Thallium: Systemic Agent

Bluish-white metal that turns gray on exposure to air.

Thallium was discovered by Sir William Crookes in 1861. It is a soft, heavy, inelastic metal. Thallium is tasteless and odorless and has been used by murderers as a difficult to detect poison. It is found in trace amounts in the earth’s crust. Thallium has not been produced in the United States since 1984, but is imported for use in the manufacture of electronics, low temperature thermometers, optical lenses, and imitation precious jewels. It also has use in some chemical reactions and medical procedures. Thallium was used historically as a rodenticide, but has since been banned in the United States due to its toxicity from accidental exposure.

• Indoor Air: Thallium can be released into indoor air as fine particles (aerosol).
• Water: Thallium cannot be used to contaminate water because it does not dissolve in water.
• Food: Thallium can be used to contaminate food.
• Outdoor Air: Thallium can be released into outdoor air as fine particles (aerosol).
• Agricultural: If thallium is released into the air as fine particles (aerosol), it has the potential to contaminate agricultural products.

Thallium can be absorbed into the body by inhalation, ingestion, and skin contact. Ingestion is an important route of exposure.

First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self Contained Breathing Apparatus (SCBA) with a Level A protective suit when entering an area with an unknown contaminant or when entering an area where the concentration of the contaminant is unknown. Level A protection should be used until monitoring results confirm the contaminant and the concentration of the contaminant.
NOTE: Safe use of protective clothing and equipment requires specific skills developed through training and experience.

Select when the greatest level of skin, respiratory, and eye protection is required. This is the maximum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A Totally-Encapsulating Chemical Protective (TECP) suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, and a hard hat worn under the TECP suit are optional items.

Select when the highest level of respiratory protection is necessary but a lesser level of skin protection is required. This is the minimum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than AEGL-2. It differs from Level A in that it incorporates a non-encapsulating, splash-protective, chemical-resistant splash suit that provides Level A protection against liquids but is not airtight.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the respiratory protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR) are met. This level is appropriate when decontaminating patient/victims.

• A NIOSH-certified CBRN tight-fitting APR with a canister-type gas mask or CBRN PAPR for air levels greater than AEGL-2.
• A NIOSH-certified CBRN PAPR with a loose-fitting face-piece, hood, or helmet and a filter or a combination organic vapor, acid gas, and particulate cartridge/filter combination or a continuous flow respirator for air levels greater than AEGL-1.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Escape mask, face shield, coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the concentration is below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.

• Limited to coveralls or other work clothes, boots, and gloves.

• Cold thallium ignites on contact with fluorine.

• Containers may explode when heated.

• Thallium is non-combustible.
• The agent itself does not burn, but it may decompose upon heating to produce corrosive and/or toxic fumes.
• Fire may produce irritating, corrosive, and/or toxic gases.
• For small fires, use dry chemical, carbon dioxide, or water spray.
• For large fires, use water spray, fog, or regular foam. Move containers from the fire area if it is possible to do so without risk to personnel. Dike fire control water for later disposal; do not scatter the material. Use water spray or fog; do not use straight streams.
• For fire involving tanks or car/trailer loads, fight the fire from maximum distance or use unmanned hose holders or monitor nozzles. Do not get water inside containers. Cool containers with flooding quantities of water until well after the fire is out. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tanks. Always stay away from tanks engulfed in fire.
• For massive fire, use unmanned hose holders or monitor nozzles; if this is impossible, withdraw from the area and let the fire burn.
• Run-off from fire control or dilution water may be corrosive and/or toxic, and it may cause pollution.
• If the situation allows, control and properly dispose of run-off (effluent).

• If a tank, rail car, or tank truck is involved in a fire, isolate it for 0.5 mi (800 m) in all directions; also consider initial evacuation for 0.5 mi (800 m) in all directions.
• This agent is not included in the DOT ERG 2004 Table of Initial Isolation and Protective Action Distances.
• In the DOT ERG 2004 orange-bordered section of the guidebook, there are public safety recommendations to isolate a thallium (Guide 151) spill or leak area immediately for at least 150 ft (50 m) for liquids and 75 ft (25 m) for solids in all directions.

• Not established/determined

• OSHA: ID 121
• NIOSH: 7300

• AIR MATRIX
• OTHER
• SOIL MATRIX
• SURFACES
• WATER

Adverse health effects from thallium are dose dependent, and occur in three stages. The gastrointestinal phase may occur immediately with large ingestions or may be delayed 24 to 48 hours with smaller ingestions. This is followed by a neurological phase 2 to 5 days or more after ingestion, although it may occur as early as 12 hours after massive ingestion. In acute toxicity, alopecia may occur 2 to 3 weeks after exposure. Death may occur in severe cases 5 to 7 days following exposure due to respiratory paralysis and failure.

Massive exposures may produce gastrointestinal symptoms (nausea, vomiting, and abdominal pain) within 30 minutes. Gastrointestinal symptoms however are usually delayed past 8 hours.

• Acute eye exposure is unlikely to result in any local or systemic effects other than mild local irritation.

• Adverse effects due to thallium poisoning are usually delayed by 12 to 24 hours in acute poisoning and reach their maximum by the second or third week after exposure.
• Transient nausea and vomiting (emesis) are seen first, followed by painful sensations in the arms/hands and legs/feet within 1 to 5 days (sometimes more).
• Other effects include: Visual effects; rapid heart rate and high blood pressure; abnormal heart rhythms; respiratory failure; unusual, painful, or burning sensations; muscle aches and weakness; headache; seizures, delirium, and coma; loss of appetite; excessive salivation; inflammation of the mouth, lips, and gums; possible green discoloration of urine shortly after exposure; kidney damage; breakdown of red blood cells; severe acne; and dry and crusty scaling of the skin.
• Severe: Possible damage to the nerves controlling the muscles of the head and neck (e.g., swallowing and eye movements) and also to the muscles that assist in breathing; possible heart damage to the point of being unable to support blood pressure; and loss of scalp hair (alopecia) that develops 2 to 3 weeks after exposure.

• See Ingestion Exposure.

• See Ingestion Exposure.

The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and effectively. Care should be taken during decontamination, because absorbed agent can be released from clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to have been released.

The following are recommendations to protect the first responders from the release area:

• Position the decontamination corridor upwind and uphill of the hot zone. The warm zone should include two decontamination corridors. One decontamination corridor is used to enter the warm zone and the other for exiting the warm zone into the cold zone. The decontamination zone for exiting should be upwind and uphill from the zone used to enter.
• Decontamination area workers should wear appropriate PPE. See the PPE section of this card for detailed information.
• A solution of detergent and water (which should have a pH value of at least 8 but should not exceed a pH value of 10.5) should be available for use in decontamination procedures. Soft brushes should be available to remove contamination from the PPE. Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.

The following methods can be used to decontaminate an individual:

• Decontamination of First Responder:
  • Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.
  • Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE has been removed.
  • Place all PPE in labeled durable 6-mil polyethylene bags.
• Decontamination of Patient/Victim:
  • Remove the patient/victim from the contaminated area and into the decontamination corridor.
  • Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene bag.
  • Thoroughly wash and rinse (using cold or warm water) the contaminated skin of the patient/victim using a soap and water solution. Be careful not to break the patient/victim’s skin during the decontamination process, and cover all open wounds.
  • Cover the patient/victim to prevent shock and loss of body heat.
  • Move the patient/victim to an area where emergency medical treatment can be provided.

Initial treatment (following external decontamination) is primarily supportive and includes internal decontamination. In cases of ingestion, repeated administration (up to 4 doses; 1 dose every 2 to 3 hours) of activated charcoal (in the absence of Prussian blue) is recommended. Charcoal binds to thallium, keeping it within the intestinal tract; thallium is thereby prevented from being absorbed and it passes out of the body more readily. The usual dose for adults or children is 0.5 to 1.0 g/kg by mouth (per dose).

The FDA has approved Prussian blue (Radiogardase™) as an antidote for thallium toxicity. It is thought that Prussian blue binds to thallium within the intestinal tract even more effectively than does activated charcoal. The usual dose for adults or children is 3 g by mouth immediately; followed by 250 mg/kg/d divided into four daily doses (QID). Prussian blue is safe for most infants, children, and adults, including pregnant and breast-feeding women.

• Immediately remove the patient/victim from the source of exposure.
• Immediately wash eyes with large amounts of tepid water for at least 15 minutes.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• Ensure that the patient/victim has an unobstructed airway.
• Induce vomiting (emesis) with syrup of ipecac if able to do so within 30-60 minutes of ingestion.
• The patient/victim may vomit spontaneously.
• Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
• Monitor heart, kidney (renal), and liver function.
• If the patient/victim can be rapidly transported to an emergency department following decontamination, stomach pumping (gastric lavage) may be considered. Gastric lavage is recommended if it can be done shortly after ingestion (generally within 1 hour).
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• Evaluate respiratory function and pulse.
• Ensure that the patient/victim has an unobstructed airway.
• Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
• If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen.
• Assist ventilation as required. Always use a barrier or bag-valve-mask device.
• If breathing has ceased (apnea), provide artificial respiration.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• See the Decontamination section for patient/victim decontamination procedures.
• Seek medical attention immediately.

Prussian blue (Radiogardase™, potassium ferric hexacyanoferrate) was approved by the FDA in 2003 for use in non-radioactive thallium poisoning. Treatment with Prussian blue should begin as soon as possible after exposure. In the absence of the ready availability of Prussian blue, use of multi-dose activated charcoal may be advocated. Stomach pumping (gastric lavage) may be considered in cases of thallium ingestion. Whole bowel irrigation with polyethylene glycol may be recommended if x-rays show thallium within the intestinal tract. Hemodialyis and charcoal hemoperfusion are recommended although efficacy may be limited. Forced diuresis with potassium loading is not recommended. Use of sodium polystyrene sulfonate to bind thallium is not recommended; its greater affinity for potassium probably renders it clinically ineffective. Cardiac, renal, and hepatic function should be monitored, as should calcium levels. Urine thallium levels above 5 µg/L are abnormal, with levels above 200 µg/L being indicative of poisoning. Thallium blood concentration levels are normal below 2 µg/L, and toxic at concentrations greater than 200 µg/L.

Long-term effects of thallium exposure can include difficulty walking, various involuntary movement disorders, and impairment of thought and mood. Neurological damage resolves slowly and may be permanent.

Thallium is not classifiable as a carcinogen, and it is not suspected to be a carcinogen. It is unknown whether chronic or repeated exposure to thallium increases the risk of reproductive toxicity or developmental toxicity. Chronic high level exposure to thallium through inhalation has been reported to cause nervous system effects, such as numbness of fingers and toes. Thallium may cross the placental barrier in humans and may be associated with fetal mortality, particularly if exposure occurs during the period of organ development (organogenesis). Thallium is excreted into breast milk of nursing mothers.

• Consult with the Incident Commander regarding the agent dispersed, dissemination method, level of PPE required, location, geographic complications (if any), and the approximate number of remains.
• Coordinate responsibilities and prepare to enter the scene as part of the evaluation team along with the FBI HazMat Technician, local law enforcement evidence technician, and other relevant personnel.
• Begin tracking remains using waterproof tags.

• Wear PPE until all remains are deemed free of contamination.
• Establish a preliminary (holding) morgue.
• Gather evidence, and place it in a clearly labeled impervious container. Hand any evidence over to the FBI.
• Remove and tag personal effects.
• Perform a thorough external evaluation and a preliminary identification check.
• See the Decontamination section for decontamination procedures.
• Decontaminate remains before they are removed from the incident site.

The following methods can be used to decontaminate the environment/spillage disposal:

• Do not touch or walk through the spilled agent if at all possible. However, if you must, personnel should wear the appropriate PPE during environmental decontamination. See the PPE section of this card for detailed information.
• Keep combustibles (e.g., wood, paper, and oil) away from the spilled agent. Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to contact the spilled agent.
• Do not direct water at the spill or the source of the leak.
• Stop the leak if it is possible to do so without risk to personnel, and turn leaking containers so that gas rather than liquid escapes.
• Prevent entry into waterways, sewers, basements, or confined areas.
• Isolate the area until gas has dispersed.
• Ventilate the area.

Agents can seep into the crevices of equipment making it dangerous to handle. The following methods can be used to decontaminate equipment:

• Not established/determined