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Medical Education Division |
Operational Medicine 2001
Standard First Aid Course
NAVEDTRA 13119
Chemical, Biological, and Radiological CasualtiesBiological and chemical substances for military use are primarily antipersonnel agents; they are intended to produce casualties without the destruction of buildings, ships, or equipment. There is still a possibility that a chemical, biological, or radiological (CBR) attack may occur in the future. Although the physical damage to a ship or station may be minimal, the possibility that dangerous levels of contamination will remain after an attack is real. All personnel should understand the nature of such attacks, the methods of reducing their effects, and the handling of casualties resulting from such attacks. Defense against an attack is both an individual and a group responsibility. What an individual does before, during, and after an attack will affect both their own and the command's chances of survival. Individuals are responsible for first aid and self aid, proper use of the protective mask, 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. Chemical Warfare 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 purpose of harassing personnel, producing casualties, or contaminating food and water. Chemical agents produce harmful physiological reactions when applied to the body externally, inhaled, or swallowed. They can be spread by aircraft, projectiles, bombs, grenades, pots, candles, land mines, and missiles. These principal factors determine the method by which a chemical agent is spread: the quantity of the agent required to accomplish specific objectives, the nature of the agent being used, the distance to the place of attack, and the way in which the agent must be used. Nerve Agents Nerve agents are not quickly and easily detected. Small quantities can quickly cause casualties and deaths. They may be colorless gases with little or no odor or colorless to light brown liquids. These agents radically disturb the chemical processes of the nervous system, impairing or stopping other bodily functions. Nerve agents can enter the body by inhalation, ingestion, and absorption through the skin and eyes. Entry through the skin is extremely effective. This means that the protective mask alone is not adequate protection because the agent can enter through any exposed skin. There are now two series or groups of nerve agents: The G series and the V series. The G series is composed of the following agents: tabun (GA) "faintly fruity odor," sarin (GB), and soman (GD) "fruity camphor odor," the V series is composed of agent VX "odorless." Signs and symptoms:
Blister Agents Blister agents, also known as vesicants, are odorless and vary in duration of effectiveness. In the pure state, mustard is a yellowish, oily liquid. Most blister agents are insidious in action; there is little or no pain at the time of exposure except with lewisite (L) "geranium odor," and phosgene oxime (CX), which causes immediate pain on contact. Wet skin absorbs more mustard than dry skin. Protection from blister agents is extremely difficult, because they attack any part of the body that comes in contact with the liquid or vapor agent. The primary blister agents, distilled mustard (HD) "garlic odor," and nitrogen mustard (HN), are most effective for general use. The newer blister agents include the nitrogen mustards (HN-1) "fishy or musty odor," (HN-2) "soapy to fruity odor," (HN-3) and the mixed blister agent (HL) "garlic-like odor." Signs and symptoms:
Incapacitating Agents Incapacitating agents, also known as psycho-chemical agents, are the latest discovery. Most agents are colorless, odorless, and tasteless. They enter the body by inhalation and interfere with mental processes that control bodily functions. Many are still in the research, development, and testing stage; much remains to be learned. These agents are used to wage and win a war without resorting to the massive killing, enormous destruction of property, and immense monetary cost. An agent of this type is benzilate (BZ), a slow-acting aerosol. Although there are many unanswered questions concerning the physiological action of these compounds and much research remains to be accomplished, they offer many advantages. 1. They are flexible. The effects can range from drowsiness to complete withdrawal. 2. They are economical. They are less expensive to produce. 3. They are not destructive. Buildings will remain standing. 4. They are less injurious. Will cause less loss of life, maiming, crippling, and less permanent after-effects. 5. They are a simpler weapons system. They are easily stored, loaded into munitions, and delivered on target. 6. They are difficult to detect. They are colorless, odorless, and tasteless. Signs and symptoms:
Blood Agents 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 non-persistent agents. The most common blood agents are hydrogen cyanide (AC) "bitter almond odor" and cyanogen chloride (CK). Although AC is one of the most deadly poisons, it is one of the least effective chemical agents because it evaporates rapidly. CK deteriorates the chemical canisters in protective masks within a short period of time. Death or recovery takes place rapidly. Signs and symptoms:
Choking Agents Choking agents, also known as lung irritants, primarily affect the respiratory tract (nose, throat, and lungs), causing pulmonary edema. Their concentrations in the air are reduced fairly rapidly by water condensation (rain and fog) and by dense vegetation. Unlike nerve and blister agents, choking agents have no poisonous effect upon foods; they are too readily destroyed. The two most common choking agents are phosgene (CG) "new mown hay odor" and diphosgene (DP) "new mown hay odor." Signs and symptoms:
Vomiting Agents Vomiting agents are dispersed as aerosols and produce their effects by inhalation. The symptoms may be delayed for several minutes after initial exposure. Therefore, effective exposure may occur before the presence of the smoke is suspected. If the protective mask is then put on, symptoms will increase for several minutes, despite adequate protection. At high concentrations, effects may last for several hours. Because of their arsenical properties, these agents make foods poisonous. The most important agents of this type are diphenylchlorarsine (DA), diphenylchanosarsine (DC), and adamsite (DM). Signs and symptoms:
Tear Agents Tear agents, also known as lacrimators, are riot-control agents. They may be solids or liquids and may be dispersed in the air as vapors or smokes. This agent is highly successful in quelling riots. An individual is incapacitated for 20 to 60 seconds after exposure. Effects last 5 to 10 minutes after the individual is removed to fresh air. Tear agents include CN, CNC, CNB, BBC, and CS. Of these, CS is the newest and most effective. It produces immediate effects even in extremely low concentrations. Signs and symptoms:
Self Aid and First Aid At the first sign of a chemical agent in the atmosphere, put on your protective mask immediately. If a liquid nerve or blister agent gets on your skin or clothing, take immediate action. If your clothing is contaminated, put on new clothing and resume your duties. Treat contaminated skin with the M258A1 skin decontaminating kit. Do not get any chemicals from the kit in your eyes or mouth. The treatment requires the use of two packets: Decon 1 wipe and Decon 2 wipe, which are found in the kit. Use these packets according to the instructions on the M258A1 carrier. After use, you should occasionally examine the contaminated areas for local sweating and muscular twitching. If none develops in the next half hour and you have no tightness in your chest, your self aid was successful. If these symptoms do occur, immediately use your atropine and 2 Pam-Chloride injectors. These injections should be self-administered, through your clothing and into the outside of your thigh. If no other symptoms develop, one injection each of atropine and 2 Pam-Chloride is enough. Dryness of the mouth is a good sign indicating that you have had enough atropine. If nerve agent symptoms persist, you may give yourself up to two more injections of atropine and 2 Pam-chloride at 10 to 15 minute intervals. More than three injections may be given only under the direct supervision of medical personnel or under the direction of the petty officer or officer in charge of the battle station. If liquid nerve agent gets into your eyes, immediately flush your eyes for 30 seconds or more. This must be done in spite of the presence of nerve agent vapor. Hold your breath as long as possible during this procedure. After taking several breaths with the mask on, again remove the mask and complete decontamination. Watch the pupil of the contaminated eye, if it gets smaller, inject into your thigh one of your atropine automatic injectors at once. Do not use atropine until you are sure that the symptoms are those of nerve agent poisoning. Severe nerve agent exposure may rapidly cause unconsciousness, muscular paralysis, and loss of breathing. When this occurs, atropine and 2 Pam-chloride alone will not save a life. Begin rescue breathing immediately and continue until breathing is restored or the casualty can be taken over by medical personnel. An atropine injection increases the effectiveness of rescue breathing. It should be administered as soon as possible, preferably by someone who is not performing rescue breathing. Whenever liquid or vaporized blister agents are known to be present, be sure to wear your protective mask. Liquid blister agents in the eyes or on the skin must be dealt with immediately. If liquid blister agent gets into your eyes, immediately flush the eyes for 30 seconds to not more than 2 minutes. The risk of leaving blister agents in the eye is much greater than the risk of exposure to blister agent vapors. Therefore, the decontamination procedure must be performed in spite of the presence of vapor. Phosgene oxime reacts rapidly, decontamination will not be entirely effective after pain has started. The contaminated area should be flushed immediately with large amounts of water. If you notice any stimulation of breathing, an odor of bitter almonds, or any irritation of the eyes, nose, or throat, mask at once. Within a few seconds after exposure, you probably will not be able to put on the mask by yourself. There is currently no self-aid or buddy-aid for blood agent symptoms. Affected personnel should seek medical attention immediately. Irritation of the eyes or a change in the taste of a cigarette might indicate the presence of phosgene. Smoking may become tasteless or offensive in taste. If any one of the signs occur, hold your breath and put on your protective mask immediately. Unless you have difficulty breathing, experience nausea or vomiting, or have more than the usual shortness of breath on exertion, continue your normal combat duties. If any of these symptoms occur, you should rest quietly until you are evacuated by medical personnel. Biological Warfare Biological warfare is the use of living agents such as bacteria, viruses, and other pathogenic microorganisms to produce disease or death of humans, animals, or plants. Biological agents are a threat that must be recognized and prepared for by all personnel. A large part of the defense against biological agents depends upon self-protection and the ability to carry out duties in the presence of such agents. Biological agents may be spread in various ways. They may be used as fillings in bombs or shells or dispersed through aerial or surface spray tanks. They may be released from munitions such as aerosols. The aerosols are cloud like formations of solid or liquid particles in which the biological agents are held suspended. There are no simple and rapid methods to detect biological agents such as those used to detect chemical agents and nuclear radiation. The positive detection and identification of a pathogen can be obtained only by taking samples of the organisms, growing a culture of the organisms under laboratory conditions, and then subjecting the culture to a variety of biochemical and biological tests. Obviously, the final identification of pathogens is a problem for medical personnel. Effects Biological agents may be selected to produce various strategic or tactical goals. These goals range from brief but crippling diseases to widespread serious illnesses with many deaths. The effects of biological agents vary widely, depending upon the agent or agents selected. The mere presence of a disease-producing organism on or in the body of a host does not guarantee infection or illness. In fact, pathogenic organisms are frequently present and cause no harm in the human body for long periods of time. Microorganisms Microorganisms are minute living organisms, which can usually be seen only with the aid of a microscope. Each organism is composed of a single cell or a group of associated cells capable of carrying on all functions of life, including growth and reproduction. They do not have a digestive tract, organs of sight, or a heat regulating system. Many of them resemble plant life and are regarded as being in the vegetable kingdom. Some, such as the protozoa, have characteristics that place them in the animal kingdom. Microorganisms are universally distributed in the air, water, and soil. Those capable of producing disease are known as pathogens. Most of these pathogens are parasites and live on or within another living organism, called a host, which provides shelter and nourishment. Bacteria are very small single-cell organisms. They may be spherical, rod-shaped, or spiral in form. They are visible through an ordinary microscope. They are present everywhere in nature, in air, soil, water, and animal and plant bodies, both living and dead. Many types of bacteria can cause infection. The powerful toxins produced by some could be used alone for biological warfare. Diseases caused by bacteria are typhoid fever, meningitis, and tuberculosis. Rickettsiae are usually smaller than bacteria, but they are still visible through an ordinary microscope. They grow only within living cells, and they are potent disease producers in man and animals. Many of them are transmitted by insect bites. Diseases caused by rickettsiae are Rocky Mountain spotted fever and typhus. Viruses are even smaller than rickettsiae and are not visible with the ordinary microscope. Some have been photographed through the electron microscope. Like the rickettsiae, they will grow only within the living cell. Viruses and rickettsiae are probably less well distributed than bacteria because they are more particular in their growth requirements. However, it is known that they can survive for short periods of time in the air. Diseases caused by viruses are mumps, smallpox, and influenza. Fungi include such plants as yeasts, molds, and mildews. These organisms are known for their ability to spoil foods and fabrics. Generally speaking, diseases caused by fungi in humans are less severe than those produced by other microorganisms. They usually produce low-grade, mild, and often chronic diseases. A few fungi are capable of producing serious diseases. Diseases of plants caused by fungi are potato blight, cotton root rot, corn smut, and wheat rust. Protozoa are single-celled, animal-like forms that occur in a variety of shapes and often have complicated life cycles. Some protozoa cause diseases in both man and animals. Problems of production and transmission limit their application in biological warfare, but it must not be assumed that these problems could not be solved. Protozoa infections of humans are amoebic dysentery and malaria. Self Aid and First Aid Since symptoms caused by pathogenic biological agents may not appear for some time, you may not know that a biological attack has occurred. If you suspect biological contamination, put on your protective mask and observe the basic principles of preventive medicine. These include individual hygiene, sanitation, and physical check-ups. Report any illness to medical personnel immediately. If there is a possibility that you have been contaminated, take the following actions: Carefully remove your clothes to avoid spreading any contamination, and take a thorough soap and water shower as soon as possible. Change your clothes and dispose of contaminated clothing as directed. Pay careful attention to your face and hands. Use a fingernail brush to remove dirt under your nails. Brush your teeth and gums frequently, including the roof of your mouth and your tongue. Some biological agents take effect with great speed. You should apply self aid or first aid immediately if you think you may have been exposed. Radiological Warfare When a nuclear device is detonated in space, in the atmosphere, or at or below the surface of the earth or ocean, many characteristic effects are produced. Some effects, such as nuclear radiation and expanding debris, are common to all of these environments, though varying in degree. Other effects, such as cratering, blast, and water shock, are peculiar to certain environments. Effects such as light and heat are visible or tangible. Others, like nuclear radiation, are not directly apparent and can only be discerned by instruments or secondary effects. Some effects occur in and last only micro-seconds, whereas others occur in micro-seconds but linger for days, months, or even years. Meteorological conditions such as atmospheric pressure, temperature, humidity, winds, and precipitation can affect some of the observed phenomena. All nuclear detonations, however, produce effects that can damage equipment and injure personnel. Airburst An airburst is a burst where the point of detonation is below an altitude of 100,000 feet and the fireball does not touch the surface of the earth. Air blast, thermal radiation (heat and light), an electromagnetic pulse, and initial nuclear radiation (neutron and gamma rays) are produced around the point of detonation. There will be no significant residual nuclear radiation (gamma and beta radiation from airborne or deposited radioactive material) unless rain or snow falls through the radioactive cloud. High-altitude Burst A high-altitude burst is an airburst where the point of detonation is above 100,000 feet. The high-altitude burst produces air blast, thermal radiation, an electromagnetic pulse, initial nuclear radiation, and atmospheric ionization. At such high altitudes, the proportion of energy appearing as blast decreases considerably, and at the same time the proportion of radiation energy increases. Surface Burst A surface burst is a burst where the point of detonation is on, or above, the surface of the earth and the fireball touches the surface of the earth. The surface burst produces air blast, thermal radiation, and an electro-magnetic pulse. Surface bursts over water will also produce underwater shock and surface water waves, but these effects will be of less importance except to submarines. Overland, earth shock will be produced but will not be an important effect at any significant distance from the point of detonation. Underwater Burst An underwater burst is a burst where the point of detonation is below the surface of the water. An underwater burst produces underwater shock and a water plume that then causes a base surge. Bursts with very shallow points of detonation can also produce air blast, initial nuclear radiation, fallout, and possibly some thermal radiation. These effects will be reduced in magnitude from those of a water surface burst and will become rapidly insignificant as the depth of the point of detonation is increased. Underground Burst An underground burst is a burst where the point of detonation is below the ground's surface. An underground burst produces a severe earth shock, especially near the point of detonation. Thermal radiation, air blast, initial nuclear radiation, and fallout will be negligible or absent if the burst is confined below the earth's surface. Early fallout can be significant, and at distances near the explosion, base surge (evidenced by a dust cloud) will be an important hazard. Self Aid and First Aid The blast and heat injuries from a nuclear explosion are treated the same as those from explosive bombs, incendiary weapons, and mechanical accidents. Fractures, concussions, lacerations, contusions, bleeding, burns, shock, and exposure are treated with standard first aid measures. There is nothing that needs to be done immediately for nuclear radiation sickness. Remember that you can receive a dose of radiation even though you are not contaminated with radioactive particles. If there is the possibility that you have been exposed to nuclear radiation, be sure you are examined and treated by medical personnel. If directed, proceed to a personnel decontamination station. Discard your clothing and equipment and take a shower using plenty of soap and warm water. In washing, pay close attention to the hairy parts of your body, body creases, and fingernails, where dirt tends to gather. Decontamination The basic purpose of decontamination is to remove or neutralize CBR contamination so that the mission of the ship or station can be carried out without endangering the life or health of assigned personnel. Decontamination operations may be both difficult and dangerous. Personnel engaged in these operations must be thoroughly trained in the proper techniques. Certain operations, such as the decontamination of food and water, should be done only by experts qualified in such work. However, all members of a command should receive adequate training in the elementary principles of decontamination so that they can assist in emergency decontamination operations. After an attack, data from CBR surveys will be used to determine the extent and degree of decontamination. Contaminated personnel must be decontaminated as soon as possible. Before decontamination of installations, machinery, and gear is undertaken, appraisals of urgency must be made in the light of the tactical situation. References 1. NAVEDTRA 10572, Damage Controlman 3 & 2
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