Intended for healthcare professionals

Clinical Review Regular review

Chemical weapons

BMJ 2002; 324 doi: (Published 09 February 2002) Cite this as: BMJ 2002;324:332
  1. Demetrius Evison, research fellow,
  2. David Hinsley, research fellow,
  3. Paul Rice, technical manager for medicine (
  1. Defence Science and Technology Laboratories, Porton Down, Salisbury, Wiltshire, SP4 0JQ
  1. Correspondence to P Rice

    Chemical warfare has been widely condemned since it was first used on a massive scale during the first world war. Chemical weapons are cheap, can cause mass casualties, and are relatively easy to produce, even by developing nations. They have been used in many conflicts during the 20th century (box), most recently by Iraq during the Iran-Iraq war,1 as well as in terrorist attacks. The psychological impact of chemical weapons on society makes them ideal for terrorism, as shown by the release of nerve gas in the Tokyo subway system by members of the Aum Shinrikyo sect in 1995.2 In this review we have focused on the agents that pose the greatest threat, recognising chemical weapons injuries, and the principles of management.

    Summary points

    Chemical agents should be considered in major incident planning

    Consider exposure to chemical agents in any casualty with unexplained and unusual symptoms

    Poisoning with many chemical agents, especially nerve agents, can be treated when diagnosed early

    Protective equipment must be worn if there is suspicion that chemical agent remains in the local environment

    Move casualties from contaminated environment to well ventilated area to give first aid

    Decontamination of the casualty involves removal of clothing, shaving contaminated hair, and irrigation with water or dilute sodium hypochlorite to remove residual agent from skin

    Use of chemical weapons in the 20th century

    1914-8: Over 1 300 000 people receive gas injuries in first world war, and over 90 000 of them die

    1935: Italy begins conquest of Abyssinia (Ethiopia) using mustard gas delivered by aircraft spray

    1936: Japan invades China using chemical weapons (including mustard gas, phosgene, and hydrogen cyanide); German chemical laboratories produce first nerve agent — tabun

    1963-7: Egypt uses phosgene and mustard aerial bombs in support of South Yemen against the Yemeni royalist forces during the Yemeni civil war

    1980-8: Iraq attacks Iran and …

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