Hey all,
This week's protocol delves into the world of ⚠weapons of mass destruction⚠ with a focus on biochemical warfare -- specifically nerve agents that cause cholinergic toxicities. And I know you're all just foaming at the mouth waiting to hear about it 👅
This protocol can only be activated via a class order by an FDNY Medical Director from the Office of Medical Affairs. Pre-hospital providers must wear the appropriate chemical protective clothing and operate within the hot, warm, and cold zones as directed by the incident commander (throwback to your Orientation HazMat training).
Patients are tagged and triaged based on signs/symptoms of cholinergic toxicity. All "red" and yellow" patients who exhibit SLUDGEM symptoms (salivation, lacrimation, urination, diarrhea, GI upset, emesis, myosis), respiratory distress, or AMS should receive immediate treatment from the nerve agent antidote kit (see image):
Atropine 2mg IM auto-injector
Pralidoxime 600mg IM auto-injector
Repeat doses of atropine can be given based on secretions and respiratory distress. Don't delay treatment in these patients for decontamination!
Paramedics can also give IM doses of Diazepam or Midazolam for actively seizing patients.
The role of OLMC is to provide additional doses of any of the standing order meds.
Hopefully, we never have to use this one, but if we do -- don't pee your pants -- just stay calm and follow the protocol!
More info at www.nycremsco.org
Best,
Chris Kuhner, MD
PGY-2 Emergency Medicine