COL Prof. Dr. Horst Thiermann
Future Forces Forum
Chief of Institute
Bundeswehr Institute of Pharmacology and Toxicology
New developments for diagnosis and treatment of nerve agent poisoning
Poisoning by nerve agents shifted in public interest due to recent incidents, e.g. the use of Sarin in Syria or of VX in Malaysia. It became obvious that the clinical picture may lead to a tentative diagnosis. However this diagnosis needs to be substantiated by laboratory results to avoid mistreatment and to discriminate between worried well and poisoned patients. Moreover, as signs and symptoms especially after percutaneous exposure may develop delayed, laboratory parameters may be indicators of poisoning prior signs and symptoms develop and may thus allow early antidote treatment in order to prevent respiratory paralysis. As the enzyme acetylcholinesterase (AChE) is the main target of nerve agents, a reduced AChE activity may indicate poisoning by any organophosphorus compound and allow start of a generic treatment protocol without exact identification of the single compound used. Test systems for determination of this parameter on the spot are available on the market. Moreover, a combination of several further parameters, e.g. reactivatability of AChE indicating whether oximes should be administered, inhibitory activity, indicating persistence of nerve agents and plasma cholinesterase activity should be made available at role 3 in order to allow adequate ongoing treatment in mass casualty scenarios.
Colonel (MC) Prof. Dr. Horst Thiermann studied medicine at the University of Regensburg and Technical University, Munich. After working in the Bundeswehr Hospital Munich in the departments of anaesthesiology and surgery, he changed to the Bundeswehr Institute of Pharmacology and Toxicology. He specialized in Pharmacology and Toxicology at the Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig Maximilians-University Munich in 1996. In 2002, he completed his advanced studies of Clinical Pharmacology at MDS Pharma Services, Höhenkirchen-Siegertsbrunn. Since November 2006 he is in charge of the Bundeswehr Institute of Pharmacology and Toxicology. In January 2012 he was appointed Professor at Technical University, Munich. Colonel (MC) Prof. Dr. Thiermann is vice-chairman of Bundesinstitut für Risikobewertung (BfR) Committee for the Assessment of Intoxications, member of the board and scientific committee of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) and past president of Clinical and Translational Toxicology Speciality Section (CTTSS) of the Society of Toxicology (SOT).