Secondary exposure of medical staff to sarin vapor in the emergency room

Nozaki, Hiroyuki; Hori, Shingo; Shinozawa, Yotaro; Fujishima, Seitaro; Takuma, Kiyotsugu; Sagoh, Masachika; Kimura, Hiroaki; Ohki, T.; Suzuki, Masatoshi; Aikawa, Naoki

doi:10.1007/bf01700667

Cited by 172 publications

(136 citation statements)

References 6 publications

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…19,20 Of the 1,364 first responders transporting contaminated patients to receiving hospitals, 10% became victims due to the off-gassing of the volatile sarin in the hot, poorly ventilated ambulances and Tokyo Fire Defense Agency minivans. 16,20,21 Eleven of 15 physicians caring for victims at a single local receiving hospital also reported symptoms attributable to sarin offgassing, with six requiring atropine. 21 Decontamination was rapidly performed by the responding fire and hazardous materials (HazMat) units during the exercise.…”

Section: Decontaminationmentioning

confidence: 99%

“…16,20,21 Eleven of 15 physicians caring for victims at a single local receiving hospital also reported symptoms attributable to sarin offgassing, with six requiring atropine. 21 Decontamination was rapidly performed by the responding fire and hazardous materials (HazMat) units during the exercise. Prior to the arrival of the dedicated HazMat units, the two first-responder pumper units coordinated a temporary decontamination shower for the victims.…”

Section: Decontaminationmentioning

confidence: 99%

See 1 more Smart Citation

Chemical weapon functional exercise—Cincinnati: observations and lessons learned from a “typical medium-sized” city's response to simulated terrorism utilizing weapons of mass destruction

FitzGerald¹,

Sztajnkrycer²,

Crocco³

2003

Public Health Reports

View full text Add to dashboard Cite

Section: Decontaminationmentioning

confidence: 99%

Section: Decontaminationmentioning

confidence: 99%

Chemical weapon functional exercise—Cincinnati: observations and lessons learned from a “typical medium-sized” city's response to simulated terrorism utilizing weapons of mass destruction

FitzGerald¹,

Sztajnkrycer²,

Crocco³

2003

Public Health Reports

View full text Add to dashboard Cite

“…Once accumulated into hydrophobic sites, OPs that do enter the CNS are retained and partition slowly back into the circulation. For example, victims of Tokyo subway nerve gas attack in 1995 were found to suffer from both short and long term symptoms of OP exposure (1)(2)(3)(4). Accordingly, comprehensive protection from and treatment of OP intoxication to minimize the longer term consequences require administration of antidotes capable of reactivating OP-inhibited AChE in the CNS.…”

mentioning

confidence: 99%

New Structural Scaffolds for Centrally Acting Oxime Reactivators of Phosphylated Cholinesterases

Sit

Radić

Gerardi

et al. 2011

Journal of Biological Chemistry

118

121

View full text Add to dashboard Cite

We describe here the synthesis and activity of a new series of oxime reactivators of cholinesterases (ChEs) that contain tertiary amine or imidazole protonatable functional groups. Equilibration between the neutral and protonated species at physiological pH enables the reactivators to cross the blood-brain barrier and distribute in the CNS aqueous space as dictated by interstitial and cellular pH values. Our structure-activity analysis of 134 novel compounds considers primarily imidazole aldoximes and N-substituted 2-hydroxyiminoacetamides. Reactivation capacities of novel oximes are rank ordered by their relative reactivation rate constants at 0.67 mM compared with 2-pyridinealdoxime methiodide for reactivation of four organophosphate (sarin, cyclosarin, VX, and paraoxon) conjugates of human acetylcholinesterase (hAChE). Rank order of the rates differs for reactivation of human butyrylcholinesterase (hBChE) conjugates. The 10 best reactivating oximes, predominantly hydroxyimino acetamide derivatives (for hAChE) and imidazole-containing aldoximes (for hBChE) also exhibited reasonable activity in the reactivation of tabun conjugates. Reactivation kinetics of the lead hydroxyimino acetamide reactivator of hAChE, when analyzed in terms of apparent affinity (1/K ox ) and maximum reactivation rate (k 2 ), is superior to the reference uncharged reactivators monoisonitrosoacetone and 2,3-butanedione monoxime and shows potential for further refinement. The disparate pH dependences for reactivation of ChE and the general base-catalyzed oximolysis of acetylthiocholine reveal that distinct reactivator ionization states are involved in the reactivation of ChE conjugates and in conferring nucleophilic reactivity of the oxime group.It has become increasingly apparent that efficient reinstatement of CNS acetylcholinesterase (AChE) 2 activity inhibited in organophosphate (OP)-intoxicated individuals is required for sustained symptom recovery. In particular, nerve agent OPs already used by terrorists, but also active metabolites of OP-based pesticides, readily cross the bloodbrain barrier (BBB). The exposure to OP doses close to lethality results in initial severe motor convulsions and epileptic seizures. Accumulating evidence points to these seizure events being linked to irreversible long term compromise of cognitive functions and alteration of CNS electrical excitability. Once accumulated into hydrophobic sites, OPs that do enter the CNS are retained and partition slowly back into the circulation. For example, victims of Tokyo subway nerve gas attack in 1995 were found to suffer from both short and long term symptoms of OP exposure (1-4). Accordingly, comprehensive protection from and treatment of OP intoxication to minimize the longer term consequences require administration of antidotes capable of reactivating OP-inhibited AChE in the CNS. Current therapy directed to reactivating inhibited AChE is limited to the peripheral circulation because commonly used quaternary pyridinium aldoxime reactivators do not cross the BBB at ...

show abstract

“…1,2,31 A substantial number of care providers experienced symptoms or signs of secondary exposure. 2,40 Most surveyed hospitals did not have appropriate types and sufficient numbers of respiratory protective equipment for ED staff. These observations echo the findings of a 1989 study of 45 hospital emergency departments in California.…”

Section: Discussionmentioning

confidence: 99%

Hospital preparedness for victims of chemical or biological terrorism

2001

View full text Add to dashboard Cite

OBJECTIVES: This study examined hospital preparedness for incidents involving chemical or biological weapons. METHODS: By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. RESULTS: Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). CONCLUSIONS: Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective.

show abstract

Secondary exposure of medical staff to sarin vapor in the emergency room

Abstract: Careful attention to the risks of secondary exposure to toxic gas in the emergency room and prompt decontamination if such exposure should occur are necessary in the case of large-scale disasters caused by sarin.

Cited by 172 publications

References 6 publications

Chemical weapon functional exercise—Cincinnati: observations and lessons learned from a “typical medium-sized” city's response to simulated terrorism utilizing weapons of mass destruction

Chemical weapon functional exercise—Cincinnati: observations and lessons learned from a “typical medium-sized” city's response to simulated terrorism utilizing weapons of mass destruction

New Structural Scaffolds for Centrally Acting Oxime Reactivators of Phosphylated Cholinesterases

Hospital preparedness for victims of chemical or biological terrorism

Contact Info

Product

Resources

About