Introduction
Chemical exposures daily pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for Irritant Gas Syndrome Agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations. This study describes the first step to developing emergency department informatics tools for chemical incidents: validation of signs/symptoms that characterize an IGSA syndrome.
Methods
Data abstracted from 146 patients treated for chlorine exposure in one emergency department during a 2005 train derailment and 152 patients not exposed (comparison group) were mapped to 93 possible signs/symptoms within two tools (i.e., WISER and CHEMM-IST) designed to assist emergency responders/emergency nurses with managing hazardous material exposures. Inferential statistics (Chi Square/Fisher’s exact test) and diagnostics tests were used to examine mapped signs/symptoms of those exposed/not exposed to chlorine.
Results
Three clusters of signs/symptoms are statistically associated with an IGSA syndrome (p<0.01):
Respiratory: shortness of breath, wheezing, coughing, choking
Chest discomfort: tightness, pain, burning
Eye, nose and/or throat: pain, irritation, burning
The syndrome requires the presence of signs/symptoms from at least two of these clusters. The latency period must also be considered for exposed/potentially exposed individuals.
Discussion
This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA Syndrome. Validating signs/symptoms is the first step in developing new emergency department informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents.
Fifty-two adult male subjects were randomly assigned to one of three possible treatment groups: supplemental ascorbic acid at one of two levels, 500 mg or 1000 mg, or a placebo. Hair and blood samples were taken before vitamin C or placebo supplementation was started and at monthly intervals thereafter for three months. Samples were analyzed for cadmium, lead, and mercury. Results indicate that vitamin C did not significantly affect levels of these metals in either hair or blood samples.
This study validates the IGSA triage algorithm as the basis for the development of a prototype software application to quickly identify victims of a chemical disaster and triage patients efficiently and accurately with the potential to dramatically improve the processing of patients in EDs.
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