People exposed to chemicals or chemical warfare agents must be undressed and, where appropriate, decontaminated before being allowed to enter hospital. It is important to evaluate an incident and to spread this information to others. Via mass media important information on e.g. a possible toxic agent may be disseminated. The general public should get information as soon as possible from the mass media, so that the need to call the poisons information or other authorities for advice will be minimised. Pronounced miosis with pin-point pupils is an early and predominant sign in nerve agent poisoning.
Miosis is present in mild and severe cases.
Estimation of plasma cholinesterase activity is mainly of diagnostic value and does not guide the need for antidote treatment. This should be based solely on symptomatology. Pronounced symptoms may be present despite normal plasma cholinesterase activity. In severe poisoning, plasma cholinesterase activity may be decreased for several weeks even though severe symptoms have disappeared already after 24 hours. In spite of very severe poisoning, plasma cholinesterase activity may be normalised within a few hours with adequate treatment.