Diagnosis and management of nerve agent exposure

Types of Disasters

Disasters are increasing around the world. Children are greatly impacted by both natural disasters (forces of nature) and man-made (intentional, accidental) disasters. Their unique anatomical, physiological, behavioral, developmental, and psychological vulnerabilities must be considered when planning and preparing for disasters. The nurse or health care provider (HCP) must be able to rapidly identify acutely ill children during a disaster. Whether it is during a natural or man-made event, the nurse or HCP must intervene effectively to improve survival and outcomes. It is extremely vital to understand the medical management of these children during disasters, especially the use of appropriate medical countermeasures such as medications, antidotes, supplies, and equipment.

When Disaster Strikes-Care Considerations for Pediatric Patients

Katrina and the events of September 11th, 2001 have made the vulnerability of our country very apparent. Communities have been preparing and organizing multihazard response plans to assure the safety and care of citizens when disasters strike. These plans focus on advance preparation to assure access and augmentation of essential resources, as well as provider education, both of which are core components of good trauma centers and effective state trauma systems. Unfortunately though, the needs of children have traditionally been overlooked in these planning processes. This article will serve as a tool for trauma nurses in the identification of the needs, challenges, actions, and nursing leadership roles that may be assumed to assure that appropriate care is available for children when disaster strikes.

The effects of weapons of mass destruction on children

PURPOSE

Children are especially vulnerable to the effects of chemical and biological weapons of mass destruction (WMD) because of physiologic, pharmacologic, and developmental characteristics. Presentation of signs and symptoms of exposure to biological and chemical agents are similar to those seen in adults. Pediatric considerations for decontamination and treatment of child victims of biological and chemical agents are discussed.

CONCLUSION

As front-line providers, nurses need to be aware of potential agents, their uses and effects as WMD, and recommended treatments.

PRACTICE IMPLICATIONS

Understanding the additional physiologic and situational needs of children, nurses can optimize the survival and outcomes of children when disaster strikes.

OP or not OP: the medical challenge at the chemical terrorism scene

Since the 1995 Tokyo subway sarin attack, terrorist attacks involving weapons of mass destruction or other industrial chemicals present worldwide security and health concerns. On-scene medical triage and treatment in such events is crucial to save as many lives as possible and minimize the deleterious effects of the toxic agent involved. Since there are many chemicals that can be used as potential terrorist weapons, the medical challenge for the emergency medical services (EMS) is a combination of: (1) recognizing that a chemical terrorist attack (non-conventional) has occurred; and (2) identifying the toxic agent followed by proper antidotal treatment. The latter must be done as quickly as possible, preferably on-scene. The most valuable decision at this stage should be whether the agent is organophosphate (OP) or not OP, based on clinical findings observed by pre-trained, first responders. This decision is crucial, since only OP intoxication has readily available, rapidly acting, onscene, specific agents such as atropine and one of the oximes, preferably administered using autoinjectors. Due to the lack of a specific antidote, exposure to other agents (such as industrial chemicals, e.g., chlorine, bromide, or ammonia) should be treated on-scene symptomatically with non-specific measures, such as decontamination and supportive treatment. This paper proposes an algorithm as a cognitive framework for the medical teams on-scene. This algorithm should be part of the medical team's training for preparedness for chemical terrorist attacks, and the team should be trained to use it in drills. Implementing this path of thinking should improve the medical outcome of such an event.