Hazardous Chemical Emergencies and Poisonings

Abstract

H azardous chemical emergencies and related poisonings result from various exposures, including inadvertent residential, industrial, occupational, or transportation mishaps; natural disasters; and hazardoussubstance releases that are intended to cause harm. 1-3 Up to 100,000 industrial chemicals are used each day in the United States, 4 and federal authorities estimate that more than 10,000 potentially consequential releases of hazardous substances occur annually. 4,5 In addition, numerous compounds have been developed primarily as military weapons, with exceedingly high toxicity. 6-8 Both toxic industrial chemicals and military chemical weapons are capable of causing mass casualties in a substantive release and may be deployed intentionally in the context of chemical terrorism, 8-10 targeted assassination attempts, 8,11,12 or wartime attacks on civilian populations, as tragically shown in the current Syrian war. 13,14 A toxidrome-based, emergency medical systems (EMS) approach to chemical weapons attacks was presented recently by Ciottone in the Journal. 8 (Toxidromes are constellations of clinical signs, particularly vital signs, mental status, and ocular, respiratory, neurologic, and skin findings, that are characteristic of general classes of poison.) A similar approach is useful for the myriad possible entities in nonintentional hazardous chemical incidents. We review the toxicology and hospital-based management of acute poisonings caused principally by dermal and inhalational exposure to several representative chemical-agent classes in incidents involving the release of hazardous substances or chemical attacks (Table 1). Cyanide and organophosphate poisonings are emphasized, since they can also affect individual patients in the more familiar contexts of occupational and residential exposures or ingestions with suicidal intent and since specific emergency antidotal therapy is crucial for good outcomes. Ov erv iew of Hospita l-Ba sed Emergenc y M a nagement Incidents involving the release of hazardous chemicals may result in widespread chaos and confusion, affecting the EMS response and emergency department (ED) care. 2,8 A rapid influx of multiple critically ill victims with unfamiliar illnesses, as well as numerous low-risk but understandably anxious patients, potentially far outnumbering the seriously ill, 1 poses significant challenges to hospital-based emergency care providers. Patients may bypass prehospital care and arrive at the hospital unaware of or misinformed regarding the cause of their symptoms, with the potential to chemically contaminate bystanders and staff. 2,15-17 Thus, prompt recognition of the chemical event is important so that ED staff and hospital emergency management personnel can secure hospital entrances and decontaminate contami

Dirty the Waters: Mothers’ Experience of a Chemical Disaster in West Virginia, Usa

“…As it stands, currently in the US, people must demonstrate that they have been harmed for a chemical to be taken out of use. US industry uses more than 100,000 different chemicals, so the traditional scientific methodologies of public health find it increasingly difficult to establish whether any one chemical has harmed an ecosystem or negatively impacted human health [17]. This is because chemicals are released into an environmental context of other untested chemicals, or with other untested chemicals, and the synergistic effects produced when combined are unknown.…”

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

“…Emergencies caused by hazardous toxicological/chemical materials may result from "inadvertent residential, industrial, occupational or transportation mishaps; natural disasters; and hazardous-substance releases that are intended to cause harm" [5]. Beyond such risks, the use of hazardous materials may be intentionally directed by humans to cause mass devastation, as part of political or military conflicts or wars, as was displayed in the Syrian civilian war [5,11,12].…”

“…Emergencies caused by hazardous toxicological/chemical materials may result from "inadvertent residential, industrial, occupational or transportation mishaps; natural disasters; and hazardous-substance releases that are intended to cause harm" [5]. Beyond such risks, the use of hazardous materials may be intentionally directed by humans to cause mass devastation, as part of political or military conflicts or wars, as was displayed in the Syrian civilian war [5,11,12]. Mass casualty incidents that involve hazardous materials may be detrimental to the functional continuity of emergency departments (EDs), leading to chaos, confusion, miscommunication, lack of coordination, and misinformation [13,14].…”

“…The potential devastation that may be caused by the manifestation of CBRN threats necessitates continued readiness, but as they require a varied operational mode compared to routine activities, they present a highly complex challenge to all healthcare systems [4]. Even a single patient that presents to an emergency department (ED) after being exposed to hazardous materials may cause extreme havoc, secondary contamination of medical personnel, full evacuation of the ED, and subsequent interruption or shutdown of operations for a limited or extended period of time [4,5].…”

“…In the past decade, the international community witnessed several MCIs that resulted from the use of toxicological and/or chemical agents [5,6]. Although this emergent threat has taxed the capacities of diverse societies and potentially may transpire in any community, to date it is perceived as occurring only infrequently, and thus constitutes a potential though uncommon risk [4].…”