A federal interagency working group convened by the White House National Security Council last week released new resources to help first responders prepare for and respond to an emergency incident involving fourth generation agents — also known as chemical warfare agents.
“These resources were developed as part of ongoing preparedness efforts for all hazards,” a spokesperson from the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) said last week. “These resources are intended for use by first responders and medical providers.”
The spokesperson told Homeland Preparedness News in a Jan. 25 email that the federal interagency working group specifically developed the new resources following an incident last year in the United Kingdom that involved a fourth generation agent (FGA).
FGAs are chemical warfare agents that are more persistent than other toxic nerve agents, according to the ASPR-produced Chemical Hazards Emergency Medical Management (CHEMM) website, where the new federal interagency resources are located.
“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,” according to CHEMM.
The federal interagency working group that devised the resources is comprised of experts in medicine, science, public health, law enforcement, fire, EMS, HAZMAT, and occupational safety and health from the U.S. Departments of Defense (DOD), HHS, Transportation, and Homeland Security, as well as those from the Federal Bureau of Investigation, Occupational Safety and Health Administration, and the Environmental Protection Agency.
The newly available resources on CHEMM are:
Safety Awareness for First On-Scene Responders Bulletin – Designed to assist departments and agencies in developing specific guidance and training that will enhance overall preparedness efforts.
Reference Guide – Designed to assist HAZMAT response teams in developing specific guidance and training to enhance overall preparedness efforts.
Medical Management Guidelines – Designed for those who medically treat patients exposed or potentially exposed to a fourth generation agent during pre-hospital care and in-hospital care.
“The 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 and can be incorporated into existing plans as part of ongoing preparedness for all hazards,” the ASPR spokesperson wrote.
While nerve agents are extremely toxic chemical warfare agents, they’re generally categorized as either volatile or low-volatility chemicals, according to the Medical Management Guidelines resource, which says that sarin is an example of a volatile nerve agent, whereas VX is a low-volatility agent.
The Reference Guide, meanwhile, says that FGAs specifically are low-volatility nerve agents, meaning they’re highly persistent; pose a significant cross-contamination hazard; don’t easily evaporate; aren’t likely to present a vapor hazard; and are most likely to be encountered as a liquid.
“Early recognition may be extremely challenging due to the possibility of delayed onset of symptoms for up to 3 days post exposure,” according to the Reference Guide. “The most likely route of exposure is skin contact, but FGAs can also be absorbed into the body by mucous membrane contact (eyes, nose, mouth), inhalation, or ingestion. FGAs may cause rapid or delayed onset of symptoms, depending on the specific agent, dose, and route of exposure.”
The Reference Guide also says that entry by first responders into an area with known or suspected FGA contamination should be limited to lifesaving activities.
Currently, according to the Medical Management Guidelines resource, no illicit use or manufacture of an FGA or other nerve agent is known to have occurred in the United States thus far, and there’s also no known threat of any nerve agent use in the United States.
However, because FGAs are more persistent than and at least as potent as other nerve agents, medical management of FGAs may require more aggressive supportive care, greater amounts of medication, and a longer duration of treatment, according to the resources.
For example, along with supportive care and patient decontamination, the mainstays of managing nerve agent toxicity, including FGA toxicity, are anticholinergics (including atropine), oxime AChE reactivators (such as pralidoxime chloride), and anticonvulsants.
Another option is Reactive Skin Decontamination Lotion (RSDL), a medical device for the decontamination of skin exposed to chemical warfare agents such as sulfur mustard, VX, and certain biological toxins, among others, according to CHEMM’s countermeasures database.
If it’s available, RSDL is recommended for spot decontamination by the Medical Management Guidelines resource.
However, the guidelines recommend that first responders “not delay decontamination awaiting specialized products such as soap or RSDL.”
“Disrobing carefully and washing with soap and water using standard protocols are effective in decontaminating skin from FGAs. While RSDL also is effective in decontaminating skin from FGAs and other chemical agents, RSDL is meant for spot decontamination and is not practical for whole body decontamination,” the ASPR spokesperson told Homeland Preparedness News. “The best general approach is to have plans, equipment and trained personnel prepared to decontaminate people using soap and water. If RSDL is available, it can be used to complement standard patient decontamination.”
The patient decontamination section of the Medical Management Guidelines also notes that FGAs are not readily degraded by water; thus, first responders are advised to avoid direct contact with water runoff. In addition, the containment section of the Reference Guide states that “FGAs can persist for extremely long periods of time on materials and effluent liquids such as water, so treat waste materials as hazardous and extremely toxic.”
Emergent BioSolutions Inc. produces the Reactive Skin Decontamination Lotion (RSDL) Kit, which is intended to remove or neutralize chemical warfare agents and T-2 Toxin from the skin. The product is military grade, lightweight, approved by the U.S. Food and Drug Administration, and starts working in 2 minutes, according to Emergent BioSolutions.
And while the ASPR spokesperson didn’t address questions from Homeland Preparedness News regarding whether the federal government should congressionally mandate the use of RSDL, the Emergent product remains in high demand by the United States government.
In fact, the Gaithersburg, Md.-based company in September 2017 was awarded a five-year follow-on contract valued at up to approximately $171 million by DOD to supply its RSDL Kit for use by all branches of the U.S. military.
“With this guidance, Emergent looks forward to continuing to work with the U.S. government at the federal, state and local levels, and with allied governments at the regional and national levels, to develop and provide medical countermeasures such as Reactive Skin Decontamination Lotion or RSDL that protect first responders and civilians alike,” said Doug White, senior vice president and head of the Devices Business Unit at Emergent BioSolutions.
White told Homeland Preparedness News last week that Emergent is pleased to be part of the solution and stands “at the ready to supply RSDL to the emergency response community.”
“With our successful 20-year track record of partnering with governments, we are committed to leveraging our products and services to support the U.S. and allied governments’ preparedness efforts and national security plans,” he said.
White also applauded the U.S. government for developing the new CHEMM resources.
“These resources address the safety of first responders and hospital staff during a potential chemical attack. At the onset of an incident, oftentimes chaos, panic, and confusion ensue, and whether the cause is known or unknown, it is imperative that responders who are first to the scene do so with adequate protection,” he said.
Additionally, White said that the new guidelines provide a clear and standardized way of responding to chemical attacks before they even happen.
In turn, the safety of the nation’s first responders is put first “so they can carry out their duties with peace of mind and confidence,” White added.
Furthermore, White said that the guidelines also offer a comprehensive response that will benefit civilians and property within the immediate vicinity and along the route to medical care through containment and decontamination procedures.