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OP or Not OP: The Medical Challenge at the Chemical Terrorism Scene

Published online by Cambridge University Press:  28 June 2012

Amir Krivoy ,
Ido Layish ,
Eran Rotman ,
Avi Goldberg  and
Yoav Yehezkelli
Amir Krivoy*
Affiliation:
CBRN Medicine Branch, Medical Corps, Israel Defense Forces
Ido Layish
Affiliation:
CBRN Medicine Branch, Medical Corps, Israel Defense Forces
Eran Rotman
Affiliation:
CBRN Medicine Branch, Medical Corps, Israel Defense Forces
Avi Goldberg
Affiliation:
Medical Department, Home Front Command, Israel Defense Forces
Yoav Yehezkelli
Affiliation:
CBRN Medicine Branch, Medical Corps, Israel Defense Forces
*
Medical Corps, Israel Defense Forces, Hahistadrut 33th St, Givaatayim, Israel E-mail: Krivoy@zahav.net.il
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Abstract

Since the 1995 Tokyo subway sarin attack, terrorist attacks involving weapons of mass destruction or other industrial chemicals present worldwide security and health concerns. On-scene medical triage and treatment in such events is crucial to save as many lives as possible and minimize the deleterious effects of the toxic agent involved. Since there are many chemicals that can be used as potential terrorist weapons, the medical challenge for the emergency medical services (EMS) is a combination of: (1) recognizing that a chemical terrorist attack (non-conventional) has occurred; and (2) identifying the toxic agent followed by proper antidotal treatment. The latter must be done as quickly as possible, preferably on-scene. The most valuable decision at this stage should be whether the agent is organophosphate (OP) or not OP, based on clinical findings observed by pre-trained, first responders. This decision is crucial, since only OP intoxication has readily available, rapidly acting, onscene, specific agents such as atropine and one of the oximes, preferably administered using autoinjectors. Due to the lack of a specific antidote, exposure to other agents (such as industrial chemicals, e.g., chlorine, bromide, or ammonia) should be treated on-scene symptomatically with non-specific measures, such as decontamination and supportive treatment. This paper proposes an algorithm as a cognitive framework for the medical teams on-scene. This algorithm should be part of the medical team's training for preparedness for chemical terrorist attacks, and the team should be trained to use it in drills. Implementing this path of thinking should improve the medical outcome of such an event.

Keywords

algorithmchemical terrorismemergency respondersnerve agentsorganophosphates (OPs)prehospital medicineterror scene
Type
Theoretical Discussion
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 3 , June 2005 , pp. 155 - 158
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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References

1.Burklow, TR, Yu, CE, Madsen, JM: Industrial chemicals:Terrorist weapons of opportunity. Pediatr Ann 2003;32:230–234.CrossRefGoogle ScholarPubMed
2.Moore, DH, Alexander, SM: Emergency Response to a Chemical Warfare Agent Incident: Domestic Preparedness, First Response and Public Health Consideration. In: Somani, SM, Romano, JA, (eds): Chemical Warfare Agents: Toxicity at Low Levels, Boca Raton, Fla: CRC Press, 2001, pp 409–435.Google Scholar
3.Okumora, T, Suzuki, K, Fukuda, A, et al. : The Tokyo subway sarin attack: Disaster management, part 2: Hospital response. Acad Emerg Med 1998;5:618–624.CrossRefGoogle Scholar
4.Okumura, T, Takasu, N, Ishimatsu, S, et al. : Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med 1996;28:129–135.CrossRefGoogle ScholarPubMed
5.Wax, PM, Becker, CE, Curry, SC: Unexpected “gas” casualties in Moscow: A medical toxicology perspective. Ann Emerg Med 2003;41(5):700–705.CrossRefGoogle ScholarPubMed
6.Kales, SN, Christiani, DC: Acute chemical emergencies. N Engl J Med 2004;350:800–808.CrossRefGoogle ScholarPubMed
7.Morita, H, Yanagisawa, N, Nakajima, T, et al. : Sarin poisoning in Matsumoto, Japan. Lancet 1995;346(8970):290–294.Google ScholarPubMed
8.Lee, ED: Clinical manifestations of sarin nerve gas exposure. JAMA 2003;290:659–662.CrossRefGoogle ScholarPubMed
9.Sidell, FR: Nerve Agents. In: Sidell, FR, Takafuji, ET, Franz, DR (eds): Textbook of Military Medicine. Medical Aspects of Chemical and Biological Warfare. Virginia, USA: Office of the Surgeon General, US Army, 1997, pp 129–179.Google Scholar
10.Kulig, K: Cyanide antidotes and fire toxicology. N Engl J Med 2002;347:1105–1106.Google Scholar
11.Rotenberg, JS: Diagnosis and management of nerve agent exposure. Pediatr Ann 2003;32:242–250.CrossRefGoogle ScholarPubMed