CHEMICAL AGENTS

OF CONCERN
Group 1 | BSN 4B
 HAZMAT

Hazardous material (HAZMAT) is any substance that can harm people, property, or the environment. This includes not
only chemicals, but also biological, radiological, nuclear, and explosive substances. Outside of the United States ates,
HAZMATs are often referred to as “dangerous goods.”

HAZMAT INCIDENTS
• an emergency response incident that involves the release of any HAZMAT. The release of hazardous chemicals may
be overt, such as the result of an explosion or leak, or much more subtle, such as the intentional use of aerosol

CHEMICAL AGENTS IN THE ENVIRONMENT

dispersal devices.

• The first challenge encountered in the event of a terrorist attack involving the use of CWAs is detection of the chemical
in the environment.

HAZMAT EMERGENCY RESPONSE

• standardized by both the Occupational Safety and Health Administration (OSHA) at the federal level and
industry-wide by the National Fire Protection Association (NFPA), and following their guidance, specialized
HAZMAT teams are called in to address these situations.
Chemical Agents and Other Common Industrial
Chemicals of Concern
• Chemical Asphyxiants (Blood Agents) Detection of Chemical Agents
• Incapacitating Agents
• Nerve Agents HAZMAT teams are routinely equipped with a variety of chemical detectors and monitoring
• Pulmonary Irritants kits, primarily chemical-specific tests indicating
• Riot Control Agents only the presence or absence of a chemical.

• Vesicants (Blister Agents)

Chemical Agents of Concern

Hazardous Material Training Levels
• First Responder Awareness • Biotoxins • Metals

• First Responder Operations • Blister agents/vesicants • Nerve agents

• Hazardous Materials Technician • Blood agents • Organic solvents

• Hazardous Materials Specialist • Caustics (acids) • Riot control agents/tear gas

• Choking/lung/pulmonary agents • Toxic alcohols
Levels of Personal Protective Equipment • Incapacitating agents • Vomiting agents
• Level A • Level C • Long acting anticoagulant
• Level B • Level D
Medical Management of HAZMAT Victims NERVE AGENTS
Primary Assessment and Resuscitation
Classifications:
Resuscitation and primary assessment can
be remembered using the mnemonic G AGENTS
ABCDE.
• The G agents include GA
• Airway (tabun), GB (sarin), GD
• Breathing (soman), and GF.
• Circulation
V AGENTS
• Disability
• Exposure • The V agents, which tend to be
more pernicious, include VG
Circulation takes priority before airway and (amigon), VS, and VX.
breathing (CAB) in victims with massive
A= Allergies
external hemorrhage or primary cardiac
Secondary Assessment M = Medications
arrest.
Secondary assessment of HAZMAT victims P = Past Medical History

includes history and physical examination. L=Last

E=Events
Recognizing Nerve Agents
Clinical presentation of patients with gasping, miosis, copious
secretions, sweating, and generalized twitching is very suggestive
of nerve agent exposure (Weinstein & Alibek, 2003).
The cholinergic toxidrome that results is characterized by
muscarinic signs and symptoms (DUMBBBELSS) and nicotinic
Patient Assessment
• Muscle fasciculations and eventual paralysis may occur.
• Symptoms usually occur within seconds of exposure to a nerve
agent but may take several hours when exposure is only
transdermal.
Mild inhalational exposure

signs and symptoms: Mydriasis, Tachycardia, Weakness, Severe inhalational exposure Clinical Diagnostic
Mild dermal exposure
Hypertension, and muscle Fasciculations (MTWHF). Nicotinic Tests:
Severe dermal exposure
symptoms may be observed initially, but muscarinic signs can be • Red blood cell and serum
observed concurrently. cholinesterase levels are
Duration/Mortality
helpful
• to determine the extent of
Recovery may take several months with nerve agents. enzyme inhibition.
Organophosphate agents result in recovery over several days
to weeks, while carbamate poisoning recovery occurs within
Treatment
• Prophylactic anticonvulsants
1 day. Permanent damage to the CNS is possible after
• Oximes
exposure to a high dose.
• Anticholinergic
Patient Assessment
Ocular: Redness and burning of the eyes with lacrimation,
blepharospasm, and lid edema
Upper airway: Nasal irritation and discharge, sinus burning, nose
bleeds, sore throat, cough, and laryngitis
Blood Agents
Blood or tissue agents are chemicals that affect the body by being
absorbed into and distributed by the blood to the tissues. Substances
include arsine, carbon monoxide, cyanide agents, and sodium
monofluoroacetate. They may act on the blood itself or more distally
in the critical tissues

Pulmonary: Dyspnea, necrosis of large airway mucosa with

sloughing, chemical pneumonitis, pulmonary edema, ARDS,
respiratory failure
Skin: Irritation and redness with delayed production of wheals,
vesicles, or bullae, followed later by areas of necrosis
Recognizing Tissue (Blood) Agents
Cyanide in chemical weapons comes in four forms. These include
cyanogen chloride (CK), hydrogen cyanide (AC), potassium cyanide
(KCN), and sodium cyanide (NaCN). All forms may be released as a
liquid, aerosol, or gas for inhalation; they may also be ingested or

Clinical Diagnostic Tests absorbed through the eyes and skin.

Laboratory findings indicative of cyanide exposure:

CBC
Glucose
• an elevated blood cyanide concentration (the most definitive);
Serum electrolytes and renal function (blood urea nitrogen
• metabolic acidosis with a high concentration of lactic acid; and
[BUN]/creatinine)
• oxygen content of the venous blood greater than normal (although
Chest x-ray
this is not specific to cyanide exposure)
Pulse oximetry (or arterial blood gas [ABG] measurements).
 VESICATING/BLISTER AGENTS
are chemicals that severely blister the eyes, respiratory tract, and skin on contact. Possible substances included in this class
are mustard agents, lewisites/chloroarsine agents, and phosgene oxime (Alibek et al., 2006).

Recognizing Vesicants Exposure Types and Onsets

While symptoms generally manifest quite rapidly after exposure to

Rapid recognition of vesicating
a blister agent, the time course is a function of the route of exposure
agents in an emergency is key to
as well as the type and volume of vesicant involved
ensuring rapid and effective care.
Though many blister agents are
similar in appearance, they may be Your paragraphDuration/Mortality
differentiated based on their
distinctive odour.
The severity of the illness is dependent on the amount and
route of exposure to the vesicant, the type of vesicant, and
the medical condition of the person exposed. Exposure to
high concentrations may be fatal.
 Patient Assessment Clinical Diagnostic Test
• CBC
Cyanide Poisoning - latency period for cyanides is • Blood glucose
10 to 15 seconds up to several minutes. • Electrolyte determinations
• Urine for hemoglobinuria

Arsine/Phosphine Poisoning - Upon inhalation: Patient Management

• Initial symptoms of arsine poisoning
include nausea, vomiting, headache, Closely monitor serum electrolytes, calcium, BUN, creatinine,
malaise, weakness, dizziness, abdominal hemoglobin, and hematocrit. For victims of arsine poisoning, fluid

pain, dyspnea, and, occasionally, administration amounts need to be monitored to avoid the onset of
congestive heart failure symptoms.
red-stained conjunctivae
• burning sensation in the chest Therapy
• chest pain
• shortness of breath and weakness. Cyanide Poisoning Victims may be successfully resuscitated by proper
• A delay of 2 to 24 hours is typical before the circulatory and respiratory support while waiting for the antidote to be
onset of any symptoms. administered. Every effort should be made to administer the antidote as
soon as possible
 PULMONARY/CHOKING AGENTS
are chemicals that cause severe irritation or swelling of the respiratory tract, causing pulmonary damage and ultimately
impairing oxygen delivery. Substances include ammonia, bromine, chlorine, hydrogen chloride, methyl bromide, methyl
isocyanate, osmium tetroxide, phosgene, phosphine, phosphorus (elemental, white or yellow), and sulfuryl fluoride.

CLASSIFICATION (according to water solubility) CLINICAL DIAGNOSTIC TESTS

• Highly water soluble
• CBC
• Moderately water soluble
• Glucose determinations
• Slightly water soluble
• Electrolyte determinations
• Intermediate water soluble • Chest radiography
• Low water soluble • Pulse oximetry (if severe inhalation exposure is
PATIENT ASSESSMENT suspected)
• Initial sx: eye pain, redness, lacrimation, sore throat, runny nose,
coughing, and headache.
• After hours - several days, pts may develop nausea, hemoptysis, and
the signs and symptoms of pulmonary edema including choking,
dyspnea, rales, hemoconcentration, hypotension, and possible cyanosis.
• Hypoxia and hypotension within 4 hours of exposure carry a poor
prognosis.
 RIOT CONTROL AGENTS
TREATMENT
(sometimes referred to as “tear gas”) are chemical
No specific treatment is required. The situation improves within 30
compounds that temporarily make people unable to
minutes after exposure ends (Weinstein & Alibek, 2003).
function by irritating to the eyes, mouth, throat, lungs,
and skin. The most common compounds are known as
chloroacetophenone (CN) and
Duration/Mortality
chlorobenzylidenemalononitrile (CS) and diphenylamine
arsine ( DM). Situation will improve 15 to 30 minutes after exposure ends. Death can
be immediate when serious chemical burns are present in the throat and
lungs
Recognizing Riot Control Agents
PATIENT ASSESSMENT
Due to the circumstances of their typical use in the
Riot control agents affect primarily the eyes, causing temporaгу
United States, identification of riot control agents may
blindness that is due to lacrimation and blepharospasm. They also
be simplified by communication with the police or
produce conjunctival redness; cough; chest tightness; sneezing: and
other agency responsible for disseminating the agent.
mouth, nose, and throat irritation.
Emergency Department Procedures in
Chemical Hazard Emergencies
 Gerleen Pelaez

Andrew Rafael S. Soberrano • Nerve Agents (part)

• Member of Editing Team Brisa Ampeloqiou
• Group Leader
• Blood Agent (Part) • Pulmonary Agent (part)
• Member of Editing Team

Juluis Caeser Ledesma

• Vesicating/Blister Agent (part) GROUP Eloisa Roldan

•Riot Control Agents

1 (part)

Tricia Mae Prado

• Medical Management (part)
• Detection of Chemical Agents
(part)
• Chemical Agents of Concern (part)
Kristel Revilla
Germaine Manao • Hazmat (part)
• Hazmat Incidence (part)
• Emergency Department
•Hazmat Emer Responce
Procedures in Chemical Hazard
(part)
Emergencies (part)
• Chief in Editing of PPT