During a chemical incident, the specific chemical hazard and exposure route may not be known for some time, complicating and potentially delaying the provision of effective medical treatment to affected individuals. Decontamination of survivors, essential equipment, and urgent care facilities prior to reuse (for example, ambulances) may also be necessary and may further delay other lifesaving treatments. First responders and medical personnel must understand that because many chemical exposures produce illness and injury quickly, they may need to provide medical treatment with limited information. Patient signs, symptoms, and accounts may in fact be the most useful and timely information available to inform incident management. Determining proper decontamination procedures with limited information can also be difficult and may again rely on patient condition.
For these reasons, first responders and healthcare personnel should be familiar with the toxidromes described in KPF 2, Recognize and Characterize the Incident, and with chemical casualty treatment and basic decontamination principles. Fortunately, many of the chemicals that produce a similar toxidrome are treated by addressing that symptom suite. For example, a survivor presenting with SLUDGEM signs and symptoms (see Appendix B) can be treated with atropine whether they were exposed in an accident at a pesticide facility or during an attack with a nerve agent. Moreover, basic decontamination procedures are the same for many chemicals, and can be applied based on the symptom suite as well (see discussion in KPF 4, Control the Spread of Contamination). Prior instruction in chemical casualty care and readily available information regarding treatment protocols, such as those obtainable from the local poison control center, will ensure that staff are not caught off-guard and unprepared for a situation where lifesaving interventions must occur within moments of exposure.
Chemicals for which there is a delay in the onset of signs and symptoms after exposure pose daunting challenges for treatment. Many of those who received a harmful dose will likely have left the incident area prior to symptom onset. The development of widespread but potentially sporadic adverse health effects may delay event recognition, accurate diagnosis, and the delivery of appropriate treatment. Decontamination efforts will also be hampered and/or be made more complex in these circumstances.