Review Article

Sarin Exposure: A Simulation Case Scenario

Authors: Martin P. Eason, MD, JD

Abstract

Given the current geopolitical tensions, the risk of a terrorist attack on the United States is constant and increasing. Chemical terrorism, specifically the use of nerve agents, has occurred in other nations. Because of the ease of manufacture, the ability to conceal them, and the lethality of these agents, they pose a potential threat as a weapon of terror. Nerve agent exposure requires prompt recognition, a series of actions to mitigate further exposure to others, and management of the physiological sequelae of exposure. Many civilian healthcare providers are unprepared to manage injuries from nerve exposure. Failure to recognize the signs of nerve agent exposure will increase mortality and morbidity in victims and place healthcare providers at risk. Simulation is an effective methodology to train healthcare personnel in disaster preparedness. This article presents a simulation scenario that reviews the presentation of nerve agent exposure, its management, and a recipe for performing this simulation in a training exercise.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Hilmas CJ, Smart JK, Hill BA. History of chemical warfare, in Tuorinsky SD (ed): Medical Aspects of Chemical Warfare. Washington, DC, Borden Institute, 2008, pp 9–75.
 
2. UK Ministry of Defense. Defending against the threat of biological and chemical weapons. Outline history of biological & chemical weapons. http://webarchive.nationalarchives.gov.uk/+/http://www.mod.uk:80/issues/cbw/history.htm. Accessed July 1, 2012.
 
3. Organization for the Prohibition of Chemical Weapons. Background of chemical disarmament. http://www.opcw.org/news-publications/publications/history-of-the-chemical-weapons-convention. Accessed July 1, 2012.
 
4. Smart JK, Mauroni A, Hil BA, et al. History of the chemical threat, chemical terrorism, and its implications for military medicine, in Tuorinsky SD (ed): Medical Aspects of Chemical Warfare. Washington, DC, Borden Institute, 2008, pp 115–153.
 
5. Office of the Press Secretary, White House. Presidential Decision Directive 39: US policy on counterterrorism. http://www.fas.org/irp/offdocs/pdd39.htm. Published June 21, 1995. Accessed November 5, 2012.
 
6. Office of the Press Secretary, White House. Presidential Decision Directive 62: combating terrorism. http://www.fas.org/irp/offdocs/pdd-62.htm. Published May 22, 1998. Accessed November 5, 2012.
 
7. Rubin JN. Recurring pitfalls in hospital preparedness and response. In: McIsaac III JH, ed. Hospital Preparation for Bioterror. New York: Academic Press; 2006.
 
8. Wilkerson W, Avstreih D, Gruppen L, et al. Using immersive simulation for training first responders for mass casualty incidents. Acad Emerg Med 2008; 15: 1152–1159.
 
9. Billett B, Peckler B, Sinert R, et al. Simulation in a disaster drill: comparison of high-fidelity simulators versus trained actors. Acad Emerg Med 2008; 15: 1144–1151.
 
10. Duke University Human Simulation and Patient Safety Center. Duke University simulation development template. http://simcenter.duke.edu/support.html. Accessed June 29, 2012.
 
11. Bossone CA, Despain K, Tuorinsky S. History of chemical warfare, domestic preparedness, in Tuorinsky SD (ed): Medical Aspects of Chemical Warfare. Washington, DC, Borden Institute, 2008, pp 753–773.
 
12. Madssen JM. Terrorism and disaster—what clinicians need to know: sarin. http://www.medscape.org/viewprogram/4362. Accessed May 31, 2012.
 
13. Velez-Daubon LI. CBRNE—Nerve agents, binary—GB2, VX2. http://emedicine.medscape.com/article/831901-overview. Accessed May 2, 2012.
 
14. Lee EC. Clinical manifestations of sarin nerve gas exposure. JAMA 2003; 290: 659–662.
 
15. Centers for Disease Control and Prevention. Emergency room procedures in chemical hazard emergencies: a job aid. http://www.cdc.gov/nceh/demil/articles/initialtreat.htm. Accessed July 2, 2012.
 
16. Agency for Toxic Substances and Disease Registry. Toxic substances portal—nerve agents (GA, GB, GD, VX). http://www.atsdr.cdc.gov/MMG/MMG.asp?id=523&tid=93. Accessed July 2, 2012.