Sulfur Mustard (Mustard Gas): Exposure, Decontamination, Treatment

• Sulfur mustard is a human-made chemical warfare agent that causes blistering of the skin and mucous membranes on contact. This type of chemical warfare agent is called a vesicant or blistering agent.
• Sulfur mustard is known as “mustard gas,” “mustard agent,” or by the military designation “H” or “HD.”
• Sulfur mustard can be clear to yellow or brown when it is in liquid or solid form.
• Sulfur mustard sometimes smells like garlic, onions, or mustard, or it may have no perceivable odor.
• Sulfur mustard can be a vapor (gas), an oily-textured liquid, or a solid. At room temperature, it is usually a liquid. Sulfur mustard is usually a solid when the temperature is less than 58° Fahrenheit.

• After a release of sulfur mustard into the air, people can be exposed through skin contact, eye contact, or inhaling (breathing in) the sulfur mustard
• Following release of sulfur mustard into water, people can be exposed by touching or drinking water that contains sulfur mustard.
• People can also be exposed to liquid sulfur mustard by swallowing it, getting it on their skin, or getting it in their eyes.
• Eating, drinking, or touching food or drink contaminated with sulfur mustard can expose people to sulfur mustard.
• Touching or inhaling sulfur mustard vapor from contaminated clothing can expose anyone who touches the clothes or inhales sulfur mustard vapors from the clothes.
• Because sulfur mustard vapor is heavier than air, it will sink to low-lying areas, increasing the risk of exposure there. Avoid low-lying areas.
• Sulfur mustard can last 1–2 days in the environment in average weather conditions and weeks to months in very cold conditions.

• Food not contained in glass or metal (such as plastic, paper, or cloth containers) that may have come into contact with vapor or liquid sulfur mustard should be avoided.
• If the food is in an undamaged sealed glass or metal container, it should not be affected by a sulfur mustard release. Wash the outside of the container before using.
• If the food smells, tastes, or looks unusual, avoid using the food.
• Follow any directions by local authorities.

Signs and symptoms vary depending on how the person was exposed, the amount of sulfur mustard (mass), and the length of time of the exposure.

Typically signs and symptoms do not occur immediately. It may take up to 24 hours for some symptoms to occur. Sulfur mustard can have the following effects on specific parts of the body:

• Abdominal pain
• Blistering of skin, yellow in color
• Bloody nose
• Cough
• Decreased formation of blood cells
• Decreased red and white blood cells and platelets (pancytopenia) leading to weakness, bleeding, and infections
• Diarrhea
• Difficulty breathing
• Eye irritation
• Eye swelling
• Eye pain
• Eye tearing
• Fever
• Hoarseness
• Nausea
• Pain at site of exposure
• Runny nose
• Shortness of breath
• Sinus pain
• Skin itching
• Skin pain
• Skin redness
• Sneezing
• Temporary Blindness
• Vomiting
• Wheezing

Exposure to large doses of sulfur mustard may result in the following harmful health effects:

• Convulsions
• Light sensitivity
• Insomnia
• Permanent or temporary blindness
• Respiratory failure leading to death

1. Get away from the area where the sulfur mustard was released and breathe fresh air. Make sure you understand your local emergency notification system if you have one. Refer to emergency broadcasts and local authorities for instructions.

• If the sulfur mustard release was outdoors, go indoors and shelter in place. Make sure windows are closed and ventilation systems are turned off to make sure the contamination does not come inside. If you cannot go indoors, leave the area where the sulfur mustard was released.
• If you cannot get away from the area where sulfur mustard was released, go to the highest ground possible because sulfur mustard is heavier than air and will sink to low-lying areas.
• If the sulfur mustard release was indoors, get out of the building and seek higher ground.

2. Get it off your body right away!

Taking off all layers of clothing (including jewelry and accessories), blotting any liquid, and showering is the best method for removing sulfur mustard from your body. Ideally, undress, blot, and shower immediately or as soon as you can, as described below. If you cannot take off all layers, take off as many clothes as you can.

• Avoid pulling clothing over your head. If you must pull clothing over your head, close your eyes and mouth, and hold your breath so you don’t get sulfur mustard in your eyes, nose, or mouth. Place items in a designated area, preferably in a plastic bag.
• If you wear contact lenses, take them out and place them with your clothing. Do not put contact lenses back in.
• Use separate, dry, clean cloths or paper towels to blot each part of your body where you feel liquid, beginning with your head and hair, and then your face, hands, body, arms, legs, and feet. Blot your skin for 10 seconds, then rub for 10 seconds any places on your skin or in your hair where you can see or feel liquid.
• Continue blotting and rubbing, with clean, dry cloths or paper towels, dropping used things to the floor. Repeat the process several times if you continue to feel liquid on you. Use a separate clean cloth or paper towels for each part of your body, and for each time you repeat the process.
• First wash your hair, face, and hands, and then wash the rest of your body. Wash from your head to your feet, including armpits and groin, with lukewarm water and mild soap (if available), for about 90 seconds. Use soapy water for a minute, followed by a 30 second plain water rinse. Try not to let the water run into your eyes, nose, or mouth. Do not scrub!
• If your eyes are burning or you can’t see normally, flush your eyes for 10–15 minutes with lukewarm water. Do not use eye drops.
• Dry your face, then tilt your head back and dry your hair, and then down your body. Use anything that will soak up water. Drop used things to the floor. Dress in any available clean clothes to prevent hypothermia. This is especially important if temperatures are cool.
• If emergency response services are available, leave used items on floor and report their location to emergency personnel. Move as far from the used items as possible. Otherwise, put on waterproof or heavy gloves that won’t let liquid seep through. Gather all used things from the floor including your clothes and put in a plastic bag. Remove gloves and put in plastic bag. Close the plastic bag and place it in a second plastic bag. Close up the second bag also.
• Do not put the bags in the regular trash! Place the bags in an area where other people are unlikely to disturb them and come in contact with sulfur mustard. Inform local authorities of the location of the bags for pick up.

3. Get help. Call 911, go to a hospital if local officials say it is safe to leave your home. If you need more information, call the Poison Control Center at 1-800-222-1222.

No known antidote exists for sulfur mustard exposure. Treatment consists of removing sulfur mustard from the body as soon as possible and providing supportive medical care in a hospital setting or by trained emergency personnel.

If someone has ingested sulfur mustard, do NOT induce vomiting.

Exposure to sulfur mustard usually is not fatal. When sulfur mustard was used during World War I, it killed fewer than 5% of the people who were exposed and got medical care.

Skin exposure to sulfur mustard may produce second- and third-degree burns, skin scarring, pigment changes, and skin cancer. Eye exposure may result in temporary or permanent eye injury or chronic eye infections. Inhalation may result in loss of taste and smell, chronic respiratory disease, recurrent respiratory infections, and possibly respiratory cancers.