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• Emergency Department Procedures During Chemical Hazard Emergencies
• Patient Assessment and Other Considerations
• See also: Emergency Department/Hospital Management of Specific Agents
• Ammonia
• Chlorine
• Hydrogen cyanide
• Mustard agents
• Nerve agents
• Phosgene
• See also: Hospitals/Poison Centers

Emergency Department Procedures During Chemical Hazard Emergencies

Adapted from Emergency Room Procedures in Chemical Hazard Emergencies: A Job Aid (CDC/NCEH)

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Patient Assessment and Other Considerations

1. The chemical threat includes more than just "official" chemical-warfare agents.
2. "Official," "classical" groupings of chemicals are not always useful.
3. The physical form or forms of the agent in the environment must be recognized.
4. Chemical events need to be recognized.
5. Patient assessment needs to be systematic.
   
   
   A	Airway
   B	Breathing
   C	Circulation
   D	Decontamination (immediate)
   D	Drugs (specific antidotes)
   
   
   
   A	Agent(s):	Type and toxicity (remember LD50)
   S	State(s):	Solid? Liquid? Gas? Vapor? Aerosol?
   B	Body site(s):	Where exposed/Route(s) of entry?
   E	Effects:	Local? Systemic?
   S	Severity:	Mild? Moderate? Severe?
   T	Time course:	Onset? Getting better/worse? Prognosis?
   O	Other diagnoses?	Instead of? In addition to? (Differential diagnosis)
   S	Synergism?	Combined effects of multiple exposures or insults?
   
   
   
   P	Poison(s):	Type and estimated dose
   O	Outside the body:	From outside the body: Solid? Liquid? Gas? Vapor? Aerosol?
   I	Into/inside the body:	Where did it get into the body? Where did it go inside the body?
   S	Sequence of events:	Time course: Onset? Latent period? Getting better/worse? Prognosis?
   O	Other diagnoses?	Instead of? In addition to? (Differental diagnosis)
   N	Net effect of all diagnoses:	Interaction among diagnoses; patient as a whole
   
   
   
6. In a chemical attack, it's easy to lose the forest for the trees.
   • Use protocols (including the ABCDD) intelligently.
7. Personnel decontamination must be quick and slick.
   • Quick: Time is of the essence.
   • Slick: Use physical or mechanical means (pick, rub, slide, or flush it off).
8. Know in advance where to get expert help.
   • What you think you know (but really don't) may hurt you (or casualties).

Adapted from Clinical Care During Man-made and Natural Disasters: Triage and Medical Management of Radiological and Chemical Casualties (PDF - 8.60 MB) (James M. Madsen, MD, MPH, FCAP, FACOEM COL, MC-FS, US Army)

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1. Emergency Room Procedures in Chemical Hazard Emergencies: A Job Aid (CDC/NCEH)
2. Clinical Care During Man-made and Natural Disasters: Triage and Medical Management of Radiological and Chemical Casualties (PDF - 8.60 MB) (James M. Madsen, MD, MPH, FCAP, FACOEM COL, MC-FS, US Army)
3. Chemical warfare agents: an overview (NIH VideoCasting and Podcasting, 1 hour 11 minutes) (James M. Madsen, MD, MPH, FCAP, FACOEM COL, MC-FS, US Army)

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