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Contingency Medical Countermeasures for Mass Nerve-Agent Exposure: Use of Pharmaceutical Alternatives to Community Stockpiled Antidotes

Published online by Cambridge University Press:  15 October 2018

Michael D. Schwartz ,
Mark E. Sutter ,
Derek Eisnor  and
Mark A. Kirk
Michael D. Schwartz*
Affiliation:
Chemical Defense Program/Countering Weapons of Mass Destruction/Department of Homeland Security
Mark E. Sutter
Affiliation:
Chemical Defense Program/Countering Weapons of Mass Destruction/Department of Homeland Security Department of Emergency Medicine, University of California, Davis, CA
Derek Eisnor
Affiliation:
Department of Emergency Medicine, Memorial Hospital, Jacksonville, FL
Mark A. Kirk
Affiliation:
Chemical Defense Program/Countering Weapons of Mass Destruction/Department of Homeland Security
*
Correspondence and reprint requests to Dr Michael D. Schwartz, Chemical Defense Program/Countering Weapons of Mass Destruction/Department of Homeland Security, 245 Murray Lane SW, Mailstop 0315, Washington, DC 20258 (Michael.schwartz@hq.dhs.gov).
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Abstract

Having sufficient medical countermeasures (MCMs) available for the treatment of acetylcholinesterase-inhibiting nerve agent poisoned patients following a mass chemical exposure is a challenge for communities. After stockpiles containing auto-injectors are exhausted, communities need to be aware of alternative pharmaceutical options. The Department of Homeland Security Chemical Defense Program convened a federal interagency working group consisting of first responders, clinicians, and experts from the fields of medical toxicology, pharmacology, and emergency management. A literature review of pharmaceutical alternatives for treating nerve agent toxicity was performed. Pharmaceuticals that met the federal Public Health Emergency Medical Countermeasures Enterprise Product Specific Requirements were prioritized. Food and Drug Administration approval for one indication, market availability, and alignment to government procurement strategy were considered. This article summarizes the literature on comparative pharmacokinetics and efficacy against nerve agents (where available) of Food and Drug Administration approved drugs with muscarinic acetylcholine receptor antagonist and gamma-aminobutyric acid receptor agonist effects. This work is intended to serve as a resource of pharmaceutical options that may be available to communities (ie, emergency managers, planners, clinicians, and poison centers) when faced with a mass human exposure to a nerve agent and inadequate supplies of MCMs. (Disaster Med Public Health Preparedness. 2019;13:605-612)

Keywords

medical countermeasuresnerve agentspharmaceutical options
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 3 , June 2019 , pp. 605 - 612
Copyright
Copyright © 2018 Society for Disaster Medicine and Public Health, Inc. 

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Footnotes

(The findings and conclusions are those of Drs Schwartz, Kirk, and Sutter and have not been formally disseminated by the Department of Homeland Security, or the US Government, and should not be construed as representing any agency determination or policy.)

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