Consensus Guideline for Care of Patients in the Prehospital and Aerospace Settings with Exposures to Hydrazine and Hydrazine Derivatives.

Objectives: Hydrazine (HZ) and Hydrazine Derivative (HZ-D) exposures pose health risks to people in industrial and aerospace settings. Several recent systematic reviews and case series have highlighted common clinical presentations and management strategies. Given the low frequency at which HZ and HZ-D exposures occur, a strong evidence base on which to develop an evidence-based guideline does not exist at this time. Therefore, the aim of this project is to establish a consensus guideline for prehospital care of patients with exposures to HZ and HZ-Ds.

Methods: A modified Delphi technique was used to develop clinical questions, obtain expert panel opinions, develop initial patient care recommendations, and revise the draft into a final consensus guideline. First, individuals (Emergency Medical Services (EMS) physicians and hazardous materials technicians) with experience in management of HZ and HZ-Ds identified relevant clinical questions. An expert panel was then convened to make clinical recommendations. In the first round, the panel voted on clinical care recommendations. These recommendations were drafted into a guideline that expert panel members reviewed. After review, additional unanswered questions were discussed electronically by expert panel members, and electronic votes were cast. Ultimately, patient care recommendations were condensed into a concise, consensus guideline.

Results: Eight clinical questions regarding treatment of patients with HZ and HZ-D exposures were identified. These questions were reviewed by the expert panel which included 2 representatives from: aerospace medicine, military medicine, EMS medicine, paramedicine, pharmacy, and toxicology. Draft patient care recommendations generated three additional questions which were discussed electronically and voted on. These recommendations were then formatted into a guideline outlining recommendations for care prior to decontamination, during decontamination, and after decontamination.

Conclusions: The consensus guideline for clinical care of patients with exposure to HZ/HZ-Ds is as follows: Prior to decontamination, use appropriate personal protective equipment, and when necessary, support ventilation using a bag-valve-mask and administer midazolam intramuscularly for seizures. After decontamination, provide supplemental oxygen; consider selective advanced airway management when indicated; administer inhaled beta-agonists for wheezing; and, for seizures unresponsive to multiple doses of benzodiazepines that occur during pre-planned, high-hazard activities, such as spacecraft recovery, consider intravenous or intraosseous pyridoxine.