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

Initial Priorities

United States Department of Defense

Casualties may present with combined injuries on the integrated battlefield - that is, chemical/nuclear exposure combined with trauma or illness. Body heat build-up inside the protective ensemble, with resultant dehydration or hyperthermia, further complicates the picture. The initial issue facing the medical officer, then is determination of treatment priorities for such combined injuries.

There is no single "best" way to prioritize emergency treatment for chemical or mixed casualties. In general, respiratory insufficiency and circulatory shock, whatever the cause, present the more immediate life threatening problems. One possible approach is suggested below:

1. Treat respiratory failure and control massive hemorrhage.

2. Administer chemical agent antidote(s).

3. Decontaminate the face (and protective mask if donned).

4. Remove contaminated clothing and decontaminate exposed skin.

5. Render emergency care for shock, wounds, and open fractures.

6. Administer supportive medical care as resources permit.

7. Transport the stabilized patient to a chemically clean area.

The following five sections group CW agents according to the categories of Table 3.

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Operational Medicine 2001

Health Care in Military Settings

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