New UNC emergency room wall chart will help health workers respond to chemical terrorism

December 11, 2002

CHAPEL HILL -- Last year, the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) developed a free wall chart about potential bioterrorism organisms for display in hospital emergency rooms. Its purpose was to help ER staff recognize and cope with illnesses caused by attacks with anthrax, plague, botulism or smallpox.

"Response to the poster from physicians and other health-care workers not only across the state, but also throughout the nation was phenomenal," said Karen K. Hoffmann, associate director of the University of North Carolina in Chapel Hill School of Medicine-based program. "Our Web site, from which the chart can be printed out, received 25,000 hits within a few months. More than half the states asked for copies, and many adopted, adapted and distributed it throughout their entire public health systems."

Now, Hoffmann and her colleagues have taken their public service effort a step further. They have completed a new wall chart focusing on chemical terrorism agents and the medical syndromes they cause. Next week, they will send it to all N.C. hospital emergency departments and health departments.

"We believe this chart is even more important than the first one since chemical terrorism is a lot more likely than biological terrorism," Hoffmann said. "Developing and distributing biological agents is relatively difficult. Planting a bomb on a tanker truck or train car loaded with chlorine is relatively easy, and there's a potential for many civilian casualties. Cyanides are 25,000 times more toxic than botulism."

North Carolina ranks eighth in the country in its risk of accidental exposure because of the type, placement and volume of chemicals it manufactures, stores and transports, she said.

"Recognition of exposed persons will fall on primary-care physicians, emergency room physicians, EMTs and infection control professionals, and most of them have had little prior experience in responding to chemical exposures," Hoffmann said. "Training these people how to recognize chemical exposure is therefore very important."

She and other SPICE staff, along with public health and military advisers, developed the large, simple chart to provide information about the more likely chemical weapons. They listed common presenting signs, symptoms, onset, clinical diagnostic tests, exposure route and treatment, differential diagnosis and decontamination methods. Also included are ways to avoid secondary exposures.

"We also included critical notification numbers in the event of a suspected case or cases," she said. "Chemical agents listed include nerve agents, cyanides, vesicants/blister agents, pulmonary/choking agents, ricin and T-2 mycotoxins."

A copy of the poster will be sent free to every North Carolina hospital because the staffs there do not have time to search for such guidance in an emergency. Information about purchasing additional copies will be available at A smaller version of the information also is available there and can be printed on two 8 ½-by-11 inch pages. Questions can be sent via email to

SPICE is charged with investigating and controlling health care-associated infections in hospitals, long-term care facilities, and other medical facilities in the state, Hoffmann said. The program provides training, education and consultation to hospitals, long-term care facilities and other medical facilities to prevent and control institutionally acquired infections.

The state funds the program. Dr. William A. Rutala of the UNC School of Medicine directs it, Dr. David J. Weber is associate director and Eva P. Clontz serves as program coordinator.

Hoffmann led development of the new wall chart. Other contributors were Weber of the UNC schools of medicine and public health, Dr. Woodall Stopford of Duke University, Dr. Gregory Smith of the N.C. Department of Health and Human Services and UNC, Drs. Jonathan Newmark and Beverly Maliner of the U.S. Army Medical Research Institute of Chemical Defense, Clontz and Rutala.

The N.C. Institute for Public Health and the N.C. Center for Public Health Preparedness at the UNC School of Public Health paid for chart development and distribution.
Note: Hoffmann can be reached at 919-966-3242 or 919-622-4811 (cell).

By DAVID WILLIAMSON 919-962-8596

University of North Carolina at Chapel Hill

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