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Definitions and Nomenclature Workshop May 8-9 2012 Report on the Toxic Chemical Syndrome
Definitions and Nomenclature Workshop
May 8-9 2012
Report on the Toxic Chemical Syndrome
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Report of the Toxic Chemical Syndrome Definitions and Nomenclature Workshop, May 2012
Report of the Toxic Chemical Syndrome Definitions and Nomenclature Workshop
May 8-9, 2012
Submitted to: National Library of Medicine and Department of Homeland Security
Submitted by: Toxicology Excellence for Risk Assessment
Report of the Toxic Chemical Syndrome Definitions and Nomenclature Workshop, May 2012 Page 1
Federal Points of Contact CAPT Joselito Ignacio, MA, MPH, CIH, CSP, REHS Acting Director, Chemical Defense Program Department of Homeland Security Office of Health Affairs [email protected]
Pertti (Bert) Hakkinen, PhD Acting Head, Office of Clinical Toxicology Specialized Information Services National Library of Medicine National Institutes of Health [email protected]
Report of the Toxic Chemical Syndrome Definitions and Nomenclature Workshop, May 2012 Page 2
Contents Contents ....................................................................................................................................................... 3
List of Figures and Tables ............................................................................................................................. 5
List of Acronyms ........................................................................................................................................... 6
1. Introduction ............................................................................................................................................. 9
1.1 Workshop Organizing Committee ...................................................................................................... 9
1.2 Background ....................................................................................................................................... 10
1.3 Intended Use of the Results of the Workshop .................................................................................. 11
1.4 Organization of this Report ............................................................................................................... 12
2. Toxic Chemical Syndrome Definitions and Nomenclature Workshop .................................................... 12
2.1 Breakout Groups ............................................................................................................................... 14
2.1.1 Breakout Group Instructions ...................................................................................................... 14
2.1.2 Breakout Group Results ............................................................................................................. 14
2.1.3 Recommended Toxidromes ....................................................................................................... 15
2.1.4 Toxidrome Naming ..................................................................................................................... 16
2.1.5 Participant Ballots ...................................................................................................................... 17
2.2 Discussion .......................................................................................................................................... 18
2.3 Conclusions ....................................................................................................................................... 20
2.4 References and Sources .................................................................................................................... 21
Appendix A: Workshop Materials ............................................................................................................... 27
A1. Agenda ............................................................................................................................................. 29
A2. List of Participants ........................................................................................................................... 31
Appendix B: Pre-Workshop Materials......................................................................................................... 33
B1. Toxic Syndrome Crosswalk ............................................................................................................... 35
B2. Pre- and Post-Workshop Comments ............................................................................................... 41
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Appendix C: Breakout Group Reports ......................................................................................................... 89
C1: Breakout Group 1.............................................................................................................................. 91
Syndrome Name: Irritant/Corrosive -Topical...................................................................................... 91
Syndrome Name: Irritant/Corrosive - Inhalation ................................................................................ 93
Syndrome Name: Irritant/Corrosive - Ingestion ................................................................................. 95
C2: Breakout Group 2.............................................................................................................................. 97
Syndrome Name: Knockdown/Asphyxiants ........................................................................................ 97
Syndrome Name: Anticoagulants .......................................................................................................99
Toxidromes Considered, but Not Recommended .............................................................................101
C3: Breakout Group 3.............................................................................................................................103
Syndrome Name: Cholinergic ............................................................................................................103
Syndrome Name: Cellular sphyxia (cyanide-like) ............................................................................ 105
Syndrome Name: Convulsant ........................................................................................................... 107
Syndrome Name: Opioid ................................................................................................................... 109
Syndrome Name: Stress-response/sympathomimetic ..................................................................... 111
Syndrome Name: Anticholinergic ..................................................................................................... 113
Syndrome Name: Exposure to Solvents, Anesthetics, or Sedatives (SAS) ........................................ 115
Appendix D. Participant Ballots................................................................................................................ 117
Appendix E: Workshop Presentation Slides .............................................................................................. 121
Report of the Toxic Chemical Syndrome Definitions and Nomenclature Workshop, May 2012 Page 4
List of Figures and Tables Figure 1 Intersection of Toxidrome User Groups. ...................................................................................... 12 Table 1 Breakout Group Assignments......................................................................................................... 15 Table 2. Breakout Group Recommendations for Toxidrome Names and Descriptions .............................. 16
Report of the Toxic Chemical Syndrome Definitions and Nomenclature Workshop, May 2012 Page 5
List of Acronyms
AHLS Advanced Hazmat Life Support program
ALS Advanced life support
BLS Basic life support
CHEMM Chemical Hazards Emergency Medical Management
CHEMM-IST Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool
CNS Central nervous system
CSAC Chemical Security Analysis Center
CTRA Chemical Terrorism Risk Assessment
CWAs Chemical warfare agents
DHS Department of Homeland Security
EMTs Emergency medical technicians
F&ES Fire and Emergency Services
GI Gastrointestinal
Hazmat Hazardous materials
HHS U.S. Department of Human and Health Services
HPV High Production Volume
HSDB Hazardous Substances Data Bank
NICC National Interagency Coordination Centers
NIOSH National Institute for Occupational Safety and Health
NLM National Library of Medicine
NOC National Operations Center
OHA Office of Health Affairs
PNS Peripheral nervous system
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SAS Solvents, Anesthetics, or Sedatives
SLTT State, Local, Tribal and Territorial
SME Subject matter expert
SOCs Support and Operations Centers
TERA Toxicology Excellence for Risk Assessment
TICS Toxic industrial chemicals
TIMS Toxic industrial materials
WISER Wireless Information System for Emergency Responders
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Report of the Toxic Chemica
