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After completing this case study, the reader should be able to:

  • Identify one of the toxidromes associated with a chemical threat agent attack.

  • Determine the indications for antidotes and supportive care options based on patient signs and symptoms.

  • State the difference between the utilization of a medical model and a mass care model during a public health emergency.

  • Identify antidote and drug treatment stockpile sources and when state or national stockpiles options may be utilized.


Patient Scenario

Via the disaster response radio in the ED, hospital staff learn that attendees at an outdoor concert have suddenly become ill. A series of four loud popping sounds had been heard immediately prior. EMS personnel are on scene donning personal protective equipment (PPE) and setting up decontamination stations. Some concert attendees have been fleeing the scene despite orders from law enforcement to stay on site for decontamination. At least four backpacks have been observed in the area via binoculars but have not yet been examined. They are suspicious because backpacks were not allowed at the concert venue and attendees were checked for large bags prior to entry. Due to the large number of attendees, it is suspected that security measures were imperfect.


The on-scene incident commander ensures that the communication chief notifies all local emergency departments (total of four) to stand up their emergency operation centers (EOC).The concert venue held 1,000 and seats had been sold out. Hospital #1 is the largest of the four and is also a Level I trauma center. Within 20 minutes of the notification, patients begin arriving at that hospital’s outdoor staging and decontamination areas via car, by foot, and via ambulance. Hospital security personnel have donned full PPE and are working to ensure that those not arriving via ambulance (and therefore lacking prior decontamination) do not enter the ED until they have been through the hospital’s decontamination stations, which are in the final stages of being set up. Security personnel are also directing friends and family members of the victims to a waiting area across the street so those needing care are not lost in the crowd.

An emergency triage center is established just outside Hospital #1’s ED entrance. It is staffed by a lead physician, three nurses, two nursing aides, two medical residents, and the ED clinical pharmacist. Dozens of victims are in the staging area awaiting decontamination, and they appear to be in various states of illness and anxiety levels. Victims arriving in the triage area via ambulance are unconscious.

In the triage area, the large number of victims and mass panic are creating chaos, making thorough individual assessment impossible. ...

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