Rapid decision-making by first responders and receivers will be needed to ensure survivors of a chemical incident are provided available treatments that will best alleviate and reduce adverse health outcomes. These decisions will be based on information regarding the chemical released, medical condition of survivors, and locally available medical treatments and countermeasures. The following framework should guide the provision of medical treatment to chemical casualties, based on the information available. An operational mapping of this framework is provided in Appendix I.
- Symptomatic and supportive care to treat the patient’s condition based solely on evident signs and symptoms, and not based on specific knowledge of the offending chemical. Attention should be paid to basic life support measures (Airway, Breathing, Circulation, ABCs) and to treating specific manifestations such as seizures.
- In addition to (1), add treatments that are specific for treating poisoning from a specific group of chemicals, based on toxidrome.
- Refine treatment based on additional, reliable information regarding the causative agent. Therapeutics specific for the agent may be utilized.
Several factors can substantially influence the efficiency and efficacy of these treatment steps; the importance of these factors to saving lives and alleviating or preventing further injury cannot be over-emphasized. Firstly, the speedy provision of basic supportive care for chemical incident survivors is paramount. For chemical injuries, supportive care is often the best medical choice; basic life support alone can treat many poisonings, including those for which specific countermeasures exist. For example, administering oxygen to a survivor of exposure to a lung irritant is often what is needed to restore/maintain respiratory function as the body self-clears the lungs. The Poison Control Center is an invaluable resource for guiding treatment management, providing specific recommendations for MCM administration, and identifying alternatives and adapting protocols in a scarce resource environment.
Secondly, reliable information must be used to refine medical treatment. The reported output of chemical detection technology at the scene or suspected source of exposure based on placards or other scene evidence must be consistent with the observed clinical manifestations (toxidromes, see Appendix B). These are very important “detectors” for determining appropriate treatment. When the expected clinical effects based on initial reports do not align with the observed clinical findings, additional investigation should be initiated at the scene to determine the specific cause of the observed signs and symptoms to facilitate appropriate treatment.
The goal is to administer the right drug by the right route in the right dose to the right patient at the right time to save lives and alleviate injuries.
Finally, the challenge of providing a smooth transition of care from on-scene providers to receiving hospital staff must be addressed. Critical communication steps include notifying hospitals in advance of the arrival of patients needing additional countermeasures or critical care, and clearly documenting any on-scene treatments (often not done in mass casualty incidents).
In some cases, the recovery process for injured patients will include the long-term use of specialized drugs and/or medical equipment; planners should consider the overall cost and supply chain considerations concerning this long-term care.