EMS Care EMT Chapter 24-MCIT-F3-2123 | Toxicological Emergencies  starts with an introduction to this important topic. Toxicological Emergencies are a critical component of the prehospital care requiring EMTs to rapidly identify and manage poisonings ,  overdoses and exposure to harmful substances. Drug overdoses claimed over 100000 lives in 2022. EMTs are often the first to arrive on the scene and play a vital role in stabilizing patients. The lessons covered in this chapter are

• Lesson 1: Toxicology & Poison Control
• Lesson 2: Carbon Monoxide Poisoning
• Lesson 3: Chemical Warfare Agents And Nerve Agent Exposure
• Lesson 4: Opioid Toxicity
• Lesson 5: Routes Of Exposure & General Management Principles
• Lesson 6: Alcohol-Related Emergencies

Excerpt from EMS Care EMT Chapter 24-MCIT-F3-2123 | Toxicological Emergencies

SLUDGE-M is a critical diagnostic tool for identifying nerve agent exposure in the field. This mnemonic captures the primary muscarinic symptoms commonly observed:

S for Salivation – Excessive drooling and oral secretions

L stands for Lacrimation – Tearing and eye irritation

U is Urination, that is involuntary urination

D for Defecation  or loss of bowel control

G is Gastrointestinal distress – Abdominal cramping and pain.

E for Emesis that is Vomiting, and,

M is Miosis or Pinpoint pupils.

In mass casualty incidents, nerve agent exposure presents with distinct scene indicators. Be alert for clusters of patients exhibiting SLUDGE-M symptoms simultaneously. Additional red flags include unexplained chemical odors, dead animals, or insects in the area—environmental clues that strongly suggest a toxic exposure.

Scene safety and situational awareness are vital. Multiple symptomatic patients should immediately trigger hazmat protocols and the use of personal protective equipment. Early recognition of these patterns is your first line of defense and can significantly impact both patient outcomes and provider safety.