EFFECTS AND CONSIDERATIONS

OBJECTIVES (TCS)

• Equipment requirements
• Expedient improvised shelters
• Survival considerations
• Personal hygiene

OBJECTIVES (CONT.)

• Major Types of Chemical Agents/Treatments
• Likelihood of Risk and Destructive Power
• Summary
• Questions

OBJECTIVES (CONT.)

• Summary
• Questions

NBC WARFARE:
"Nuclear, biological, and chemical (NBC) warfare is not a separate, special form of war, but instead battlefield conditions just like rain, snow, darkness, electronic warfare, and heat. Units must train to accomplish their wartime missions under all battlefield conditions. Whenever NBC is separated from other training events or conditions, our soldiers regard operations under NBC conditions as a separate form of warfare (Officer comment during chemical training SOLID SHIELD 87, Army Chemical Review, January 1988)."

Chemical Warfare Agents:
"Chemical warfare (CW) agents produce both immediate and delayed effects that will degrade operations through lethal, incapacitating, or other damaging effects to individuals as well as contamination of equipment, supplies, and critical terrain features. The types of chemical warfare agents that could be encountered by GUARDIAN ANGEL forces are classified as lethal and incapacitating. Agents may exist as solids, liquids, or gases. In addition, toxic industrial materials and potentially dangerous herbicides/pesticides could be encountered accidentally or employed by an adversary."

EQUIPMENT REQUIREMENTS

BASIC MOPP CONFIGURATION

• Chemical Protective Overgarments
• Mask
• Over boots and gloves
• Decontamination kits
• Detection Kits

TWO TYPES OF CHEMICAL PROTECTIVE OVERGARMENTS:

• the fabric may be impermeable to most molecules, even to air and water vapor.

OR
• the fabric may be permeable to most molecules but chemically alters or physically removes chemical agents before they reach the skin.

First type of fabric can be butyl rubber or an impermeable plastic.

Pros: It offers complete protection against all agent threats.

Cons: Places a heavy heat load and limits movement. Since skin doesn't contact outside air, sweating does not cool body and heat is trapped. (Heat rash probable)

Second and most commonly used type allows some limited air exchange through the fabric but filters the air through charcoal lining which then absorbs the agent.

Pros: More breathable and wearable in warm environments

Cons: Movement is still limited and heat injuries are still factors.

MASK

• Joint Service General Purpose Mask
• Two models M50/M51
• We use the model M50 mask

The M50 mask is built on a butyl/silicone rubber faceblank to prevent air from escaping the seal created around the face.

A front module assembly provides drinking, communications, and filtering capabilities.

The mask is kept from fogging due to the flow of filtered air through the nose cup past the eye lenses.

OVERBOOTS AND GLOVES:
Keep feet and hands safely contained from any chemical agents. Mobility/dexterity is greatly hindered and can increase chance of heat injuries.

All gloves and boots can be effectively decontaminated with simple 5% household bleach.

DETECTION AND DECON KITS:
--M8 and M9 are most common detection devices.
M8 paper detects and identifies the type of GA (G series nerve agent) simulant from the vial by changing color in less than 30 seconds.


M9 paper turns pink, red, reddish brown, or red-purple when exposed to an agent but does not identify the specific agent. It is similar to masking tape and can be taped to surfaces and checked periodically.

-M295 Decontamination Kit
This is the primary decontamination kit we carry.

The M295 is used to apply de- contaminant to an individual’s personal equipment, including mask, hood, and boots.

EXPEDIENT IMPROVISED SHELTERS

CHEMICALLY PROTECTED DEPLOYABLE MEDICAL SYSTEM:
-Capable of sustaining continuous operations for up to 72 hours in a contaminated environment.

-This system provides medical personnel a contamination-free work space allowing them to operate without wearing cumbersome individual protective equipment items.

-The system is also equipped with two 12-person latrines and 20,000 gallons of water.

OTHER SHELTERS:
-Collectively Protected Expeditionary Medical Support
-Chemical and Biological Protected Shelter
-M20 Simplified Collective Protection Equipment
-Modular General Purpose Tent System
-Chemical/Biological Protective Liner System

All these shelters are similar in nature with exception to sizes which vary.

The Patient Protective Wrap:
Designed to protect a patient during evacuation after the chemical protective overgarment has been removed and the patient has received medical treatment.

A patient can remain in the wrap for up to 3 hours. The M48 motor blower must be attached to provide fresh air to the patient.

Individual Chemical Patient Resuscitation Device:
It is a ventilatory system that can be used in contaminated environment.

The device can deliver up to 600 mL of filtered air per cycle at a rate of 30 cycles per minute, and it can be used in contaminated environments as well as all conventional ventilation emergencies.

SURVIVAL CONSIDERATIONS

Survival considerations will vary in different environments.
-Urban Areas
-Desert Areas
-Low terrain temperate zone areas
-Mountain Areas
-Jungle Areas
-Cold Weather Regions
-Maritime and Riverine Areas
-Atmospheric Environments

Urban Areas:
Structures such as sewers, storm drains, concrete buildings, subways, and basements, can protect against spray attacks of chemical agents.

GUARDIAN ANGEL personnel should avoid low areas where agents tend to collect. Personnel should attempt to shut down ventilation systems in urban structures to prevent the spread of vapor or aerosol hazards.

The potential for a mass casualty event due to the population density is high.

Desert Areas:
Temperatures can vary from below freezing to highs of 90 to 125 degrees F resulting in unstable temperature gradients that are not favorable to chemical attacks.

Evaporation of chemical agents during the day will rapidly create a downwind hazard and an inhalation problem.

With nightfall, the desert cools rapidly, and a stable temperature gradient occurs creating the possibility of night or early morning attacks.

Low terrain temperate zones:
Terrain features such as tall grass or scrub brush have the tendency to retard the flow of an agent cloud, thus reducing the overall size of the contamination.

The grass and brush may absorb the chemical agent, which would not pose a significant effect on the mission.

However, movement through the area requires care because the absorbed agent may be released when the vegetation is disturbed or crushed, creating a secondary toxic hazard.

Mountain Areas:
Rugged terrain limits deployment of large forces, reduces maneuver, and impedes logistical support. Shelters are difficult to dig and may require improvisation using rocks, snow, and timber. The same terrain may also provide caves, ravines, and cliffs as a natural source of protection.

Chemical agents are heavier than air and will settle in valleys and depressions.
Mountain breezes have the capacity to push agents down and within the valley. High dosages are less likely on crests or sides of ridges or hills.

Jungle Areas:
Climatic features of constant temperatures are heavy rainfall and very high humidity. These features increase the survivability of biological/chemical agents.

In thick jungle, there is usually little or no wind and the canopy blocks most of the sunlight from the ground, thus providing excellent conditions for enemy use of chemical agents and toxins.

Heat injuries will also complicate the situation and should be noted.

Cold Weather Regions:
In cold environments agents may be undetectable, yet still hazardous.

Most decontaminates have reduced effectiveness at temperatures below 0 degrees F.
But..
Sarin gas, most choking agents, hydrogen cyanide, and mustard agents can still be effective and used dangerously due to their ability to withstand freezing temps ranging from -20 to -40.

Maritime Environments and Riverine Areas:
Delivery of a chemical agent is no different across open water from that of low, rolling terrain.

The effects of wind and heavy surf will tend to disperse a chemical cloud.

PERSONAL HYGIENE :

It's simple. Stay clean and shower. Wash hands when appropriate.

Shaving is important in a chemical threat environment so there is no compromise of the seal on the gas mask.

Constant cleaning of self, garments, and gear prevents the chance of secondary exposure if exposed once already.
Use of decon kits should be exercised as soon exposure has occurred.

MAJOR TYPES OF CHEMICAL AGENTS

FIVE MAJOR TYPES OF CHEMICAL AGENTS

• Nerve Agents
• Vesicants
• Cyanide
• Pulmonary Agents
• Riot Control agents

Nerve Agents:
Effects if nerve agents are on the lungs, airway, and the nervous system.

They exert their effects by inhibiting or blocking the action of acetylcholinesterase (AChE).

AChE is found in the plasma, red blood cells, and nervous tissue. The neurological effects Are the most important.

SLUDGE
-Salivation
-Lacrimation
-Urination
-Defecation
-Gastric
-Emptying

SIGNS AND SYMPTOMS
Vapor exposure:

Small exposure - miosis, rhinorrhea, mild dyspnea.

Large exposure - sudden unconsciousness, convulsions, apnea, copious secretions, miosis.

SIGNS AND SYMPTOMS (cont.)
Liquid Exposure:

Small exposure - localized sweating, nausea, vomiting, fatigue.

Large exposure - sudden unconsciousness, convulsions, apnea, paralysis, copious secretions.

Guidelines for Treatment
Mild Symptoms: Atropine 2mg plus 2-Pam-Chloride 600mg (one Mark 1). Repeat in 10 minutes.

Severe Symptoms: Atropine 6mg plus 2-Pam-Chloride 1800mg (3 Mark 1's)

Continued resuscitation: Above plus, Atropine 2mg EVERY 5 min up to 20mg total. Plus Valium 5mg every 5min up to 20mg total.

Vesicants:
Group of chemical agents that cause damage to exposed skin, lungs, and eyes.

They are traditionally known as "blister agents".

These agents will cause localized blistering, burning, and tissue damage on contact.

All vesicants except phosgene oxime are thick oily liquids.

Guidelines for Treatment
The most important step to treatment is removal of the agent from the victim.

Immediate irrigation with water should follow. Medical treatment includes continuing irrigation and decontamination.

Saline from an IV bag is useful for eye irrigation.

Never delay irrigation of the eyes while searching for sterile solutions.

Guidelines for Treatment (cont.)

Once blistering or other damage occurs, care is the same for ordinary chemical burns.

Fluid within blisters is sterile and will not cause further injury if exposed.

Just like burn injuries, dry sterile dressings applied loosely with pain management on board. Fluid resuscitation is not required for most of these patients.

Cyanide:
A rapidly acting lethal agent that directly poisons the body's cellular metabolism.

Fancy way for saying...

Cyanide binds to hemoglobin better than oxygen does. When cyanide is bound to the hemoglobin, the blood can't pick up oxygen in the lungs and carry it to the body's tissues, and the cells die from lack of oxygen.

SIGNS AND SYMPTOMS
High Concentration:
- 30-60 second loss of consciousness

- Convulsions

- 2-3 minute apnea

- 6-8 minute cardiac arrest

SIGNS AND SYMPTOMS (cont.)
Low Concentration:
- Tachycardia
- Tachypnea
- Dizziness
- Nausea
- Weakness
- LOC, apnea, and death

Guidelines for Treatment
- High flow 02

- Amyl nitrite - 1 amp (inhaled)

- Sodium nitrite 300mg IV (primary antidote)

- Sodium thiosulfate
12.5mg IV

Pulmonary Agents:
These agents include phosgene (CG), other halogen compounds and various nitrogen-oxygen compounds.

These agents act primarily to cause lung injury, hence the term "choking agents".

SIGNS AND SYMPTOMS
Low concentrations of phosgene irritate the mucous membranes so initial signs and symptoms will reflect:
- Tearing
- Runny nose
- Throat irritation

SIGNS AND SYMPTOMS (cont.)
Exposure to higher concentrations will damage the airway and lungs.

Symptoms of pulmonary edema may take several hours to manifest.

The key is knowing the initial mild symptoms will lead to a serious condition within a few hours.

Guidelines for Treatment
Mild symptoms (mild dyspnea, wheezing, coughing):

- Beta-agonist nebulizer (Albuterol) as needed.

- Oxygen and rest

Guidelines for Treatment
Severe symptoms (pulmonary edema, severe dyspnea, stridor, airway obstruction):

- Said treatment plus airway management

- Positive pressure ventilation (CPAP)

Riot Control Agents:
Known as "tear gas" or "mace", CS, CN, CA, CR, and pepper spray intensely irritates the eyes, nose, and other mucous membranes.

Guidelines for Treatment
The effects of RCAs are self limited and treatment is usually simply fresh air.

Rarely, a patient may have severe shortness of breath and wheezing which can be cured with a beta-2 agonist.

LIKELIHOOD OF RISK AND DESTRUCTIVE POWER

LIKELIHOOD OF RISK

LIKELIHOOD OF DESTRUCTIVE POWER

SUMMARY
--Equipment requirements
--Expedient improvised shelters
--Survival considerations
--Personal hygiene
--Major types of Chemical Agents/Treatments
--Likelihood of Risk and Destructive Power

QUESTIONS

Untitled Slide

• What does sludge stand for?
• What is the treatment for a patient exposed to vesicants?
• What is the name of the mask we carry?