chemical / radiological principles chemical terrorism
TRANSCRIPT
Chemical / Radiological Principles
CHEMICAL TERRORISM
Chemical / Radiological Principles
OBJECTIVES• Learn how to perform a rapid assessment
of a nerve agent terrorism situation.
• Recognize characteristic signs and symptoms of nerve agent poisoning.
Chemical / Radiological Principles
OBJECTIVES
• Understand proper decontamination for nerve agent poisoning.
• Learn medical management of nerve agent exposed victims.
• Learn specific antidotes for nerve agent poisoning victims.
Chemical / Radiological Principles
• An unknown gas is released in the downtown rapid transit station. It is described as a thick mist, and was found in 5 separate stops. Thousands of commuters rapidly fled the stations to the streets. EMS transport is overwhelmed, and several local ED’s are unable to absorb the patients presenting by ambulance, car, taxi, and on foot.
• Many patients present to offices and local health departments.
ScenarioFriday, January 31 – 8:47 AM (Rush Hour)
Chemical / Radiological Principles
• One patient that presents to a local health clinic complains of tearing and runny nose. He also has mild shortness of breath. Mild wheeze is noted on exam.
• Ten other patients at the clinicare asymptomatic, but are very worried.
ScenarioFriday, January 31 – 10:02 AM
Chemical / Radiological Principles
• Public health officials confirm that the gas was Sarin, similar to the toxin used in the subway of Tokyo.
ScenarioFriday, January 31 – 10:27 AM
Chemical / Radiological Principles
• Has your staff been adequately trained about chemical weapons?
• Does your staff understand basic principles of decontamination?
• Who should your staff alert?
• Who will alert your staff in the event of a chemical terrorism event?
Things to Consider
Chemical / Radiological Principles
Nerve Agents
Chemical / Radiological Principles
• Liquids that disseminate in the vapor/aerosolized form
• Onset is abrupt (seconds to hours)• Designed to irritate, incapacitate, injure
or kill• Predominantly inhalational and dermal
threats• If death occurs, usually respiratory cause
Characteristics of Nerve Agents
Chemical / Radiological Principles
• Chemical incidents are obvious shortly after exposure.
• Biological agents will take days to cause symptoms.
• ONE patient can contaminate your facility
• First responders/health care providers are in the line of fire
Characteristics of Nerve Agents
Chemical / Radiological Principles
• First used as a weapon during WWI
• Most recent event - Japanese subway incident in 1995– Aum Shinrikyo cult released Sarin into 5
subway cars in downtown Tokyo– 12 deaths, hundreds injured, 5500 sought
care – 4,600 self-referred– 135 first responders were injured
History of Nerve Agent Weapons Use
Chemical / Radiological Principles
Shoko Asahara
Chemical / Radiological Principles
NERVE AGENTS
Chemical / Radiological Principles
• Military– Tabun (GA), Sarin (GB), Soman (GD), VX
• Commercial– Parathion, Sevin
• Therapeutic Drugs– Antilirium®– Prostigmine ®– Mestinon ®
General Characteristics
Chemical / Radiological Principles
• Effects of vapor - immediate
• Wide range of symptoms- Affects sensitive organs of the face
and respiratory system
- Over-stimulation of the central nervous system
General Characteristics
Chemical / Radiological Principles
AChACh
Normal Nerve Function
Chemical / Radiological Principles
AChACh
AChEAChE
Normal Nerve Function
Chemical / Radiological Principles
AChEAChE
AChACh GBGB
Nerve Agent Action
Chemical / Radiological Principles
SLUGBAM:• Salivation• Lacrimation• Urination• GI distress (Nausea, Vomiting, Diarrhea)• Bronchorrhea (Bradycardia, Bronchospasm)• Abdominal cramps• Miosis
Signs and SymptomsMuscarinic Effects
Chemical / Radiological Principles
How Bad Is This Stuff?
VX – LD50
Chemical / Radiological Principles
System Effect
Skeletal muscles TwitchingWeaknessFlaccidity
Cardiovascular HRBlood Pressure
CNS LOC, Seizures
Signs and Symptoms
Nicotinic Effects
Chemical / Radiological Principles
Exposure Symptom
Very small drop SweatingLocal twitch
Small drop NauseaVomitingDiarrhea
Drop LOCConvulsionsApneaFlaccid paralysis
Signs and Symptoms
Dermal Exposure Effects
Chemical / Radiological Principles
Exposure Symptom
Small amount MiosisSLUGBAMSOBChest tightness
Large amount LOCConvulsionsParalysisDeath
Signs and Symptoms
Vapor Exposure Effects
3
6
13
20
41
62
Signs and SymptomsEffect on pupil at x number of days
Chemical / Radiological Principles
• Clinical picture is key• Erythrocyte acetylcholinesterase activity level
- Amount of inhibition does not correlate with symptoms
• Various electronic and “paper” detectors are available - for HAZMAT use
Diagnosis
Chemical / Radiological Principles
GENERAL PATIENT MANAGEMENT
Chemical / Radiological Principles
Chemical / Radiological Principles
• PPE (mask, gloves and protective suit)
• Decontamination– Don’t let your setting become contaminated
• ABC’s • Communicate with public health officials • Poison Control Center (800 222-1222)• Antidotes where appropriate
General Management
Chemical / Radiological Principles
• Soap and Water
• Hypochlorite Solution– 0.5% for skin
• 6 oz calcium hypochlorite in 5 gallons water
– 5.0% for equipment• 48 oz calcium hypochlorite in 5 gallons water
Prehospital Management
Chemical / Radiological Principles
• Adult atropine dose: “enough”• Give atropine regardless of heart rate• Pediatric Considerations
– 0.01mg/kg
• Atropine used until endpoint achieved (resolution of secretions)
Treatment
Chemical / Radiological Principles
• Atropine - Blocks the effects of neurotransmitter
• 2-PAMCl (Pralidoxime)
- Removes nerve agent from the enzyme
• Military Autoinjector– MARK I
Antidote
AChEAChE 2-PAMCl
Nerve AgentNerve Agent
Chemical / Radiological Principles
Name Synonym Aging T1/2
Sarin GB ~5 hours
Soman GD ~2 min
Tabun GA >40 hours
VX None >40 hours
“Aging”
Chemical / Radiological Principles
Nerve Agent Questions
Chemical / Radiological Principles
What was the public health lesson learned from the 1995 Sarin terrorists attack in the subway system of Tokyo, Japan?
a. This bioterrorist attack could only occur in a large city with an enclosed underground subway system.
b. The walking wounded and hysterical patients often overload the medical system
c. Religious cults should be placed under strict federal surveillance
d. Ample supplies of the antidotes are readily available
Question #1
Chemical / Radiological Principles
In the acute phase of poisoning, one of the consistent findings that differentiates Sarin poisoning from hysteria is:
a. Cholinesterase enzyme blood levels b. Garlic smell on victims c. Pinpoint pupils d. Tachycardia
Question #2
Chemical / Radiological Principles
Based on past experience, which of the hospital supplies/equipment below is most likely to run out after a mass casualty exposure to Sarin gas?
a. Ventilatorsb. Personal Protective Equipment c. Hemodialysis machinesd. Atropine
Question #3
Chemical / Radiological Principles
This completes the current presentation.