Critical care requirements after mass toxic agent release.

There is an increasing risk of mass exposure of civil populations after release of toxic agents. These include military chemical warfare agents or industrial compounds, some of which have been used as a chemical. The traditional military divisions among chemical agents, toxins, and biologic agents may be viewed as a continuous spectrum of hazards. Each of these has four specific qualities (toxicity, latency, persistency, and transmissibility), which determine management of casualties and the toxic release. Toxic hazards may be released accidentally or deliberately, producing potentially large numbers of casualties. Previous incidents have shown that many of these require extended hospital care. This article reviews aspects of the nature of the toxic agents, the pathophysiology they produce, and therapeutic measures. The central and peripheral nervous systems and the respiratory systems are particularly vulnerable and may lead to fatal results unless early action is taken. Specific antidotes and life support care is required at all levels of prehospital and hospital management. Critical care management is required for severe cases, and this must combine continuing antidote, ventilatory and supportive therapy.