The Tokyo subway sarin attack--lessons learned.
The sarin gas attack in the Tokyo subway system is reviewed from a clinical toxicology perspective. Based on the lessons learned from this attack, the following areas should be addressed on a global scale. First, an adequate supply of protective equipment is required, including level B protective equipment with a pressure demand breathing apparatus. In addition, a system should be established that enables a possible cause to be determined based on symptoms, physical findings, general laboratory tests, and a simple qualitative analysis for poisonous substances. If an antidote is needed, the system should enable it to be administered to the victims as quickly as possible. Preparation for a large-scale chemical attack by terrorists requires the prior establishment of a detailed decontamination plan that utilizes not only mass decontamination facilities but also public facilities in the area. A system should be established for summarizing, evaluating, and disseminating information on poisonous substances. Finally, a large-scale scientific investigation of the Tokyo sarin attack should be conducted to examine its long-term and subclinical effects and the effects of exposure to asymptomatic low levels of sarin.
Okumura
T
T
Department of Acute and Disaster Medicine, Emergency Department, Jutendo University Hospital, Bunkyo-city, Tokyo 113-8431, Japan. xj2t-okmr@asahi-net.or.jp
Hisaoka
T
T
Yamada
A
A
Naito
T
T
Isonuma
H
H
Okumura
S
S
Miura
K
K
Sakurada
M
M
Maekawa
H
H
Ishimatsu
S
S
Takasu
N
N
Suzuki
K
K
D000931:Antidotes / Q000008:administration & dosage; D002619:Chemical Warfare Agents / Q000032:analysis / Q000506:poisoning*; D002849:Chromatography, Gas; D002851:Chromatography, High Pressure Liquid; D006801:Humans; D013058:Mass Spectrometry; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy; D011482:Protective Devices; D012524:Sarin / Q000032:analysis / Q000506:poisoning*; D023481:Terrorism; D014041:Tokyo
D000931:Antidotes; D002619:Chemical Warfare Agents; D012524:Sarin