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Related Experiment Video

Updated: Feb 11, 2026

Development of a Gaze-Contingent Display Framework Designed for Perceptual and Oculomotor Research with Simulated Central Vision Loss
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ACMT Position Statement: Alternative or Contingency Countermeasures for Acetylcholinesterase Inhibiting Agents.

Andrew Stolbach1, Vikhyat Bebarta2, Michael Beuhler3

  • 1Johns Hopkins University, Baltimore, MD, USA. positionstatements@acmt.net.

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology
|April 19, 2018
PubMed
Summary

First responders need strategies for nerve agent poisoning when medical countermeasures are insufficient. The American College of Medical Toxicology supports using expired drugs and developing alternative treatments.

Keywords:
Acetylcholinesterase inhibitorsAtropineCountermeasuresExpiration datePralidoxime

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Area of Science:

  • Toxicology
  • Emergency Medicine
  • Pharmacology

Background:

  • First responders and healthcare providers require effective treatments for acetylcholinesterase (AchE) inhibitor poisoning from chemical warfare agents or pesticides.
  • Pre-deployed medical countermeasures (MCMs) may be insufficient due to supply chain issues, rapid depletion, expiration, or lack of local availability.

Purpose of the Study:

  • To outline strategies for augmenting community-based and forward-deployed nerve agent countermeasures.
  • To address the potential insufficiency of approved MCMs in emergency situations.

Main Methods:

  • Recommending the use of expired atropine, diazepam, and pralidoxime auto-injectors and vials when non-expired MCMs are unavailable.
  • Advocating for the investigation, development, and identification of alternative countermeasures, specifically commonly stocked drugs within the same therapeutic class as approved agents.

Main Results:

  • The American College of Medical Toxicology (ACMT) endorses two primary strategies to bolster nerve agent countermeasure supplies.
  • These strategies aim to ensure treatment availability when standard MCMs are compromised or inaccessible.

Conclusions:

  • Expired MCMs can serve as a viable option in critical situations where approved agents are absent.
  • Exploring and approving alternative, readily available drugs offers a promising approach to enhance preparedness for AchE inhibitor poisoning incidents.