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Injury following exposure to toxic chemical agents has potential life–threatening effects, particularly on the respiratory system. Antidotes alone often are not sufficient to reverse this situation, and the need to provide early and effective advanced life support for chemical casualties increasingly has been accepted by emergency services around the world. Although the principles of life support are the same for toxic as for conventional casualties, the requirement for responders to wear personal protective equipment makes airway and ventilation management more difficult. Special training and familiarity with devices and equipment used are essential to ensure effectiveness. Recent studies have indicated both the limitations and the possibilities for resuscitation of casualties in a contaminated environment before decontamination. Ventilation of patients with respiratory failure or arrest requires the use of devices which are able to operate and be used by responders wearing protective equipment. The laryngeal mask airway has been shown to be an easier and viable alternative to intubation in this situation. Portable automatic ventilators have been developed which can be used to provide controlled ventilation in a contaminated zone. The ideal mode of ventilation for potentially damaged lungs, following exposure to agents such as chlorine and phosgene has yet to be established. There may be a case for early application of the protective lung ventilation strategies that are now common in intensive care units. This presentation will review recent human and animal studies related to resuscitation in a contaminated zone and provide illustrations of the practical approaches currently used by emergency medical services.
