state of west virginia department of health & human resources state trauma and emergency care...

State of West VirginiaState of West VirginiaDepartment of Health & Human ResourcesDepartment of Health & Human Resources

State Trauma and Emergency Care SystemState Trauma and Emergency Care System

Office of EMSOffice of EMS

Nerve Agent Antidote KitNerve Agent Antidote Kit

Training ProgramTraining Program

OBJECTIVESOBJECTIVES

This program is intended to assist the EMS This program is intended to assist the EMS provider in:provider in:

Identifying the Nerve Agent Antidote Kits, Identifying the Nerve Agent Antidote Kits, its components, and contents.its components, and contents.

Recognizing the signs and symptoms of Recognizing the signs and symptoms of nerve agent exposure.nerve agent exposure.

Obtaining the skills needed to safely Obtaining the skills needed to safely administer the kits.administer the kits.

Mark I Auto InjectorsMark I Auto Injectors

Through the Through the HRSA Bio-Terrorism Hospital HRSA Bio-Terrorism Hospital Preparedness GrantPreparedness Grant, the West Virginia , the West Virginia Office of EMS has purchased Nerve Agent Office of EMS has purchased Nerve Agent Antidote kits for Antidote kits for crew protectioncrew protection for each for each licensed ambulance in the state.licensed ambulance in the state.

Throughout this presentation, the terms Throughout this presentation, the terms Mark I KitsMark I Kits and and Nerve Agent Antidote KitsNerve Agent Antidote Kits may be used interchangeably. may be used interchangeably.

Nerve Agents such as Nerve Agents such as TabunTabun (GA), (GA), SarinSarin (GB), (GB), SomanSoman (GD), and (GD), and VXVX are are the most toxic of the chemical agents.the most toxic of the chemical agents.

They penetrate skin, eyes, and lungs.They penetrate skin, eyes, and lungs. Signs and symptoms include loss of Signs and symptoms include loss of

consciousness, seizures, apnea, and consciousness, seizures, apnea, and death after large exposure.death after large exposure.

Exposure diagnosis made clinically Exposure diagnosis made clinically based upon signs and symptoms.based upon signs and symptoms.

Nerve AgentsNerve Agents

Routes of ExposureRoutes of Exposure

Direct contactDirect contact

InhalationInhalation

IngestionIngestion

DIRECT CONTACTDIRECT CONTACT The agent liquid or vapor comes in direct The agent liquid or vapor comes in direct

contact with the victim’s skin or eyes.contact with the victim’s skin or eyes.

The agent is then absorbed through skin. The agent is then absorbed through skin. Scrapes, cuts and other skin damage offer Scrapes, cuts and other skin damage offer direct entry points – including freshly direct entry points – including freshly shaven skin, sunburn, insect bites, and shaven skin, sunburn, insect bites, and rashes.rashes. VX remains on skin and absorbed more completely.VX remains on skin and absorbed more completely. GB evaporates quickly, but still a threat.GB evaporates quickly, but still a threat.

Eyes most sensitive organ for nerve agent Eyes most sensitive organ for nerve agent vapor effects.vapor effects.

Nerve agents enter Nerve agents enter through respiratory through respiratory system.system.

The agent rapidly and The agent rapidly and effectively enters into effectively enters into blood stream.blood stream.

Respiratory failureis the chief cause of death

after severe exposure

INHALATIOINHALATIONN

Nerve agent inhaled into respiratory system

INGESTIOINGESTIONN

The agent enters the The agent enters the body through the body through the ingestion of contaminated ingestion of contaminated food or drink, food or drink, incidental incidental hand to mouth or eye hand to mouth or eye contactcontact, or smoking., or smoking.

It is unlikely that agent It is unlikely that agent will contaminate food or will contaminate food or drink.drink.

Gastrointestinal system

How It WorksHow It Works Nerve agents block an enzyme called Nerve agents block an enzyme called

acetylcholinesteraseacetylcholinesterase. . This enzyme is normally responsible for This enzyme is normally responsible for

breaking down breaking down acetylcholineacetylcholine that has that has been used as a neurotransmitter to been used as a neurotransmitter to glands and smooth muscle. glands and smooth muscle.

When it is blocked, the acetylcholine When it is blocked, the acetylcholine remains in the synapse, causing glands remains in the synapse, causing glands to secrete, and muscle to constrict. to secrete, and muscle to constrict.

Death is from lack of oxygen.Death is from lack of oxygen.

Nerve, gland or muscle

AChAChACh=Acetylcholine stimulates muscle contraction, gland secretion and

nerve-to-nerve conduction.

Normal Nerve FunctionNormal Nerve Function

AChACh

Electrical message continues…


AChACh

AChEAChE

To stop further stimulation, ACh is broken down by AChE, preventing over-stimulation.


AChEAChE

AChACh GBGB

ACh accumulates and causes over-stimulation of nerves, muscles and glands.

Nerve Agents Inhibit ACHENerve Agents Inhibit ACHE

EffectsEffects Acetylcholine is a transmitter in two Acetylcholine is a transmitter in two

kinds of synapses, meaning nerve kinds of synapses, meaning nerve agents function in two ways.agents function in two ways.

Muscarinic receptors:Muscarinic receptors: Smooth muscleSmooth muscle GlandsGlands

Nicotinic receptors:Nicotinic receptors: Skeletal MusclesSkeletal Muscles GanglionGanglion

Effects: MuscarinicEffects: Muscarinic

Smooth muscle contraction:Smooth muscle contraction: Eyes: miosisEyes: miosis Airway: dyspnea due to Airway: dyspnea due to

severe bronchoconstriction.severe bronchoconstriction. GI: vomiting & diarrhea.GI: vomiting & diarrhea.

Secretions:Secretions: Saliva, tearsSaliva, tears Runny noseRunny nose BronchorrheaBronchorrhea SweatingSweating

Effects: NicotinicEffects: Nicotinic

Skeletal muscle:Skeletal muscle: FasiculationsFasiculations Localized Localized

twitchingtwitching Leads to Leads to

flaccidityflaccidity Ganglion:Ganglion:

TachycardiaTachycardia HypertensionHypertension

Overall EffectsOverall Effects

Heart rate: fast or slow – may develop Heart rate: fast or slow – may develop other arrhythmias. other arrhythmias.

Central nervous system:Central nervous system: Acute:Acute:

Loss of consciousnessLoss of consciousnessSeizuresSeizuresApneaApnea

Prolonged:Prolonged:Psychological effects Psychological effects

Signs and Symptoms of Signs and Symptoms of VaporVapor Exposure Exposure Mild exposure:Mild exposure:

Miosis (dim vision, eye pain), rhinorrhea, Miosis (dim vision, eye pain), rhinorrhea, dyspnea.dyspnea.

Moderate exposure:Moderate exposure: Pronounced dyspnea, nausea, vomiting, Pronounced dyspnea, nausea, vomiting,

diarrhea, weakness. diarrhea, weakness. Severe exposure:Severe exposure:

Immediate loss of consciousness, Immediate loss of consciousness, seizures, apnea, and flaccid paralysis.seizures, apnea, and flaccid paralysis.

Vapor effectsVapor effects occur within seconds and occur within seconds and peak within minutespeak within minutes; no late onset.; no late onset.

Signs and Symptoms of Signs and Symptoms of LiquidLiquid Exposure Exposure

Mild exposureMild exposure (to 18 hours): (to 18 hours): Localized sweating.Localized sweating. Fasciculations.Fasciculations. No miosis.No miosis.

Moderate exposure (<LD50) (to 18 Moderate exposure (<LD50) (to 18 hours):hours): Gastrointestinal effects.Gastrointestinal effects. Miosis uncommon.Miosis uncommon.

Severe exposureSevere exposure (LD50) (<30 (LD50) (<30 minutes):minutes): Sudden loss of consciousness.Sudden loss of consciousness. Seizures, apnea.Seizures, apnea. Flaccid paralysis.Flaccid paralysis. Death.Death.

Signs and SymptomsSigns and Symptoms

Mild:Mild: Eyes - small pupils (miosis). Eyes - small pupils (miosis). Dim vision.Dim vision. Headache. Headache. Runny nose (rhinnorhea). Runny nose (rhinnorhea). Salivation. Salivation. Tightness in the chest. Tightness in the chest. Time of onset: seconds to minutes after exposure. Time of onset: seconds to minutes after exposure.

Treated with Treated with one (1)one (1) Nerve Agent Antidote Kit. Nerve Agent Antidote Kit.

Signs and SymptomsSigns and Symptoms

Severe: Severe: All of the mild, plus. All of the mild, plus. Severe breathing difficulty or cessation of respiration. Severe breathing difficulty or cessation of respiration. Generalized muscular twitching, weakness, or Generalized muscular twitching, weakness, or

paralysis. paralysis. Convulsions. Convulsions. Loss of consciousness. Loss of consciousness. Loss of bladder and bowel control. Loss of bladder and bowel control. Time of onset: seconds to minutes after exposure.Time of onset: seconds to minutes after exposure.

Treated with Treated with two (2) – three (3)two (2) – three (3) Nerve Agent Nerve Agent Antidote Kits.Antidote Kits.

Cardiovascular:Cardiovascular: Tachycardia, bradycardiaTachycardia, bradycardia Heart block, ventricular arrhythmiasHeart block, ventricular arrhythmias Most disappear once antidote is givenMost disappear once antidote is given

Central nervous systemCentral nervous system Acute:Acute:

Loss of consciousness.Loss of consciousness. Seizures.Seizures. Apnea.Apnea.

Prolonged (4-6 weeks):Prolonged (4-6 weeks): Psychological effects.Psychological effects.

Nerve Agents Other Signs and Nerve Agents Other Signs and SymptomsSymptoms

SLUDGEMSLUDGEM

S S – Saliva– Saliva LL – Lacrimation (tearing) – Lacrimation (tearing) UU – Urination – Urination DD – Defecation/Diarrhea – Defecation/Diarrhea GG – Gastrointestinal Effects (cramping) – Gastrointestinal Effects (cramping) EE – Emesis – Emesis MM – Miosis (pinpoint pupils)/Muscle – Miosis (pinpoint pupils)/Muscle twitching twitching

Antidote UsesAntidote Uses

The Nerve Agent Antidote Kits provided by The Nerve Agent Antidote Kits provided by the West Virginia Office of EMS are the West Virginia Office of EMS are intended for use in the treatment of intended for use in the treatment of public public safety personnelsafety personnel in cases involving nerve in cases involving nerve agent poisoning.agent poisoning.

Antidote kits for the general public will be Antidote kits for the general public will be provided by the ChemPack program.provided by the ChemPack program.

Auto-InjectorsAuto-Injectors

Auto-InjectorsAuto-Injectors

Simple, compact injection Simple, compact injection systems: systems:

Permit rapid injection of required Permit rapid injection of required antidotes. antidotes.

Prevent needle from being Prevent needle from being subject to cross-contamination.subject to cross-contamination.

Enable rapid and accurate Enable rapid and accurate administration, even if care giver administration, even if care giver or patient is in protective or patient is in protective clothing. clothing.

Escape the Area.Escape the Area.

DO NOT ENTER ONCE SUSPICION EXISTS!DO NOT ENTER ONCE SUSPICION EXISTS!

Decontaminate – gross emergency decon (strip Decontaminate – gross emergency decon (strip down/flush with copious amounts of water).down/flush with copious amounts of water).

IFIF symptomatic, use the Nerve Agent Antidote Kits. symptomatic, use the Nerve Agent Antidote Kits.

Nerve Agent TreatmentNerve Agent Treatment

MEDICAL TREATMENT

Nerve Agent Antidote Kit consists of:

autoinjector with 2 mg Atropine

and an

autoinjector with 600 mg 2-PAM (Pralidoxime)

ATROPINE

• Potent parasympatholytic, blocks acetylcholine receptors. Treats SLUDGEM.

• There are no contraindications to atropine when used in the management of severe chemical or organophosphate poisoning.

• 2 mg doses with no maximum total dose.

Pralidoxime Chloride

• Cholinesterase reactivator

• Reverses respiratory depression and skeletal muscle paralysis resulting from organophosphate/nerve agent poisonings

• 600 mg per dose-not to exceed 1.8 grams total.

aka: 2-PAM or Protopam

NOTE: THE MAXIMUM DOSE OF PRALIDOXIME IS 1.8 GRAMS. THERE IS NO MAXIMUM DOSE OF ATROPINE.

Pralidoxime (2-PAM)Pralidoxime (2-PAM)

Use of AntidoteUse of Antidote

Self-AidSelf-Aid Buddy-AidBuddy-Aid

Self-AidSelf-Aid

The nerve agent antidotes need to be injected The nerve agent antidotes need to be injected into a large muscle. In most individuals, the thigh into a large muscle. In most individuals, the thigh muscle is used. If a person is very thin, however, muscle is used. If a person is very thin, however, the injection should be given in the buttocks.the injection should be given in the buttocks.

Note:Note: If you are exhibiting signs and symptoms If you are exhibiting signs and symptoms of severe nerve agent poisoning, you will of severe nerve agent poisoning, you will probably be unable to conduct self-aid probably be unable to conduct self-aid technique.technique.

Self-AidSelf-Aid

Thigh:Thigh: If you are right-handed, select a site on your If you are right-handed, select a site on your

right thigh. If you are left-handed, select a site right thigh. If you are left-handed, select a site on your left thigh. The injection site should be on your left thigh. The injection site should be in the outer part of the thigh. It is important in the outer part of the thigh. It is important that the injections be given into a large that the injections be given into a large muscle area. The site should be at least one muscle area. The site should be at least one hand's width below the hip joint and at least hand's width below the hip joint and at least one hand's width above the knee. Choose a one hand's width above the knee. Choose a site that is away from buttons, zippers, and site that is away from buttons, zippers, and objects being carried in your pockets.objects being carried in your pockets.

Self-AidSelf-Aid

Buttocks:Buttocks: If you are right-handed, select a site on the If you are right-handed, select a site on the

upper, outer quadrant of your right buttocks. If upper, outer quadrant of your right buttocks. If you are left-handed, select a site on the you are left-handed, select a site on the upper, outer quadrant of your left buttocks. upper, outer quadrant of your left buttocks. The upper, outer part of the buttocks is used The upper, outer part of the buttocks is used to avoid hitting a major nerve or artery. Hitting to avoid hitting a major nerve or artery. Hitting the nerve could result in paralyzing the leg. the nerve could result in paralyzing the leg. The site should be free of objects in your The site should be free of objects in your pocket which could be hit by the needle.pocket which could be hit by the needle.

Self-AidSelf-Aid

Self-AidSelf-AidADMINISTER ONE (1) NERVE AGENT ANTIDOTE KIT

Administer a Nerve Agent Antidote Kit (NAAK) only if you are having signs and symptoms of nerve agent poisoning. In freezing temperatures, carry the kits where they will be protected from the cold. The kit has two automatic injectors (autoinjectors). The large autoinjector contains pralidoxime chloride (2-PAM chloride). The smaller autoinjector contains atropine. Procedures for administering the antidotes follow.

Administering the AntidoteAdministering the Antidote Remove one Mark I kit. Remove one Mark I kit.

Hold the kit with your non-dominant hand by the plastic clip with the Hold the kit with your non-dominant hand by the plastic clip with the larger (2-PAM Chloride) autoinjector on top. larger (2-PAM Chloride) autoinjector on top. Hold the set at eye level in Hold the set at eye level in front of you so that you can see the autoinjectorsfront of you so that you can see the autoinjectors..

Grasp the body of the smaller (atropine) autoinjector with the thumb and Grasp the body of the smaller (atropine) autoinjector with the thumb and first two fingers of your dominant handfirst two fingers of your dominant hand. . Do notDo not cover the green (needle) cover the green (needle) end of the autoinjector with your fingers or hand. Touching the green end end of the autoinjector with your fingers or hand. Touching the green end may cause the autoinjector to function when you remove it from the clip.may cause the autoinjector to function when you remove it from the clip.

Pull the autoinjector out of the clip with a smooth motionPull the autoinjector out of the clip with a smooth motion (upon removal (upon removal the injector is automatically armed). If the autoinjector accidentally the injector is automatically armed). If the autoinjector accidentally functions, obtain another kit. Nerve agent antidote must be administered functions, obtain another kit. Nerve agent antidote must be administered into a large muscle in order to be effective quickly. Administering antidote into a large muscle in order to be effective quickly. Administering antidote into a finger or hand is not adequate.into a finger or hand is not adequate.

Hold the autoinjector with your thumb and two fingers (pencil writing Hold the autoinjector with your thumb and two fingers (pencil writing position).position).

Administering the AntidoteAdministering the Antidote

Administering the AntidoteAdministering the Antidote The auto injector should be held at a 90° angle to your The auto injector should be held at a 90° angle to your

body. body. Place the green (needle) end of the autoinjector Place the green (needle) end of the autoinjector against the thigh (or buttocks) muscle.against the thigh (or buttocks) muscle. Make sure that Make sure that the needle will not hit anything in your pocket when it the needle will not hit anything in your pocket when it functions. If your jacket is covering the injection site, lift functions. If your jacket is covering the injection site, lift the bottom of the jacket before giving yourself the the bottom of the jacket before giving yourself the injection.injection.

Press the green end of the autoinjector against the Press the green end of the autoinjector against the injection site using firm even pressure until it functions injection site using firm even pressure until it functions (needle is activated).(needle is activated). The needle will penetrate through The needle will penetrate through your clothing and into the muscle. The antidote will be your clothing and into the muscle. The antidote will be injected automatically. injected automatically. Do not use a jabbing motion to Do not use a jabbing motion to activate the needleactivate the needle as it may cause the auto injector to as it may cause the auto injector to function improperly.function improperly.

Administering the AntidoteAdministering the Antidote Hold the autoinjector in place for at least Hold the autoinjector in place for at least ten (10) ten (10)

secondsseconds after the needle has functioned. This time is after the needle has functioned. This time is needed to ensure that all of the antidote has been needed to ensure that all of the antidote has been injected.injected.

Carefully remove the atropine autoinjector by pulling it Carefully remove the atropine autoinjector by pulling it straight out.straight out.

Place the used autoinjector between two fingers of the Place the used autoinjector between two fingers of the hand holding the remaining autoinjector and clip. The hand holding the remaining autoinjector and clip. The green (needle) end should point away from your hand.green (needle) end should point away from your hand.


Administer 2-PAM ChlorideAdminister 2-PAM Chloride Grasp the body of the 2-PAM chloride autoinjector Grasp the body of the 2-PAM chloride autoinjector

(the large autoinjector remaining in the clip) with the (the large autoinjector remaining in the clip) with the thumb and two fingers of your right hand. thumb and two fingers of your right hand. Do not Do not cover the black (needle) end of the autoinjector with cover the black (needle) end of the autoinjector with your fingers or hand.your fingers or hand.

Pull the autoinjector out of the clip with a smooth Pull the autoinjector out of the clip with a smooth motionmotion. If you accidentally activate the needle while . If you accidentally activate the needle while removing the autoinjector, obtain another kit and removing the autoinjector, obtain another kit and administer the new 2-PAM chloride autoinjector.administer the new 2-PAM chloride autoinjector.


Note: The used Atropine injector is between the pinky and ring finger of the non-dominant hand


• Place the black (needle) end of the autoinjector against your thigh (or buttocks) muscle.

• Using firm, even pressure, press the black end of the autoinjector against the injection site until the needle functions. Use the same procedure as used with the atropine autoinjector.

• Hold the autoinjector in place for at least ten (10) seconds, then carefully remove the 2-PAM chloride autoinjector by pulling it straight out.

Administering the AntidoteAdministering the Antidote• Secure used autoinjectors:

• Drop the plastic clip. Do not drop the autoinjectors.

• Lift a pocket flap on your protective jacket or location designated by local SOP and push the needle of the used 2-PAM chloride autoinjector through the flap. (The flap is penetrated from the back so that the needle will be away from your body.)

• Bend the needle down to form a hook.


NOTE: PPE issued to EMS Personnel may not have exterior pockets. Local SOP will have to establish where to secure used injectors so they are visible by medical personnel at the hospital.

(NOTE: The expended autoinjectors are secured to your clothing in case you require medical help. Attaching both used autoinjectors to your outer clothing will inform medical personnel that nerve agent antidote has been administered and the amount that has been administered.)

Notes!Notes!

If you can walk and are not confused (you know If you can walk and are not confused (you know who you are and where you are), you will who you are and where you are), you will probably not need additional antidote.probably not need additional antidote.

WARNINGWARNINGIf your heart is beating very fast and If your heart is beating very fast and your mouth is very dry about five (5) to your mouth is very dry about five (5) to ten (10) minutes after administering the ten (10) minutes after administering the antidotes, you have already given antidotes, you have already given yourself enough antidoteyourself enough antidote..

Buddy-AidBuddy-Aid A victim showing signs of severe nerve agent poisoning will A victim showing signs of severe nerve agent poisoning will

not be able to help himself. Unless he receives help, he will not be able to help himself. Unless he receives help, he will probably die. However, your self-protection must be first and probably die. However, your self-protection must be first and foremost. You cannot help the casualty if you are also foremost. You cannot help the casualty if you are also overcome by the nerve agent.overcome by the nerve agent.

Buddy-aid will be required when a victim is totally and Buddy-aid will be required when a victim is totally and immediately incapacitated prior to being able to apply self-aid. immediately incapacitated prior to being able to apply self-aid. All three(3) sets of nerve agent antidote need to be given by a All three(3) sets of nerve agent antidote need to be given by a buddy.buddy.

Buddy-aid may also be required for a victim who attempts to Buddy-aid may also be required for a victim who attempts to counter the nerve agent by self-aid but becomes counter the nerve agent by self-aid but becomes incapacitated after administering one(1) set of the antidote. incapacitated after administering one(1) set of the antidote. Before initiating buddy-aid, a buddy should determine if one Before initiating buddy-aid, a buddy should determine if one (1) set of injectors has already been used so that (1) set of injectors has already been used so that no more no more than three (3) setsthan three (3) sets of the antidote are administered. of the antidote are administered.

Buddy-AidBuddy-Aid

WARNINGWARNING

Do not kneel when administering aid to a Do not kneel when administering aid to a chemical agent casualty. If you press your knee chemical agent casualty. If you press your knee against the contaminated ground, you may force against the contaminated ground, you may force the chemical agent into or through your clothing. the chemical agent into or through your clothing.

Kneeling on a contaminated area will greatly Kneeling on a contaminated area will greatly reduce the protection time afforded by your reduce the protection time afforded by your clothing. Place yourself near the casualty's clothing. Place yourself near the casualty's

head, face his feet, and head, face his feet, and squat squat behind his left behind his left shoulder.shoulder.

ADMINISTER NERVE AGENT ADMINISTER NERVE AGENT ANTIDOTE KITSANTIDOTE KITS

Position the casualty on his/her left side with the head slanted down Position the casualty on his/her left side with the head slanted down so that the casualty will not roll back over. Determine if the victim so that the casualty will not roll back over. Determine if the victim has self-administered any antidote. Begin administering injections of has self-administered any antidote. Begin administering injections of atropine and 2-PAM chloride. atropine and 2-PAM chloride. The victim may be administered a The victim may be administered a total of total of three(3)three(3) Nerve Agent Antidote Kits. Nerve Agent Antidote Kits.

Select Injection SiteSelect Injection Site If the victim’s thigh muscle is large enough, give the injections in If the victim’s thigh muscle is large enough, give the injections in

his thigh. If the casualty is very thin, give the injection in the his thigh. If the casualty is very thin, give the injection in the large muscle of his buttocks.large muscle of his buttocks.

ThighThigh. If the injections are to be given in the victim's thigh, . If the injections are to be given in the victim's thigh, position yourself near the casualty's thigh. The injection site position yourself near the casualty's thigh. The injection site should be on the outer part of the victim upper thigh. The should be on the outer part of the victim upper thigh. The injection site should be at least one hand's width below the hip injection site should be at least one hand's width below the hip joint and at least one-hand's width above the knee.joint and at least one-hand's width above the knee.

ButtocksButtocks. If the injection is to be given in the . If the injection is to be given in the victim's buttocks, roll the victim onto his side and victim's buttocks, roll the victim onto his side and position yourself at his hip. The injection site position yourself at his hip. The injection site should be in the upper, outer quadrant of the should be in the upper, outer quadrant of the victim's upper buttocks when victim is on his victim's upper buttocks when victim is on his side. The upper, outer quadrant is used to avoid side. The upper, outer quadrant is used to avoid hitting the major nerve in the buttocks. If the hitting the major nerve in the buttocks. If the victim's jacket is covering the injection site, lift victim's jacket is covering the injection site, lift the bottom of the jacket.the bottom of the jacket.


Apply firm, even pressure until the needle Apply firm, even pressure until the needle functions. Do not use a jabbing motion.functions. Do not use a jabbing motion.

Hold the autoinjector in place for at least ten (10) Hold the autoinjector in place for at least ten (10) seconds; then pull out the autoinjector.seconds; then pull out the autoinjector.

Drop the empty plastic clip without dropping the Drop the empty plastic clip without dropping the autoinjectors.autoinjectors.

Lay the used injectors on the victim's side.Lay the used injectors on the victim's side.


Administer Additional AntidoteAdminister Additional Antidote

CAUTION:CAUTION: If the victim has already If the victim has already administered one (1) kit to himself, only administered one (1) kit to himself, only administer two (2) additional kits. The administer two (2) additional kits. The victim victim should not receive more than three should not receive more than three (3) sets of injections(3) sets of injections without being seen by without being seen by medical personnel.medical personnel.


Additional AntidoteAdditional Antidote

Victims with signs and symptoms of Victims with signs and symptoms of severe exposure must be re-evaluated severe exposure must be re-evaluated every five minutes.every five minutes.

If SLUDGEM remains present, administer If SLUDGEM remains present, administer additional kits-additional kits-up to a total of three (3)up to a total of three (3)..

Atropine can be continued at 2 mg doses Atropine can be continued at 2 mg doses as long as SLUDGEM remains present.as long as SLUDGEM remains present.

Secure Used AutoinjectorsSecure Used Autoinjectors Attach all used autoinjectors (one at a time) to Attach all used autoinjectors (one at a time) to

the victim’s outer clothing or a location the victim’s outer clothing or a location designated in your local SOP.designated in your local SOP. Push the needle Push the needle of the autoinjector through the pocket flap and of the autoinjector through the pocket flap and bend the needle to form a hook. Repeat the bend the needle to form a hook. Repeat the procedure with all remaining autoinjectors. Be procedure with all remaining autoinjectors. Be careful not to puncture your gloves with the careful not to puncture your gloves with the needles. (The used autoinjectors will tell medical needles. (The used autoinjectors will tell medical personnel how much medication the victim has personnel how much medication the victim has received. This information will help them received. This information will help them determine what additional care is needed.)determine what additional care is needed.)


Once antidote has been administered, Once antidote has been administered, send victim to decon and transport to send victim to decon and transport to definitive health care as directed by definitive health care as directed by medical command.medical command.


Questions?Questions?

For additional informationFor additional information

West Virginia Office of EMSWest Virginia Office of EMS

350 Capitol Street, Room 425350 Capitol Street, Room 425

Charleston, WV 25301-3714Charleston, WV 25301-3714

304-558-3956304-558-3956

www.wvoems.orgwww.wvoems.org

state of west virginia department of health & human resources state trauma and emergency care...

Documents

nerve agent antidote

nerve agents

agent liquid

nerve agent vapor effects

shaven skin

skin damage

victims skin

respiratory system slide