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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

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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
   • B
   • C
   • D
   • D

   • Airway
   • Breathing
   • Circulation
   • Decontamination (immediate)
   • Drugs (specific antidotes)
   • A
   • S
   • B
   • E
   • S
   • T
   • O
   • S

   • Agent(s):
   • State(s):
   • Body site(s):
   • Effects:
   • Severity:
   • Time course:
   • Other diagnoses?
   • Synergism?

   • Type and toxicity (remember LD₅₀)
   • Solid? Liquid? Gas? Vapor? Aerosol?
   • Where exposed/Route(s) of entry?
   • Local? Systemic?
   • Mild? Moderate? Severe?
   • Onset? Getting better/worse? Prognosis?
   • Instead of? In addition to? (Differential diagnosis)
   • Combined effects of multiple exposures or insults?
   • P
   
   
   • O
   
   
   • I
   
   
   • S
   
   
   • O
   
   
   • N

   • Poison(s)
   
   
   • Outside the body:
   
   
   • Into/inside the body:
   
   
   • Sequence of events:
   
   
   • Other diagnoses?
   
   
   • Net effect of all diagnoses:

   • Type and estimated dose
   
   
   • From outside the body:
     Solid? Liquid? Gas? Vapor? Aerosol?
   • Where did it get into the body?
     Where did it go inside the body?
   • Time course:
     Onset? Latent period? Getting better/worse? Prognosis?
   • Instead of? In addition to?
     (Differental diagnosis)
   • 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 Madsen J. Chemical terrorism: Rapid recognition and initial medical management. UpToDate®. Last update was September 13, 2017. Literature review current through September 2017. Access unavailable without a personal or institutional account at: UpToDate

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1. Emergency Room Procedures in Chemical Hazard Emergencies: A Job Aid (CDC/NCEH)
2. Madsen J. Chemical terrorism: Rapid recognition and initial medical management. UpToDate®. Last update was September 13, 2017. Literature review current through September 2017. Access unavailable without a personal or institutional account at: UpToDate
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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