The Sarin Nerve Gas Attack on the Tokyo Subway System: Hospital Response to Mass Casualties and Psychological Issues in Hospital Planning

Abstract

On the morning of March 20, 1995 victims of an unknown odorless, colorless chemical agent began arriving in large numbers at the emergency department of St. Luke’s International Hospital in Tokyo, Japan. The author was, at the time, the chief resident on duty and chronicles his experiences and raises a number of hospital planning notes in responding to such a mass casualty event. Only later did the author learn that a cult group, Aum Shinrikyo had perpetrated this coordinated attack at the Tokyo subway employing sarin gas, a powerful neurotoxic agent. More than 500 victims sought care at St. Luke’s International Hospital within the first few hours following this attack and; more than 5500 in all sought medical evaluations following this attack. Although some of the victims were very sick due to their nerve gas exposures and twelve victims eventually died, the vast majority of the victims were acute psychological casualties - worried well - who feared they might have been exposed to sarin gas. This and a number of other psychosocial parameters of this terrorist attack are considered in this article.