Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VI: Chemical Injury

General Principles of Management

United States Department of Defense

Personal Hazards. First, do not become a casualty yourself: protect yourself and instruct your personnel to do likewise. Next, prevent further injury of the casualty: apply his protective mask and cover him, administer treatment, remove clothing, and decontaminate exposed body surfaces. Casualty decontamination may not always be as complete as desired because of the urgency of the situation or resource constraints. Thus, the potential for vapor exposure from an off-gassing residual agent or inadvertent contact with unsuspended, undetected liquid is an ever-present hazard for medical personnel.

Route of Entry. The nerve agents and blood agents are liquids, the vapors of which gain systemic access mainly via the respiratory tract. Their onset of action is precipitous and lethality can be swift. Other nerve agents, VX and thickened GD for instance, are absorbed percutaneously so that the onset of first effect may be delayed. Once in the blood stream, however, they act as quickly as the inhaled nerve agents.

Although agents such as mustard rapidly fix in the skin, the visible dermal injury takes time to develop. One observes both the early irritant effect of a mustard gas on the eyes and respiratory tract, and the delayed systemic effects of leukocytopenia with mustard and hemolysis with lewisite.

Persistent (non-volatile) agents also can contaminate uncovered food or water supplies. Ingestion of blister agent, for instance, may cause necrotic changes in the gastrointestinal tract.

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Operational Medicine 2001

Health Care in Military Settings

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