1 1 ACMT Chemical Agents of Opportunity for Terrorism: TICs/TIMs Charles McKay MD, FACMT American College of Medical Toxicology Bethesda, MD, April 29, 2014 2 2 What is Medical Toxicology? • A medical subspecialty focused on the diagnosis, management and prevention of adverse health effects from medications, occupational & environmental toxins, and biological agents SOLVENTS PESTICIDES HEAVY METALS WORKER SAFETY & FITNESS FOR DUTY ENVENOMATIONS DRUG OVERDOSE BACK PAIN REPETITIVE STRAIN INJURIES Occupational Medicine Medical Toxicology Acute and Critical Care Medicine TERRORISM (Bio/Chem/Rad) Infectious Disease ACUTE ORGAN FAILURE SYNDROMES 3 3 Medical Toxicology • Officially recognized as a subspecialty by the American Board of Medical Specialties • Of ~800,000 physicians in the USA, less than 700 ever board certified in medical toxicology • ~600 physician members of ACMT board certified in medical toxicology
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What is Medical Toxicology? · Medical Toxicology • ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology. • The ACMT is
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ACMT Chemical Agents of Opportunity for Terrorism: TICs/TIMs
Charles McKay MD, FACMT American College of Medical Toxicology Bethesda, MD, April 29, 2014
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What is Medical Toxicology? • A medical subspecialty focused on the diagnosis,
management and prevention of adverse health effects from medications, occupational & environmental toxins, and biological agents
SOLVENTS
PESTICIDES
HEAVY METALS
WORKER SAFETY & FITNESS FOR DUTY
ENVENOMATIONS
DRUG OVERDOSE
BACK PAIN
REPETITIVE STRAIN INJURIES Occupational
Medicine
Medical Toxicology
Acute and Critical Care Medicine
TERRORISM (Bio/Chem/Rad)
Infectious Disease
ACUTE ORGAN FAILURE SYNDROMES
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Medical Toxicology • Officially recognized as a subspecialty
by the American Board of Medical Specialties
• Of ~800,000 physicians in the USA, less than 700 ever board certified in medical toxicology
• ~600 physician members of ACMT board certified in medical toxicology
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Examples of Medical Problems Addressed by Medical Toxicologists • Unintentional and Intentional Drug
Overdose – therapeutic drugs; drugs of abuse; over-
Examples of Medical Problems Addressed by Medical Toxicologists (2)
• Drug abuse management – in-patient care for acute withdrawal from addictive
drugs and outpatient Medical Review Officer services for industry and organization
• Hazardous Exposure to Chemical Products – Pesticides, heavy metals (e.g. lead, arsenic,
mercury), household products (e.g. cleaning agents), toxic gases (e.g. carbon monoxide, hydrogen sulfide, hydrogen cyanide), toxic alcohols (e.g. methanol, ethylene glycol), and other industrial and environmental agents
• Independent Medical Examinations – assessing injury or disability resulting from toxic
exposures
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Medical Toxicologists Provide Professional Services in Clinical, Industrial, Educational, and Public Health Settings:"
• Emergency departments, ICU's, other in-patient units • Outpatient clinics, offices, job sites • Poison Control Centers • Medical Schools, universities, and clinical training sites • Industries and corporations (e.g. chemical,
• ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology.
• The ACMT is dedicated to advancing the science and practice of medical toxicology.
• About 600 board certified or board eligible physicians
www.acmt.net
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Subspecialty training programs • 30 fellowship programs across the US • 2 years in length, average 2 fellows/year • Generally affiliated with Poison Centers
and academic medical centers • Serve as educational sites for many
emergency medicine residents in the US – Other rotating trainees include: Pediatrics,
critical care, medical students, pharmacy students, Pediatric emergency medicine fellows
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United States Regional Poison Control Centers Alaska
• Poisoning is an interaction between a host, the environment, and a toxin or toxicant
• An exposure pathway must be completed in order to have toxicity
• Exposure to a given compound generally results in predictable, often fairly specific host responses (toxidromes)
• Dose determines effect – Large scale exposures require large doses – Mere detection of a compound does not identify
it as the culprit
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Basic Toxicology Principles (2) • It is often difficult to distinguish between
toxicity and host physiological responses – Causation vs. Association
• General vs. Specific Causation • The proper care of large numbers of
poisoned patients correctly balances the potential role (including benefit and risk) of – Decontamination – Supportive care – Diagnostic studies – Antidote therapy
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Chemical Agents of Opportunity Course
• More than 90 courses presented in last 10 years throughout the country
• More than 9000 participants • Contributions by more than
100 medical toxicologists
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Agents of Opportunity Topics • Intro/Background • Neurotoxins • Toxic Gases • Cyanide & Fumigants • Delivery of Agents by
• Environmental Monitoring • Post-Event Biomonitoring • OSHA First Receiver
Guidance • Regulatory Aspects and
Local Implementation
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10.
2.3.4.5.6.7.8.9. Basic Science
Administrative or LogisticsVeterinary PracticeOccupational or EnvironmentalPublic HealthClinical Medicine or Nursing (Military)Law Enforcement (Police, MPs, FBI)
Which of the following best describes the type of work you do?
Other
Clinical Medicine or Nursing (Civilian)First Responder (FIre, EMT, Paramedic)
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7.
8. Other
Consulting firm
Corporation
Hospital / Medical Facility
Educationall (university, high school)
Local Gov. (inc police, fire, EMS)
Which of the following best describes who you work for?