title: Pediatric nerve agent poisoning: medical and operational considerations for emergency medical services in a large American city.
abstract: Most published recommendations for treatment of pediatric nerve agent poisoning are based on standard resuscitation doses for these agents. However, certain medical and operational concerns suggest that an alternative approach may be warranted for treatment of children by emergency medical personnel after mass chemical events. (1) There is evidence both that suprapharmacological doses may be warranted and that side effects from antidote overdosage can be tolerated. (2) There is concern that many emergency medical personnel will have difficulty determining both the age of the child and the severity of the symptoms. Therefore, the Regional Emergency Medical Advisory Committee of New York City and the Fire Department, City of New York, Bureau of Emergency Medical Services, in collaboration with the Center for Pediatric Emergency Medicine of the New York University School of Medicine and the Bellevue Hospital Center, have developed a pediatric nerve agent antidote dosing schedule that addresses these considerations. These doses are comparable to those being administered to adults with severe symptoms and within limits deemed tolerable after inadvertent nerve agent overdose in children. We conclude that the above approach is likely a safe and effective alternative to weight-based dosing of children, which will be nearly impossible to attain under field conditions.
authors.affiliation: Center for Pediatric Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY 10016, USA.
authors.forename: George
authors.initials: G
authors.lastname: Foltin
authors.forename: Michael
authors.initials: M
authors.lastname: Tunik
authors.forename: Jennifer
authors.initials: J
authors.lastname: Curran
authors.forename: Lewis
authors.initials: L
authors.lastname: Marshall
authors.forename: Joseph
authors.initials: J
authors.lastname: Bove
authors.forename: Robert
authors.initials: R
authors.lastname: van Amerongen
authors.forename: Allen
authors.initials: A
authors.lastname: Cherson
authors.forename: Yedidyah
authors.initials: Y
authors.lastname: Langsam
authors.forename: Bradley
authors.initials: B
authors.lastname: Kaufman
authors.forename: Glenn
authors.initials: G
authors.lastname: Asaeda
authors.forename: Dario
authors.initials: D
authors.lastname: Gonzalez
authors.forename: Arthur
authors.initials: A
authors.lastname: Cooper
mesh_terms: D000931:Antidotes / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D051337:Chemical Terrorism / Q000517:prevention & control*; D002619:Chemical Warfare Agents / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004189:Disaster Planning / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009339:Needles; D009519:New York City; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D011220:Pralidoxime Compounds / Q000008:administration & dosage
chemical_list: D000931:Antidotes; D002619:Chemical Warfare Agents; D011220:Pralidoxime Compounds; D001285:Atropine; C028797:pralidoxime