Operational Medicine 2001
Field Medical Service School
Student Handbook

CHEMICAL AGENT CASUALTIES

FMST 0415

17 Dec 99

TERMINAL LEARNING OBJECTIVE:

1.  Given a chemical warfare agent casualty in a combat environment (day or night) and the

     standard Field Medical Service Technician supplies and equipment, manage chemical warfare

     agent casualities, per the references.  (FMST.04.16)

ENABLING LEARNING OBJECTIVES:

1.      Without the aid of reference materials and given a list of chemical warfare agents, select the appropriate treatment for each agent, per the student handbook. (FMST.04.16a)

2.      Without the aid of reference materials and given a list of chemical warfare agents, select the appropriate characteristics for each agent, per the student handbook. (FMST.0416b)

3.      Without the aid of reference materials and given the FMST MOLLE Medic bag and a simulated casualty, identify, treat, and monitor a chemically contaminated casualty per the student handbook. (FMST.04.16c)

OUTLINE:

A.  A BRIEF HISTORY OF CHEMICAL WARFARE

1.      The use of chemical weapons dates from at least 423 B.C. when allies of Sparta used sulfur fumes during the Peloponnesian War.

2.  In World War I, German units released Chlorine and Mustard Gas which caused several

           thousand casualties and deaths.

3.  During World War II, Germany utilized cyanide gas and other chemical agents in its

     concentration camps.

       4.  Widely publicized reports of Iraqi use of chemical agents against Iran during the 1980's

            led to a United Nations investigation that confirmed the use of Sulfur Mustard (HD) and           

            Sarin (GB).

       5.  During Operation Desert Storm, the United States destroyed several Iraqi chemical

            stockpiles both by air and land. Since Operation Desert Storm, Congress has passed a bill

            mandating the destruction of all U.S. chemical agents.

B.  CHEMICAL WARFARE (CW)

      1.  DEFINITION - The use of chemical agents in military operations to kill, seriously injure,

           or incapacitate personnel through physiological effects.

C.  TYPES OF CW AGENTS, CHARACTERISTICS, SYMPTOMS AND TREATMENTS

      1.  NERVE AGENTS

           GA-Tabun         GB-Sarin

           GD-Soman        VX

a.  CHARACTERISTICS:

1.      Colorless to light brown liquid.

2.      Nonpersistent.

3.      Faint fruity odor.

4.      May be inhaled, ingested, and absorbed through the skin.

           b.  SIGNS/SYMPTOMS:

                1.  S/S can appear from seconds to hours depending on the agent and amount of

                     exposure.

2.      Runny nose.

3.      Chest tightness.

4.      Headache above the eyes with blurred vision.

5.      Fasiculation-localized muscle twitching which can progress into convulsions.

6.      Excess salivation.

7.      Constricted pupil - classic symptom of nerve agent.

8.      Incontinence - bowel and urinary tracts.

9.      Respiratory arrest.

10.  Death.

           c.  TREATMENT

1.      Don protective mask.

2.      Decontaminate exposed skin.

3.      Intramuscularly, inject one MARK I Syrette (2mg Atropine Sulfate and 2 PAM-Chloride) every 10 to 15 minutes.  A maximum of three syrettes may be administered.  When giving the third syrette, 10 mg Diazepam (Valium) is also administered.

     a)  If symptoms continue after three auto injectors have been administered, medical personnel may administer repeated Atropine (2mg) injections at three to five-minute intervals and injections should be titrated to a reduction of secretions and to a reduction of ventilatory resistance.

                4.  Administer CPR as tactical situation permits.

      2.  BLISTER AGENTS

           HD-Distilled Mustard         HN-Nitrogen Mustard

           L-Lewisite                          Phosgene Oxide

           a.  CHARACTERISTICS:

1.      Yellow to brown in color.

                2.  Persistent. 

                3.  Odor:

                     a)  Distilled Mustard (HD) - smells of garlic or horseradish.

                     b)  Nitrogen Mustard (HN) - smells fishy.

                     c)  Lewisite (L) -  smells like geraniums.

                     d)  Phosgene Oxide -  smells pepperish/pungent odor.

5.      Heavier than water.

6.      May be absorbed through the skin.

           b.  SIGNS / SYMPTOMS:

1.      Appear after 2 to 48 hours of contamination.

2.      Skin - Redness, blisters, and necrosis where the agent touches.

3.      Nausea and vomiting.

4.      Eyes - Edema of the eyes, eyelids, and corneal scarring.

5.      If ingested, intense pain in the GI tract and diarrhea.

           c.  TREATMENT

1.      Don protective mask.

2.      Decontaminate using a M258 kit.

3.      Flush eyes with copious amounts of water to prevent scarring of the cornea.

4.      Apply Sodium Sulfacetamide ophthalmic ointment to the eyes in first 24 hours.

5.      Consider giving Morphine for pain if needed.

                6.  Use antibiotics and IV fluid replacement as required.

      3.  BLOOD AGENTS

           AC-Hydrocyanic Acid         CK-Cyanogen Chloride

           a.  CHARACTERISTICS:

1.      Colorless liquids dispersed in gas form.

2.      Smells like bitter almonds or peach pits.

3.      Must be inhaled.

           b.  SIGNS / SYMPTOMS:

1.      Lacrimation - tearing of the eyes.

2.      Skin flushed with red streaks.

3.      Deep breathing and gasping.

4.      Unconsciousness and seizures - 30 seconds after exposure.

5.      Respiratory arrest and death - 2 to 4 minutes if treatment is delayed.

           c.  TREATMENT:

1.      Don protective mask.

2.      Decontaminate exposed skin.

3.      Treat symptomatically as required.

                4.  Administer IV Sodium Nitrite (10ml) followed by Sodium Thiosulfate (50ml)

                     a)  Second treatment with each of the two antidotes may be given at up to half the  

                          original dose if needed.

                5.  Administer CPR as tactical situation permits; giving Oxygen if available.

      4.  CHOKING AGENTS

           CG-Phosgene         DP-Diphosgene

           CL-Chlorine

           a.  CHARACTERISTICS:

1.      Colorless.

2.      Smell like freshly mown hay, grass or corn.

3.      Must be inhaled.

                4.  Contaminated food is of little consequence.  Agent has no effect on body when 

                     ingested.

4.      Rapidly becomes nontoxic in water.

           b.  SIGNS / SYMPTOMS:

1.      Headache, and eye irritation.

2.      Coughing and choking.

3.      Substernal ache with sensation of pressure.

                4.  Two to six hours after exposure: 

                     a)  Dyspnea - difficulty breathing.

                     b)  Cyanosis - blue tint to skin due to poor oxygenation.

                     c)  Pneumonia - latent sign.

                     d)  Pulmonary edema and frothy sputum may be observed.

           c.  TREATMENT

1.      Don protective mask.

2.      Establish a patent airway.

3.      Provide rest, warmth, and sedation.

4.      No known antidote for choking agents.

                5.  Give Oxygen, if available.

      5.  VOMITING AGENTS

           DA-Diphenylchlorarsine         DC-Diphenylcyanarsine

           DM-Adamsite

           a.  CHARACTERISTICS:

                1.  Color:

                      a)  DA and DC have a white smoke color.

                      b)  DM has a canary yellow smoke color.

2.      Odor of burning fireworks.

3.      Crystalline solids, dispersed as a gas.

4.      Must be inhaled.

           b.  SIGNS / SYMPTOMS:

1.      Appear 30 seconds to two minutes after exposure.

2.      Nasal stuffiness and severe headache.

3.      Intense burning in the throat.

4.      Chest tightness and pain.

5.      Lacrimation.

                6.  Coughing, sneezing, nausea, and vomiting.

           c.  TREATMENT: (symptomatic)

1.      Don Protective Mask.

2.      Get to fresh air as soon as possible.

3.      Lift mask to vomit.

                4.  Untreated symptoms usually subside within 30 minutes to three hours.

      6.  LACRIMATORS/TEAR AGENTS

           CS-Ochlorobenzylmalonitrile         CN-Chloracetophenone

           a.  CHARACTERISTICS:

1.      Crystalline solids or liquids dispersed in the air as vapors or white smoke.

                2.  Strong pepper odor for CS and apple blossom odor for CN.

2.      CS can cause severe burns.

3.      Absorbed through the eyes, nasal passages and skin pores.

           b.  SIGNS / SYMPTOMS:

1.      Burning eyes and pain.

2.      Profuse tearing.

3.      Chest tightness, coughing and dyspnea.

4.      Blepharospasm - spasm around the eye.

           c.  TREATMENT:

1.      Don protective mask.

2.      Get to fresh air ASAP.

                3.  Heavy contaminants should be flushed from the eyes with copious amounts of

                     water.

      7.  INCAPACITATING AGENTS

           BZ-Buzz Gas

           a.  CHARACTERISTICS:

1.      Odorless and non-irritating.

2.      Highly potent.

                3.  Produce their effects mainly by altering or disrupting the higher regulatory activity

                     of the Peripheal Nervous System and Central Nervous System.

3.      Rate of action:  Delayed, 1-4 hours.

           b.  SIGNS / SYMPTOMS:

1.      Skin – Dry and flushed.

2.      Slowing of mental activity.

3.      Disorientation and hallucinations.

           c.  TREATMENT: (supportive)

1.      Clear the airway if needed.

                2.  Treat as for heat stroke.

3.      Give fluids only if the victim can drink unassisted.

4.      Approach with caution, the individual could become dangerous.

5.      Remove all weapons.

6.      Restrain as needed.

D.  NATO CW WARNING MARKER

      1.  A triangular sign measuring 11"x 8" x 8" with yellow background, and red letters spelling 

          " GAS."

REFERENCE (S):

1. HM3&2 Rate Training Manual (NAVEDTRA 10669)

2.Aspects of NBC Defensive Operation (NATO handbook)

3.USAMRICD Medical Management of Chemical Casualty Handbook

Field Medical Service School
Camp Pendleton, California

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Operational Medicine 2001
Health Care in Military Settings

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