Pharmacy preparedness for incidents involving weapons of mass destruction.

Recent worldwide terrorist acts and hoaxes have heightened awareness that incidents involving weapons of mass destruction (WMD) may occur in the United States. With federal funding assistance, local domestic preparedness programs have been initiated to train and equip emergency services and emergency department personnel in the management of large numbers of casualties exposed to nuclear, biological, or chemical (NBC) agents. Hospital pharmacies will be required to provide antidotes, antibiotics, antitoxins, and other pharmaceuticals in large amounts and have the capability for prompt procurement. Pharmacists should become knowledgeable in drug therapy of NBC threats with respect to nerve agents, cyanide, pulmonary irritants, radionucleotides, anthrax, botulism, and other possible WMD.

The nation's first poison control center: taking a stand against accidental childhood poisoning in Chicago.

Prior to the 1950's, there existed no formal system for poison prevention or treatment in the US. Estimates place the number of pediatric poisoning fatalities at over 400/y at that time. After World War II, urbanization and modern technological methods brought forth over 250,000 different brand name products on the market. Health care professionals presented with cases of acute poisoning usually had little knowledge of what ingredients were contained in these new products, making it difficult to treat these patients. In the 1930's, pharmacist Louis Gdalman established a poison information service at St Luke's hospital. Because of Gdalman's training in pharmacy and chemistry, physicians throughout Chicago and the US called on him in search of assistance. In the late 1940's, Gdalman began recording information on small cards, and developed a standard data collection from. By the 1950's he had established an extensive library on the management of acute and chronic poisonings. In 1948, a national effort to reduce the number of accidents in children was started by the American Academy of Pediatrics, and a committee was formed in Chicago to address this public safety need. In November, 1953, the poison center at Presbyterian-St Luke's Hospital was formally recognized, and the poison program model spread nationwide. As the number of poison centers grew, coordination was achieved through the National Clearing House for Poison Control Centers, founded in 1957, and the American Association of Poison Control Centers, created in 1958. By 1970, the number of poison centers in the US was reported to be 597. The need for large and better centers led to regional poison control centers. Other outgrowths were the formation of the National Poison Prevention Week Council, the enactment of the Poison Prevention Packaging Act, development of "Mr. Yuk" and other symbols, and formation of the National Animal Poison Control Center. As a result, the number of children dying from accidental poisoning has dropped to under 50/y.

Methylene chloride: report of five exposures and two deaths.

Five patients presented to the emergency department (ED) following exposure in an enclosed space to methylene chloride (dichloromethane), used for removing paint. Two workers and three rescuers were involved. Two rescuers complained only of dizziness and mild nausea, and were subsequently discharged from the ED. One rescuer was asymptomatic. Worker no. 1 arrived in cardiac arrest and eventually died in the ED despite resuscitation efforts. Worker no. 2 also presented to the ED in cardiac arrest, and was successfully resuscitated to pulse and blood pressure. However, he never regained consciousness or spontaneous respirations, and died on the fourth day. Of interest is that worker no. 2's carboxyhemoglobin level increased from 2% to 8% over the 9 hours following admission, despite administration of 40% to 50% oxygen by endotracheal tube. Among the conclusions that can be drawn are (1) the cause of death in these patients was not carbon monoxide poisoning, but solvent-induced narcosis; (2) carboxyhemoglobin levels may continue to rise following cessation of exposure, despite administration of high flow oxygen; (3) rescuers can easily become victims if proper protective clothing and respirators are not worn.