"The Risk is Only Going to Grow"

CU Professor seeks an antidote for chemical weapons exposure

By Tonia Twichell

(December 2017) When two bombs exploded at the Boston Marathon in 2013, bystanders jumped in to help, improvising tourniquets, bandaging wounds and driving the wounded to hospitals. 

Three people were killed and 264 injured, but U.S. Air Force Col. Vikhyat Bebarta, MD, CU professor of emergency medicine, imagines an even darker scenario “if that bomb had had chemicals instead of nails and screws.” 

Bystanders entering the “hot zone” could be exposed to contaminants and would be helpless to render aid in any case, he said.  

“There are antidotes for a lot of these chemicals but they involve using an IV,” he said. “No taxi cab driver knows how to put in an IV. No shop owner knows how to do ventilation.”  

Without immediate treatment, victims would die or suffer long-term health consequences because most chemical agents bind tissue rapidly. 

As terrorism spreads around the world, governments are searching for an antidote to chemical exposure that is simple to use and cheap to manufacture, and Bebarta is on the forefront of that effort.  

A Growing Danger 

Bebarta, who served his residency at University of Colorado Hospital and Denver Health Medical Center, and completed a fellowship in toxicology at Rocky Mountain Poison & Drug Center, first saw chemical weapon casualties while stationed in Iraq in 2006. An explosion injured dozens of Iraqi civilians and U.S troops, and they arrived at his hospital with burns and breathing problems. 

“Al Qaeda and other groups were blowing up chlorine trucks and tanks,” he said. “Some patients were very sick.” 

During his deployments Bebarta also saw mustard gas injuries from munitions left over from the 1980s, though most of those chemicals were too old to ignite and generally just caused burns, often to the terrorists themselves. 

Treating victims of chemical exposure became commonplace for Bebarta, who estimates he’s seen hundreds of victims in his four deployments, but the chaos and fear they inspired never became routine. 

“All war injuries are very difficult to treat … but chemical weapons are psychologically challenging,” said Bebarta, an Air Force Academy graduate, who has trained doctors in chemical exposure treatment in Jordan, Afghanistan and Iraq. “Most of these folks are prepared for a gunshot wound or explosion. But they are not prepared for chemicals because they don’t know what the long-term effects are. They don’t know what the short-term effects are. They don’t know what next four hours will look like.” 

Dealing with victims of chemical agents is difficult for hospital staff, partly because they don’t know if they are in danger of contamination, and also because of the large number of casualties. 

“I can give a world of care to one or two patients, but when you have 40, 50 or even 80 people in the field or in a hospital room that are exposed after drinking or inhaling cyanide, you can’t treat them as quickly as you should. And you have to treat chemicals right away. You can’t wait.” 

Bebarta fears that the number of attacks will continue to increase and spread to civilian populations because many deadly chemicals are readily available, and information on deploying them is easy to access.  

“The risk is only going to grow now. Whether it’s in Somalia, the Philippines, Korea or some guy in South Dakota or Denver, they now have that technology and understanding because it’s being disseminated quickly by the internet. They know they can use chemicals in ways that would bring terror and media attention, cause some deaths, and scare and injure a lot of people. It’s not going to settle down. Because we haven’t solved the problem of getting rid of those folks, it’s going to spread.”  

Fast-Track to a Solution 

A member of the Air Force Reserve appointed to the Office of Chief Scientist of the 59th Medical Wing, the Department of Defense’s (DoD) largest ambulatory surgical care facility, and serving on several Joint DoD research steering committees, Bebarta has been working on development of an antidote that could be administered in the field. 

In an emergency, even experts like Bebarta often need to treat without the certainty of a diagnosis because the tests results needed to verify the agent can take hours.  

An antidote would have to reflect that reality by counteracting multiple chemical agents. 

“We treat empirically and make some guesses. Sometimes we can differentiate a little because of the type of burns, but for most part we don’t know.”  

Chemical weapons fall into two categories: toxic industrial chemicals (TICs) like cyanide, chlorine and hydrogen sulfide which are common and usually found in large quantities, and manufactured warfare agents that include nerve agents like sarin and mustard gas. 

“I think industrial chemicals are where it’s at, because they’re available, they’re toxic, they’re easily released and they’re cheap. Chemical warfare agents traditionally have been used in Syria, but it’s much harder to get access to them. So the average terrorist or antigovernment person will probably use TICs.” 

Some chemicals like cyanide, sulfide and sarin gas are more susceptible to an antidote development than chlorine, which poses more of a challenge.  

Bebarta envisions an antidote that can be ingested, inhaled or injected into muscle to simplify delivery. He would like to see it packaged alongside automated external defibrillators, which can be found in any public building or gathering place in the United States. 

“Say there’s an explosion down the street at 7-Eleven. We want drugs that can be administered by the Arapahoe County sheriff deputy or Denver paramedic or Aurora fireman. Then, in the hospital, we can do follow up care.” 

Using DoD and National Institutes of Health grants, Bebarta’s team at the School of Medicine is working with scientists around the country as well as in Europe and Israel to develop the drug cobinamide to treat chemical reactions. The researchers are moving “from ‘bench to bedside to bystander,’ covering the whole path from ‘molecule to market.’” 

Bebarta and his colleagues have met with the U.S. Food and Drug Administration, and he expects the approval process to begin within approximately two years “if everything continues to go as quickly it is now.” He feels some self-imposed pressure to move fast. 

“This is not just an academic endeavor for me. I could research anything. For me, it’s personal. When I’m on active duty, these are the guys I take care of. I do feel responsible for them. Getting these solutions into practice is very important. My buddies are the ones in Syria, Somalia and Iraq right now. I know what they are going through. I feel obligated to figure out a solution. It’s not hypothetical. These are real soldiers and airmen I want to get the antidote to. These are my friends who will be getting exposed. The same goes for my colleagues, neighbors, community members and friends in Denver and Colorado.”