Chemical Terrorism

By James A. Geiling, MD, FCCP

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Case Scenario

Scene

Facing a bleak holiday buying season, local stores and malls drastically cut prices to attract buyers. On the Friday after Thanksgiving, shoppers flock to a local outlet mall to take advantage of many sales. The weather is clear, winds are light and variable, and the temperature ranges from 28 to 45°F. At 12:15 PM, your colleagues in the emergency department begin to hear via emergency medical services (EMS) radio traffic that there is a mass emergency at the mall. Initial reports describe a scene near the food court where many people are unconscious or seizing. Many people outside the mall are lying on the ground, seizing, vomiting, or generally feeling ill. Initial estimates report more than 800 automobiles in the parking lot. EMS vehicles dispatched to the scene report mass hysteria, a large traffic snarl leaving the area, and frantic people heading for the ambulances. EMS personnel that arrive at the food court report themselves becoming weak, having difficulty seeing, and feeling nauseous.

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