The Tokyo Subway Sarin Attack: Acute and Delayed Health Effects in Survivors

On the morning of March 20, 1995, 15 stations in the Tokyo subway system were filled with a noxious substance that later was identified as a diluted form of sarin. A total of five subway commuter cars were affected during the Monday morning rush hour. Fortunately, only a relatively small number of victims died, but the details of the incident suggest that it was not a full-scale attack. What this means is that humanity has not yet experienced a full-scale sarin attack in a modern major city. This chapter describes the emergency treatment, signs and symptoms, and laboratory findings connected with this and similar incidents. The medical treatment required for responding to a chemical terrorist attack on the general public will require a different strategy to that employed for such attacks in a military setting. From the standpoint of international security, collaborative research on drugs for treating chemical terrorism and a global agreement on standard treatment is needed.