Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-16T03:28:43.057Z Has data issue: false hasContentIssue false
  • English
  • Français

Civilian Exposure to Toxic Agents: Emergency Medical Response

Published online by Cambridge University Press:  28 June 2012

David Baker
Get access Rights & Permissions [Opens in a new window]

Abstract

Civilian populations are at risk from exposure to toxic materials as a result of accidental or deliberate exposure. In addition to industrial hazards, toxic agents designed for use in warfare now are a potential hazard in everyday life through terrorist action. Civil emergency medical responders should be able to adapt their plans for dealing with casualties from hazardous materials (HazMat) to deal with the new threat.

Chemical and biological warfare (CBW) and HazMat agents can be viewed as a continuous spectrum. Each of these hazards is characterized by qualities of toxicity, latency of action, persistency, and transmissibility. The incident and medical responses to release of any agent is determined by these characteristics.

Chemical and biological wardare agents usually are classified as weapons of mass destruction, but strictly, they are agents of mass injury. The relationship between mass injury and major loss of life depends very much on the protection, organization, and emergency care provided.

Detection of a civil toxic agent release where signs and symptoms in casualties may be the first indicator of exposure is different from the military situation where intelligence information and tuned detection systems generally will be available.

It is important that emergency medical care should be given in the context of a specific action plan. Within an organized and protected perimeter, triage and decontamination (if the agent is persistent) can proceed while emergency medical care is provided at the same time.

The provision of advanced life support (TOXALS) in this zone by protected and trained medical responders now is technically feasible using specially designed ventilation equipment. Leaving life support until after decontamination may have fatal consequences. Casualties from terrorist attacks also may suffer physical as well as toxic trauma and the medical response also should be capable of dealing with mixed injuries.

Keywords

civiliandecontaminationemergencyexposurehazardsHazMatinjuriespersonal protective equipment (PPE)preparednessresponserisktoxic agentschemical and biological warfare
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 19 , Issue 2 , June 2004 , pp. 174 - 178
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Baker, DJ: The prehospital management of injury following mass toxic release: A comparison of military and civil approaches. Resuscitation 1999;42:155–159.CrossRefGoogle ScholarPubMed
2Organisation of Economic Cooperation and Development: Health Aspects of Chemical Accidents: Guidance on Chemical Accident Awareness, Preparedness and Response for Health Professional and Emergency Responders. OECD environment monograph No 81 (OECD/GD(94)1): Paris; OECD 1994.Google Scholar
3Borak, J, Callan, M, Abbott, W: Hazardous Materials Exposure: Emergency Response and Patient Care. New Jersey: Prentice Hall, 1991.Google Scholar
4Bronstein, AC, Currance, PL: Emergency Care for Hazardous Materials Exposure. Mosby Lifeline, 2nd ed. 1994.Google Scholar
5Harris, R, Paxman, J: A Higher Form of Killing. Paladin Books, London. 1983.Google Scholar
6Baker, DJ: The chemical–biological spectrum of toxic hazards. Jane's Intelligence Review 1993;5(1).Google Scholar
7Baker, DJ: Medical management of hazardous materials victims in civilian practice. Current Anaesth Crit Care 1998;9:52–57.CrossRefGoogle Scholar
8Lambert, Y, Carli, PA, Cantineau, JP: Smoke inhalation injury. In: Grande, C (ed): Textbook of Trauma Anesthesia and Critical Care. St Louis: Mosby Year Book, 1993:583–593.Google Scholar
9Laurent, JF, Richter, F, Michel, A: How to cope with the victims of chemical attacks in an urban area. Resuscitation 1999;42:141–149.CrossRefGoogle Scholar
10Anon. Calamity at Bhopal. Lancet 1984;137:1378–1379.Google Scholar
11United Nations: Report of the Mission Dispatched by the Secretary General to Investigate Allegations of the Use of Chemical Weapons in the Conflict Between the Islamic Republic of Iran and Iraq. UN document S/18852 (8 May) New York 1987. United Nations.Google Scholar
12Moles, TM, Baker, DJ: Clinical analogies for the management of toxic trauma. Resuscitation 1999;117:124.Google Scholar
13Okumura, T, Suzuki, K, Fukuda, A, et al. : The Tokyo subway disaster: Disaster management, part 2: Hospital response. Acad Emerg Med 1998;5:618–624.CrossRefGoogle ScholarPubMed
14Baker, DJ: The compPac: A new approach to field and general emergency ventilation. Int Rev Armed Forces Med Serv 1998;LXXI:284–287.Google Scholar
15Moles, TM: Emergency medical services and hazardous materials major incidents. Resuscitation 1999;42:103–116.CrossRefGoogle ScholarPubMed
16Senanayake, N, Karalliede, L: Neurotoxic effects of organophosphorus insecticides–An intermediate syndrome. N Eng J Med 1987;316:761–763.CrossRefGoogle ScholarPubMed