Sulfur mustard is a type of chemical warfare agent. When heated to decomposition between 300°F and 350°F (149°C to 177°C), sulfur mustard emits highly toxic fumes of sulfur oxides and hydrochloric acid. Adverse health effects caused by sulfur mustard depend on how much people are exposed to, how they were exposed (the route of exposure), and the length of time that people are exposed. Mustard gas or sulfur mustard is a chemical warfare agent (King of the battle gases) [] with cytotoxic, vesicant and blistering effects on exposed skin [].This agent can enter the body through various routes including the skin, the respiratory system, conjunctiva and the gastrointestinal system by contaminated foods [].It can cause both acute and delayed manifestations and late complications . Getting the sulfur mustard off as soon as possible after exposure is the only effective way to prevent or decrease tissue damage to the body. https://www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.htmlExternal. Assist ventilation as required. Move containers from the fire area if it is possible to do so without risk to personnel. Iran J Psychiatry Behav Sci 2014; 8(3): 11-21. Sulfur mustard can have the following effects: SKIN: redness and itching of the skin (2 to 48 hours after exposure); may change to yellow blisters. They will spread along the ground and collect and stay in poorly-ventilated, low-lying, or confined areas (e.g., sewers, basements, and tanks). Today it has no medical use. The most important factor is removing sulfur mustard from the body. Sulfur Mustard Effects on Mental Health and Quality-of-Life: A Review. J Chromatogr A 928(2):187-199. Dike fire control water for later disposal; do not scatter the material. The decontamination zone for exiting should be upwind and uphill from the zone used to enter. The aim of this study was to assess the long-term psychological symptoms among samples of exposed to sulfur mustard gas compared with unexposed civilians 20 years after exposure. Please see the Glossary for definitions of these exposure limits: Do not touch or walk through the spilled agent if at all possible. Breathing sulfur mustard's can cause coughing, bronchitis, and other breathing symptoms. Hand any evidence over to the FBI. Severe (usually from liquid agent; onset within 1 to 2 hours): Increased fluid accumulation (edema) in eyelids, painful sensitivity to light (photophobia), damage to the cornea (ulceration), blindness, and severe pain. Sulfur mustard (SM; bis- (2-chloroethyl) sulfide) is a potent bi-functional alkylating agent, with considerable potential for use as a chemical warfare agent or terrorist attacks ( Geraci, 2008 ). Saving Lives, Protecting People, https://emergency.cdc.gov/agent/sulfurmustard/basics/facts.asp, https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750008.html, https://www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html, https://emergency.cdc.gov/chemical/lab.asp, https://chemm.nlm.nih.gov/mustard_hospital_mmg.htm, Division of Emergency and Environmental Health Services, Overview of U.S. Chemical Weapons Elimination, Recovery of Sea-disposed Chemical Munitions, Signs & Symptoms of Exposure to Sulfur Mustard, Elimination of Chemical Weapons: CDC’s Role, History of U.S. Chemical Weapons Elimination, Methods Used to Destroy Chemical Warfare Agents, Offsite Shipment of Secondary Waste and Hydrolysate, Closing U.S. Chemical Warfare Agent Disposal Facilities, CDC Participation in the Chemical Stockpile Emergency Preparedness Program, Blue Grass Facility, Madison County, Kentucky, Emergency Room Procedures in Chemical Hazard Emergencies, U.S. Department of Health & Human Services. Hooijschuur EWJ, Kientz CE, Brinkman UAT [2001]. Background. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. In 1860, Frederick Guthrie was the first person to mix sulfur dichloride and ethylene together and record the . A NIOSH-certified CBRN tight-fitting APR with a canister-type gas mask or CBRN PAPR for air levels greater than AEGL-2. When used in impure form, such as warfare agents, they are usually yellow-brown . Prolonged exposure of the container to fire or intense heat . Kenyon NJ, Ward RW, McGrew G, Last JA. In an effort to mitigate the effects of exposure to sulfur mustard gas, research on its chemical effects on tissue resulted in rational chemical therapy for lymphoid and non-lymphoid tumors. After dissemination in an area, Mustard gas or sulfur mustard is a chemical warfare mustard gas remains in that area for a long time and agent (King of the . If sulfur mustard is released as a vapor, it is highly unlikely to contaminate agricultural products. Hazardous concentrations may develop quickly in enclosed, poorly-ventilated, or low-lying areas. Begin tracking remains using waterproof tags. Galvanized metal was selected for its wide application in heating, ventilation, and air conditioning systems. Kientz CE, Verweij A, Dejong GJ, et al. If sulfur mustard is released into the air as a vapor, people can be exposed through skin contact, eye contact, or breathing. Verification of nonproduction of chemical warfare agents. Application of microcolumn liquid chromatography and capillary electrophoresis with flame photometric detection for the screening of degradation products of chemical warfare agents in water and soil. Miosis due to cholinergic effects may occur. For more information about sulfur mustard, people can contact the following: To receive email updates about this page, enter your email address: Centers for Disease Control and Prevention. Specific and sensitive quantitation of 2,2′-dichlorodiethyl sulphide (sulphur mustard) in water, plasma and blood: application to toxicokinetic study in the rat after intravenous intoxication. Sulfur mustard (military designation HD or H) is a blister agent (vesicant) that causes severe, delayed burns to the eyes, skin, and respiratory tract. It is more harmful to the skin on hot, humid days, or in a tropical climate. Citation: Razavi SM, Negahban Z, Pirhosseinloo M, Razavi MS, Hadjati Gh, Salamati P. Sulfur mustard effects on mental health and quality-of-life: a review. The study was planned to investigate the protective efficacy of amifostine, DRDE-07 and their analogues, and few conventional antidotes (30 minutes pretreatment) against dermally applied SM and nitrogen mustards in preventing hematological and biochemical changes in mice. BONE MARROW: decreased formation of blood cells (aplastic anemia) or decreased red or white blood cells and platelets (pancytopenia) leading to weakness, bleeding, and infections. Then protect persons downwind during the night: 0.2 mi (0.4 km). Exposure to sulfur mustard is treated by giving the victim supportive medical care to minimize the effects of the exposure. Nausea, vomiting (emesis), pain, diarrhea, possible chemical burns of the gastrointestinal (GI) tract, and complete exhaustion (prostration). Acute exposures to sulfur mustard can also result in long-term respiratory damage manifested as asthma-like conditions, bronchitis, and increases in incidence of secondary respiratory infections. METHODS: We searched English databases including Medline, ISI and Scopus as well . Both local effects at the site of contact and systemic effects from chemical absorption may develop. Runoff from fire control or dilution water may be corrosive and/or toxic, and it may cause pollution. CDC helps connect providers with a network of laboratory and emergency response professionals who can assist with identifying the chemical agents and measuring human exposure levels. Moist tissues such as the eyes and respiratory tract are especially vulnerable. Skin must be decontaminated within minutes after exposure to limit injury. Technical Support Documentpdf iconexternal icon. The acute effects of mustard are relatively well characterised, and are still subject to research in order to find effective treatments. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. See the emergency response card for hydrochloric acid. Extensive breathing in of the vapors can cause chronic respiratory disease, repeated respiratory infections, or death. Severe: As above, with more severe blistering (vesication) with areas of central tissue death (necrosis), plus whole-body (systemic) health effects including weakness (malaise), vomiting (emesis), fever, and complete exhaustion (prostration). The severity of damage increases as the concentration of sulfur mustard increases. For more information on sulfur mustard visit https://emergency.cdc.gov/agent/sulfurmustard/basics/facts.asp or https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750008.html, Vessel Name: ______________________________Vessel #: _____________________Time/Date: ____________________ Inhalation, the major route of exposure, induces respiratory and systemic toxicity. Mohammad Ali Zare, MD 2 • Zohreh Poursaleh, MD 1. Sulfur mustard evaporates slowly and is primarily a liquid hazard under temperate conditions. thoroughly with plain, clean water. This agent can enter the body through various routes includ- Sulfur mustard vapor or liquid may cause intense conjunctival and scleral pain, swelling, lacrimation, blepharospasm, and photophobia; however, these effects do not appear for an hour or more. Background Sulfur mustard (SM) is a chemical warfare agent (CWA) that was widely used during the World War I and by the Iraqi forces against the Iranian soldiers and even innocent civilians between 1983 and 1988. Ensure that the patient/victim has an unobstructed airway. Clinical effects often do not occur until hours after . Abstract . Sulfur mustard (SM) (Chemical Abstracts Service Registry Number 505-60-2) is a vesicant chemical warfare agent. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tanks. Pure sulfur mustards are colorless, viscous liquids at room temperature. Severe (onset within 2 to 6 hours): Same as above, plus acute inflammation of the upper and lower airways; tissue death (necrosis) of the airway lining (respiratory epithelium); possible obstruction of both upper and lower airways due to formation of a false membrane or fibrous deposit (pseudomembrane); airway blockage (occlusion) from inflamed and dead (necrotic) cells; and death, due to inflammatory lung disease (pneumonia). Chemical-resistant boots with a steel toe and shank. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. The toxicity of sulfur mustard as an incapacitating agent is of much greater importance than its ability to cause leth-ality. Contact with metals may evolve flammable hydrogen gas. Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE. Mostly, the exposed areas of the body are the main targets for SM; however, it also adversely affects various tissues of the body and ultimately exhibits long-term complications including genotoxic and . Additional clinical guidance is available from the National Institutes of Health’s Chemical Emergency Medical Management website https://chemm.nlm.nih.gov/mustard_hospital_mmg.htmExternal. SM exerts its cytotoxicity via direct alkylation of biomacromolecules, and overproduction of reactive . Immediately wash eyes with large amounts of tepid water for at least 15 minutes. Ocular Effects of Sulfur Mustard . They are called vesicants or blistering agents. Extensive eye exposure can cause permanent blindness. Immediately remove the patient/victim from the source of exposure. Contact 800-CDC-INFO (800-232-4636) or go to https://emergency.cdc.gov/chemical/lab.asp. Typically, signs and symptoms do not occur immediately. It is a cytotoxic and alkylating compound. Sulfur mustard is a powerful irritant and blistering agent that damages the skin, eyes, Sulfur mustard (SM) is a strong blistering, highly reactive, lipophilic chemical war agent that causes injury in different organs including the skin, eyes, and respiratory tract. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Objective: To find out the late pulmonary sequelae of sulfur mustard gas inhalation in 197 veterans, 10 years after their exposure. 1996). 1996). Mustard gas is a clear amber colored oily liquid with a faint odor of mustard/garlic. 1 The prototypical and most common blister agent is sulfur mustard (SM) (bis-(2-chloroethyl) sulfide), commonly referred to as mustard gas. Semi-continuous high speed gas analysis of generated vapors of chemical warfare agents. Always move in a downward motion (from head to toe). Be careful not to break the patient/victim’s skin during the decontamination process, and cover all open wounds. If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen. Saving Lives, Protecting People, The National Institute for Occupational Safety and Health (NIOSH), National Institute for Occupational Safety and Health (NIOSH), Emergency Response Safety and Health Database, AMMONIA SOLUTION (UN 3318); AMMONIA, ANHYDROUS (UN 1005), U.S. Department of Health & Human Services. 1, 2 Numerous studies have reported different pathological and clinical effects of SM exposure on various organs. Int J Mass Spectrom 208(1-3):135-145. More than 1,000 tons of sulfur mustard gas was used in the battlefields by the Iraqis against Iranian people. [1992]. Application of headspace solid-phase microextraction and gas chromatography–mass spectrometry for detection of the chemical warfare agent bis(2-chloroethyl) sulfide in soil. The technical objective was to investigate the effects of fumigant concentration and contact time on the decontamination efficacy. This study aimed to evaluate the delayed toxic effects of sulfur mustard gas on Iranian victims. Always use a barrier or bag-valve-mask device. Sulfur mustard can have the following effects: Centers for Disease Control and Prevention. Sulfur mustard can cause skin burns and blisters, especially around sweaty parts of the body. Stay upwind. and mutagenic effects of sulfur mustard. However, if you must, personnel should wear the appropriate PPE during environmental decontamination. The Eyes are especially susceptible to the consequences of SM poisoning because of the aqueous and mucosal nature of conj … If sulfur gas is not removed from the skin relatively quickly, second and third-degree burns may appear. Though no antidote exists for sulfur mustard, exposure is usually not fatal. Inhalation, the major route of exposure, induces respiratory and systemic toxicity. Agent-specific identification, medical symptoms, prevention & personal protective equipment, fire fighting, sampling & analytical methods, decontamination, spillage . Sulfur mustard reacts vigorously with oxidants. It is heavier than water as a liquid and heavier than air as a vapor. Exposure to very high levels can cause long-term respiratory disease or death. Begin washing PPE of the first responder using soap and water solution and a soft brush. The chemical warfare agents sulfur mustard (SM) and nitrogen mustards (HN-1, HN-2, and HN-3) are highly reactive vesicants. Mustard gas impacts the digestive tract in the form of abdominal pain, diarrhea and vomiting. Try to find higher ground, because sulfur mustard is heavier than air and will settle in low-lying areas. In their pure form most sulfur mustards are colorless, odorless, viscous liquids at room temperature. Tender skin, the moist lining of body passages and cavities (mucous membranes), and perspiration-covered skin are more sensitive to the effects of sulfur mustard. J Microcolumn 4(6):477 483. CDC twenty four seven. Gather evidence, and place it in a clearly labeled impervious container. If avoiding sulfur mustard exposure is not possible, rapidly remove the sulfur mustard from the body. First isolate in all directions: 200 ft (60 m). Bis-(beta-chloroethyl) sulfide (Sulfur Mustard) is a potent skin vesicant previously used for chemical warfare. Because no antidote exists for sulfur mustard exposure, the best thing to do is avoid it. Exposure to sulfur mustard liquid is more likely to produce second- and third- degree burns and later scarring than is exposure to sulfur mustard vapor. I may have been exposed to a sea-disposed chemical warfare blister agent such as sulfur or nitrogen mustard or lewisite. You will be subject to the destination website's privacy policy when you follow the link. Although sulfur mustard is heavier than water, small droplets float on water surfaces and present a hazard in contaminated areas. Depending on the severity of the exposure, symptoms may not occur for up to 24 hours. Mild to moderate: Erythema (redness) begins to appear 1 to 24 hours after exposure (typically within 4 to 8 hours); blistering (vesication) begins 2 to 18 hours after onset of redness; possible intense itching (pruritus), and burning pain. Eyes need to be flushed with water for 5 to 10 minutes. People can be exposed to liquid sulfur mustard by eating it or getting it on their skin. A Toxicological Profile for Sulfur Mustard (previously Mustard Gas), Draft for Public Comment was released in September 2001. 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