Chemical terrorism: Rapid recognition and initial medical management
- James M Madsen, MD, MPH, FCAP, FACOEM, COL, MC-FS, USA
James M Madsen, MD, MPH, FCAP, FACOEM, COL, MC-FS, USA
- US Army Medical Research Institute of Chemical Defense, APG-EA, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Section Editors
- Richard D Zane, MD
Richard D Zane, MD
- Section Editor — Emergency Medical Services/Disaster Medicine
- Professor and Chair of Emergency Medicine
- University of Colorado School of Medicine
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Potential actions by terrorist groups span the chemical, biological, radiological, nuclear, and high explosive (CBRNE) threat spectrum . This topic provides guidance for the rapid recognition and initial management of patients exposed to the chemical agents that are most likely to be used in warfare or by terrorists.
Bioterrorism and clinical features and treatment of radiation exposure, including exposure cause by acts of nuclear terrorism, are reviewed separately. (See "Identifying and managing casualties of biological terrorism" and "Clinical features of radiation exposure in children" and "Biology and clinical features of radiation injury in adults" and "Management of radiation exposure in children following a nuclear disaster" and "Treatment of radiation injury in the adult".)
Planning and preparation for field and medical response to weapons of mass destruction are beyond the scope of this topic but are reviewed elsewhere [2-11].
The use of chemical weapons violates current international law and is governed by treaties administered by the United Nations (UN). Since 1997, the Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and on Their Destruction, or Chemical Weapons Convention (CWC), has been in force. The CWC is administered by the Organisation for the Prohibition of Chemical Weapons (OPCW), in The Hague, Netherlands .
Despite international prohibitions against the use of chemical weapons, large amounts of various agents remain available in national stockpiles in several countries, and their use against military and civilian populations has been documented as follows:
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- CHEMICAL AGENT DEFINITIONS
- RECOGNITION OF CHEMICAL EXPOSURE
- Features of chemical exposures
- Clinical syndromes
- Rapid detection and ancillary studies
- FIELD INCIDENT RESPONSE
- HOSPITAL INCIDENT RESPONSE
- INITIAL MANAGEMENT OF CHEMICAL EXPOSURES
- Protection of providers
- - Special considerations for chemical events
- - Local or spot decontamination
- - Field decontamination
- - Hospital decontamination
- Initial management of specific exposures
- - Antidotes
- Nerve agents
- BZ (3-quinuclidinyl benzilate)
- ADDITIONAL RESOURCES