A Field-Expedient Algorithmic Approach to the Clinical Management of Chemical and Biological Casualties

Abstract

Warriors on the modern battlefield face considerable danger from possible attack with chemical and biological weapons. Aggravating this danger is the fact that medical resources at the lowest echelons of care, already likely to be strained to capacity during modern conventional combat, are at present inadequate to handle large numbers of chemical or biological casualties. Complicating this problem further is the austere nature of diagnostic modalities available at lower echelons. With this in mind, and given the urgency required to adequately manage chemical and biological casualties, it is likely that such casualties will initially require significant empiric care in the absence of a definitive diagnosis. Such care under field conditions, often rendered by relatively inexperienced medical personnel, might best be provided using an algorithmic approach. We have developed such an algorithm.

A Model Curriculum for Public Health Bioterrorism Education

“…For example, the lecture on principles of medical management of biological casualties is one designed for military clinicians by USAMRIID physicians. 10 Students were introduced to concepts of treatment for nonspecific initial symptoms resulting from exposure to Class A biological agents by the infectious disease division chair of the Department of Medicine at Hartford Hospital. This was then reinforced by a lecture presenting the algorithm for empirical patient care in the absence of a definitive diagnosis developed by USAMRIID physicians.…”

“…This was then reinforced by a lecture presenting the algorithm for empirical patient care in the absence of a definitive diagnosis developed by USAMRIID physicians. 10 The lecture on the epidemiology of diseases of bioterrorism was made pertinent to Connecticut clinicians and public health officials through the use of Connecticut examples, including the human inhalational anthrax case of 2001 11 and the tularemia index case of the Martha's Vineyard outbreak of 2000. 12 Similarly, occupational health perspectives on processing and distribution of the U.S. mail were discussed in connection with the Connecticut anthrax mailing case by occupational health and postal service officials involved in the protection of U.S. postal workers in Connecticut.…”

Rapid diagnostic assays in the genomic biology era: detection and identification of infectious disease and biological weapon agents

“…Because of the threat posed by both BW and emerging ID agents, there is a need to rapidly identify such agents in order to treat individuals at risk and limit disease transmission, improve public health surveillance and epidemiology, and monitor environmental impact. As shown by the anthrax attack during the fall of 2001 and the SARS outbreak of 2002-2003, patients would begin appearing at hospitals and clinics within several days of exposure, most presenting with nonspecific flu-like symptoms (5)(6)(7). The first days of the outbreak might not even cause undue concern.…”

Testing the Use of Symptom-Based Terrorism Triage Algorithms with Hospital-Based Providers

“…In the case of the US military, some have suggested an algorithmic approach to the early empiric treatment of biological and chemical casualties in the field. 18 However, their approach was based on field management in a military setting and may not reflect decision-making issues in a civilian setting. The authors of this manuscript are not aware of attempts to test the usability of the above-mentioned systems.…”