Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media

Ann Intern Med. 2014 May 6;160(9):644-8. doi: 10.7326/M13-2799.


On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events.

MeSH terms

  • Atropine / therapeutic use
  • Chemical Terrorism*
  • Child
  • Cholinergic Antagonists / therapeutic use
  • Decontamination
  • Disaster Planning
  • Female
  • Humans
  • Infant
  • Injections, Intravenous
  • Male
  • Mass Casualty Incidents*
  • Poisoning / complications
  • Poisoning / diagnosis
  • Poisoning / therapy
  • Sarin / poisoning*
  • Social Media*
  • Syria / epidemiology


  • Cholinergic Antagonists
  • Atropine
  • Sarin