Research
Validating Signs and Symptoms From An Actual Mass Casualty Incident to Characterize An Irritant Gas Syndrome Agent (IGSA) Exposure: A First Step in The Development of a Novel IGSA Triage Algorithm

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Contribution to Emergency Nursing Practice

• Chemical exposures daily pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for Irritant Gas Syndrome Agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations.

• This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA Syndrome. Validating signs/symptoms is the first step in developing new emergency department informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents.

AbstractIntroduction

Chemical exposures can pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for irritant gas syndrome agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations. This study describes the first step in developing ED informatics tools for chemical incidents: validation of signs/symptoms that characterize an IGSA syndrome.

Methods

Data abstracted from 146 patients treated for chlorine exposure in one emergency department during a 2005 train derailment and 152 patients not exposed to chlorine (a comparison group) were mapped to 93 possible signs/symptoms within 2 tools (WISER and CHEMM-IST) designed to assist emergency responders/emergency nurses with managing hazardous material exposures. Inferential statistics2/Fisher’s exact test) and diagnostics tests were used to examine mapped signs/symptoms of persons who were and were not exposed to chlorine.

Results

Three clusters of signs/symptoms are statistically associated with an IGSA syndrome (P < .01): respiratory (shortness of breath, wheezing, coughing, and choking); chest discomfort (tightness, pain, and burning), and eye, nose and/or throat (pain, irritation, and burning). The syndrome requires the presence of signs/symptoms from at least 2 of these clusters. The latency period must also be considered for exposed/potentially exposed persons.

Discussion

This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA syndrome. Validating signs/symptoms is the first step in developing new ED informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents.

Section snippets

Methods

Only de-identified data were used for this study. The Office of Research Compliance at the University determined that this study was exempt from the protection of human subject’s regulations. All information from the paper medical records of the 198 patients seen in the emergency department at the local hospital within 24 hours of the chlorine incident were abstracted (146 patients were exposed to chlorine, and 52 patients were not exposed to chlorine). Ten years later, in the same hospital and

Results

Table 1 shows actual patient signs and symptoms that mapped to WISER and CHEMM-IST.

Table 2, Table 3 show sensitivity, specificity, positive predictive value, negative predictive value, false-positive probability, false-negative probability, and 95% confidence interval for WISER and CHEMM-IST.

The results showed good sensitivity for both WISER and CHEMM-IST, from 0.84 to 0.94 and 0.92 to 0.97, respectively, and poor specificity for both WISER and CHEMM-IST, from 0.31 to 0.47 and 0.29 to 0.33,

Discussion

Clinical signs and symptoms of an IGSA exposure depend upon the route of exposure (inhalation, skin/eye contact, or ingestion).15 The Graniteville 2005 incident related primarily to inhalational exposures; therefore, this study validated signs and symptoms based on such an exposure. During a chemical MCI, when patient needs outstrip resources, patients must be triaged with particular emphasis given to the chemical’s impact on the respiratory system—an impact that may not be evident until after

Conclusion

This study is the first known study that uses actual patient data from a chemical incident to characterize the signs and symptoms of an IGSA syndrome. The characterization of signs and symptoms related to an IGSA syndrome is the first step in the development of a triage algorithm specifically designed for IGSA incidents. Once the IGSA triage algorithm is fully developed and tested, it will be incorporated into a computer informatics tool that is being designed to help emergency nurses

Joan M. Culley is Associate Professor, College of Nursing, University of South Carolina, Columbia, SC.

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Joan M. Culley is Associate Professor, College of Nursing, University of South Carolina, Columbia, SC.

Jane Richter is Co-Investigator, College of Nursing, University of South Carolina, Columbia, SC.

Sara Donevant is Co-Investigator, College of Nursing, University of South Carolina, Columbia, SC.

Abbas Tavakoli is Biostatistician, College of Nursing, University of South Carolina, Columbia, SC.

Jean Craig is Systems Architect and Database Warehouse, Office of Biomedical Informatics Systems/Health Sciences South Carolina, Medical University of South Carolina, Charleston, SC.

Salvatore DiNardi is Co-Investigator, College of Nursing, University of South Carolina, Columbia, SC.

Earn Up to 5.5 CE Hours. See page 381.

This study was funded by National Library of Medicine grant 1R01LM011648.

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