Medical Aspects of Chemical Warfare (2008) - The Black Vault

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Field Management of Chemical CasualtiesChapter 14FIELD MANAGEMENT OF CHEMICALCASUALTIESCharles H. Boardman, MS, ORR/L*; Shirley D. Tuorinsky, MSN † ; Duane C. Caneva, MD ‡ ; John D. Malone,MD, MSPH § ; a n d William L. Jackson, MD, PhD ¥INTRODUCTIONHEALTH SERVICE SUPPORT AND MILITARY FORCE HEALTH PROTECTION ONTHE BATTLEFIELDSERVICE-SPECIFIC OPERATIONS FOR FIELD MANAGEMENT OF CHEMICALCASUALTIESLand-Based ForcesSea-Based ForcesMANAGEMENT OF CHEMICAL CASUALTIES FROM A CIViLIAN PERSPECTIVEINTEGRATION OF MILITARY SUPPORT INTO CIVILIAN HOMELANDRESPONSETHE MEDICAL MANAGEMENT PROCESS IN A CHEMICAL EVENTPreattack, Attack, and Postattack MeasuresPersonnel RequirementsNecessary Medical Equipment and SuppliesZones of ContaminationLevels of DecontaminationMilitary Management Concepts in the Civilian SettingProcessing PatientsSUMMARY*Lieutenant Colonel, Biomedical Sciences Corps, US Air Force; Air Force Liaison, Instructor, and Occupational Therapist, Chemical Casualty Care Division,US Army Medical Research Institute of Chemical Defense, 3100 Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010-5400† Lieutenant Colonel, AN, US Army; Executive Officer, Combat Casualty Care Division, US Army Medical Research Institute of Chemical Defense, 3100Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010-5400‡ Commander, US Navy;;Head, Medical Plans and Policy, Navy Medicine Office of Homeland Security, 2300 E Street, NW, Washington, DC 20372§ Captain, US Navy; Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814; formerly, CommandingOfficer, Medical Treatment Facility, USNS Mercy¥ Commander, US Public Health Service; Centers for Disease Control and Prevention Quarantine Station, Honolulu International Airport, 300 RodgersBlvd, Terminal Box 67, Honolulu, Hawaii 96819-1897; formerly, Assistant Chief Medical Officer, US Coast Guard Personnel Command, Arlington,Virginia485
Medical Aspects of Chemical WarfareINTRODUCTIONThe management of casualties exposed to chemical,biological, radiological, and nuclear (CBRN) agents haslong been part of military doctrine. Since the eventsof September 11, 2001, interest in the management ofthese types of casualties has extended to the civilianresponse network. The military mission has likewiseexpanded beyond the battlefield to include operationsin support of homeland defense and humanitariandisaster relief. This expansion of military roles hasnot significantly changed the procedures for chemicalcasualty care. Although specific medical and decontaminationequipment has changed with time, thecore principles for managing contaminated casualtiesremain basically unchanged since World War I, whenthe treatment of chemical casualties was conducted ona large scale. These core principles include the earlyremoval of hazardous agent from patients to reduceinjury and contamination spread, and the provision ofearly and effective life-saving treatment.To save the lives of those contaminated by hazardousagents, medical care providers, whether civilianor military, must be capable of a rapid and effectiveresponse. This involves first responders providinginitial medical intervention in the contaminated area,or on the periphery, while wearing protective equip-ment. First responders, as well as first receivers (thosewho receive contaminated patients at the hospital),must have the training to carry out patient triage andlife saving treatment for contaminated patients before,during, and after decontamination. This method of casualtymanagement will reduce injury and should significantlyreduce the health impact of a mass casualtyevent caused by the release of hazardous substances.This chapter compares the current field managementoperations of the various military services (landbasedand sea-based forces) and the civilian medicalcommunity. Although patient treatment strategies stillvary, there are now many similarities in the decontaminationprocedures used by these various organizations,with key differences related to the platformson which field management takes place (eg, on landvs. on sea-going vessels) and the specific equipmentused for medical care, transport, and decontamination.The emphasis in this text is on the managementof chemical casualties; however, these same processesare equally applicable to treating patients affected bybiological and radiological contaminants. Doctrine andtechniques continue to be upgraded, but it is expectedthat any future developments should continue to followthe basic principles discussed here.HEALTH SERVICE SUPPORT AND MILITARY FORCEHEALTH PROTECTION ON THE BATTLEFIELDHealth service support (HSS) includes all servicesperformed, provided, or arranged by the military servicesto promote, improve, conserve, or restore the mental orphysical well-being of personnel. 1 Military doctrine andterminology are rapidly changing to better support jointoperations both on the battlefield and in civil support missionsat home and abroad. This brief overview of currentand developing doctrine focuses on its application to themanagement of chemical casualties across the military.Force health protection (FHP) consists of measurestaken by all military members, from commander tothe individual service member, to promote, improve,conserve, or restore mental and physical well-beingof personnel. 1 FHP, the medical component of forceprotection, is a comprehensive approach to care thatincludes proactive medical services, striving to preventcasualties instead of focusing only on postcasualtyintervention. 1 The basic objectives of military HSSand FHP are to promote and sustain a fit and healthyforce, prevent injury and illness, protect the force fromhealth threats, and sustain medical and rehabilitativecare. The newer, more comprehensive, focus on FHPconsists of three pillars of health protection (Figure14-1), providing a continuum of military health carebefore, during, and after military operations. 1On the battlefield, medical care focuses on• minimizing the effects of wounds, injuries,disease, environment, occupational hazards,and psychological stressors on unit effectiveness,readiness, and morale; and• returning to duty as many service membersas possible at each level of care. 2These objectives also apply when the military assistsin homeland defense operations in support of local andstate assets during a national emergency. Military andcivilian HSS planning includes the medical responseto CBRN agent threats.In any setting, far-forward medical treatment is criticalto reduce injury and save lives. Military medicine focuseson this far-forward care, provided initially by the militarymember or a fellow unit member (a “buddy”), andefficient casualty evacuation to medical facilities offeringthe appropriate care. 2 Table 14-1 gives an overviewof the new taxonomy of care capabilities, comparingthem to the current concept of levels (echelons) of careparticular to the management of chemical casualties. 1,2486
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The Coat of Arms1818Medical Departm
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Textbooks of Military MedicinePubli
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MEDICAL ASPECTS o fCHEMICAL WARFARE
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ContentsContributorsForeword by The
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ContributorsMICHAEL ADLER, PhDResea
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DONALD M. MAXWELL, MSResearch Chemi
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ForewordThe US military has been co
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PrefaceA significant concern for th
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PrologueThe original edition of Med
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Medical Aspects of Chemical Warfare
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Nerve AgentsChapter 5NERVE AGENTSFR
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Nerve AgentsAbout 10,000 to 30,000
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Nerve Agentsphorofluoridate (DFP) w
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Nerve AgentsFig. 5-2. This schemati
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Nerve AgentsExhibit 5-1 continuedis
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Nerve Agentsactivity but only 15% t
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Nerve AgentsTABLE 5-3CHEMICAL, PHYS
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Nerve AgentsTABLE 5-4EFFECTS OF EXP
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Nerve Agentsaffecting the other eye
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Nerve Agentsmay cause severe rhinor
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Nerve Agentsof jerks and tremor.Cen
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Nerve Agentsand they were decreased
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Nerve Agentsnerve agent toxicity on
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Nerve Agentspatient. Decontaminatio
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Nerve AgentsFig. 5-5. The Mark I ki
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Nerve Agentsadministered intramuscu
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Nerve Agentsthat hydroxamine reacti
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Nerve AgentsOral administration may
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Nerve AgentsTABLE 5-7RECOMMENDED TH
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Nerve Agentsimpairment such as whee
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Nerve Agentssuboptimal, manner. The
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Nerve Agentsthan those who did not.
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Nerve Agentssible for binding nerve
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Nerve Agentsfor comparison was not
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Nerve AgentsTABLE 5-11EFFECTS OF PY
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Nerve Agentstivity of smooth muscle
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Nerve Agents38. Grob D, Lilienthal
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Nerve Agents77. McDonough JH, Shih
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Nerve Agents117. McLeod CG Jr, Sing
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Nerve Agents154. Tryphonas l, Veino
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Nerve Agents193. Funckes AJ. Treatm
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Nerve Agents235. Suzuki T, Morita H
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Nerve Agents274. Pellegrini JE, Bak
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PROCESSMedical Aspects of Chemical
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Page 457 and 458: Medical Aspects of Chemical Warfare
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Decontamination of Chemical Casualt
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• Analyze using GC-MS with methan
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Abbreviations and AcronymsAbBreviat
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Abbreviations and AcronymsPADPRP: p
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