Journal of Medical Toxicology

, Volume 14, Issue 3, pp 261–263 | Cite as

ACMT Position Statement: Alternative or Contingency Countermeasures for Acetylcholinesterase Inhibiting Agents

  • Andrew Stolbach
  • Vikhyat Bebarta
  • Michael Beuhler
  • Shaun Carstairs
  • Lewis Nelson
  • Michael Wahl
  • Paul M. Wax
  • Charles McKay
Position Statement


First responders and health care providers must prepare to provide care for patients poisoned by acetylcholinesterase (AchE) inhibitor chemical warfare agents or pesticides. However, pre-deployed medical countermeasures (MCMs) may not be sufficient due to production and delivery interruption, rapid depletion of contents during a response, expiration of MCM components, or lack of local availability of approved MCMs. To augment supplies of community-based and forward-deployed nerve agent countermeasures, the American College of Medical Toxicology (ACMT) supports several strategies: (1) The use of expired atropine, diazepam, and pralidoxime auto-injectors and vials if non-expired drugs are unavailable; and (2) Investigation, development, and identification of alternative countermeasures—commonly stocked drugs that are not approved for nerve agent poisoning but are in the same therapeutic class as approved drugs.


Acetylcholinesterase inhibitors Atropine Pralidoxime Countermeasures Expiration date 


Funding Information

This statement was funded, in part, by the United States Department of Homeland Security ACMT/DHS Contract number HSHQDC-14-R-00102.

Compliance with Ethical Standards

Conflicts of Interest



While individual practices may differ, this is the position of the American College of Medical Toxicology (ACMT) at the time written, after a review of the issue and pertinent literature.


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Copyright information

© American College of Medical Toxicology 2018

Authors and Affiliations

  • Andrew Stolbach
    • 1
  • Vikhyat Bebarta
    • 2
  • Michael Beuhler
    • 3
  • Shaun Carstairs
    • 4
  • Lewis Nelson
    • 5
  • Michael Wahl
    • 6
  • Paul M. Wax
    • 7
  • Charles McKay
    • 8
  1. 1.Johns Hopkins UniversityBaltimoreUSA
  2. 2.University of Colorado School of MedicineDenverUSA
  3. 3.Carolinas Poison CenterCharlotteUSA
  4. 4.University of CaliforniaSan DiegoUSA
  5. 5.Rutgers New Jersey Medical SchoolNewarkUSA
  6. 6.Illinois Poison CenterChicagoUSA
  7. 7.University of Texas Southwestern Medical SchoolDallasUSA
  8. 8.University of Connecticut School of MedicineFarmingtonUSA

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