Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 34 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Is it Real • Emergency Response – Don’t get caught up on figuring out if it exists or not – “Psychogenic illness ” is a diagnosis of exclusion – Create a “holding environment ” • Location away from high -tempo triage activities • Symptoms monitored and re -evaluated • Research – Need for good epidemiological data that clarifies characteristics of each group (defines needs) Module One – Observed Behaviors during Mass Chemical Exposures 34 Don’t ask this question. Assume it is real, until and unless you have very good evidence of psychogenic/stress-response symptoms only. People should be placed in as “low stress” an environment as possible and re-evaluated for under-triage based on a developing case definition as more information becomes available. Characterizing the response of various groups (e.g. vulnerable populations) is still an area that needs more research. December 2008 Version 2.0 Page 460
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 35 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Planning Suggestions • Expect the problem – Plan for it • “Base disaster plans on what people are likely to do rather than what they should do ” Auf der Heide : Disaster Response: Principles of Preparation and Response • Don’t ignore these patients – And take them seriously • Early diagnostic & management decisions are critical to the success of the emergency response – EDs have little surge capacity – Decontamination and PPE burden the health care system Module One – Observed Behaviors during Mass Chemical Exposures 35 The problem of stress-response symptoms and their effect on both the number of people presenting for evaluation and the interpretation of clinical presentations is very real and should be incorporated into disaster planning. As one of the CDC–based emergency physicians has written, disaster plans should be based on what people are LIKELY to do, rather than what they SHOULD do. Since you can be sure that people will seek care if concerned or scared – and will not wait for an orderly triage or decontamination process in the field – we should plan to direct people arriving to our hospitals to an area that allows for secondary triage, to avoid overwhelming the acute care areas. Expert assistance should be sought to determine the actual need for decontamination, and the need for or level of personal protective equipment (PPE). December 2008 Version 2.0 Page 461
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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