title: Validating Signs and Symptoms From An Actual Mass Casualty Incident to Characterize An Irritant Gas Syndrome Agent (IGSA) Exposure: A First Step in The Development of a Novel IGSA Triage Algorithm.
abstract: CONCLUSIONS
  • Chemical exposures daily pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for Irritant Gas Syndrome Agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations. • This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA Syndrome. Validating signs/symptoms is the first step in developing new emergency department informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents.
  Chemical exposures can pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for irritant gas syndrome agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations. This study describes the first step in developing ED informatics tools for chemical incidents: validation of signs/symptoms that characterize an IGSA syndrome.
  
  
  METHODS
  Data abstracted from 146 patients treated for chlorine exposure in one emergency department during a 2005 train derailment and 152 patients not exposed to chlorine (a comparison group) were mapped to 93 possible signs/symptoms within 2 tools (WISER and CHEMM-IST) designed to assist emergency responders/emergency nurses with managing hazardous material exposures. Inferential statistics (χ2/Fisher's exact test) and diagnostics tests were used to examine mapped signs/symptoms of persons who were and were not exposed to chlorine.
  
  
  RESULTS
  Three clusters of signs/symptoms are statistically associated with an IGSA syndrome (P < .01): respiratory (shortness of breath, wheezing, coughing, and choking); chest discomfort (tightness, pain, and burning), and eye, nose and/or throat (pain, irritation, and burning). The syndrome requires the presence of signs/symptoms from at least 2 of these clusters. The latency period must also be considered for exposed/potentially exposed persons.
  
  
  CONCLUSIONS
  This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA syndrome. Validating signs/symptoms is the first step in developing new ED informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents.
authors.affiliation: Columbia, SC; Charleston, SC. Electronic address: jculley@sc.edu.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Culley
authors.affiliation: Columbia, SC; Charleston, SC.
authors.forename: Jane
authors.initials: J
authors.lastname: Richter
authors.affiliation: Columbia, SC; Charleston, SC.
authors.forename: Sara
authors.initials: S
authors.lastname: Donevant
authors.affiliation: Columbia, SC; Charleston, SC.
authors.forename: Abbas
authors.initials: A
authors.lastname: Tavakoli
authors.affiliation: Columbia, SC; Charleston, SC.
authors.forename: Jean
authors.initials: J
authors.lastname: Craig
authors.affiliation: Columbia, SC; Charleston, SC.
authors.forename: Salvatore
authors.initials: S
authors.lastname: DiNardi
mesh_terms: D000465:Algorithms; D055884:Chemical Hazard Release / Q000706:statistics & numerical data*; D002713:Chlorine / Q000009:adverse effects; D004636:Emergency Service, Hospital; D006801:Humans; D007509:Irritants / Q000009:adverse effects*; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods*
chemical_list: D007509:Irritants; D002713:Chlorine
keywords: Chemical exposure; Irritant Gas Syndrome Agent; Mass casualty; Triage; Validation study