Best Parenteral Access in a CBRN Environment
When providing medical treatment to CBRN casualties, to save lives, initial treatment will need to be conducted before formal decontamination can be completed. These procedures, performed in a “dirty casualty collection point,” will require the medical provider themselves to still be in CBRN appropriate PPE.
While atropine/pralidoxime auto-injectors exist for treatment of the nerve agent casualty, severely nerve agent poisoned individuals will need additional atropine dosing requiring either an enormous quantity of single drug auto-injectors or multi-dose vials of atropine. In experimental animal models, hypotensive animals who were also nerve agent poisoned atropine administered via IM auto-injectors took 19.5 minutes to reach maximum serum concentration.1 The same dose administered IV / IO reached maximum serum concentration nearly instantaneously. Midazolam, the best benzodiazepine to control nerve agent-induced seizures, reaches peak concentration in 2 minutes given IV / IO, but a full 10 minutes when administered IM.2
For many chemical warfare agents, like cyanide, no intramuscular antidotes are readily available, and treatment will require parenteral access. This requires either intravenous or intraosseous access.
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