Emergency Department Management
Biochemical Exposures


•Emergency Department (ED) personnel can easily be contaminated by victims skin or clothing that has been contaminated with chemical or biological agents by direct contact or vapors released by the contaminated clothing.
•Nerve agents are extremely toxic, causing death from respiratory failure within minutes to hours of exposure.
•Atropine and pralidoxime chloride (2-PAM Cl) are antidotes for nerve agent toxicity. Pralidoxime must be administered within minutes (up to 2 hours for some nerve agents) following exposure in order to be effective. Treatment consists of supportive measures and repeated administration of antidotes.


•Establish if patient has been decontaminated

• If patient has received decontamination, they may proceed into the ED for treatment and observation
• If patient has NOT received prior decontamination, decontamination must be accomplished prior to the patient entering the ED.

•If the facility has a decontamination room with negative air pressure and floor drains, patient may undergo decontamination inside of the facility.

•If patients are able, allow them to participate in their own decontamination.

• Clothing should be removed and double bagged in plastic.
• Refer to protocols for specific decontamination for each agent.

ED Personnel Attire:


•Staff must insure that the local health department and law enforcement agencies have been notified.

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Nerve agents can cause death from respiratory failure within minutes of exposure.