Archive for the ‘Novichok’ Category
Pre-Hospital Treatment Recommendations (Autoinjector-Based) Nerve Agent Poisoning
Thursday, November 21st, 2019https://chemm.nlm.nih.gov/nerveagents/FGAMMGPrehospital.htm
Pre-Hospital Treatment Recommendations (Autoinjector-Based) Nerve Agent Poisoning
| Patient Age | Antidotes | Additional Treatment | |
|---|---|---|---|
| Mild/Moderate Symptoms | Severe Symptoms | ||
| Infant (0-2 yrs) |
Atropine 0.05 mg/kg IM or Atropine AI 0.25 mg or 0.5 mg
AND 2-PAM 15-30 mg/kg IM |
Atropine 0.1 mg/kg IM or Atropine AI 0.25 mg or 0.5 mg
AND 2-PAM 45 mg/kg IM; AND Midazolam 0.15 mg/kg IM OR Lorazepam 4 mg IM OR Lorazepam 0.1 mg/kg IN OR Diazepam 0.2-0.5 mg/kg IM |
For mild/moderate, repeat atropine (2 mg) (for child 3-7 yrs, 1 mg; for infant, 0.25-0.5 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.
For severe, repeat atropine as above but at 2-5 minute intervals.
Anticonvulsant should be administered in severe cases whether seizures are apparent or not.
If convulsions are present, repeat benzodiazepine until convulsions resolve.
Assisted ventilation should be started as needed after administration of antidotes. |
| Child (3-7 yrs; 13–25 kg) |
1 Atropine AI 1 mg
AND 1 2-PAM AI or 2-PAM 15-30 mg/kg IM |
1 DuoDote; OR 1 Atropine AI 2 mg
AND 1 2-PAM AI or 2-PAM 45 mg/kg IM; AND Midazolam 5 mg IM OR Lorazepam 4 mg IM OR Lorazepam 0.1 mg/kg IN OR 1 CANA |
|
| Child (8-14 yrs; 26-50 kg) |
1 DuoDote; OR 1 Atropine AI 2 mg
AND 1 2-PAM AI or 2-PAM 15-30 mg/kg IM |
2 DuoDote; OR 2 Atropine AI 2 mg AND 2 2-PAM AI or 2-PAM 45 mg/kg IM;
AND Midazolam 5 mg IM OR Lorazepam 4 mg IM OR Lorazepam 0.1 mg/kg IN OR 1 CANA |
|
| Adolescent (>14 years)/ Adult |
1 to 2 DuoDote; OR
1 to 2 Atropine AI 2 mg AND |
3 DuoDote;
AND 1 CANA OR Midazolam 10 mg IM OR Lorazepam 6 mg IM/IN |
|
| Elderly, frail | 1 DuoDote | 2 to 3 DuoDote; OR
1 to 2 Atropine AI 2 mg AND 2 to 3 2-PAM AI; AND 1 CANA OR Midazolam 10 mg IM OR Lorazepam 6 mg IM/IN |
|
Autoinjector Products:
DuoDote = ATNAA = Mark 1 kit = Atropine 2 mg + 2-PAM 600 mg AI
Atropine AI = various doses, two different manufacturers*
2-PAM AI = 2-PAM 600 mg AI
CANA = Diazepam 10 mg AI
* Please see the following webpage for more information on FDA approved atropine AI products and current nerve agent emergency use authorization information: https://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm063809.htm
Hospital Treatment Recommendations (Weight-Based) Nerve Agent Poisoning
Thursday, November 21st, 2019https://chemm.nlm.nih.gov/nerveagents/FGAMMGHospital.htm
Hospital Treatment Recommendations (Weight-Based) Nerve Agent Poisoning
| Patient Age | Antidotes | Additional Treatment | |
|---|---|---|---|
| Mild/Moderate Symptoms | Severe Symptoms | ||
| Infant (0-2 yrs) |
Atropine 0.05 mg/kg IV/IO/IM
AND 2-PAM 15-30 mg/kg IV/IO/IM |
Atropine 0.1 mg/kg IV/IO/IM
AND 2-PAM 45 mg/kg IV/IO/IM; AND Midazolam 0.15 mg/kg IV/IO/IM OR Lorazepam 4 mg IV/IO/IM OR Lorazepam 0.1 mg/kg IN OR Diazepam 0.2-0.5 mg/kg IV/IO/IM |
For mild/moderate, repeat atropine (2 mg) (for child 3-7 yrs, 1 mg; for infant, 0.25-0.5 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.
For severe, repeat atropine as above but at 2-5 minute intervals.
Anticonvulsant should be administered in severe cases whether seizures are apparent or not.
If convulsions are present, repeat benzodiazepine until convulsions resolve.
Assisted ventilation should be started as needed after administration of antidotes. |
| Child (3-7 yrs; 13–25 kg) |
Atropine 1 mg IV/IO/IM
AND 2-PAM 15 -30 mg/kg IV/IO/IM |
Atropine 2 mg IV/IO/IM or Atropine 0.1 mg/kg IV/IO/IM;
AND 2-PAM 45 mg/kg IV/IO/IM; AND Midazolam 5 mg IV/IO/IM OR Lorazepam 4 mg IV/IO/IM OR Lorazepam 0.1 mg/kg IN OR Diazepam 0.2-0.5 mg/kg IV/IO/IM |
|
| Child (8-14 yrs; 26-50 kg) |
Atropine 2 mg IV/IO/IM
AND 2-PAM 15-30 mg/kg IV/IO/IM |
Atropine 4 mg IV/IO/IM AND 2-PAM 45 mg/kg IV/IO/IM;
AND Midazolam 5 mg IV/IO/IM OR Lorazepam 4 mg IV/IO/IM OR Lorazepam 0.1 mg/kg IN OR Diazepam 0.2-0.5 mg/kg IV/IO/IM |
|
| Adolescent (>14 years)/ Adult |
Atropine 2-4 mg IV/IO/IM
AND |
Atropine 6 mg IV/IO/IM AND 2-PAM 1800 mg IV/IO/IM;
AND Diazepam 10 mg IV/IO/IM OR Midazolam 10 mg IV/IO/IM OR Lorazepam 6 mg IV/IO/IM/IN |
|
| Elderly, frail | Atropine 2 mg IV/IO/IM
AND 2-PAM 10 mg/kg IV/IO/IM |
Atropine 2-4 mg IV/IO/IM
AND 2-PAM 25 mg/kg IV/IO/IM; AND Diazepam 10 mg IV/IO/IM OR Midazolam 10 mg IV/IO/IM OR Lorazepam 6 mg IV/IO/IM/IN |
|
Product Definitions:
DuoDote = ATNAA = Mark 1 kit = Atropine 2 mg + 2-PAM 600 mg AI
AtroPen = Atropine AI, various doses
2-PAM AI = 600 mg 2-PAM
Fourth Generation Agents
Thursday, November 21st, 2019Fourth Generation Agents: https://chemm.nlm.nih.gov/nerveagents/FGA.htm
(Information as of January 18, 2019)
After the incidents in the United Kingdom (U.K.) in 2018 involving a fourth generation agent, the White House National Security Council convened a federal interagency working group to identify and develop resources to help the emergency response community prepare for and respond to a fourth generation agent incident if one ever occurs in the U.S., as well as support the development of specific guidance and training to enhance overall preparedness efforts. These resources meet the needs of U.S. emergency response professionals who sought to learn more about the agent used in the U.K. and how to protect themselves and respond if such incidents ever occur in their communities.
Fourth generation agents, also known as Novichoks or A-series nerve agents, belong to a category of chemical warfare agents that are unique organophosphorus compounds. They are more persistent than other nerve agents and are at least as toxic as VX. While fourth generation agents share similar characteristics with other nerve agents, fourth generation agents also pose several unique challenges in terms of toxicity, detection, persistence, and potential for delayed onset of symptoms. The following resources were developed to address these characteristics and challenges and provide tailored guidance to various segments of the emergency response community.
- Safety Awareness for First On-Scene Responders Bulletin – Designed to educate and prepare first responders for situations when law enforcement, fire, and emergency medical services (EMS) personnel are first to arrive on scene and initially may be unaware that a fourth generation agent is present. This bulletin will assist departments and agencies develop specific guidance and training to enhance overall preparedness efforts. (PDF – 791 KB)
- Reference Guide – Designed to educate and prepare hazardous materials (HAZMAT) response teams, the guide includes chemical and physical properties of fourth generation agents, as well as detection, firefighting, personal protective equipment, and decontamination recommendations for situations when responding to a known or suspected fourth generation agent incident. This guide will assist HAZMAT response teams develop specific guidance and training to enhance overall preparedness efforts. (PDF – 789 KB)
- Medical Management Guidelines – Designed to educate and prepare fire, EMS, and hospital staff and guide the medical management of patients exposed or potentially exposed to a fourth generation agent. (PDF – 858 KB) (Note: This is one PDF document that is divided into two Web pages, one for pre-hospital care and one for in-hospital care.)
These resources were developed by a federal interagency working group comprising experts in medicine, science, public health, law enforcement, fire, EMS, HAZMAT, and occupational safety and health from the Department of Defense, Department of Health and Human Services (Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention, and National Institute for Occupational Safety and Health), Department of Transportation (Pipeline and Hazardous Materials Safety Administration and National Highway Traffic Safety Administration’s Office of Emergency Medical Services), Department of Homeland Security, Federal Bureau of Investigation, Occupational Safety and Health Administration, and Environmental Protection Agency.
These resources are based on the interpretation of available data on fourth generation agents by U.S. government experts and previously developed federal guidance related to nerve agents. Moreover, the guidance was developed through a collaborative process which included extensive stakeholder review in the form of listening sessions and consultations with representatives from the various disciplines across the emergency response community.
Information as of January 18, 2019, was used to inform the development of these resources. They will be updated as new data becomes available that can further support any response to a potential fourth generation agent incident and help protect responders if such an incident ever occurs in the U.S.
Please refer comments and questions on these fourth generation agent resources to askasprtracie@hhs.gov.
Fourth generation agents, also known as Novichoks or A-series nerve agents
Wednesday, April 24th, 2019Fourth Generation Agents
(Information as of January 18, 2019)
After the incidents in the United Kingdom (U.K.) in 2018 involving a fourth generation agent, the White House National Security Council convened a federal interagency working group to identify and develop resources to help the emergency response community prepare for and respond to a fourth generation agent incident if one ever occurs in the U.S., as well as support the development of specific guidance and training to enhance overall preparedness efforts. These resources meet the needs of U.S. emergency response professionals who sought to learn more about the agent used in the U.K. and how to protect themselves and respond if such incidents ever occur in their communities.
Fourth generation agents, also known as Novichoks or A-series nerve agents, belong to a category of chemical warfare agents that are unique organophosphorus compounds. They are more persistent than other nerve agents and are at least as toxic as VX. While fourth generation agents share similar characteristics with other nerve agents, fourth generation agents also pose several unique challenges in terms of toxicity, detection, persistence, and potential for delayed onset of symptoms. The following resources were developed to address these characteristics and challenges and provide tailored guidance to various segments of the emergency response community.
- Safety Awareness for First On-Scene Responders Bulletin – Designed to educate and prepare first responders for situations when law enforcement, fire, and emergency medical services (EMS) personnel are first to arrive on scene and initially may be unaware that a fourth generation agent is present. This bulletin will assist departments and agencies develop specific guidance and training to enhance overall preparedness efforts. (PDF – 791 KB)
- Reference Guide – Designed to educate and prepare hazardous materials (HAZMAT) response teams, the guide includes chemical and physical properties of fourth generation agents, as well as detection, firefighting, personal protective equipment, and decontamination recommendations for situations when responding to a known or suspected fourth generation agent incident. This guide will assist HAZMAT response teams develop specific guidance and training to enhance overall preparedness efforts. (PDF – 789 KB)
- Medical Management Guidelines – Designed to educate and prepare fire, EMS, and hospital staff and guide the medical management of patients exposed or potentially exposed to a fourth generation agent. (PDF – 858 KB) (Note: This is one PDF document that is divided into two Web pages, one for pre-hospital care and one for in-hospital care.)
These resources were developed by a federal interagency working group comprising experts in medicine, science, public health, law enforcement, fire, EMS, HAZMAT, and occupational safety and health from the Department of Defense, Department of Health and Human Services (Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention, and National Institute for Occupational Safety and Health), Department of Transportation (Pipeline and Hazardous Materials Safety Administration and National Highway Traffic Safety Administration’s Office of Emergency Medical Services), Department of Homeland Security, Federal Bureau of Investigation, Occupational Safety and Health Administration, and Environmental Protection Agency.
These resources are based on the interpretation of available data on fourth generation agents by U.S. government experts and previously developed federal guidance related to nerve agents. Moreover, the guidance was developed through a collaborative process which included extensive stakeholder review in the form of listening sessions and consultations with representatives from the various disciplines across the emergency response community.
Information as of January 18, 2019, was used to inform the development of these resources. They will be updated as new data becomes available that can further support any response to a potential fourth generation agent incident and help protect responders if such an incident ever occurs in the U.S.
Please refer comments and questions on these fourth generation agent resources to askasprtracie@hhs.gov.
Allegedly: A third man suspected of involvement in the nerve agent poisoning of former Russian spy Sergei Skripal in England last year is a high-ranking Russian military intelligence agent
Friday, February 15th, 2019‘……Bellingcat [investigative website] said it had identified a third Russian agent who was also in Britain at the time and was suspected of being involved.
“Bellingcat can now reveal the true identity and background of this GRU officer, who operated internationally under the cover persona of Sergey Vyachaeslavovich Fedotov,” it said.
“In fact, this person is Denis Vyacheslavovich Sergeev, a high-ranking GRU officer and a graduate of Russia’s Military Diplomatic Academy.”…..’
Current Emergency Use Authorizations
Thursday, December 6th, 2018
The Emergency Use Authorization (EUA) authority allows FDA to help strengthen the nation’s public health protections against CBRN threats by facilitating the availability and use of MCMs needed during public health emergencies.
Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), the FDA Commissioner may allow unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when there are no adequate, approved, and available alternatives.
Section 564 of the FD&C Act was amended by the Project Bioshield Act of 2004 and the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), which was enacted in March 2013
Current EUAs
The tables below provide information on current EUAs:
- Anthrax: Doxycycline Mass Dispensing EUA Information and National Postal Model Anthrax EUA Information
- Ebola Virus EUA Information
- Enterovirus D68 (EV-D68) EUA Information
- French Freeze Dried Plasma Information
- H7N9 Influenza EUA Information
- Middle East Respiratory Syndrome Coronavirus (MERS-CoV) EUA Information
- Nerve Agent EUA Information
- Zika Virus EUA Information
Brits accuse 2 Russian officers as potential assassins in the Salisbury-Novichok affair
Thursday, September 6th, 2018“……Investigators released a cache of evidence in the case, including security camera images that captured the progress of two husky men [Alexander Petrov and Ruslan Boshirov] from an Aeroflot flight to the scene of the crime, near the victim’s home, and from there back to Moscow.
They also released photographs of the delicate perfume bottle that was used to carry Novichok……..two swabs taken from the suspects’ hotel were found to contain traces of the nerve agent...……“The same two men are now the prime suspects in the case of Dawn Sturgess and Charlie Rowley,” Mrs. May said, adding that the same poison was used in both cases and that the two were “victims of the reckless disposal of this agent.”…….Russia imprisoned Mr. Skripal in 2004 for selling secrets to Britain, and released him in 2010 as part of a spy swap with Western countries. He settled in Salisbury but quietly continued working in intelligence, offering insights into Russian espionage practices...…..”