Lessons learned from nerve agent attacks in Iran and Japan: Is it really necessary to stockpile oximes?

Abstract

Nerve agents have only ever been used in Iran and Japan: in the Iran-Iraq war and the Matsumoto and Tokyo subway sarin attacks. When discussing responses to nerve agent attacks in peace-time, it is important to maximize the lessons learned from these two incidents. The golden standard for the treatment of nerve agents has conventionally been the combination of atropine sulfate, oxime, and diazepam as recommended. While this recommendation also applies to civil defense for terrorism in peace-time, there is nonetheless a need to re-evaluate the golden standard. In addition, factors such as cost-effectiveness must be considered.

Keywords::

• Atropine
• chemical terrorism
• Iran
• Japan
• oxime therapy
• the Tokyo subway sarin attack

Acknowledgements

This paper is dedicated to Dr Sidell from the US Army who spent his professional life dealing with chemical weapons and gave us valuable advice after the Tokyo subway sarin attacks.

Declaration of interest: The authors report no conflicts of interest.