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Chemical Terrorism

• Chemical agents used in terrorist attacks can be from industrial or warfare sources
• Chemical agents act quickly. Rapid response is essential.
• Chemicals are categorized into choking, blood, nerve or blister agents
• Onset of symptoms may be immediate or delayed up to 24 hours
• Learn to recognize the effects of chemical terrorism
• Chemical agents may contaminate you and your home or business.
• Do not become a casualty! Implement procedures to protect yourself
• Listen and follow instructions to either evacuate or “shelter-in-place

Awareness

Recognizing Chemical Terrorism-Related Illnesses

Adequate planning and regular training are key to preparedness for terrorism-related events. Healthcare providers should be alert to illness patterns and reports of chemical exposure that might signal an act of terrorism. The following clinical, epidemiological and circumstantial clues may suggest a possible chemical terrorist event:

• Any unusual increase in the number of people seeking care, especially with respiratory, neurological, dermatological or gastrointestinal symptoms.
• Any clustering of symptoms or unusual age distribution (e.g., chemical exposure in children).
• Any unusual clustering of patients in time or location (e.g., persons who attended the same public event).
• Location of release not consistent with a chemical's use.
• Simultaneous impact to human, animal and plant populations.

Any unusual symptoms, illnesses or clusters of these should be reported to 911 immediately.

Personal Protective Equipment (PPE)

DO NOT BECOME A CASUALTY!

Exposure can occur from inhalation of vapors, dermal contact or eye contact. The following general information can help responders/healthcare providers determine appropriate PPE.

Inhalation Exposure

Protection from both vapors and particulates may be required when the chemical agent is being released. After release, protection from vapors is most important. Half-face and full-face respirators, with the appropriate canister, can provide protection from vapors. These operate by negative pressure and must be fit tested for optimal protection. Powered, air-purifying respirators (PAPR) and self-contained breathing apparatus (SCBA) provide even greater protection and operate under positive pressure so that fit characteristics are less important. Surgical and N-95 masks will not protect against inhalation of vapors.

Dermal (skin) Exposure

Latex examination gloves provide very little protection from most chemical agents and can cause allergies. Gloves made of Viton, nitrile, butyl or neoprene provide better protection and, in some styles, allow adequate dexterity. However, the resistance of these materials to different chemicals varies and it is best to have a variety of gloves available. Double gloving may provide additional protection. Chemical-resistant aprons, suits and boots can also minimize dermal exposure.

Eye Exposure

Full-face respirators will provide protection from both splashes and vapors. Protective eyewear, such as goggles or a face shield, will not provide protection from chemical vapors. Protective eyewear is necessary during decontamination to prevent splashing into eyes.

For more information, refer to OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. (2 MB)

Decontamination Guidelines

Decontamination is the most important first step in patient care. Confirm or provide patient decontamination upon arrival.

To decontaminate

• Immediately remove patient clothing. Removed clothing should be double bagged and sealed.
• Flush patient eyes with plenty of water or normal saline.
• Wash patient skin with soap and water. Do not abrade skin. Follow with a thorough water rinse.
• Do not use bleach, concentrated or diluted, on people.

Antidotes

Nerve agent antidotes may be obtained as auto-injector syringes. These devices rapidly deliver antidotes intramuscularly, typically to the thigh or buttocks. Atropine, in auto-injector form, is available as the AtroPen in amounts of 0.5, 1, or 2 mg. 2-PAM chloride, in auto-injector form, is available as the 600 mg ComboPen. A Mark I kit contains two auto-injector syringes; the smaller one with 2 mg atropine and the larger one with 600 mg 2-PAM chloride.

The spring-loaded design of the auto-injectors provides a forceful delivery that may cause tissue damage, especially to children and smaller patients. Children weighing less than 15 lb (about 7 kg), generally those younger than 6 months old, should not ordinarily be treated with the nerve agent antidote auto-injectors. In this age group, atropine should be individualized at doses of 0.05 mg/kg.