Nerve Agent First Aid Guidelines

When providing First Aid to nerve agent exposure please follow the below recommendations (white text for lay responder - yellow text for medical first responder)   

EYE:

  • Immediately remove the patient/victim from the source of exposure. 
  • Often the first physical finding of minimal symptomatic exposure to nerve agent vapor is markedly constricted pupils (miosis); however, if this is the only physical finding of nerve agent exposure, do not administer antidotes but follow the instructions below. 
  • When exposed to liquid nerve agent, immediately flush the eyes with water for about 5 to 10 minutes by tilting the head to the side, pulling the eyelids apart with fingers, and pouring water slowly into the eyes. 
  • When exposed to nerve agent vapor, there is no need to flush the eyes. 
  • Do not cover eyes with bandages. 
  • Changes in the eye can lead to nausea and vomiting without necessarily being a sign of systemic exposure. However, if eye pain, nausea, or vomiting are seen in combination with any other physical findings of nerve agent poisoning, administer antidotes atropine and 2-PAM Cl as directed. 
  • Seek medical attention immediately.

 

INGESTION:

  • Immediately remove the patient/victim from the source of exposure. 
  • Ensure that the patient/victim has an unobstructed airway. 
  • Do not induce vomiting (emesis). 
  • Administer nothing by mouth (NPO). 
  • If the patient/victim's condition can be evaluated within 30 minutes after ingestion, in a hospital setting, consider gastric lavage. Gastric contents should be considered potentially hazardous and should be quickly isolated. 
  • Be alert to physical findings of systemic exposure, and administer antidotes as required. 
  • Maintain records of all injections given. 
  • Seek medical attention immediately.

 

INHALATION:

  • Immediately remove the patient/victim from the source of exposure. 
  • In cases of moderate to severe exposure, antidotes alone will not provide effective treatment, and ventilatory support is essential. 
  • Evaluate respiratory function and pulse. 
  • Ensure that the patient/victim has an unobstructed airway. 
  • Assist with ventilation as required. Do not provide mouth-to-mouth resuscitation. Contact with off-gassed vapor or with liquid agent may occur. 
  • If shortness of breath occurs, or breathing is difficult (dyspnea), administer oxygen. 
  • Suction secretions from the nose, mouth, and respiratory tract. Marked resistance to ventilation is expected due to bronchial constriction and spasm. 
  • Resistance lessens after administration of atropine. Ventilatory distress is a physical finding of systemic exposure and requires antidote administration. 
  • Maintain records of all injections given. 
  • Seek medical attention immediately.

  

SKIN:

  • Immediately remove the patient/victim from the source of exposure. 
  • Some nerve agents may remain in the hair or clothing an d shou ld be decontaminated if that was not previously done. 
  • See the decontamination section of this card. 
  • Skin exposure to liquid nerve agents will not necessarily result in systemic exposure if the site of exposure is decontaminated promptly. Before administering nerve agent antidotes, observe the site of exposure for localized sweating and muscular twitching. If these physical findings appear, administer antidotes, otherwise careful observation is all that is needed. 
  • Maintain records of all injections given. 
  • Seek medical attention immediately.

 

See ATSDR Medical Management Guidelines for Nerve Agents for more detailed recommendations, http://www.atsdr.cdc.gov/MHMI/mmg166.pdf.