Nervgasmotmedel : aktuellt kunskapsläge

This report is aimed to support the process in finding a system to renew the present autoinjector, one of the most important components in the nerve agent medical countermeasures not only of the Swedish Armed Forces but also for civil use by rescue services and emergency medical staffs. Some new principles for pre-treatment and treatment that are interesting future alternatives are also presented. Physostigmine and scopolamine delivered by a medical patch and bioscavengers are examples of new candidate nerve agent antidotes. The available commercial autoinjector devices, their contents and the pre-treatment as well as the acute, initial medical treatment of nerve agent poisoning a number of countries have choosen are also reviewed. We recommend a modification of the present autoinjector by keeping the device but replacing the ampoule with a new one. The content is suggested to be atropine sulphate as earlier in the wet chamber, but Hl-6 dichloride in the dry chamber should be replaced by an equivalent amount of the more water soluble Hl-6 dimethane sulphonate. A anticonvulsant benzodiazepine, for instance avizafone (a pro-drug of diazepam) is also suggested in the wet chamber. there is strong experimental evidence for the H(Hagedom)-oximes to provide the best medical protection against nerve agents. HLö-7, effective also in tabun intoxication, is probably the best oxime, but for HLö-7, the documentation is limited compared with that for HL-6. Therefore, Hl-6 is recommended. If another oxime than an H-oxime is chosen, for example obidoxime (Toxogonin(R) a good medical protection against several pesticide organophosphates is obtained. The medical protection against nerve agents will in that case be poor.