Sarin Tokyo subway

Discovered in the late 1930s in Germany as improved poisonous insecticides, organophosphorus ChEIs were developed as chemical warfare agents (e.g. sarin, soman, and tabun) and were more recently employed in the 1995 terrorist attack in the Tokyo subway system [5]. 

In March 1995, a Japanese religious cult, Aum Shinriyko, released sarin nerve gas in the Tokyo subway system. Thousands were injured and 11 people were killed. 

Organophosphate and carbamate cholinesterase inhibitors (see Chapter 7) are widely used to kill insects and other pests. Most cases of serious organophosphate or carbamate poisoning result from intentional ingestion by a suicidal person, but poisoning has also occurred at work (pesticide application or packaging) or, rarely, as a result of food contamination or terrorist attack (eg, release of the chemical warfare nerve agent sarin in the Tokyo subway system in 1995). 

M. Nagao, T. Takatori, Y. Matsuda, M. Nakajima, H. Iwase and K. Iwadate, Definitive evidence for the acute sarin poisoning diagnosis in the Tokyo Subway, Toxicol. Appl. Pharmacol., 144, 198-203 (1997). 

Fidder and coworkers (50) developed a versatile procedure that identifies phosphylated butyrylcholi-nesterase. Adducted butyrylcholinesterase is isolated from plasma by affinity chromatography (procainamide column), digested with pepsin, and a nonapep-tide containing the phosphylated active-site serine residue detected using LC/ESI/MS/MS (quadrupole-TOF hybrid instrument). A C18 150 x 0.3-mm LC column was used, eluted with a gradient of water-acetonitrile-0.2 % formic acid. The method was applied successfully to casualties of sarin poisoning from the Tokyo subway attack (see Chapter 17). 

The only reported incidents of nerve agent poisoning, where biomedical samples have been obtained, are those resulting from terrorist dissemination of sarin in Matsumoto (1994) and the Tokyo subway (1995), plus an assassination using VX, also in Japan (60). In contrast to the CW incidents involving sulfur mustard, many of the biomedical samples associated with these terrorist attacks were collected within hours of the event. 

Application of the fluoride-reactivation method to serum samples of victims from the Tokyo subway attack, and of the Matsumoto incident, yielded, sarin concentrations in the range of 0.2-4.1ng/ml serum (44). Evidently, these casualties had been exposed to an organophosphate with the formula i-PrO(CH3)P(0)X, presumably with X = F (sarin). 

Finally, mass spectrometric determination of the phosphonylated peptic nonapeptide from butyrylcholinesterase allowed the positive identification of sarin-inhibited enzyme in serum samples from several Japanese victims of the Tokyo subway attack (see Figure 10). 

In the early 1990s, leaders of Aum Shinrikyo, the Japanese religious cult that in 1995 attacked riders on the Tokyo subway with a sarin nerve agent, made numerous trips to Russia.The group s leader in charge of weapons procurement made 21 trips to Russia between 1992 and 1995. Group leaders frequently met with senior government officials, such as the secretary of Russian Security Council, the Parliament speaker, and vice... 

Okumura, T., Suzuki, K., Fukuda, A. (1998). The Tokyo subway sarin attack Disaster management. Part 2 Hospital response. Academic Emergency Medicine, 5, 625-628. 

Okumura, T., Takasu, N., Ishimatsu, S. (1996). Report on 640 victims of the Tokyo subway sarin attack. Annals of Emergency Medicine, 28, 129-135. 

In June 1994 and again in May 1995 the Japanese cult group Aum Shinrikyo created much havoc when they released the deadly nerve agent sarin in two Japanese cities. In the first attack in Matsumoto, Japan, sarin vapor was released in a residential area where judges unfriendly to the cult resided. Seven people died as a consequence of this nerve agent exposure, and 500 people were injured. The 1995 attack occurred in the Tokyo subway system. Several coordinated releases of this potentially deadly vapor resulted in more than 5,000 visits to local emergency departments. Fortunately, the vast majority of exposed victims had few if any symptoms and there were only a handful of fatalities (Tucker, 2006 for further discussion, see chapter 19—Biological and Chemical Terrorism A Unique Threat). 

Murata, K., S. Araki, K. Yokoyama, T. Okumura, S. Ishimatsu, N. Takasu, and R.F. White. 1997. Asymptomatic sequelae to acute sarin poisoning in the central and autonomic nervous system 6 months after the Tokyo subway attack. J. Neurol. 244 601-606. 

Terrorists have expressed an interest in nerve agents and have deployed them in attacks on unprotected civilians (Rotenberg and Newmark, 2003). A Japanese religious cult, Aum Shinrikyo, independently manufactured numerous chemical and biological agents. The first such attack with sarin occurred in Matsumoto in 1994 and the Tokyo subway in 1995. Thousands of people were affected and dozens of people died (Nagao et al, 1997 Ohtomi et al, 1996 Okumura et al, 1998 Yokoyama et al, 1998). In... 

Yokoyama, K., Araki, S., Murata, K., Nishikitami, M., Okomura, T., Ishimatsu, S., Takasu, M. (1998). Chronic neurobehavioral and central autonomic nervous system effects in Tokyo subway sarin poisoning. J. Physiol. 92 317-23. 

The Tokyo Subway Sarin Attack Toxicological Whole Truth... 

The Tokyo subway sarin attack occurred in 1995, following the Matsumoto sarin attack, and served as a wake-up call for anti-NBC (nuclear, biological, and chemical) terrorism policy throughout the world. In the 10 years since the attack, efforts to combat NBC terrorism have focused on rapid and effective measures to respond to attacks employing nerve agents such as sarin. 

According to a subsequent poliee report, the terrorists placed sarin in five subway trains. Approximately 600 grams of sarin at a concentration of 33% was mixed with hexane and N, A-diethylaniline and placed in a nylon/polyethylene bag. Five terrorists then wrapped the bags in newspaper, punctured the bags with the tips of their umbrellas and left the bags on the subways. In this way the sarin seeped out of the bags and vaporized, but no other active means of dispersal were used, and in this sense, the Tokyo subway sarin attaek was not really a full-scale attack. 

In victims of the Tokyo subway sarin attack, endotracheal intubation was not difficult. The Japanese medical literature describes the standard treatment for sarin toxicity as... 

After the Tokyo subway sarin attack, St Luke s Hospital, which treated 640 victims, used about 700 ampules of PAM and 2,800 ampules of atropine (Okumura et al, 1998). This calculates out to 550 mg of PAM and 2.2 mg of atropine for each victim. The route of administration was intravenous in all cases with a total dose of atropine in severe cases 1.5 mg to 9 mg (Okumura et al, 1996) doses which reflect the low concentration and passive means of sarin dispersal used in the Tokyo attack. 

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