|
|
Medical Education Division |
Operational Medicine 2001
United States Naval Hospital Corpsman 3 & 2 Training Manual
NAVEDTRA 10669-C June 1989
United States Naval Hospital Corpsman 3 & 2 Training Manual
NAVEDTRA 10669-C June 1989
Home · Military Medicine · Sick Call · Basic Exams · Medical Procedures · Lab and X-ray · The Pharmacy · The Library · Equipment · Patient Transport · Medical Force Protection · Operational Safety · Operational Settings · Special Operations · Humanitarian Missions · Instructions/Orders · Other Agencies · Video Gallery · Phone Consultation · Forms · Web Links · Acknowledgements · Help · Feedback
|
Hospital Corpsman 3 & 2: June 1989 Chapter 12: Chemical, Biological, and Radiological WarfareNaval Education and Training Command
There is a distinct possibility that a chemical, biological, or radiological (CBR) attack may occur in the next major war of the future. Although the physical damage to a ship or station as a result of a CBR attack may be minimal, the possibility that dangerous levels of contamination will remain after such an attack is real. Therefore, all personnel should understand the nature of such attacks, the methods of reducing their effects, and the treatment of casualties resulting from such attacks. Defense against a CBR attack is both an individual and a group responsibility. What an individual does before, during, and after such an attack will affect both his own and his activity's chances of survival. Individuals are responsible for first aid and self-aid, proper use of the protective mask and clothing, and personal decontamination. Group responsibilities include the setting of proper material conditions, detection of agents, isolation of contaminated areas, and decontamination and restoration of the ship or station and equipment. You, as a hospital corpsman, are responsible for recognizing the signs and symptoms associated with exposure to chemical or biological agents and knowing the treatment to be rendered. It is your job to maintain the health and welfare of those personnel for whom you are responsible. You must also protect yourself and others in a nuclear attack. This can only be achieved by being aware of and understanding the effects of a nuclear blast. Thus, you will be able to render the appropriate treatment and return to duty those personnel under your charge. Table 12-1 provides a summary of symptoms and treatments.
The use of chemical agents in warfare, frequently referred to as "gas warfare," may be defined as the deliberate use of a variety of chemical agents in gaseous, solid, or liquid states for the express purpose of harassing personnel or producing casualties, rendering areas impassable or untenable, contaminating food and water, or initiating incendiary action. The first large-scale use of chemical agents came in World War I when, in 1915, the Germans released chlorine gas against the Allied positions at Ypres, Belgium. Over 5,000 casualties resulted. There were other gas attacks by both combatant forces during World War 1, and it is well-documented that approximately one-third of all American casualties in this conflict were due to chemical agent attacks. During the interval between World Wars I and II, each of the major powers continued to develop its capability for chemical warfare in spite of the Geneva Treaty banning it. In isolated cases in the late 1930's, toxic chemicals were used; however, they were not used during World War II. Toxic chemicals were not authorized for use in Korea or Vietnam. Defoliants and riot control agents were used with some degree of effectiveness in the jungles of Vietnam in tunnel and perimeter clearing operations. A naval unit afloat finds itself in a unique situation concerning defense against toxic chemical agents. Since agents can be released as clouds of vapor or aerosol, they can envelop the exterior of a vessel and may penetrate within the hull. Because of the use of artificial ventilation aboard ship, extensive contamination may result from such an attack. As the ship, in most instances, cannot be abandoned, it must be decontaminated while the personnel manning it continue to eat, sleep, live, and maintain combat. The medical officer or the hospital corpsman on independent duty must organize his or her department to meet the medical needs of defense against chemical agents well in advance of actual need. All hands must be indoctrinated in the use of protective equipment and self-aid procedures. Close liaison and planning must be maintained with damage control personnel responsible for area decontamination, and all medical personnel must know the approved methods for treating chemical agent casualties. Biological agents are not known to have ever been used as part of a modern weapons systems. There is some doubt about their tactical (immediate) effectiveness. However, as a strategic device, as a covert weapon, biological agents are ideally suited. Throughout the history of warfare, disease has been as effective as combat in causing casualties. Recall the plagues that swept Europe during the Middle Ages or, more recently, the influenza outbreaks of 1918, 1958, and 1968. Any epidemic can totally disrupt normal functioning. Imagine being able to cause an epidemic when and where you choose, and you have some idea of the potential military strategic usefulness of biological warfare. The importance of planning and training for defense against chemical and biological agents cannot be overstated. Chemical and Biological Weapons Chemical and biological (CB) weapons have unique characteristics that distinguish them from conventional or nuclear weapons.
There are differences between chemical and biological weapons that determine their usefulness in a particular situation. In general, chemical weapons are more suited for tactical, short-term local use, while biological weapons have a strategic, long-range goal. Several factors contribute to this.
In any discussion of toxic chemical agents, it is convenient to consider them under several classifications. The broadest classification we will use is based on the general effect produced (i.e., severe casualty, harassment, or incapacitation). Within each general group, there are further breakdowns. The most convenient, from a medical point of view, is the classification by physiologic effect. Casualty-producing chemical agents include:
Under incapacitants, the psychochemicals are the main group. They produce mental confusion and inability to function intelligently. Harassing agents are also called riot control agents and include:
Chemical agents may also be classified as lethal or nonlethal. Lethal agents are those that result in a 10 percent or greater death rate among casualties. They may further be classified as persistent or nonpersistent, depending on the length of time they retain their effectiveness after dissemination. Physically, nerve agents are odorless, almost colorless liquids varying greatly in viscosity and volatility. They are moderately soluble in water and fairly stable unless strong alkali or chlorinating compounds are added. They are very effective solvents readily penetrating cloth either as a liquid or vapor. Other materials, including leather and wood, are fairly well penetrated. Butyl rubber and synthetics, such as polyesters, are much more resistant. Pharmacologically, the nerve agents are cholinesterase inhibitors. Their reaction with cholinesterases is irreversible; consequently, the effects of inhibition are prolonged until the body synthesizes new cholinesterases. Signs and Symptoms of Exposure Nerve agent intoxication can be readily identified by its characteristic signs and symptoms. If a vapor exposure has occurred, the pupils will constrict, usually to a pinpoint; if the exposure has been through the skin, characteristic local muscular twitching will occur. Other symptoms will include rhinorrhea, dyspnea, diarrhea and vomiting, convulsions, hypersalivation, drowsiness, coma, and unconsciousness. Treatment Specific therapy for nerve agent casualties is atropine, an acetylcholine blocker. For immediate self-aid or first aid, each individual is issued three automatic injectors containing 2 mg of atropine sulfate for intramuscular injection or two autoinjectors containing the Nerve Agent Antidote. These injectors are designed to be used by individuals on themselves when symptoms appear. After the first injection, if the symptoms have not disappeared within 10 to 15 minutes, another injection should be given. If the symptoms still persist after an additional 15 minutes, a third injection may be given by nonmedical personnel. For medical personnel, the required therapy is to continue to administer atropine at 15-minute intervals until a mild atropinization occurs. This can be noted by tachycardia and a dry mouth. Atropine alone will not relieve any respiratory muscle failure. Prolonged artificial respiration may be necessary to sustain life. Oxime therapy, using pralidoxime chloride, or 2-PAM Cl, may also be used for regeneration of the blocked cholinesterase. For individuals treated initially with the new autoinjector, additional oxime therapy is generally not medically indicated; it is already included in the autoinjector. Blister agents or vesicants exert their primary action on the skin, producing large and painful blisters that are incapacitating. Although vesicants are classed as nonlethal, high doses can cause death. Common blister agents include mustard (HD), nitrogen mustard (HN), and Lewisite (L). Although each is chemically different and will cause significant specific symptoms, they are all sufficiently similar in their physical characteristics and toxicology to be considered as a group. Mustards are particularly insidious because they do not manifest their symptoms for several hours after exposure. They attack the eyes and respiratory tract as well as the skin. Further, there is no effective therapy for mustard once its effects become visible. Treatment is largely supportive, to relieve itching and pain and to prevent infection. Mustard (HD) and Nitrogen Mustard (HN) HD and HN are oily, colorless or pale yellow liquids, sparingly soluble in water. HN is less volatile and more persistent than HD and has the same blistering qualities. Symptoms - The part of the body most vulnerable to mustard gas is the eyes. Contamination insufficient to cause injury elsewhere may produce eye inflammation. Vapor or liquid may burn any area of the skin, but the burns will be most severe in the warm, sweaty areas of the body; that is, the armpits, groin, and on the face and neck. Blistering begins in about 12 hours but may be delayed for up to 48 hours. Inhalation of the gas is followed in a few hours by irritation of the throat, hoarseness, and a cough. Fever, moist rales, and dyspnea may develop. Bronchopneumonia is a frequent complication; the primary cause of death is massive edema or mechanical pulmonary obstruction. Because the eye is the most sensitive part of the body, the first noticeable symptoms of mustard exposure will be pain and a gritty feeling in the eye, accompanied by spastic blinking of the eyelids and photophobia. Treatment - There is no specific antidotal treatment for mustard poisoning. Physically removing as much of the mustard as possible, as soon as possible, is the only effective method for mitigating symptoms before they appear. All other treatment is symptomatic; that is, the relief of pain and itching, and control of infection. Lewisite (L) Lewisite is an arsenical. This blistering compound is a light to dark brown liquid that vaporizes slowly. Symptoms - The vapors of arsenicals are so irritating that conscious persons are immediately warned by discomfort to put on the mask. No severe respiratory injuries are likely to occur, except in the wounded who are incapable of donning a mask. The respiratory symptoms are similar to those produced by mustard gas. While distilled mustard and nitrogen mustard cause no pain on the skin during absorption, Lewisite causes intense pain upon contact. Treatment - Immediately decontaminate the eyes by flushing with copious amounts of water to remove liquid agents and to prevent severe burns. Sodium sulfacetamide, 30 percent solution, may be used to combat eye infection after the first 24 hours. In severe cases, morphine may be given to relieve pain. British Anti-Lewisite (BAL), dimercaprol, is available in a peanut oil suspension for injection in cases of systemic involvement. BAL is a specific antiarsenical, which combines with the heavy metal to form a water-soluble, nontoxic complex that is excreted. However, BAL is somewhat toxic and an injection of more than 3 mg/kg will cause severe symptoms. Aside from the use of dimercaprol for systemic effects of arsenic, treatment is the same as for mustard lesions. Hydrocyanic acid (AC) and cyanogen chloride (CK) are cyanide-containing compounds commonly referred to as blood agents. These blood agents are chemicals that are in a gaseous state at normal temperatures and pressures. They are systemic poisons and casualty-producing agents that interfere with vital enzyme systems of the body. They can cause death in a very short time after exposure by interfering with oxygen transfer in the blood. Although very deadly, they are nonpersistent agents. Symptoms These vary with concentration and duration of exposure. Typically, either death or recovery takes place rapidly. After exposure to high concentrations of the gas, there is a forceful increase in the depth of respiration for a few seconds, violent convulsions after 20 to 30 seconds, and respiratory failure and cessation of heart action within a few minutes. Treatment There are two suggested antidotes in the treatment of cyanides. Amyl nitrite in crush ampules is provided as first aid. Followup therapy with intravenous sodium thiosulfate solution is required. In an attack, if you notice sudden stimulation of breathing or an almondlike odor, hold your breath and don your mask immediately. In treating a victim, if no blood agents remain present in the atmosphere, crush 2 ampules of amyl nitrite in the hollow of your hand and hold it close to the victim's nose. This may be repeated every few minutes until 8 ampules have been used. If the atmosphere is contaminated and the victim must remain masked, insert the crushed ampules into the mask under the face plate. Whether amyl nitrite is used or not, sodium thiosulfate therapy is required after the initial lifesaving measures. The required dose is 100 to 200 mg/kg given intravenously over a 10-minute period. The key to successful cyanide therapy is speed; cyanide acts rapidly on an essential enzyme system. The antidotes act rapidly to reverse this action. If the specific antidote and artificial respiration is given soon enough, the chance of survival is greatly enhanced. The toxicity of lung agents is due to their effect on lung tissues; they cause extensive damage to alveolar tissue, resulting in severe pulmonary edema. This group includes phosgene (CG) and chlorine (Cl) as well as chloropicrin and diphosgene. However, CG is most likely to be encountered and its toxic action is representative of the group. Phosgene is a colorless gas with a distinctive odor similar to that of new-mown hay or freshly cut grass; unfortunately, the minimal concentration in air that can cause damage to the eyes and throat is below the threshold of olfactory perception. Generally speaking, CG does not represent a hazard of long duration, so that if an individual were to be exposed to a casualty-producing amount, he or she should be able to smell it. Symptoms There may be watering of the eyes, coughing, and a feeling of tightness in the chest. More often, however, there will be no symptoms for 2 to 6 hours after exposure. Latent symptoms are rapid, shallow, and labored breathing; painful cough; cyanosis; frothy sputum; leadened, clammy skin; rapid, feeble pulse; and low blood pressure. Shock may develop, followed by death. Treatment Once symptoms appear, complete bed rest is mandatory. Keep victims with lung edema only moderately warm, and treat the resulting anoxia with oxygen. Because no specific treatment for CG poisoning is known, treatment has to be symptomatic. Psychochemical agents, often referred to as incapacitating agents, temporarily prevent an individual from carrying out assigned actions. These agents may be administered covertly by contaminating food or water, or they may be released as aerosols. The characteristics of the incapacitants include:
Symptoms The first symptoms appear in 30 minutes to several hours and may persist for several days. Abnormal, inappropriate behavior may be the only sign of intoxication. Those affected may make irrational statements and have delusions or hallucinations. In some instances, the victim may complain of dizziness, muscular incoordination, dry mouth, and difficulty in swallowing. The standard incapacitant in the United States is 3-quinuclidinyl benzilate (BZ), a cholinergic blocking agent, which is effective in producing delirium that may last several days. In small doses it will cause an increase in heart rate, pupil size, and skin temperature, as well as drowsiness, dry skin, and a decrease in alertness. As the dose is increased to higher levels, there is a progressive deterioration of mental capability, ending in stupor. Treatment The principal requirement for first aid is to prevent victims from injuring themselves and others during the toxic psychosis. Generally, there is no specific therapy for intoxication. However, with BZ and other agents in the class of compounds known as glycolates, physostigmine is the treatment of choice. It is not effective during the first 4 hours following exposure; after that, it is very effective as long as treatment is continued. However, treatment does not shorten the duration of BZ intoxication, and premature discontinuation of therapy will result in relapse. "Riot control agents" is the collective term used to describe a divergent collection of chemical compounds, all having similar characteristics. They are relatively nontoxic compounds, which produce an immediate but temporary effect in very low concentrations. Generally, no therapy is required; removal from their environment is sufficient to effect recovery in a short time. These agents are either lacrimators or vomiting agents. Lacrimators Lacrimators or tear gases are essentially local irritants that act primarily on the eyes. In high concentrations, they irritate the respiratory tract and the skin. These agents are used to harass enemy personnel or to discourage riot action. The principal agents used are chloracetophenone (CN) and orthochlorobenzilidine malanonitrile (CS). Although CS is basically a lacrimator, it is considerably more potent than CN and causes more severe respiratory symptoms. CN is the standard training agent and is the tear gas most commonly encountered. CS is more widely used by the military as a riot control agent. Protection against all tear agents is provided by protective masks and ordinary field clothing secured at the neck, wrists, and ankles. Personnel handling CS should wear rubber gloves for additional protection. Symptoms - Lacrimators produce intense pain in the eyes with excessive tearing. The symptoms following the most severe exposure to vapors seldom last over 2 hours. After moderate exposure they last only a few minutes. Treatment - First aid for lacrimators generally is not necessary. Exposure to fresh air and letting wind blow into wide open eyes, held open if necessary, is sufficient for recovery in a short time. Any chest discomfort after CS exposure can be relieved by talking. An important point to remember is that this material adheres to clothing tenaciously, and a change of clothing may be necessary. Do not forget the hair, both head and facial, as a potential source of recontamination. Vomiting Agents The second class of agents in the riot control category are the vomiting agents. The principal agents of this group are diphenylaminochloroarsine (Adamsite (DM)), diphenychloroarsine (DA), and diphenylcyanoarsine (DC). They are used as training and riot control agents. They are dispersed as aerosols and produce their effects by inhalation or by direct action on the eyes. All of these agents have similar properties and pathology. Symptoms - Vomiting agents produce a strong pepperlike irritation in the upper respiratory tract with irritation of the eyes and lacrimation. They cause violent uncontrollable sneezing, coughing, nausea, vomiting, and a general feeling of malaise. Inhalation causes a burning sensation in the nose and throat, hypersalivation, and rhinorrhea. The sinuses fill rapidly and cause a violent frontal headache. Treatment - It is of the utmost importance that the mask be worn in spite of coughing, sneezing, salivation, and nausea. If the mask is put on following exposure, symptoms will increase for several minutes in spite of adequate protection. As a consequence, victims may believe the mask is ineffective and remove it, further exposing themselves. While the mask must be worn, it may be lifted from the face briefly, if necessary, to permit vomiting or to drain saliva from the face piece. Carry on duties as vigorously as possible. This will help to lessen and shorten the symptoms. Combat duties usually can be performed in spite of the effects of vomiting agents if an individual is motivated. First aid consists of washing the skin and rinsing the eyes and mouth with water. A mild analgesic may be given to relieve headache. Usually there is spontaneous recovery, which is complete within 1 to 3 hours. A few words about screening smokes are in order since they fit in with, and complement, riot control agents. Their primary use is to obscure vision and to hide targets or areas. When used for this purpose outdoors, they are not generally considered toxic. However, exposure to heavy smoke concentration for extended periods, particularly near the source, may cause illness or death. Under no circumstances should smoke munitions be activated indoors or in closed compartments. Symptomatic treatment to medical problems or discomfort resulting from exposure to screening smokes will generally suffice. White phosphorus (WP) smoke not only obscures, but it also has a secondary effect upon personnel if burning WP contacts the skin. WP is a pale waxy solid that ignites spontaneously on contact with air to give a hot, dense, white smoke composed of phosphorus pentoxide particles. While field concentrations of the smoke may cause temporary irritation to the eyes, nose, and throat, casualties from the smoke have not occurred in combat operations. No treatment is necessary and spontaneous recovery is rapid. If burning particles of WP embed in the skin, they must be covered with water, a wet cloth, or mud. A freshly mixed 0.5 percent solution of copper sulfate, which produces an airproof black coating of copper phosphide, may be used as a rinse but must not be used as a dressing. The phosphorus particles must be removed surgically. The effects of radiation must be understood to apply this knowledge intelligently to the sorting of casualties. The special procedures for nuclear first aid are important, and you must become familiar with them to function effectively as a hospital corpsman Action Before Nuclear Explosion If there is sufficient warning in advance of an attack, head as quickly as possible for the best shelter available. If you are on duty, your action must be determined by the circumstances existing at the time. In general, this will be the same as for an attack by ordinary high-explosive bombs. At the sound of the alarm, get your protective mask ready. Proceed to your station or to a shelter as ordered. If you are ordered to a shelter, remain there until the "all clear" signal is given. In the absence of specially constructed shelters during a nuclear explosion ashore, you can get some protection in a foxhole, a dugout, or on the lowest floor or basement of a reinforced concrete or steel framed building. Generally, the safest place is in the basement near walls. The next best place is on the lowest floor in an interior room, passageway, or hall, away from the windows and, if possible, near a supporting column. Avoid wooden buildings if at all possible. If you have no choice, take shelter under a table or bed rather than go out into the open. If you have time, draw the shades and blinds to keep out most of the heat from the blast. Only those people in the direct line of sight of thermal emission will be burn casualties; that is, anything that casts a shadow will afford protection. Tunnels, storm drains, and subways provide effective shelter except in the case of a nearby underground explosion. In the event of a surprise attack, no matter where you are, out in the open on the deck of a ship, in a ship compartment, out in the open ashore, or inside a building, drop to a prone position in a doorway or against a bulkhead or wall. If you have a protective mask with you, put it on. Otherwise, hold or tie a handkerchief over your mouth and nose. Cover yourself with anything at hand, being especially sure to cover the exposed portions of the skin, such as the face, neck, and hands. If this can be done within a second of seeing the bright light of a nuclear explosion, some of the heat radiation may be avoided. Ducking under a table, desk, or bench indoors, or into a trench, ditch, or vehicle outdoors, with the face away from the light, will provide added protection. The injuries to personnel resulting from a nuclear explosion may be divided into three broad classes:
Apart from the ionizing radiation effects, most of the injuries suffered in a nuclear weapon explosion will not differ greatly from those caused by ordinary high explosives and incendiary bombs. An important aspect of injuries in nuclear explosions is the "combined effect"; that is, a combination of all three types of injuries. For example, a person within the effective range of a weapon may suffer blast injury, burns, and also from the effects of nuclear radiation. In this respect, radiation injury may be a complicating factor, since it is combined with injuries due to other sources. Blast and Shock Wave Injuries Injuries caused by blast can be divided into:
Primary blast injuries are those that result from the direct action of the air shock wave on the human body. These injuries will be confined to a zone where fatal secondary blast and thermal damage may be anticipated. Therefore, most surviving casualties will not have the severe injuries that result from the direct compressive effects of the blast wave. Secondary blast injuries are caused by collapsing buildings and by timber and other debris flung about by the blast. Persons may also be hurled against stationary objects or thrown to the ground by the high winds accompanying the explosions. The injuries sustained are thus similar to those due to a mechanical accident: bruises, concussions, cuts, fractures, and internal injuries. At sea, the shock wave accompanying an underwater burst will produce various "mechanical" injuries. These injuries will resemble those caused aboard ship by more conventional underwater weapons, such as noncontact mines and depth charges, but instead of being localized, they will extend over the entire vessel. Equipment, furniture, gas cylinders, boxes, and similar gear, when not well secured, can act as missiles and cause many injuries. Burn Injuries A weapon detonated as an air burst may produce more burn casualties than blast or ionizing radiation casualties. Burns due to a nuclear explosion can also be divided into two classes: direct and indirect burns. Direct burns (usually called flash burns) are the result of thermal (infrared) radiation emanating from a nuclear explosion, while indirect burns result from fires caused by the explosion. Biologically, they are similar to any other burn and are treated in the same manner. Since all radiation travels in a straight line from its source, flash burns are sharply limited to those areas of the skin facing the center of the explosion. Furthermore, clothing will protect the skin to some degree unless the individual is so close to the center of the explosion that the cloth is ignited spontaneously by heat. Although light colors will absorb heat to a lesser degree than dark colors, the thickness, air layers, and types of clothing (wool is better than cotton) are far more important for protection than the color of the material. Eye Burns In addition to injuries to the skin, the eyes may also be affected by thermal radiation. If people are looking in the general direction of a nuclear detonation, they may be flash blinded. This blindness may persist for 20 to 30 minutes. A second and very serious type of eye injury may also occur. If people are looking directly at the fireball of a nuclear explosion, they may receive a retinal flash burn similar to the burn that occurs on exposed skin. Unfortunately, when the burn heals, the destroyed retinal tissue is replaced by scar tissue that has no light perception capability, and the victims will have scotomas, blind or partially blind areas in the visual field. In severe cases, the net result may be permanent blindness. The effective range for eye injuries from the flash may extend for many miles when a weapon is detonated as an air burst. This effective range is far greater at night when the pupils are dilated, thereby permitting a greater amount of light to enter the eye. Radiation Injuries Radioactivity may be defined as the spontaneous and instantaneous decomposition of the nucleus of an unstable atom with the accompanying emission of a particle, a gamma ray, or both. The actual particles and rays involved in the production of radiation injuries are the alpha and beta particles, the neutron, and the gamma ray. These particles and rays produce their effect by ionizing the chemical compounds that make up the living cell. If enough of these particles or rays disrupt a sufficient number of molecules within the cell, the cell will not be able to carry on its normal functions and will die. Alpha particles are emitted from the nucleus of some radioactive elements. Alpha particles are helium nuclei of nuclear origin having an atomic mass number of four and an electrical charge of two positive. Because of this charge, alpha particles produce a high degree of ionization when passing through air or tissue. Also, due to their large size and electrical charge, they are rapidly stopped or absorbed by a few inches of air, a sheet of paper, or the superficial layers of skin. Therefore, alpha particles do not constitute a major external radiation hazard. However, because of their great ionization power, they constitute a serious hazard when taken into the body through ingestion, inhalation, or an open wound. Beta particles are electrons of nuclear origin. They have a mass of approximately 1/2,000 of a hydrogen atom and an electrical charge of minus one. The penetration ability of a beta particle is greater than an alpha particle, but it will only penetrate a few millimeters of tissue and will most probably be shielded out by clothing. Therefore, beta particles, like alpha particles, do not constitute a serious external hazard; however, like alpha particles, they do constitute a serious internal hazard. Neutrons, which are emitted from the nucleus of the atom, are particles with no electrical charge and a mass of approximately one. Their travel is therefore unaffected by the electromagnetic fields of other atoms. The neutron is a penetrating radiation which interacts in billiard ball fashion with the nucleus of small atoms like hydrogen. This interaction produces high energy, heavy ionizing particles that can cause significant biological damage similar to alpha particles. Gamma rays are electromagnetic waves having no mass or electrical charge. Biologically, gamma rays are identical to x-rays of the same energy and frequency. Because they possess no mass or electrical charge, they are the most penetrating form of radiation. Gamma rays produce their effects mainly by knocking orbital electrons out of their path, thereby ionizing the atom so affected, and imparting energy to the ejected electron. Neutrons and gamma rays are emitted at the time of the nuclear explosion along with light. Gamma rays and beta particles are present in nuclear fallout along with alpha particles from unfissioned nuclear material. Neutrons and gamma rays are an important medical consideration in a nuclear explosion, since their range is great enough to produce biologic damage either alone or in conjunction with blast and thermal injuries. Treatment of Nuclear Casualties Most injuries resulting from the detonation of a nuclear device are likely to be mechanical wounds resulting from collapsing buildings and flying debris, and burns caused by heat and light liberated at the time of detonation. A burn is a burn regardless of whether it is caused by a nuclear explosion or by napalm, and its management remains the same. This is also true of fractures, lacerations, mechanical injuries, and shock. In none of these is the treatment dictated by the cause. For most of the conventional injuries, standard first-aid procedures should be followed. The following word of caution should be considered when you are treating wounds and burns. Dressings for wounds and burns should follow a closed-dressed principle, with application of an adequate sterile dressing using aseptic techniques, if sufficient medical supplies are available. Make no attempt to close the wound, regardless of its size, unless authorized by a physician. A few variations in treatment have been proposed by researchers in the field, one concerning the use of antibiotics. If signs of infection and fever develop, give antibiotics. When a physician is not available to direct treatment, the corpsman should select an antibiotic on the basis of availability and appropriateness and administer three times the recommended amount. If the antibiotic does not control the fever, switch to another. If the fever recurs, switch to still another. Overwhelming infection can develop rapidly in the pancytopenic state from burn or hematopoietic damage from radiation. Whenever a broad-spectrum antibiotic is given, administer oral antifungal agents. To date, there is no specific therapy for injuries produced by lethal or sublethal doses of ionizing radiation. This does not mean that all treatment is futile. Good nursing care and aseptic control of all procedures is a must; casualties should get plenty of rest, light sedation if they are restless or anxious, and a bland, nonresidue diet. Each member of the Armed Forces is responsible for carrying out personal decontamination measures at the earliest opportunity. Medical personnel will direct decontamination of casualties who are physically unable to perform this function. Decontamination of the ship as a whole is the responsibility of the damage control officer. The principle in personnel decontamination is to avoid the spread of contamination to clean areas and to manage casualties without aggravating other injuries. It will frequently be necessary to decide whether to handle the surgical condition or the CBR hazard first. If the situation and the condition of the casualty permit, decontamination should be carried out first. The longer the substance remains on the body, the more severe the symptoms and the greater the danger of spreading the substance to other personnel and equipment. Emergency medical conditions should always be addressed (unless significant hazard to medical staff exists) prior to radioactive decontamination. Within the limits imposed by operating in full protective gear, life-saving procedures, such as controlling massive hemorrhage or administering nerve agent antidote, should be carried out before decontamination. This is true even if a liquid agent is present. It is imperative to remember that in a mass casualty situation triage is essential to provide the greatest good to the greatest number of people. This means that some casualties will be beyond the treatment capabilities of the location. If these casualties can be stabilized without jeopardizing the mission of the treatment facility, they should be treated. Otherwise, treatment priority is to those who can be returned to duty the quickest. Medical personnel must take all reasonable precautions to protect themselves while handling contaminated casualties. This means wearing full protective gear, including the mask and gloves. Mass casualty decontamination and triage is discussed in the chapter of the HM 1 & C Rate Training Manual entitled "Medical Aspects of Chemical, Biological, and Radiological Defense."
Approved for public release; Distribution is unlimited. The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. Operational Medicine 2001 Health Care in Military Settings
This web version is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. |