Most published recommendations for treatment of pediatric nerve agent poisoning are based on standard resuscitation doses for these agents. However, certain medical and operational concerns suggest that an alternative approach may be warranted for treatment of children by emergency medical personnel after mass chemical events. (1) There is evidence both that suprapharmacological doses may be warranted and that side effects from antidote overdosage can be tolerated. (2) There is concern that many emergency medical personnel will have difficulty determining both the age of the child and the severity of the symptoms. Therefore, the Regional Emergency Medical Advisory Committee of New York City and the Fire Department, City of New York, Bureau of Emergency Medical Services, in collaboration with the Center for Pediatric Emergency Medicine of the New York University School of Medicine and the Bellevue Hospital Center, have developed a pediatric nerve agent antidote dosing schedule that addresses these considerations. These doses are comparable to those being administered to adults with severe symptoms and within limits deemed tolerable after inadvertent nerve agent overdose in children. We conclude that the above approach is likely a safe and effective alternative to weight-based dosing of children, which will be nearly impossible to attain under field conditions.

The Fire Department of the City of New York EMS Command utilizes air medical evacuation for patient transports very infrequently. The parameters of New York City's large urban environment may not be conducive to air medical transport. These data seem to be consistent with experiences of other large urban cities.

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Recent incidents have proven the danger of being unknowledgeable. For example, the attack on the Moscow Theatre resulted in many unnecessary victims due to poorly informed prehospital medical teams. Conclusion: More education and information regarding such hazards should be available for medical rescue teams. Keywords: ammunition; education; nuclear, biological, chemical (NBC); weapons; World War I (WWI)Prtboip Disast AW2005;20(2):s91-s92The Bhopal Saga-Causes and Consequences of the World's Largest Industrial Disaster I. EckermanSwedish Doctors for the Environment, SwedenIntroduction: The Bhopal Gas Leak in India, 1984 is the largest chemical, industrial event ever. A total of 520,000 persons were exposed to the gases, and up to 8,000 died during the first several weeks following the event. A total of 100,000 persons now suffer from permanent injuries. The catastrophe has become the symbol of negligence to human beings from transnational corporations. Industrial disasters still happen in India as well as in the rest of the industrialized part of the world. Although more recent events are far smaller than that of the event in Bhopal, they are so numerous that chemical hazards could easily be considered a public health problem. The companies involved usually dispute their own roll in the events, and often deny the health effects of the incident. The companies also have been reluctant to compensate the victims financially.Methods: This report is based on a thorough review of material already published from India and its surroundings, as well as the author's experiences while visiting Bhopal. The Logical Framework Approach (LFA), a tool for project planning and management, was tested on this major event, in order to analyze its causes and consequences. Results: The Logical Framework Approach (LFA) provided one main message: Irrespectively of the direct cause of the leakage, only two parties are responsible for the magnitude of the disaster: (1) the Union Carbide Corporation; and (2) the Governments of India and Madhya Pradesh. Models developed for analysis of injuries can be used for analyzing a complicated, major incident, such as the Bhopal gas leak, though different models might stress different aspects. Visualizing causes and consequences in tree models might provide a new understanding. When visualizing causes and consequences of this kind of event, it is obvious that "chain" and "tree" are not the right words-"net" is more appropriate. Analysis according to the LFA problem tree demonstrates that to create such a major gas leak, water entering the tank alone was not enough. The most important factors were the design of the plant and the recent cut in expenses because of economic pressure. The same analysis shows that the most important factor for the outcome of the leakage is the negligence of the Union Carbide Corporation and the Governments of India and Madhya Pradesh.Conclusion: To reduce the influence of chemical industries on public health, there is a great need for actions from many areas. The government...