Critical care requirements after mass toxic agent release

Abstract

There is an increasing risk of mass exposure of civil populations after release of toxic agents. These include military chemical warfare agents or industrial compounds, some of which have been used as a chemical. The traditional military divisions among chemical agents, toxins, and biologic agents may be viewed as a continuous spectrum of hazards. Each of these has four specific qualities (toxicity, latency, persistency, and transmissibility), which determine management of casualties and the toxic release. Toxic hazards may be released accidentally or deliberately, producing potentially large numbers of casualties. Previous incidents have shown that many of these require extended hospital care. This article reviews aspects of the nature of the toxic agents, the pathophysiology they produce, and therapeutic measures. The central and peripheral nervous systems and the respiratory systems are particularly vulnerable and may lead to fatal results unless early action is taken. Specific antidotes and life support care is required at all levels of prehospital and hospital management. Critical care management is required for severe cases, and this must combine continuing antidote, ventilatory and supportive therapy.

Preparedness Lessons from Modern Disasters and Wars

“…50 Many of these patients may have no exposure, and are merely worried. 51 Demands from these anxious people decrease the ability of the medical system to effectively triage and identify the most critically ill patients. 49 This event can be circumvented by planning for treatment of thousands of patients at the same time.…”

Chemical, Biological and Radiation Casualties: Critical Care Considerations

“…Although the term weapons of mass destruction (WMD) is sometimes used to describe CBRN weapons, this only really applies to a nuclear detonation and the phrase 'weapons of mass effect' is perhaps more appropriate. The mass effect seen by the deployment of a CBRN device is likely to have significant critical care issues throughout the casualty evacuation chain from Point of Exposure (PoE) through to repatriation to a Role 4 facility [2,3]. There are a number of scenarios that would require a CBRN critical care response, these include:…”

Functional Genomics of Chlorine-induced Acute Lung Injury in Mice

“…Our central hypothesis is that the interplay between molecular signaling determines survival and controls the susceptibility to sequelae from CIALI. To explore this hypothesis, the long-term objectives of this study are: (1) to identify the genetic determinants and molecular mechanisms controlling CIALI common to exposure to five leading hazardous chemicals: chlorine, phosgene, sulfuric acid, ammonia, and acrolein; (2) to evaluate the therapeutic efficacy based on common events in cell signaling during CIALI; and (3) to identify the molecular mechanisms that are unique to each of the five leading hazardous chemicals during the early development of CIALI. This interim report presents our initial progress toward meeting these goals and supports the feasibility of the overall experimental approach.…”

“…Even without signs of external injury, chemical exposure can produce severe trauma to internal target organs including the lungs, heart, gastrointestinal tract, eyes, and the central nervous system (1). Of these injuries, the extent of lung injury often is the most critical to survival (1)(2)(3).…”

“…Of these injuries, the extent of lung injury often is the most critical to survival (1)(2)(3). Chemical-induced acute lung injury (CIALI) can be viewed as a molecular cascade mounting over hours and days subsequent to even a transient incident.…”