Global conflict and the war on terrorism requires both military and civilian first-responders to be able to recognize and effectively manage mass disaster casualties associated with unconventional weapons, including chemical weapons such as nerve agents. Although these types of events are relatively rare, timely and accurate care for casualties, along with appropriate self-protection for clinician responders, can limit mortality and provide the best chance for full recovery after exposure. The challenge for clinical providers is that the opportunity to train for a mass casualty event associated with nerve agents is extremely limited. A crisis medical event - such as managing cholinergic crisis - requires an accurate and rapid clinical response by clinicians when it occurs. This App-based instruction provides on-demand access to comprehensive, evidence-based information designed to aid in the development and maintenance of clinical reasoning abilities in diagnosing and clinically managing a cholinergic (nerve agent) casualty event. The content domain includes this information, as well as demonstration of procedural processes that comprise successful and accurate recognition and clinical management of nerve agent casualties. The instructional modules facilitate an understanding of the following:
· Normal function of organ systems impacted during cholinergic crisis; recognize abnormal physiological responses as potential indicators of a cholinergic reaction.
· Normal action of acetylcholinesterase (AChE) and the parts of the human body affected by blocking of AChE and subsequent excessive acetylcholine accumulation; normal AChE function; symptoms of nerve agent exposure that result from inactivation of AChE and buildup of acetylcholine.
· Identification of exposure agent by using detection device(s) and situational cues to diagnose nerve agent exposure.
· Implementation of patient management strategies for managing cholinergic crisis - how to provide effective patient treatment and clinical care.
· Physical and physiological signs to look for during patient assessment, information to request from conscious patients during clinical assessment, areas where physical assessment provide indicators of cholinergic crisis, and skills to assess patient physical and physiological status. Relevant health metrics for assessing exposure agent, extent of exposure, relevant time sequences, and physical and physiological status of patient.
· Other possible exposures and medical conditions leading to similar patient symptomology as nerve agent exposure; how to differentiate between a patient experiencing cholinergic crisis and other conditions.
· Relevant symptomology for performing differential diagnosis (DDx), primary combination of nerve agent exposure indicators, distinguishing clinical indicators for vapor or liquid exposure and extent of poisoning.
· Drugs, drug purpose, dosages, administration routes, times sequences, and evaluation of clinical effects of each drug.
· Identification, selection, and correct implementation of medical instruments and supplies used for the clinical management of cholinergic crisis.
· Recognition of clinical treatment effects and effects of clinical mismanagement during the treatment of a patient exposed to nerve agent, and remediate mismanagement, if necessary.
The App includes interactive media-rich content with high-definition video and animations to illustrate essential conceptual aspects of anatomy, physiology, and both clinical and procedural patient management. It is strongly recommended that those using this App for instruction consider developing and maintaining hands-on clinical and procedural skills using a patient simulator. Training that makes use of multimedia and hands-on engagement with mannequin simulators may provide a feasible solution for training medical personnel to rapidly and effectively respond to the type of mass casualties that would result from a chemical weapon.