Tokyo subway sarin attack victims

Matsui, Y., Ishimatsu, S., Kawana, N., Tamaki, S., Sugata, K. (2002). Official Report of Ministry of Welfare and Labor Science Project Sequelae in the Tokyo Subway Sarin Attack Victims. 

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 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. 

The only published study of the brain structural effects of nerve agent exposure in a human population focused on longterm changes induced in victims of the 1995 Tokyo subway sarin attack (Yamasue et al, 2007). In this event, which resulted in 12 deaths, approximately 5,500 victims were exposed to sarin, and essentially all patients exhibited typical symptoms of acute intoxication (Lee, 2003 Ohbu et al. 

Araki, T., Kasai, K., Yamasue, H., Kato, N., Kudo, N., Ohanti, T., Nakagome, K., Kirihara, K., Yamada, H., Abe, O., Iwanami, A. (2005). Association between lower P300 amplitude and smaller anterior cingulate cortex volume in patients with posttraumatic stress disorder a study of victims of Tokyo subway sarin attack. Neuroimage 25 43-50. 

Given that the Tokyo subway sarin attack was the first major chemical terrorist attack in an urban setting, the first responders were unaware of the need to remove the victims from the subway stations as quickly as possible. Some of the victims who had trouble walking were barely able to get out of the subway cars and collapsed on the station platforms, resulting in continued... 

In instances where a chemical gas is used in a terrorist attack, it is necessary to perform dry decontamination (i.e. change clothes) in order to minimize secondary exposure. Because the Tokyo subway sarin attack occurred in winter, many victims were wearing many layers of clothes. The extent of secondary exposure could have been... 

Okumura T, Takasu N, Ishimatsu S, et al Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med 28 129-135,1996 Persian Gulf Veterans Coordinating Board Unexplained illnesses among Desert Storm veterans. Arch Intern Med 155 262-268,1995 Petrucci N, Sardini S Severe neurotoxic reaction associated with oral ingestion of low-dose diethyltoluamide-containing insect repellent in a child. Pediatr Emerg Care 16 341-342, 2000... 

Thus, the way in which we use the lessons learned from this attack will affect our ability to deal adequately with future terrorist attacks using sarin, which could be even greater and more serious with respect to the number of victims. Can we really assume that only 12 of the approximately 5,500 victims died because the Japanese medical system was particularly well prepared for such an eventuality Probably not. It is more likely that the relatively small number of fatalities was due to the low concentration of sarin and the passive means of dispersing it. From tiiis perspective, the Matsumoto sarin attack one year earlier was more aggressive than the Tokyo subway sarin attack. In a trial after the Matsumoto incident, it was revealed tiiat a 70% concentration of sarin was actively volatilized using an electric heater and dispersed using an electric fan. A total of 7 victims died and 660 were injured and one victim died 14 years after sarin exposme. In other words, if the Tokyo subway sarin attack had been conducted using the same means as those employed in the Matsumoto sarin attack, the number of fatalities may have been 50 or 60. So humanity has not yet experienced the effects of a full-scale sarin attack in a major city. 

---