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Crit Care Nurse 2004 Feb; 24(1): 14
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Letters to the Editor

Chemical warfare issues

I read the article, "Chemical Warfare: Toxicity of Nerve Agents" in your October (2003:15–22) issue. It amazes me how many articles and how many journals are publishing "terrorism-related" material. There seems to be such a rush on the material that errors are often overlooked. I found some errors in the article as follows:

On page 15, it is written that "...differences in these properties influence an agent’s potential as a biological [hazard]." Chemicals are not alive! Chemical agents are not biological agents.

On page 15, it is also written that VX can persist on the ground for 2 to 6 days. Actually, it can persist for weeks.

On page 18, the authors state that treatment "begins with the rapid removal of the agent through a decontamination process." This only applies to contamination (liquid on skin or clothing). For an exposure (inhalation), no decontamination is required.

On page 18, the authors state that removal of the aerosolized agent is done by removing clothing and thoroughly rinsing the skin with soap and water. However, when the nerve agent is inhaled (aerosolized), no soap and water is needed. Just remove the clothing and treat the victim.

On page 18, the authors state that patients should not enter the emergency department until "complete decontamination is verified." There is no means to verify.

In the article (page 19), diazepam is listed as a treatment and the authors state that the intramuscular route is an alternate to intravenous administration. Actually, diazepam is poorly absorbed via the intramuscular route. Lorazepam (Ativan) is a good intramuscular alternate if intravenous access is unavailable.

Overall, the article may have been a good review, but not useful as a practical guide, as it lacks specificity.

Mark Hollinger, RN, MICN, EMT-B
 Los Angeles, Calif

 

The authors respond

Please keep in mind that our summary was meant as an overview. We do note that detailed emergency protocols must be developed by each agency. All the information reported is supported by the references listed; however, a few of the references vary regarding some of the details. The information presented is in agreement with the Center for Disease Control (CDC) Web site. We do use the term "biological weapon" because these agents can destroy biological and physiological systems. Even though agents may cause death by inhalation, they may persist on clothing and skin for a period of time. Therefore, decontamination is advisable. Whenever history suggests that a chemical exposure has occurred, it is also advisable to decontaminate outside the emergency department for protection of personnel and patients. Lastly, valium is the antidote recommended by the CDC.

Tina Martin, RN, MSN, FNP
 Sharon Lobert, RN, PhD
 Jackson, Miss




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This Article
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