Nerve Agent Incidents and Public Health Preparedness
Authors: Arthur Chang, Jerry Thomas, Rudolph Johnson, Susan E. Gorman, Josh Schier, Luke Yip
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions1 January 2019Nerve Agent Incidents and Public Health PreparednessArthur Chang, MD, MS, Jerry Thomas, MD, Rudolph Johnson, PhD, Susan E. Gorman, PharmD, MS, Josh Schier, MD, MPH, and Luke Yip, MDArthur Chang, MD, MSNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (A.C., J.T., R.J., J.S., L.Y.)Search for more papers by this author, Jerry Thomas, MDNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (A.C., J.T., R.J., J.S., L.Y.)Search for more papers by this author, Rudolph Johnson, PhDNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (A.C., J.T., R.J., J.S., L.Y.)Search for more papers by this author, Susan E. Gorman, PharmD, MSOffice of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia (S.E.G.)Search for more papers by this author, Josh Schier, MD, MPHNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (A.C., J.T., R.J., J.S., L.Y.)Search for more papers by this author, and Luke Yip, MDNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (A.C., J.T., R.J., J.S., L.Y.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2428 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Recent use of nerve agents (NAs) by terrorists and assassins exposes the need for public health responders and medical preparedness personnel to work together (1). Health care providers might find themselves at the scene of such an attack. Would the involvement of an NA be recognized? What should be done immediately to assess the situation, treat the victims, protect others and oneself, and alert appropriate health officials? These are essential questions a health care provider in the vicinity of an attack might face. We provide an overview of key clinical and public health concerns related to this topic for health ...References1. Vale JA, Marrs TC OBE, Maynard RL CBE. Novichok: a murderous nerve agent attack in the UK. Clin Toxicol (Phila). 2018;56:1093-7. [PMID: 29757015] doi:10.1080/15563650.2018.1469759 CrossrefMedlineGoogle Scholar2. Wiener SW, Hoffman RS. Nerve agents: a comprehensive review. J Intensive Care Med. 2004;19:22-37. [PMID: 15035752] CrossrefMedlineGoogle Scholar3. Leikin JB, Thomas RG, Walter FG, Klein R, Meislin HW. A review of nerve agent exposure for the critical care physician. Crit Care Med. 2002;30:2346-54. [PMID: 12394966] CrossrefMedlineGoogle Scholar4. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank's Toxicologic Emergencies. 10th ed. New York: McGraw-Hill; 2015. Google Scholar5. Ciottone GR. Toxidrome recognition in chemical-weapons attacks. N Engl J Med. 2018;378:1611-20. [PMID: 29694809] doi:10.1056/NEJMra1705224 CrossrefMedlineGoogle Scholar6. Marrs TC. The role of diazepam in the treatment of nerve agent poisoning in a civilian population. Toxicol Rev. 2004;23:145-57. [PMID: 15862082] CrossrefMedlineGoogle Scholar7. Skinner C, Thomas J, Johnson R, Kobelski R. Medical toxicology and public health—update on research and activities at the Centers for Disease Control and Prevention, and the Agency for Toxic Substances and Disease Registry: introduction to the Laboratory Response Network-Chemical (LRN-C). J Med Toxicol. 2009;5:46-9. [PMID: 19191216] CrossrefMedlineGoogle Scholar8. Centers for Disease Control and Prevention. Strategic national stockpile: CHEMPACK. 2018. Accessed at www.cdc.gov/phpr/stockpile/chempack.htm on 30 July 2018. Google Scholar9. Barbera JA, Yeatts DJ, Macintyre AG. Challenge of hospital emergency preparedness: analysis and recommendations. Disaster Med Public Health Prep. 2009;3:S74-82. [PMID: 19491592] doi:10.1097/DMP.0b013e31819f754c CrossrefMedlineGoogle Scholar10. BBC News. Russian spy poisoning: what we know so far. 8 October 2018. Accessed at www.bbc.com/news/uk-43315636 on 18 October 2018. Google Scholar Author, Article, and Disclosure InformationAffiliations: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (A.C., J.T., R.J., J.S., L.Y.)Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia (S.E.G.)Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2428.Corresponding Author: Arthur Chang, MD, MS, Emergency Management, Radiation and Chemical Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, F60, Atlanta, GA 30341; e-mail, [email protected]gov.Current Author Addresses: Drs. Chang, Thomas, Johnson, Schier, and Yip: National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341.Dr. Gorman: Centers for Disease Control and Prevention, 1600 Clifton Road, MS D-08, Atlanta, GA 30333.Author Contributions: Conception and design: A. Chang, J. Thomas, R. Johnson, S.E. Gorman, J. Schier, L. Yip.Drafting of the article: A. Chang, J. Thomas, R. Johnson, S.E. Gorman, J. Schier, L. Yip.Critical revision of the article for important intellectual content: A. Chang, J. Thomas, R. Johnson, S.E. Gorman, J. Schier, L. Yip.Final approval of the article: A. Chang, J. Thomas, R. Johnson, S.E. Gorman, J. Schier, L. Yip.This article was published at Annals.org on 18 December 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIntramuscularly administered A1 adenosine receptor agonists as delayed treatment for organophosphorus nerve agent-induced Status Epilepticus 1 January 2019Volume 170, Issue 1Page: 59-61KeywordsCholinergicsEnvironmental healthFasciculationsHealth care providersNervesOpioidsPrevention, policy, and public healthResearch laboratoriesRisk managementSigns and symptoms ePublished: 18 December 2018 Issue Published: 1 January 2019 PDF downloadLoading ...