Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Module Two The Clinical Neurotoxicology of Chemical Terrorism - Administration Page The underlying neurophysiology of the brain makes it a likely target for terrorism. Interruption of the normal role of neurotransmitters in the brain will alter functionality and render the individual incapable of ‘fight or flight’. Because the potential exists for neurotoxins to be used in a terrorist attack it is imperative that clinicians and first responders are able to recognize the common toxic syndromes that affect the nervous system, including sedation, convulsions and hallucinations. Duration 45 minutes Scope Statement This module provides a detailed overview of the major toxic syndromes along with examples of chemical agents of opportunity for each clinical syndrome. Case studies are presented that highlight the historical use of these agents in terrorist attacks. Potential antidotes, initial treatment strategies and management of each clinical syndrome are reviewed. Terminal Learning Objective (TLO) • Recognize the common toxic syndromes that affect the nervous system, including sedation, convulsions and hallucinogens. Enabling Learning Objectives (ELO) Resources • Describe the role of neurotransmitters in brain function. • List examples of agents of opportunity for each clinical syndrome. • Describe initial treatment strategies for each clinical syndrome. • Identify antidotes where appropriate. 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) Reference List 1. Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 2001;37(2):239-41. December 2008 Version 2.0 Page 66
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Practical Exercise Statement 2. Centers for Disease Control and Prevention (CDC). Nicotine poisoning after ingestion of contaminated ground beef –Michigan, 2003. MMWR May 9, 2003;52(18):413-16. 3. Centers for Disease Control and Prevention (CDC). Poisoning by an illegally imported Chinese rodenticide containing tetramethylenedisulfotetramine--New York City, 2002. MMWR Morb Mortal Wkly Rep. 2003 Mar 14;52(10):199-201. 4. Hoffman JR et al. The empiric use of naloxone in patients with altered mental status: a reappraisal. Ann Emerg Med 1991;20:246-52. 5. Lakoski JM, et al. The advantages and limitations of calmatives for use as a non-lethal technique. nldt2.arl.psu.edu/documents/calamative_report.pdf 6. McCarron MM et al. Acute phencyclidine intoxication: clinical patterns, complications and treatment. Ann Emerg Med 1981;6:290-7. 7. Wax PM, et al. Unexpected "gas" casualties in Moscow: a medical toxicology perspective. Ann Emerg Med 2003;41:700-5. Each module presentation contains one or more interactive audience response questions designed to drive discussion, promote participant engagement, and test knowledge. Through the use of the Meridia® Audience Response system, participant responses can be collected, tabulated, and displayed within the presentation in real time. In order to use the interactive slides accompanying this presentation, the lecture hall must be equipped with the Meridia® Audience Response system and user keypads. In addition, a copy of the “Meridia® Q&A” software component for MS PowerPoint must be installed on the presenter’s computer. Assessment Strategy Participant progress toward course learning objectives is monitored through informal discussion and responses to each module’s practical exercise questions. Overall mastery of module content and concepts is documented by means of a comprehensive, end-of-day posttest touching on key learning objectives from each module. Each participant must obtain a score of 80% or better to successfully complete the training and obtain a course completion certificate. December 2008 Version 2.0 Page 67
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