A Novel Approach to Chemical Attacks

Dr. Greg Ciottone, Director for Medical Preparedness at the NPLI, recently published a piece in the New England Journal of Medicine addressing the challenges of responding to medical response to chemical attacks. Chemical attacks are on the rise and present an emerging challenge for first responders. The article reviews:

…the toxidromes (constellations of signs and symptoms that are characteristic of a given class of agents) for known and suspected chemical-warfare agents that have properties that are well suited for terrorist attacks — namely, high volatility and rapid onset of incapacitating or lethal effects.11 Poison-control procedures currently use toxidromes to identify specific classes of agents. Although symptoms such as eye irritation and coughing are common to a number of classes, specific clinical findings, including fasciculations, hypersecretions, early seizure, and miosis or mydriasis, can be rapidly identified as part of an acute-phase triage system and used to differentiate among classes of agents. This should lead to reduced morbidity and mortality while also decreasing the risk to responding health care workers.12 The combined group of chemical-warfare agents examined here includes nerve agents, asphyxiants (blood agents), opioid agents, anesthetic agents, anticholinergic (antimuscarinic) agents, botulinum toxin, pulmonary agents, caustic agents (acids), riot-control agents, T-2 toxin, and vesicants.

Download the full article here.