Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide occurs as early as minutes after exposure and lasts for up to several days. During this time, nausea, vomiting, anorexia, and, depending on dose, diarrhea occur. In the latent stage, the patient will feel generally well for hours to days. Timing and duration of the latent stage is also variable and dose dependent. The manifest illness stage occurs next, and the type of illness depends on the dose received and the type of syndrome, or syndromes, that occurs. At doses in the range of 0.7–10 Gy, the full hematopoietic syndrome occurs. Bone marrow depression leads to reduced white blood cell and platelet counts, with subsequent hemorrhage and infection. Patients exposed to lower doses recover over periods of weeks to a year. At doses above 1.2 Gy, the mortality rate for the hematopoietic syndrome increases, and the 60-d median lethal dose (LD50) is 2.5–5 Gy. Death due to the hematopoietic syndrome occurs within a few months of exposure. At doses greater than 10 Gy (though known to occur at doses as low as 6 Gy), the gastrointestinal syndrome occurs as a result of intestinal mucosal stem cell death. This leads to fluid and electrolyte imbalance, dehydration, shock, and hemorrhage. In patients who develop the gastrointestinal syndrome death usually occurs within 2 weeks. At even higher doses (20 Gy), the neurovascular syndrome occurs. Damage to neurovascular tissue leads to hypotension, cerebral edema, seizures, and invariable death, often within 3 days of exposure. The management of patients with radiation exposure includes supportive care, care for other injuries, and assessment for signs of poor prognosis. The latter signs include rapid onset of symptoms, gastrointestinal complaints, and a falling white blood cell count (lymphocyte number) measured by the Andrews nomogram. Decontamination is only relevant for patients who are contaminated, that is those with dermal or internal radioisotope deposition. Exposure to ionizing beams of radiation do not leave a patient radioactive or with the need for (or possibility of) decontamination. Expert consultation can be obtained locally through the radiation safety officer or medical physicist at most medical centers or through the Radiation Emergency Assistance Center/Training Site (REAC/TS) consulting service in Oak Ridge, TN. December 2008 Version 2.0 Page 422
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Module Eight Observed Behaviors during Mass Chemical Exposures- Administration Page Mass chemical exposures, irrespective of their cause, have understandably resulted in considerable public anxiety. While public reaction to such events is not, per se, a toxicological issue, the burden placed on health care and triage systems by the “worried well” is an important concern for everyone involved in the management of such a crisis. Anticipating demand and encouraging communication are key elements in ensuring effective care and preventing public hysteria. Duration 45 minutes Scope Statement Using illustrative examples, this module explores common stress reactions to mass chemical exposures with a view towards attenuating their potential impact. Terminal Learning Objective (TLO) • Understand how to anticipate and appropriately respond to psychological issues encountered in victims of real & perceived chemical exposures Enabling Learning Objectives (ELO) Resources • Describe expected behaviors of large groups of people after a perceived toxic chemical exposure • Recognize the signs and symptoms of acute psychological and emotional response to a traumatic event (e.g. disaster or fear of real or perceived toxic chemical exposure • Develop a strategy to aid victims with fear/strong emotions following a real or perceived toxic chemical exposure Each of the eight course modules is deployed as an interactive, instructor-lead, MS PowerPoint presentation containing didactic content, historical examples, and selected case studies. All presentations are included in a printed participant guide (PG) containing the modules’ overview, scope statement, terminal and enabling learning objectives, PowerPoint slide handouts, and a summary section. Instructor to Participant Ratio 1:8 (minimum) to 1:25 (maximum) December 2008 Version 2.0 Page 423
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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