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Children more vulnerable to chemical attack

Emergency Management Alert, July 23, 2003

The effects of a chemical weapons attack or chemical spill are much more pronounced on children, making it vital to administer proper on-site "chemical first aid," according to Lloyd Brown, MD, associate director of the pediatrics residency training program at Cedars-Sinai Medical Center in Los Angeles.

Chemical agents have an almost instantaneous impact, requiring immediate intervention to help minimize injuries and damage. Unlike some biological weapons, there are no vaccinations available for chemical exposure.

Children are at increased risk because it takes a smaller amount of a chemical to have an adverse effect on children than adults. In addition, since children breathe faster than adults, they take in more air pound-for-pound and therefore inhale more of the chemicals. Many chemicals are dense and hover closer to the ground, meaning children breathe in a more concentrated dose.

Brown recommends first aid treatment for the five main classifications of chemical weapon agents as follows:

* Vesicants, or blister agents (mustard gas)-Rinse immediately with soap and water or a 0.5% hypochlorite solution, remove contaminated clothing, and treat skin blisters similar to blisters from burns. Flush eyes with water and instruct victim to wear dark sunglasses for light sensitivity. Provide oxygen as soon as possible if there is an injury to the airway.

* Nerve agents (Sarin, Tabun, Soman, and VX)-Rinse exposed skin with soap and water or diluted bleach immediately. Remove contaminated clothing and seek medical attention immediately because there are antidotes for nerve agent poisoning, including atropine and pralidoxime chloride. Victims may also need anti-seizure medications.

* Cyanide-Move victim to fresh air immediately and provide supportive care, including oxygen if available, until professional medical care arrives. Antidotes for cyanide poisoning include sodium nitrite and sodium thiosulfate.

* Pulmonary irritants or choking industrial chemicals (chlorine, phosgene, and diphosgene)-Wash any exposed skin or eyes with water and provide supportive care until medical help arrives. If available, and if needed, provide oxygen. Treat wheezing with inhaled medications.

* Riot control agents-Move victim to fresh air. Most symptoms disappear within 30 minutes without treatment. Flush intensely irradiated skin or eyes with water.

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