Sigh, it seems like just yesterday we were all worked up over the polio scare and now here we are lining up like Apple customers for gas masks. Everyone seems to be really worked up after the chemical attacks in Syria and I’ve been getting a lot of questions about just what the heck we are talking about.

First and foremost, we need to take a deep breath (ok, that may be a poor choice of words). The chances of any chemical attack in Israel are – at this point – slim to none. When the threat was considered real during the Gulf War, they were handing out the things at every street corner.

Am I too gullible to rely on Israeli intelligence and the Home Front Command? Hell, we’ve made it this far! I mean, someone must know what they’re doing. We live surrounded by millions who want to murder us and we can still get some killer carpaccio, and the Petit Syrah is to die for. Oops … Anyway….

So what’s the deal with “chemical weapons”? Sarin gas? Nerve gas?

I’ll try to explain what we are all twerking about.

What is sarin gas?

Sarin gas, also known as “GB” is a G series nerve agent in the organophosphate family. At room temperature sarin is actually a volatile (high tendency to vaporize) liquid and evaporates at the same rate as water. Sarin was developed at the end of World War II by German scientists, hence the G series, (no comments). It was created as a more lethal version of the original nerve agent “Tabun” which was initially synthesized as an insecticide. Sarin is colorless and odorless… yay….

How does it work?

Ok, let’s take a little trip down memory lane back to biology,chemistry and a shtickle physiology… hey, you asked! The organophosphate family works by interfering with cellular transmission (no, not the Cellcom vs. Golan debate). Between two nerve endings there is a little gap called a synapse. One nerve cell releases chemicals or “neurotransmitters” that stimulates the next cell. Once the next cell is all stimulated and the message is passed along, the neurotransmitter, in our case “acetylcholine” is degraded by an enzyme called acetylcholinesterase.

Sarin gas deactivates our good friend acetylcholinesterase. This causes overstimulation of the nervous system and all the nasty effects we will talk about later.

But we have gas masks so we’re cool right?

Err, um, aha, no, not really. Given the fact that they (sarin and other nerve gases in the same family) are volatile liquids at room temperature there is high risk for dermal contact (i.e. liquid getting on your skin) and being that they are soluble in fat and water they are readily absorbed through the eyes, respiratory tract and even the skin. That’s not to mention the vapors getting on your clothes etc… The scientists who actually go test the stuff get dressed up à la E.T. style.

So why the heck are we lining up to get the masks?

I’ll quote Dr. John Clements, professor of immunology and microbiology at Tulane University, in an interview with ABC news: “I believe individuals buying gas masks to protect themselves against an unspecified biological or chemical attack is pretty useless.”

Part of it is surely psychological, while if the threat is real then more would be needed. I guess there is also always the chance Assad lobs over some tear gas for good fun.

Hey! I just noticed our relatively ineffective kits don’t have the antidote injector! What gives?

Oh, don’t worry about that… the injector had a dose of atropine and some had another antidote called pralidoxime as well. Although they are theoretically effective, practically they are much less so given the fact that a) by the time you realize you are exposed, the fat lady is already doing an encore b) the half-lives of these drugs are so short, one or two doses are basically not enough; often, multiple doses are needed.

Wonderful! So what are the symptoms?

The symptoms can affect many systems;

Eyes: tearing, burning, redness.

Lungs:coughing, wheezing, chest tightness

Nose: rhinorrhea (fancy word for runny nose)

Urine: Incontinence (loss of control of bladder)

Gastrointestinal: diarrhea, vomiting, stool incontinence.

Nervous system: agitation, seizures, loss of consciousness, twitching.

These symptoms usually progress to paralysis, respiratory failure and death.

So remember, if you have a runny nose, cough and some diarrhea… you have a g-d damn virus so relax!

How is the gas delivered?

Um, I’m an ER doc not a ballistics expert! Anyway, although the chemicals used to make sarin can be readily obtained, delivery systems can be more complex. Given how toxic the gas is, the chemicals need to be separated and then mixed in flight before detonation (hence the term “binary weapon”). Local, more basic delivery systems are easier, as was used in the Tokyo subway incident in 1995. It is yet unclear how Syria delivered the sarin gas but it seems to have been a short-range rocket. As far as I know, sarin gas has never been used in long- range-International ballistics.

* * * *

Sorry for the depressing facts, but sarin is really bad news. All the information at this time points to the fact that the chance of any attack, let alone a chemical attack on Israel, is pretty close to zero. I’m sure in the meantime, if there is any new intelligence, Israel will adapt its policies. At this point, hospitals have not been told to stockpile antidotes. I think Israel knows that the best defense against sarin is destroying it where it’s stored.

While we all watch, wait and gesticulate, I’d like to wish everyone a happy and healthy new year!