Sarin emergency treatment

There were inadequate facilities in the Emergency Department at St Luke s to permit a large number of casualties to remove contaminated clothing and to shower formal decontamination was, therefore, impossible. In addition, the ventilation in the patient reception area was poor. Consequently, some of the medical staff complained of eye or throat pain, nausea, or miosis (Okumura et al, 1996). This was relieved by improving ventilation and by rotation of affected staff to other locations within the hospital. Secondary exposure of medical staff from patients affected by sarin vapour was limited. No medical staff required pharmacological treatment for their signs and symptoms. 

The Matsumoto sarin attack occurred on June 27, 1994, one year before the Tokyo subway sarin attack, and although the group responsible for the Matsumoto attack was not known at the time of the Tokyo subway attack, emergency doctors in Japan knew that the diagnosis and treatment of sarin poisoning should follow that of accidental organophosphorus poisoning. 

Treatment of the victims exposed to sarin and VX in the Japanese terrorist incidents is similar in many ways to the descriptions of the Sidell casualties . All victims were seen in hospital emergency rooms where treatment was initiated. In cases of severe poisoning, atropine therapy was given IV, which insures maximum therapeutic effect within minutes. Nozaki and Aikawa (1995) described the treatment of one severely poisoned patient of the Tokyo subway exposures at Keio University Hospital. The patient arrived at the hospital in a coma 1 h after exposure (Glasgow coma scale El M1V1), displaying profuse sweating and oral secretions, convulsions,... 

Nozaki et al. (1995) also reported on the treatment of a patient exposed to VX in an attempted murder by the same Aum Shinrikyo cult that released sarin in Matsumoto and the Tokyo subway terrorist attacks. Reportedly, VX was sprayed on the victim s back the man noted impaired vision and then experienced seizures and loss of consciousness. He arrived at the emergency room about 2 h after exposure semi-comatose... 

In the Tokyo subway attacks in 1995, 10-23 % of rescuers at the scene and hospital emergency staff displayed the clinical features of exposure to sarin. Some of these displayed chronic physiological abnormalities such as disturbed lymphocyte function 3 years later and cognitive impairment at least 7 years afterwards. In one instance, 11 doctors were significantly affected while treating two patients (one required treatment for seizures, the other received cardiopulmonary resuscitation for 40 min). 

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