PDF TREATMENT OF CHEMICAL AGENT CASUALTIES AND CONVENTIONAL MILITARY CHEMICAL INJURIES

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As circumstances permit, casualties in this category may be reexamined and possibly be retriaged to a higher category. Quickly ensure that the victim has a patent airway. Maintain adequate circulation. If trauma is suspected, maintain cervical immobilization manually and apply a decontaminable cervical collar and a backboard when feasible. Apply direct pressure to stop arterial bleeding, if present.

Administration of antidotes is a critical step in managing a nerve agent victim; however, this may be difficult to achieve in the Hot Zone, because the antidotes may not be readily available, and procedures or policies for their administration while in the Hot Zone may be lacking. If the military Mark I kits containing autoinjectors are available, they provide the best way to administer the antidotes.

One autoinjector automatically delivers 2 mg atropine and the other automatically delivers mg 2-PAM Cl. Otherwise, administer antidotes as described in Table 3. If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. Dependant upon available resources, triage of remaining victims should be performed.

Victims who are unable to walk may be removed on backboards or gurneys. If these are not available, carefully carry or drag victims to safety. Should there be a large number of casualties, and if decontamination resources permit, separate decontamination corridors should be established for ambulatory and non-ambulatory victims. Assisted ventilation should be started after administration of antidotes for severe exposures. Repeat atropine 2 mg IM at 5 10 minute intervals until secretions have diminished and breathing is comfortable or airway resistence has returned to near normal.

Resulting solution is 3.


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Severe symptoms include unconsciousness, convulsions, apnea, flaccid paralysis. Rapid decontamination is critical to prevent further absorption by the patient and to prevent exposure to others. Decontaminable gurneys and back boards should be used if possible when managing casualties in a contaminated area. Decontaminable gurneys are made of a monofilament polypropylene fabric that allows drainage of liquids, does not absorb chemical agents, and is easily decontaminated.

These are nonpermeable and readily decontaminated. The Chemical Resuscitation Device is a bag-valve mask equipped with a chemical agent cannister that can be used to ventilate casualties in a contaminated environment. Personnel should continue to wear the same level of protection as required in the Hot Zone see Rescuer Protection under Hot Zone, above. Stabilize the cervical spine with a decontaminable collar and a backboard if trauma is suspected.

Antidote administration may be required to allow ventilation. Suction oral and bronchial secretions. Administer supplemental oxygen if cardiopulmonary compromise is suspected. Assist ventilation with a bag-valve-mask device equipped with a cannister or air filter if necessary. Direct pressure should be applied to control heavy bleeding, if present. Administer antidotes if they have not been administered.

If possible, a system should be employed to track antidotes administered.

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If atropine was previously administered and signs and symptoms have not diminished within 5 to 10 minutes, give a second dose of atropine 2 mg for adults or 0. The eyes must be decontaminated within minutes of exposure to liquid nerve agent to limit injury. Flush the eyes immediately with water for about 5 to 10 minutes by tilting the head to the side, pulling eyelids apart with fingers, and pouring water slowly into eyes.

There is no need to flush the eyes following exposure to nerve agent vapor. Do not cover eyes with bandages. If exposure to liquid agent is suspected, cut and remove all clothing and wash skin immediately with soap and water. If shower areas are available, a thorough shower with soap and water should be used. However, if water supplies are limited, and showers are not available, an alternative form of decontamination is to use 0. Place contaminated clothes and personal belongings in a sealed double bag.

In cases of ingestion, do not induce emesis. If the victim is alert and able to swallow, immediately administer a slurry of activated charcoal. As soon as basic decontamination is complete, move the victim to the Support Zone. All victims must be decontaminated properly before entering the Support Zone see Decontamination Zone , above.


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If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. Ensure adequate respiration; administer supplemental oxygen if cardiopulmonary compromise is suspected. In a severely exposed casualty unconscious, gasping, or not breathing , the antidotes will be required to allow ventilation. Establish intravenous access if necessary. Attach a cardiac monitor, as needed. Direct pressure should be applied to stop bleeding, if present.

Administer antidotes if they have not been administered see Antidotes under Hot Zone , Table 3. Administer atropine 2 mg for adults and 0. If the victim is alert and able to swallow, immediately administer a slurry of activated charcoal if not given previously. Intubate the trachea in cases of coma or respiratory compromise, or to facilitate removal of excessive pulmonary secretions.


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  • When the patient's condition precludes endotracheal intubation, perform cricothyrotomy if equipped and trained to do so. Frequent suctioning of the airways will be necessary to remove mucous secretions. When possible, atropine and 2-PAM Cl should be given under medical supervision to symptomatic patients who have known or strongly suspected nerve agent toxicity see Antidote sections, above. Patients who are comatose, hypotensive, or seizing or have cardiac dysrhythmias should be treated according to advanced life support ALS protocols. Diazepam 5 to 10 mg in adults and 0. Lorazepam or other benzodiazepines may be used but barbiturates, phenytoin, and other anticonvulsants are not effective.

    Report to the base station and the receiving medical facility the condition of the patient, treatment given, and estimated time of arrival at the medical facility. Consult with the base station physician or the regional poison control center for advice regarding triage of multiple victims. Patients who are seriously symptomatic as in cases of chest tightness or wheezing , patients who have histories or evidence of significant exposure, and all patients who have ingested acrolein should be transported to a medical facility for evaluation.

    Others may be discharged at the scene after their names, addresses, and telephone numbers are recorded. Those discharged should be advised to seek medical care promptly if symptoms develop see P atient Information Sheet below. Previously decontaminated patients may be treated or held for observation. Others require decontamination as described below. Evaluate and support the airway, breathing, and circulation. If the patient is apneic, give antidotes immediately see Antidote section below. Intubate the trachea in cases of respiratory compromise. Suctioning may be required for excessive bronchial secretions.

    If the patient's condition precludes intubation, surgically create an airway. If contaminated patients arrive at the Emergency Department, they must be decontaminated before being allowed to enter the facility. Decontamination can only take place inside the hospital if there is a decontamination facility with negative air pressure and floor drains to contain contamination. Personnel should wear the same level of protection required in the Hot Zone see Rescuer Protection under Hot Zone , above.

    Patients who are able and cooperative may assist with their own decontamination. Remove and double bag contaminated clothing and all personal belongings. For patients exposed to nerve agent vapor only, remove outer clothing and wash exposed areas including the head and hair with soap and water.

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    Share this page. To share this page just click on the social network icon of your choice. Twitter Facebook Delicious Google Technorati. John Hopkins Bioterrorism Information and Resources. Medical Society of the State of New York. Appendix B describes measures for handling contaminated clothing and equipment at medical treatment facilities MTFs.

    Appendix C describes medical management and treatment in chemical environment operations. Appendix D describes procedures for individual skin protection and decontamination. Appendix E describes procedures for administering nerve agent antidotes. Appendix H provides information regarding protection and treatment of military working dogs MWDs. The principal audience for this publication is the members of the Armed Forces Medical Services and other medically trained or qualified personnel. Published by Independently Published, United States Additionally, this publication provides information on first aid self-aid and buddy aid and enhanced first aid combat lifesaver [United States U.

    Army and U. Marine Corps] for these casualties. This publication classifies and describes CW agents and other hazardous chemicals associated with military operations, and describes how to diagnose and treat conventional military chemical injuries for example, riot control agents, obscurants, incendiary agents, and other toxic industrial chemicals [TICs]. Further, thispublication-Describes procedures for recognizing chemical agent casualties Appendix A. Describes measures for handling contaminated clothing and equipment at medical treatment facilities MTFs Appendix B.

    Describes medical management and treatment in chemical environment operations Appendix C.

    MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES - INCAPACITATING AGENTS

    Describes procedures for individual skin protection and decontamination Appendix D. Describes procedures for administering nerve agent antidotes Appendix E. Metric measurements used throughout this publication are approximate equivalents of the customary units of measure. They are provided for the convenience of the users of this publication.

    The principal audience for this publication is the members of the Armed Forces Medical Services and other medically qualified personnel. This publication uses joint terms where applicable. Selected joint and Army terms and definitions appear in both the glossary and the text. Terms and definitions for which this publication is the proponent publication are boldfaced in the text. For other definitions shown in the text, the term is italicized and the number of the proponent publication follows the definition.

    About this Item: War Department. Addenda sheets included. Front cover is missing a 2" x 1" piece on the top. Rear cover has a band of discoloration along the outer edge. Seller Inventory C Further, this publication- 1 Describes procedures for recognizing chemical casualties Appendix A. From: Gyan Books Pvt. Delhi, India. Reprinted in with the help of original edition published long back []. As these are old books, we processed each page manually and make them readable but in some cases some pages which are blur or missing or black spots.

    If it is multi volume set, then it is only single volume, if you wish to order a specific or all the volumes you may contact us. We expect that you will understand our compulsion in these books. We found this book important for the readers who want to know more about our old treasure so we brought it back to the shelves. Hope you will like it and give your comments and suggestions.

    Seller Inventory PB Stamp on cover. It explains the use; classification; and physical, chemical, and physiological properties of these agents and compounds. Purpose This publication provides a technical reference for CB agents and related compounds.

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    The technical information furnished provides data that can be used to support operational assessments based on intelligence preparation of the battlespace IPB. Item added to your basket View basket. Proceed to Basket. View basket.

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