Pre-Hospital Management of Bio-Chemical Exposures


•Rescuers can easily be contaminated by victim's skin or clothing that have been contaminated with chemical or biological agents.

•Nerve agents can cause seizures and loss of consciousness within seconds, and death from respiratory failure within minutes 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.



Scene Control:

•Only rescuers trained in Hazardous Material should be allowed to respond to a hot zone of contamination.
•Nerve agent vapor is readily absorbed by inhalation, ocular contact, or skin contact (depending on the agent) and causes both local and systemic symptoms very rapidly.
•Proper personal protection equipment (PPE) must be donned before entering the area of contamination.
•Law enforcement agencies will section off the area with established command posts.

Rescuer Attire:

•Respiratory Protection: Pressure demand, self-contained breathing apparatus (SCBA) is recommended in response situations that involve exposure to a potentially deadly substance.
•Appropriate protective clothing and gloves are recommended when skin contact is possible.


•Military Mark I kits contain auto-injectors and are preferred. They contain:
(1) auto-injector of Atropine 2 mg
(1) auto-injector of 600 mg 2-PAM Cl
•If the Military Mark I auto-injectors are not available, refer to the pre-hospital antidote dosing chart.
•Be sure to carefully document the administration of antidotes and times.


Rescue Equipment:

•Use fiberglass backboards that are specifically made for use with Hazardous Material incidents. These backboards are non-permeable and easily decontaminated.
•Use stretchers made of monofilament polypropylene fabric which allow drainage of liquids, are non-permeable, and easily decontaminated.
•Use the specially created chemical resuscitation device (bag-valve mask) which has a chemical agent canister that can be used to ventilate the patient in a contaminated environment.

Decontamination Zone:

•Maintain monitoring of patient medical status, with careful constant evaluation of the patient’s respiratory status (which may change suddenly).
•Rescue workers must wear personal protective equipment.
•Continue to administer antidotes per established protocols.
•Treat patient contamination per recommendations for each agent.

i.e. flush eyes, remove clothes, wash skin, do NOT induce vomiting, etc.

Instant Feedback:

Select common nerve toxin antidotes. (Check 2 that apply)

Please visit the CDC's Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents, and look for the answer to the following question.

A properly fitted SCBA can reduce the hazard to the user by a factor of at least 10,000. A properly fitted full face respirator with a P100 filter or powered air-purifying respirator (PAPR) with a HEPA filter can reduce the user's exposure by a factor of _____________?


RnCeus Homepage | Nursing CE course catalog | Discount prices | Login | Nursing jobs | Help