{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:51:04Z","timestamp":1785891064891,"version":"3.56.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X22000528_as1\"><jats:title>Background:<\/jats:title><jats:p>The use of chemical weapons in terrorist attacks, though rare, remains a significant challenge and concern due to their ability to inflict mass casualties. Chemical attacks remain a topic of interest for Disaster Medicine (DM) and Counter-Terrorism Medicine (CTM) specialists and are clearly an area in need of enhanced preparedness. This study aims to provide an epidemiological description of all terrorism-related attacks using chemical agents as a primary weapon, sustained from 1970 - 2019. These data will be useful in the development of education programs in CTM and provide an insight into how best to prepare for potential attacks in the future.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X22000528_as2\"><jats:title>Methods:<\/jats:title><jats:p>Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all events using chemical weapons as a primary attack method from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. The GTD also details the specific chemical used, when known, in the summary of incidents. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X22000528_as3\"><jats:title>Results:<\/jats:title><jats:p>A total of 292 terrorist attacks involving chemical agents as a primary attack method were recorded from 1970 - 2019, registering 284 deaths and 13,267 injuries. Acid (52) was the most commonly used chemical agent, followed by \u201cunspecified poison\u201d (43), \u201cunknown chemical agents\u201d (29), \u201cunspecified gas\u201d (27), tear gas (27), chlorine gas (24), cyanide (21), mercury (9), pepper spray or mace (9), mustard gas (8), insecticide or 1080 (8), diphenylamine chloroarsine (7), phosphate or phosphorous (3), sodium hydroxide or corrosive liquid (3), sarin (2), \u201cunspecified drugs\u201d (2), VX nerve gas and other nerve gas (2), pesticides (2), cleaning chemicals\/paint thinner (2), ammonia (2), anesthesia agent (1), arsenic (1), chlorine and mustard gas mix (1), phenarsazine chloride (1), rat poison (1), unknown irritative gas (1), hydrochloric acid and sodium cyanide mix (1), unknown white powder (1), antiseptic dye (1), and chlorine gas and white phosphorous mix (1).<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X22000528_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>The use of chemical weapons in warfare, though prohibited by the Chemical Weapons Convention (CWC), remains a rare but concerning terrorist attack methodology. In recent years, there have been more instances where potentially deadly chemicals have been used in civilian settings. Dual use industrial chemicals, in particular, pose a significant concern. Acid was the most commonly used chemical weapon in 52 attacks. Tear gas, chlorine, and cyanide were each used in over 20 attacks. Both DM and CTM specialists advocate for better preparedness and response training for intentional events in civilian settings.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x22000528","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:56:32Z","timestamp":1649379392000},"page":"327-332","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":16,"title":["Chemical Agent Use in Terrorist Events: A Gathering Storm Requiring Enhanced Civilian Preparedness"],"prefix":"10.1017","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0804-5313","authenticated-orcid":false,"given":"Derrick","family":"Tin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory R.","family":"Ciottone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"S1049023X22000528_ref8","unstructured":"8. OPCW. Chemical weapons convention. https:\/\/www.opcw.org\/chemical-weapons-convention. Accessed December 5, 2021."},{"key":"S1049023X22000528_ref10","unstructured":"10. Annex on Chemicals Schedule 1. Organization for the Prohibition of Chemical Weapons. 2021. https:\/\/www.opcw.org\/chemical-weapons-convention\/annexes\/annex-chemicals\/schedule-1. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref12","unstructured":"12. Keyes, D , Benitez, F , Vezel-Daubon, L. CBRNE - Nerve Agents, V-series. Medscape. 2019. https:\/\/emedicine.medscape.com\/article\/831760-overview. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref17","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X21000868"},{"key":"S1049023X22000528_ref5","unstructured":"5. Global Terrorism Database (GTD). START. https:\/\/www.start.umd.edu\/data-tools\/global-terrorism-database-gtd. Accessed July 18, 2021."},{"key":"S1049023X22000528_ref13","unstructured":"13. Annex on Chemicals Schedule 2. Organization for the Prohibition of Chemical Weapons. 2021. https:\/\/www.opcw.org\/chemical-weapons-convention\/annexes\/annex-chemicals\/schedule-2. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref11","unstructured":"11. Thiodiglycol. PubChem. https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Thiodiglycol#section=Absorption-Distribution-and-Excretion. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref7","unstructured":"7. Codebook : Inclusion Criteria and Variables. College Park, Maryland USA: National Consortium for the Study of Terrorism and Responses to Terrorism; 2019."},{"key":"S1049023X22000528_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X21000625"},{"key":"S1049023X22000528_ref3","unstructured":"3. Tactical Emergency Casualty Care Guidelines for BLS\/ALS Medical Provider Response to Chemical Warfare Agents\/Events. Committee for Tactical Emergency Casualty Care. 2021:1\u201318."},{"key":"S1049023X22000528_ref4","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X21001059"},{"key":"S1049023X22000528_ref19","unstructured":"19. Sadeghi, M. Fact check: it\u2019s true tear gas is a chemical weapon banned in war. USA Today. 2020. https:\/\/www.usatoday.com\/story\/news\/factcheck\/2020\/06\/06\/fact-check-its-true-tear-gas-chemical-weapon-banned-war\/3156448001\/. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref15","unstructured":"15. Zanders, JP. What is a chemical weapon? When is chlorine a chemical weapon? The Trench. 2018. https:\/\/www.the-trench.org\/what-is-a-cw. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1705224"},{"key":"S1049023X22000528_ref1","doi-asserted-by":"publisher","DOI":"10.55460\/UU8Q-EDYQ"},{"key":"S1049023X22000528_ref20","unstructured":"20. What is a Chemical Weapon? Organization for the Prohibition of Chemical Weapons. 2021. https:\/\/www.opcw.org\/our-work\/what-chemical-weapon. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref14","unstructured":"14. Annex on Chemicals Schedule 3. Organization for the Prohibition of Chemical Weapons. 2021. https:\/\/www.opcw.org\/chemical-weapons-convention\/annexes\/annex-chemicals\/schedule-3. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref6","unstructured":"6. National Consortium for the Study of Terrorism and Responses to Terrorism. https:\/\/www.start.umd.edu\/. Accessed November 28, 2021."},{"key":"S1049023X22000528_ref16","unstructured":"16. 5 Questions About Syria and Chemical Weapons. NPR . 2018. https:\/\/www.npr.org\/sections\/parallels\/2018\/04\/09\/600900702\/5-questions-about-syria-and-chemical-weapons. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref9","unstructured":"9. Annex on Chemicals. Guidelines for Schedules of Chemicals. Organization for the Prohibition of Chemical Weapons. 2021.https:\/\/www.opcw.org\/chemical-weapons-convention\/annexes\/annex-chemicals\/annex-chemicals. Accessed December 12, 2021."},{"key":"S1049023X22000528_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.10.051"},{"key":"S1049023X22000528_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X21000765"}],"container-title":["Prehospital and Disaster Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1049023X22000528","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T07:48:16Z","timestamp":1653637696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1049023X22000528\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,8]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["S1049023X22000528"],"URL":"https:\/\/doi.org\/10.1017\/s1049023x22000528","relation":{},"ISSN":["1049-023X","1945-1938"],"issn-type":[{"value":"1049-023X","type":"print"},{"value":"1945-1938","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,8]]},"assertion":[{"value":"\u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}