Would you recognize a chemical attack?
If a chemical attack occurs in your community, you or another ED nurse may be the one to identify it. Thus, you should have a high index of suspicion for terrorism when triaging or assessing patients.
"A possible occurrence includes a chemical or biological agent attack, and recognizing such an event may rest squarely on the shoulders of health care professionals," says Bettina Stopford, RN, director of public health and medical emergency preparedness for Global Solutions Securities Group, a division of Science Applications International Corp., a San Diego-based research and engineering company.
"A possible occurrence includes a chemical or biological agent attack, and recognizing such an event may rest squarely on the shoulders of health care professionals," she says.
The Centers for Disease Control and Prevention (CDC) has issued new guidelines to help you recognize exposure to chemical agents in the event of a covert chemical release.1
CDC offers advice in 3 areas
To improve readiness for chemical attacks, consider these key points from the CDC recommendations:
• Symptoms of exposure to some chemical agents might be similar to those of common diseases, which makes them difficult to identify.
The guidelines state that a covert chemical release may not present with a large number of patients rapidly symptomatic as you would see in a typical hazardous materials event, says Stopford.
"ED nurses should be alert for clusters of syndromes, unexpected deaths, and patients with similar exposure histories," she advises. "The questions you ask patients should delve deeper than your triage and assessment prior to the events of 9/11."
In addition, you’ll need to review your procedures for reporting, surveillance, and appropriate treatment methods for chemical agents, says Stopford.
• Immediate symptoms from certain chemical exposures may be mild or nonexistent, despite the risk for long-term effects.
Multiple agent exposures may confuse the diagnosis, says Stopford. She recommends having reference material and resources at hand to assist ED nurses in identifying agent symptoms, guiding diagnostic testing, and providing appropriate interventions.
• Exposure to contaminated food, water, or consumer products might result in reports of illness over a long period and in various locations.
Be aware that an isolated case in one ED may be repeated in another ED, which highlights the need for an integrated surveillance and communication system — and your constant vigilance, notes Stopford.
"ED nurses can make the difference in saving lives in the event of a chemical release, as they make the difference in so many other illnesses," she says.
Reference
1. Centers for Disease Control and Prevention. Recognition of Illness Associated With Exposure to Chemical Agents — United States, 2003. MMWR 2003; 52(39):938-940.
Sources and Resources
For more information about assessing patients for chemical attacks, contact:
- Bettina Stopford, RN, Director, Public Health and Medical Emergency Preparedness, Science Applications International Corp., Global Security Solutions Group, 8301 Greensboro Drive, MS E-1-6, McLean, VA 22102. Telephone: (703) 676-6348. E-mail: [email protected].
- The issue of Morbidity and Mortality Weekly Report containing the Centers for Disease Control and Prevention guidelines for "Recognition of Illness Associated with Exposure to Chemical Agents — United States, 2003" can be accessed at www.cdc.gov/mmwr/PDF/wk/mm5239.pdf. Materials for emergency and health care personnel, including a list of chemical agents and biologic toxins and their expected clinical syndromes, are available at www.bt.cdc.gov/agent/agentlistchem.asp. Go to p. 938.
- Thomson Micromedex Drug Information clinical database gives in-depth, referenced data on dosing, pharmacokinetics, interactions, clinical applications, efficacy, etc., for Food and Drug Administration-approved, investigational, and international drugs. Toxicology Information database provides unbiased toxicology and exposure treatment information, including clinical effects and range of toxicity. For more information, contact Thomson Micromedex, 6200 S. Syracuse Way, Suite 300, Greenwood Village, CO 80111-4740. Telephone: (800) 525-9083 or (303) 486-6444. Fax: (303) 486-6464. E-mail: [email protected]. Web: www.micromedex.com/products.
- The United States Army Research Division of Infectious Diseases’ Medical Management of Biological Casualties Handbook — Fourth Edition — February 2001 can be downloaded free of charge at the web site usamriid.detrick.army.mil/education/bluebook.html.
- The Chemical Casualty Care Division, a division of the United States Army Medical Research Institute of Chemical Defense, offers downloadable textbooks, including Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, Field Management of Chemical Casualties, and Medical Management of Chemical Casualties Handbook. To access the textbooks, go to the web site ccc.apgea.army.mil and log on as a new user.
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