Nerve agents & Mark 1 Auto injectors

1. Nerve agents & Mark 1 Auto injectors Harbor-UCLA Medical Center South Bay Disaster Resource Center

2. Objectives • At the end of this in-service participants will be able to: • Describe potential chemical agents used as weapons of mass destruction • Discuss the clinical presentation of a patient exposed to a nerve agent • Demonstrate the use of a Mark 1 Nerve Antidote kit

3. Priorities in an “all hazards” response • Life safety • Safety of rescuers • Safety of victims • Appropriate decontamination and treatment of victims • Appropriate protection for staff/rescuers and treatment if necessary • Incident coordination/stability • Property preservation-evidence collection • Protection of the environment

4. Initial treatment for nerve agent exposure • Scene safety • Immediate removal of victim from source of exposure • Direct proportional relationship between absorbed dose and severity of symptoms/morbidity & mortality • Airway management is key • Antidote administration • Seizures

5. Nerve agent triage • Was Mark 1 given in the pre-hospital treatment? How many? • Signs and symptoms upon presentation • Initial symptoms improving? • Is miosis still present • Bronchorhhea present?

6. Minimal Treatment- Nerve agent exposure • Patient exposed to nerve agent • Recovering well from Mark 1 Kit admininstration • Walking and talking indicates respiratory and circulatory status is sufficient to maintain function

7. Expectant patients exposed to nerve agents • Apneic for more than five minutes • Seizures have already begun • No pulse or blood pressure • Patient has minimal to no chance of survival no matter what treatment • Patient is declared expectant (black triage tag)

8. Signs and Symptoms: SLUDGE Over-stimulation of the nervous system causes muscles and certain glands to over-react • Salivation • Lacrimation • Urination • Defecation • GI Distress • Excrement/Emesis

9. Effects of nerve agent on victim • The nervous system controls body functions by secreting chemical transmitters which act as "instructions" to nerves, muscles and glands. • Nerve agent exposure -interferes with the normal instructions of chemical transmitters that direct the muscle or gland to return to an un-stimulated, relaxed state. • Action of toxic nerve agents is to over-stimulate the nerve endings and central nervous system.

10. Organophosphate poisonings • SLUDGE symptoms • Cases we are familiar with in healthcare due to frequent exposures • Massive doses of Atropine • Common with gardeners in hot house environment • Industrial plants • Migrant farm workers exposed to Malephyon

11. Nerve agent antidote • History of the Mark 1 Kit auto injectors • Placement of Mark 1 Kits in CHEMPACK and pharmaceutical caches • Dosaging- Adult and Pediatric • Administration of Mark 1 Kit

12. Mark 1 Autoinjectors • Atropine: administered to block receptor sites of acetylcholine • 2-PAM Chloride: restores acetylcholinesterase • Combo Pen/ Mark 1 • Package insert- review administration, side effects

13. Mark 1 Kits • One chamber has 2mg of Atropine • One chamber has 600 mg of 2 Pam • Other auto injectors contain Valium for seizure control

14. Source: New York Department of Health Policy Statement 03-05 Use of "Mark I Kits" (AtroPen Auto-Injector & Pralidoxime Chloride Injector)

15. How to obtain the Mark 1 Kits at Harbor-UCLA Medical Center • Attending physician of ER declares a Code Triage- overhead page for disaster • Notification to pharmacy that pharmaceutical caches are necessary • Delivery of medications to ER • Treatment of staff/victims • Pharmacy notifies CDC that CHEMPACK as been activated via Sensaphone

16. Thank you for your attention • Please sign in on roster • Please take three handouts • For any further questions please notify Dr. Amy Kaji akaji@emedharbor.edu or KathyCrow kcrow@southbaydrc.org