 3 to12 hours of a mild to moderate exposure. A severe exposure may cause symptoms within 1 to 2 hours and may include the symptoms of a mild or moderate exposure plus light sensitivity, severe pain, or blindness (lasting up to 10 days).
Respiratory tract: runny nose, sneezing, hoarseness, bloody nose, sinus pain, shortness of breath, and cough within 12 to 24 hours of a mild exposure and within 2 to 4 hours of a severe exposure.
Digestive tract: abdominal pain, diarrhea, fever, nausea, and vomiting.
Showing these signs and symptoms does not necessarily mean that a person has been exposed to sulfur mustard.

What the long-term health effects may be

Exposure to sulfur mustard liquid is more likely to produce second- and third- degree burns and later scarring than is exposure to sulfur mustard vapor. Extensive skin burning can be fatal. Extensive breathing in of the vapors can cause chronic respiratory disease, repeated respiratory infections, or death. Extensive eye exposure can cause permanent blindness. Exposure to sulfur mustard may increase a person’s risk for lung and respiratory cancer.

How people can protect themselves and what they should do if they are exposed to sulfur mustard

Because no antidote exists for sulfur mustard exposure, the best thing to do is avoid it. Immediately leave the area where the sulfur mustard was released. Try to find higher ground, because sulfur mustard is heavier than air and will settle in low-lying areas. If avoiding sulfur mustard exposure is not possible, rapidly remove the sulfur mustard from the body. Getting the sulfur mustard off as soon as possible after exposure is the only effective way to prevent or decrease tissue damage to the body. Quickly remove any clothing that has liquid sulfur mustard on it. If possible, seal the clothing in a plastic bag, and then seal that bag inside a second plastic bag. Immediately wash any exposed part of the body (eyes, skin, etc.) thoroughly with plain, clean water. Eyes need to be flushed with water for 5 to 10 minutes. Do NOT cover eyes with bandages, but do protect them with dark glasses or goggles. If someone has ingested sulfur mustard, do NOT induce vomiting. Give the person milk to drink. Seek medical attention right away. Dial 911 and explain what has happened.

How sulfur mustard exposure is treated

The most important factor is removing sulfur mustard from the body. Exposure to sulfur mustard is treated by giving the victim supportive medical care to minimize the effects of the exposure. Though no antidote exists for sulfur mustard, exposure is usually not fatal.

Phosgene

What phosgene is

Phosgene is a major industrial chemical used to make plastics and pesticides. At room temperature (70°F), phosgene is a poisonous gas. With cooling and pressure, phosgene gas can be converted into a liquid so that it can be shipped and stored. When liquid phosgene is released, it quickly turns into a gas that stays close to the ground and spreads rapidly. Phosgene gas may appear colorless or as a white to pale yellow cloud. At low concentrations, it has a pleasant odor of newly mown hay or green corn, but its odor may not be noticed by all people exposed. At high concentrations, the odor may be strong and unpleasant. Phosgene itself is nonflammable (not easily ignited and burned), but it can cause flammable substances around it to burn. Phosgene is also known by its military designation, “CG.”

Where phosgene is found and how it is used

Phosgene was used extensively during World War I as a choking (pulmonary) agent. Among the chemicals used in the war, phosgene was responsible for the large majority of deaths. Phosgene is not found naturally in the environment. Phosgene is used in industry to produce many other chemicals such as pesticides. Phosgene can be formed when certain compounds are exposed to heat, such as some types of plastics. Phosgene gas is heavier than air, so it would be more likely found in low-lying areas.

How people are exposed to phosgene

People’s risk for exposure depends on how close they are to the place where the phosgene was released. If phosgene gas is released into the air, people may be exposed through skin contact or eye contact. They may also be exposed by breathing air that contains phosgene. If phosgene liquid is released into water, people may be exposed by touching or drinking water that contains phosgene. If phosgene liquid comes into contact with food, people may be exposed by eating the contaminated food.

How phosgene works

Poisoning caused by phosgene depends on the amount of phosgene to which a person is exposed, the route of exposure, and the length of time that a person is exposed. Phosgene gas and liquid are irritants that can damage the skin, eyes, nose, throat, and lungs.

Immediate signs and symptoms of phosgene exposure

During or immediately after exposure to dangerous concentrations of phosgene, the following signs and symptoms may develop:

Coughing
Burning sensation in the throat and eyes
Watery eyes
Blurred vision
Difficulty breathing or shortness of breath
Nausea and vomiting
Skin contact can result in lesions similar to those from frostbite or burns
Following exposure to high concentrations of phosgene, a person may develop fluid in the lungs (pulmonary edema) within 2 to 6 hours.
Exposure to phosgene may cause delayed effects that may not be apparent for up to 48 hours after exposure, even if the person feels better or appears well following removal from exposure. Therefore, people who have been exposed to phosgene should be monitored for 48 hours afterward. Delayed effects that can appear for up to 48 hours include the following:
Difficulty breathing
Coughing up white to pink-tinged fluid (a sign of pulmonary edema)
Low blood pressure
Heart failure
Showing these signs or symptoms does not necessarily mean that a person has been exposed to phosgene.

What the long-term health effects are

Most people who recover after an exposure to phosgene make a complete recovery. However, chronic bronchitis and emphysema have been reported as a result of phosgene exposure.

How people can protect themselves and what they should do if they are exposed to phosgene

Leave the area where the phosgene was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to phosgene. If the phosgene release was outdoors, move away from the area where the phosgene was released. Go to the highest ground possible, because phosgene is heavier than air and will sink to low-lying areas. If the phosgene release was indoors, get out of the building. If you think you may have been exposed, remove your clothing, rapidly wash your entire body with soap and water, and get medical care as quickly as possible.
Removing and disposing of clothing:

Quickly take off clothing that has liquid phosgene on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag. Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will help protect you and other people from any chemicals that might be on your clothes.
If you placed your clothes in plastic bags, inform either the local or state health department or emergency personnel upon their arrival. Do not handle the plastic bags.
If you are helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.

Washing the body:

As quickly as possible, wash your entire body with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
If your eyes are burning or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If you wear contacts, remove them and place them in the bags with the contaminated clothing. Do not put the contacts back in your eyes. If you wear eyeglasses, wash them with soap and water. You can put the eyeglasses back on after you wash them.
If you have ingested (swallowed) phosgene, do not induce vomiting or drink fluids.
Seek medical attention right away. Dial 911 and explain what has happened.

How phosgene exposure is treated

Treatment for phosgene exposure consists of removing phosgene from the body as soon as possible and providing supportive medical care in a hospital setting. No antidote exists for phosgene. Exposed people should be observed for up to 48 hours, because it may take that long for symptoms to develop or reoccur.

Sarin

What sarin is

Sarin is a human-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. They are similar to certain kinds of pesticides (insect killers) called organophosphates in terms of how they work and what kind of harmful effects they cause. However, nerve agents are much more potent than organophosphate pesticides. Sarin originally was developed in 1938 in Germany as a pesticide. Sarin is a clear, colorless, and tasteless liquid that has no odor in its pure form. However, sarin can evaporate into a vapor (gas) and spread into the environment. Sarin is also known as GB.

Where sarin is found and how it is used

Sarin and other nerve agents may have been used in chemical warfare during the Iran-Iraq War in the 1980s. Sarin was used in two terrorist attacks in Japan in 1994 and 1995. Sarin is not found naturally in the environment.

How people can be exposed to sarin

Following release of sarin into the air, people can be exposed through skin contact or eye contact. They can also be exposed by breathing air that contains sarin. Sarin mixes easily with water, so it could be used to poison water. Following release of sarin into water, people can be exposed by touching or drinking water that contains sarin. Following contamination of food with sarin, people can be exposed by eating the contaminated food. A person’s clothing can release sarin for about 30 minutes after it has come in contact with sarin vapor, which can lead to exposure of other people. Because sarin breaks down slowly in the body, people who are repeatedly exposed to sarin may suffer more harmful health effects. Because sarin vapor is heavier than air, it will sink to low-lying areas and create a greater exposure hazard there.

How sarin works

The extent of poisoning caused by sarin depends on the amount of sarin to which a person was exposed, how the person was exposed, and the length of time of the exposure. Symptoms will appear within a few seconds after exposure to the vapor form of sarin and within a few minutes up to 18 hours after exposure to the liquid form. All the nerve agents cause their toxic effects by preventing the proper operation of the chemical that acts as the body’s “off switch” for glands and muscles. Without an “off switch,” the glands and muscles are constantly being stimulated. They may tire and no longer be able to sustain breathing function. Sarin is the most volatile of the nerve agents, which means that it can easily and quickly evaporate from a liquid into a vapor and spread into the environment. People can be exposed to the vapor even if they do not come in contact with the liquid form of sarin. Because it evaporates so quickly, sarin presents an immediate but short-lived threat.

Immediate signs and symptoms of sarin exposure

People may not know that they were exposed because sarin has no odor. People exposed to a low or moderate dose of sarin by breathing contaminated air, eating contaminated food, drinking contaminated water, or touching contaminated surfaces may experience some or all of the following symptoms within seconds to hours of exposure:

Runny nose
Watery eyes
Small, pinpoint pupils
Eye pain
Blurred vision
Drooling and excessive sweating
Cough
Chest tightness
Rapid breathing
Diarrhea
Increased urination
Confusion
Drowsiness
Weakness
Headache
Nausea, vomiting, and/or abdominal pain
Slow or fast heart rate
Low or high blood pressure
Even a small drop of sarin on the skin can cause sweating and muscle twitching where sarin touched the skin.
Exposure to large doses of sarin by any route may result in the following harmful health effects:
Loss of consciousness
Convulsions
Paralysis
Respiratory failure possibly leading to death
Showing these signs and symptoms does not necessarily mean that a person has been exposed to sarin.

What the long-term health effects are

Mild or moderately exposed people usually recover completely. Severely exposed people are not likely to survive. Unlike some organophosphate pesticides, nerve agents have not been associated with neurological problems lasting more than 1 to 2 weeks after the exposure.

How people can protect themselves, and what they should do if they are exposed to sarin

Recovery from sarin exposure is possible with treatment, but the antidotes available must be used quickly to be effective. Therefore, the best thing to do is avoid exposure:

Leave the area where the sarin was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to sarin vapor.
If the sarin release was outdoors, move away from the area where the sarin was released. Go to the highest ground possible, because sarin is heavier than air and will sink to low-lying areas.
If the sarin release was indoors, get out of the building.
If people think they may have been exposed, they should remove their clothing, rapidly wash their entire body with soap and water, and get medical care as quickly as possible.

Removing and disposing of clothing:

Quickly take off clothing that has liquid sarin on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag. Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will help protect people from any chemicals that might be on their clothes.
If clothes were placed in plastic bags, inform either the local or state health department or emergency personnel upon their arrival. Do not handle the plastic bags.
If helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.

Washing the body:

As quickly as possible, wash any liquid sarin from the skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
Rinse the eyes with plain water for 10 to 15 minutes if they are burning or if vision is blurred.
If sarin has been swallowed, do not induce vomiting or give fluids to drink.

Seek medical attention immediately. Dial 911 and explain what has happened.

How sarin exposure is treated

Treatment consists of removing sarin from the body as soon as possible and providing supportive medical care in a hospital setting. Antidotes are available for sarin. They are most useful if given as soon as possible after exposure.

Soman

What soman is

Soman is a human-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. They are similar to pesticides (insect killers) called organophosphates in terms of how they work and the kinds of harmful effects they cause. However, nerve agents are much more potent than organophosphate pesticides. Soman was originally developed as an insecticide in Germany in 1944. Soman is also known as “GD.” Soman is a clear, colorless, tasteless liquid with a slight camphor odor (for example, Vicks Vapo-Rub®) or rotting fruit odor. It can become a vapor if heated.

Where soman is found and how it is used

It is possible that soman or other nerve agents were used in chemical warfare during the Iran-Iraq War in the 1980s. Soman is not found naturally in the environment.

How people can be exposed to soman

Following release of soman into the air, people can be exposed through skin contact, eye contact, or inhalation (breathing in the soman). Soman mixes easily with water, so it could be used to poison water. Following release of soman into water, people can be exposed by drinking contaminated water or getting contaminated water on their skin. Following contamination of food with soman, people can be exposed by eating the contaminated food. A person’s clothing can release soman for about 30 minutes after contact with soman vapor, which can lead to exposure of other people. Soman breaks down slowly in the body, meaning that repeated exposures to soman and/or other nerve agents can have a cumulative effect (build up in the body). Because soman vapor is heavier than air, it will sink to low-lying areas and create a greater exposure hazard there.

How soman works

The extent of poisoning caused by soman depends on the amount of soman to which a person was exposed, how the person was exposed, and the length of time of the exposure. Symptoms will appear within a few seconds after exposure to the vapor form of soman, and within a few minutes to up to 18 hours after exposure to the liquid form. All the nerve agents cause their toxic effects by preventing the proper operation of the chemical that acts as the body’s “off switch” for glands and muscles. Without an “off switch,” the glands and muscles are constantly being stimulated. They may tire and no longer be able to sustain breathing function. Compared with other nerve agents, soman is more volatile than VX but less volatile than sarin. The higher a chemical’s volatility, the more likely it will evaporate from a liquid into a vapor and disperse into the environment. People can be exposed to the vapor even if they do not come in contact with the liquid form. Because of its high volatility, soman is an immediate but short-lived threat and does not last a long time in the environment. Because soman is more volatile than the nerve agent VX (the most potent nerve agent), it will remain on exposed surfaces for a shorter period of time compared with VX.

Immediate signs and symptoms of soman exposure

Although soman has a camphor or fruity odor, the odor may not be noticeable enough to give people sufficient warning against a toxic exposure. People exposed to a low or moderate dose of soman by inhalation, ingestion (swallowing), or skin absorption may experience some or all of the following symptoms within seconds to hours of exposure:

Runny nose
Watery eyes
Small, pinpoint pupils
Eye pain
Blurred vision
Drooling and excessive sweating
Cough
Chest tightness
Rapid breathing
Diarrhea
Increased urination
Confusion
Drowsiness
Weakness
Headache
Nausea, vomiting, and/or abdominal pain
Slow or fast heart rate
Abnormally low or high blood pressure
Even a tiny drop of nerve agent on the skin can cause sweating and muscle twitching where the agent touched the skin.
Exposure to a large dose of soman by any route may result in these additional health effects:
Loss of consciousness
Convulsions
Paralysis
Respiratory failure possibly leading to death
Showing these signs and symptoms does not necessarily mean that a person has been exposed to soman.

What the long-term health effects are

How people can protect themselves, and what they should do if they are exposed to soman

Recovery from soman exposure is possible with treatment, but the antidotes available must be used quickly (within minutes) to be effective. Therefore, the best thing to do is avoid exposure:

Leave the area where the soman was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to soman vapor.
If the soman release was outdoors, move away from the area where the soman was released. Go to the highest ground possible, because soman is heavier than air and will sink to low-lying areas.
If the soman release was indoors, get out of the building.
If people think they may have been exposed, they should remove their clothing, rapidly wash their entire body with soap and water, and get medical care as quickly as possible.

Removing and disposing of clothing:

Quickly take off clothing that has liquid soman on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag. Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will help protect people from any chemicals that might be on their clothes.
If clothes were placed in plastic bags, inform either the local or state health department or emergency personnel upon their arrival. Do not handle the plastic bags.
If helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.

Washing the body:

As quickly as possible, wash any liquid soman from the skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
Rinse the eyes with plain water for 10 to 15 minutes if they are burning or if vision is blurred.
If soman has been ingested (swallowed), do not induce vomiting or give fluids to drink.
Seek medical attention right away. Dial 911 and explain what has happened.

How soman exposure is treated

Treatment consists of removing soman from the body as soon as possible and providing supportive medical care in a hospital setting. Antidotes are available for soman. They are most useful if given as soon as possible after exposure.

Stychnine

What strychnine is

Strychnine is a white, odorless, bitter crystalline powder that can be taken by mouth, inhaled (breathed in), or mixed in a solution and given intravenously (injected directly into a vein). Strychnine is a strong poison; only a small amount is needed to produce severe effects in people. Strychnine poisoning can cause extremely serious adverse health effects, including death.

Where strychnine is found and how it is used

The primary natural source of strychnine is the plant Strychnos nux vomica. This plant is found in southern Asia (India, Sri Lanka, and East Indies) and Australia. In the past, strychnine was available in a pill form and was used to treat many human ailments. Today, strychnine is used primarily as a pesticide, particularly to kill rats. Uncommonly, strychnine is found mixed with “street” drugs such as LSD, heroin, and cocaine.

How you could be exposed to strychnine

Following release of strychnine into water, you could be exposed by drinking contaminated water. Following contamination of food with strychnine, you could be exposed by eating the contaminated food. It is also possible to absorb strychnine through the membranes in the nose, eyes, or mouth. For example, a person could be poisoned by inhaling strychnine powder that has been released in the air. Strychnine could be smoked or snorted as a component of street drugs. Poisoning has been reported from strychnine given intravenously and through the nose.

How strychnine works

The extent of poisoning caused by strychnine depends on the amount and route of strychnine exposure and the person’s condition of health at the time of the exposure. Strychnine prevents the proper operation of the chemical that controls nerve signals to the muscles. The chemical controlling nerve signals works like the body’s “off switch” for muscles. When this “off switch” does not work correctly, muscles throughout the body have severe, painful spasms. Even though the person’s consciousness or thinking are not affected at first (except that the person is very excitable and in pain), eventually the muscles tire and the person can’t breathe.

Immediate signs and symptoms of strychnine exposure

Following the ingestion (swallowing) of strychnine, symptoms of poisoning usually appear within 15 to 60 minutes. People exposed to low or moderate doses of strychnine by any route will have the following signs or symptoms:

Agitation
Apprehension or fear
Ability to be easily startled
Restlessness
Painful muscle spasms possibly leading to fever and to kidney and liver injury
Uncontrollable arching of the neck and back
Rigid arms and legs
Jaw tightness
Muscle pain and soreness
Difficulty breathing
Dark urine
Initial consciousness and awareness of symptoms
People exposed to high doses of strychnine may have the following signs and symptoms within the first 15 to 30 minutes of exposure:
Respiratory failure (inability to breathe), possibly leading to death
Brain death
Showing these signs and symptoms does not necessarily mean that a person has been exposed to strychnine.

What the long-term health effects are

If the person survives the toxic effects of strychnine poisoning, long-term health effects are unlikely. However, long-term effects may result from damage caused by the poisoning (for example, brain damage from low oxygen, kidney failure). People severely affected by strychnine poisoning are not likely to survive.

How you can protect yourself, and what you should do if you are exposed to strychnine

Since ingestion is likely to be the primary route of exposure, if poisoning is suspected, avoid any further ingestion and call 911 immediately. Recovery from strychnine exposure is possible with early hospital treatment. Therefore, the best thing to do is get medical care as quickly as possible. Do not induce vomiting or give fluids to drink. If you think strychnine may have been released into the air, the best thing to do is avoid it. If the strychnine release was indoors, get out of the building. If the release was outdoors, move away from the area of the release, stay upwind if possible, and seek higher ground. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to a chemical that has been released into the air. If you are near a release of strychnine, emergency coordinators may tell you to either evacuate the area or “shelter in place” inside a building to avoid being exposed to the chemical. For more information on evacuation during a chemical emergency, see “Facts About Evacuation”. For more information on sheltering in place during a chemical emergency, see “Facts About Sheltering in Place”.

Removing your clothing:

Quickly take off clothing that has strychnine on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head.
If you are helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.
Washing yourself:
As quickly as possible, wash any strychnine from your skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
If your eyes are burning or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If you wear contacts, remove them and put them with the contaminated clothing. Do not put the contacts back in your eyes (even if they are not disposable contacts). If you wear eyeglasses, wash them with soap and water. You can put your eyeglasses back on after you wash them.

Disposing of your clothes:

After you have washed yourself, place your clothing inside a plastic bag. Avoid touching contaminated areas of the clothing. If you can't avoid touching contaminated areas, or you aren't sure where the contaminated areas are, wear rubber gloves or put the clothing in the bag using tongs, tool handles, sticks, or similar objects. Anything that touches the contaminated clothing should also be placed in the bag. If you wear contacts, put them in the plastic bag, too.
Seal the bag, and then seal that bag inside another plastic bag. Disposing of your clothing in this way will help protect you and other people from any chemicals that might be on your clothes.
When the local or state health department or emergency personnel arrive, tell them what you did with your clothes. The health department or emergency personnel will arrange for further disposal. Do not handle the plastic bags yourself.
Seek medical attention right away. Dial 911 and explain what has happened.

How strychnine exposure is treated

Treatment consists of removing the drug from the body (decontamination) and getting supportive medical care in a hospital setting. Supportive care includes intravenous fluids (fluids injected directly into a vein), medications for convulsions and spasms, and cooling measures for high temperature.

Tabun

What tabun is

Tabun is a man-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. They are similar to pesticides (insect killers) called organophosphates in terms of how they work and what kinds of harmful effects they cause. However, nerve agents are much more potent than organophosphate pesticides. Tabun was originally developed as a pesticide in Germany in 1936. Tabun is also known as “GA.” Tabun is a clear, colorless, tasteless liquid with a faint fruity odor. Tabun can become a vapor if heated.

Where tabun is found and how it is used

It is possible that tabun or other nerve agents were used in chemical warfare during the Iran-Iraq War in the 1980s. Tabun is not found naturally in the environment.

How people can be exposed to tabun

Following release of tabun into the air, people can be exposed through skin contact, eye contact, or inhalation (breathing in the tabun). Tabun mixes easily with water, so it could be used to poison water. Following release of tabun into water, people can be exposed by drinking contaminated water or getting contaminated water on their skin. Following contamination of food with tabun, people can be exposed by eating the contaminated food. A person’s clothing can release tabun for about 30 minutes after contact with tabun vapor, which can lead to exposure of other people. Tabun breaks down slowly in the body, meaning that repeated exposures to tabun and/or other nerve agents can have a cumulative effect (build up in the body). Because tabun vapor is heavier than air, it will sink to low-lying areas and create a greater exposure hazard there.

How tabun works

The extent of poisoning caused by tabun depends on the amount of tabun to which a person was exposed, how the person was exposed, and the length of time of the exposure. Symptoms will appear within a few seconds after exposure to the vapor form of tabun, and within a few minutes to up to 18 hours after exposure to the liquid form. All the nerve agents cause their toxic effects by preventing the proper operation of the chemical that acts as the body’s “off switch” for glands and muscles. Without an “off switch,” the glands and muscles are constantly being stimulated. They may tire and no longer be able to sustain breathing function. Compared with other nerve agents, tabun is more volatile than VX but less volatile than sarin. The higher a chemical’s volatility, the more likely it will evaporate from a liquid into a vapor and disperse into the environment. People can be exposed to the vapor even if they do not come in contact with the liquid form. Because of its high volatility, tabun is an immediate but short-lived threat and does not last a long time in the environment. Because tabun is more volatile than VX, it will remain on exposed surfaces for a shorter period of time compared with VX. Because tabun is less volatile than sarin, it will remain on exposed surfaces for a longer period of time compared with sarin.

Immediate signs and symptoms of tabun exposure

Although tabun has a faint fruity odor, the odor may not be noticeable enough to give people sufficient warning about a toxic exposure. People exposed to a low or moderate dose of tabun by inhalation, ingestion (swallowing), or skin absorption may experience some or all of the following symptoms within seconds to hours of exposure:

Runny nose
Watery eyes
Small, pinpoint pupils
Eye pain
Blurred vision
Drooling and excessive sweating
Cough
Chest tightness
Rapid breathing
Diarrhea
Increased urination
Confusion
Drowsiness
Weakness
Headache
Nausea, vomiting, and/or abdominal pain
Slow or fast heart rate
Abnormally low or high blood pressure
Even a tiny drop of nerve agent on the skin can cause sweating and muscle twitching where the agent touched the skin.
Exposure to a large dose of tabun by any route may result in these additional health effects:
Loss of consciousness
Convulsions
Paralysis
Respiratory failure possibly leading to death
Showing these signs and symptoms does not necessarily mean that a person has been exposed to tabun.

What the long-term health effects are

How people can protect themselves, and what they should do if they are exposed to tabun

Recovery from tabun exposure is possible with treatment, but the antidotes available must be used quickly to be effective. Therefore, the best thing to do is avoid exposure:

Leave the area where the tabun was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to tabun vapor.
If the tabun release was outdoors, move away from the area where the tabun was released. Go to the highest ground possible, because tabun is heavier than air and will sink to low-lying areas.
If the tabun release was indoors, get out of the building.
If people think they may have been exposed, they should remove their clothing, rapidly wash their entire body with soap and water, and get medical care as quickly as possible.

Removing and disposing of clothing:

Quickly take off clothing that has liquid tabun on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag. Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will help protect people from any chemicals that might be on their clothes.
If clothes were placed in plastic bags, inform either the local or state health department or emergency personnel upon their arrival. Do not handle the plastic bags.
If helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.

Washing the body:

As quickly as possible, wash any liquid tabun from the skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
Rinse the eyes with plain water for 10 to 15 minutes if they are burning or if vision is blurred.
If tabun has been ingested (swallowed), do not induce vomiting or give fluids to drink.
Seek medical attention right away. Dial 911 and explain what has happened.

How tabun exposure is treated

Treatment consists of removing tabun from the body as soon as possible and providing supportive medical care in a hospital setting. Antidotes are available for tabun. They are most useful if given as soon as possible after exposure.

What VX is

VX is a human-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. They are similar to pesticides (insect killers) called organophosphates in terms of how they work and what kinds of harmful effects they cause. However, nerve agents are much more potent than organophosphate pesticides. It was originally developed in the United Kingdom in the early 1950s.

VX is odorless and tasteless. It is an oily liquid that is amber in color and very slow to evaporate. It evaporates about as slowly as motor oil.

Where VX is found and how it is used

It is possible that VX or other nerve agents were used in chemical warfare during the Iran-Iraq War in the 1980s. VX is not found naturally in the environment.

How people can be exposed to VX

Following release of VX into the air, people can be exposed through skin contact, eye contact, or inhalation (breathing in the VX mist). Though VX does not mix with water as easily as other nerve agents do, it could be released into water. Following release of VX into water, people can be exposed by drinking contaminated water or getting contaminated water on their skin. Following contamination of food with VX, people can be exposed by eating the contaminated food. VX is primarily a liquid exposure hazard, but if it is heated to very high temperatures, it can turn into small amounts of vapor (gas). A person’s clothing can release VX for about 30 minutes after contact with VX vapor, which can lead to exposure of other people. VX breaks down slowly in the body, meaning that repeated exposures to VX and/or other nerve agents can have a cumulative effect (build up in the body). Because VX vapor is heavier than air, it will sink to low-lying areas and create a greater exposure hazard there.

How VX works

The extent of poisoning caused by VX depends on the amount of VX to which a person was exposed, how the person was exposed, and the length of time of the exposure. Symptoms will appear within a few seconds after exposure to the vapor form of VX, and within a few minutes to up to 18 hours after exposure to the liquid form. VX is the most potent of all nerve agents. Compared with the nerve agent sarin (also known as GB), VX is considered to be much more toxic by entry through the skin and somewhat more toxic by inhalation. It is possible that any visible VX liquid contact on the skin, unless washed off immediately, would be lethal.

All the nerve agents cause their toxic effects by preventing the proper operation of the chemical that acts as the body’s “off switch” for glands and muscles. Without an “off switch,” the glands and muscles are constantly being stimulated. They may tire and no longer be able to sustain breathing function. VX is the least volatile of the nerve agents, which means that it is the slowest to evaporate from a liquid into a vapor. Therefore, VX is very persistent in the environment. Under average weather conditions, VX can last for days on objects that it has come in contact with. Under very cold conditions, VX can last for months. Because it evaporates so slowly, VX can be a long-term threat as well as a short-term threat. Surfaces contaminated with VX should therefore be considered a long-term hazard.

Immediate signs and symptoms of VX exposure

People may not know they were exposed to VX because it has no odor. People exposed to a low or moderate dose of VX by inhalation, ingestion (swallowing), or skin absorption may experience some or all of the following symptoms within seconds to hours of exposure:

Runny nose
Watery eyes
Small, pinpoint pupils
Eye pain
Blurred vision
Drooling and excessive sweating
Cough
Chest tightness
Rapid breathing
Diarrhea
Increased urination
Confusion
Drowsiness
Weakness
Headache
Nausea, vomiting, and/or abdominal pain
Slow or fast heart rate
Abnormally low or high blood pressure
Even a tiny drop of nerve agent on the skin can cause sweating and muscle twitching where the agent touched the skin.
Exposure to a large dose of VX by any route may result in these additional health effects:
Loss of consciousness
Convulsions
Paralysis
Respiratory failure possibly leading to death
Showing these signs and symptoms does not necessarily mean that a person has been exposed to VX.

What the long-term health effects are

How people can protect themselves, and what they should do if they are exposed to VX

Recovery from VX exposure is possible with treatment, but the antidotes available must be used quickly to be effective. Therefore, the best thing to do is avoid exposure:

Leave the area where the VX was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing the possibility of death from exposure to VX vapor.
If the VX release was outdoors, move away from the area where the VX was released. Go to the highest ground possible, because VX is heavier than air and will sink to low-lying areas.
If the VX release was indoors, get out of the building.
If people think they may have been exposed, they should remove their clothing, rapidly wash their entire body with soap and water, and get medical care as quickly as possible.

Removing and disposing of clothing:

Quickly take off clothing that has liquid VX on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If possible, seal the clothing in a plastic bag. Then seal the first plastic bag in a second plastic bag. Removing and sealing the clothing in this way will help protect people from any chemicals that might be on their clothes.
If clothes were placed in plastic bags, inform either the local or state health department or emergency personnel upon their arrival. Do not handle the plastic bags.
If helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.

Washing the body:

As quickly as possible, wash any liquid VX from the skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
Rinse the eyes with plain water for 10 to 15 minutes if they are burning or if vision is blurred.
If VX has been ingested (swallowed), do not induce vomiting or give fluids to drink.
Seek medical attention right away. Dial 911 and explain what has happened.

How VX exposure is treated

Treatment consists of removing VX from the body as soon as possible and providing supportive medical care in a hospital setting. Antidotes are available for VX. They are most useful if given as soon as possible after exposure.

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