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

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Field Management of Chemical CasualtiesTable 14-1 continuedDefinitive Care CapabilityCompares to a stateside level V.Definitive care, which is normally providedin the continental United States,Department of Veterans Affairs hospitals,or civilian hospitals with committedbeds for casualty treatment as part of theNational Defense Medical System. Mayalso be provided by overseas allied orhost nation MTFsCare rendered to conclusively manage apatient’s condition, includes the full rangeof acute, convalescent, restorative, andrehabilitative care sites outside the theaterof operations.Includes the full range of acute convalescent,restorative, and rehabilitativecare.Same as for level IV plus:• Longer term respiratorytherapy.• Full rehabilitative servicesfor mental health, cognitive/memory retraining, retrainingin activities of daily living/lifeskills, prevocational services,and post traumatic stress counseling.This incorporates a teamof rehabilitation professionssuch as physical, occupational,speech, and mental healthservices as needed based onthe severity of exposure andresulting disability, if any.*Taxonomy of care terms are in italics.FRC: forward resuscitative careHSS: health service supportIV: intravenous2-PAM: 2-pyridine aldoxime methyl chlorideRTD: return to dutyData sources: (1) US Department of Defense. Health Service Support in Joint Operations. Revision, Final Coordination. Washington, DC: DoD;2005. Joint Publication 4-02. (2) US Department of Defense. Doctrine for Health Service Support in Joint Operations. Washington, DC: DoD;2001. Joint Publication 4-02.liners liners and and fitted fitted with with air air filtering units. units.Land-based Naval units are divided into broadwarfare areas including expeditionary warfare, forcesthat move to a theater of operations, and naval installations.4 Expeditionary units include construction forces,logistic support personnel, special warfare units,and fleet hospitals. Expeditionary forces on land aretypically deployed in support of USMC units. Theseusually include land-based FRC (level II) capability,which may initially contain as few as 10 beds but canbe expanded to 500 beds with a theater hospitalizationcapability (ie, a combat zone fleet hospital). 1Casualties from these facilities can then be evacuatedto land-based facilities of other services or to hospitalships. Expeditionary medical units deploy as part of alanding force, with CBRN defense capabilities for individualprotection, self-decontamination, and limitedequipment decontamination.Naval installations such as fleet hospitals, on theother hand, are more permanent, fixed facilities thatoffer FRC capabilities at level III or greater. Installationplanning at these facilities involves disaster preparedness,including coordination with local authorities.Plans for operations in a contaminated environmentinclude using shelter-in-place procedures, individualprotective gear, and various types of detection equipment.The installation disaster officer directs emergency-responseteams, coordinates decontaminationoperations, and assists in the command and controloperations center. 4 In addition to triage and treatingcasualties from an incident, the medical departmentalso organizes medical supplies; provides food andwater inspection; conducts disease monitoring; distributesantidotes and medications as needed for CBRNincidents; and provides training on CBRN hazards,self aid, and first aid as part of FHP. 4The approximately 175,000-member USMC is anintrinsic part of the Department of the Navy; medicalsupport to the Marine Corps is provided by the NavyMedical Department. USMC personnel may augmentNavy medical patient decontamination operations.First responder capability (level I) is provided throughself aid and buddy aid as well as by Navy corpsmenassigned to USMC units. The Marines, at this level,also utilize their intrinsic BASs, or USMC wing supportsquadron aid stations, staffed by Navy medical personnel.Unique to the USMC is the Chemical/BiologicalIncident Response Force (CBIRF) with first respondermedical capabilities. CBIRF deploys domestically, particularlyin the National Capital Region of Washington,DC, or overseas to pre-position or respond to a CBRNincident. Composed of USMC and Navy personnel,CBIRF has the capability to monitor, detect, identify,and analyze toxic industrial chemicals (TICs), toxic489
Medical Aspects of Chemical WarfareFig. 14-2. Taxonomy of care capabilities.Reproduced from: US Department of Defense. Health Service Support in Joint Operations. Revision, Final Coordination. Washington,DC: DoD; 2005. Joint Publication 4-02: I-4.industrial materials, and other CBRN hazards. Theforce has casualty extraction teams, technical searchand rescue teams, and patient/responder decontaminationassets to support a mass casualty incident.CBIRF medical personnel are trained to conduct triageand provide emergency medical care to stabilize largenumbers of contaminated casualties extracted from theincident site, then decontaminate them for transfer tolocal medical facilities. 4Air Force first responder capability (level I) consistsof self aid and buddy care. 5 First responders then retrievethe patient and form a casualty collection pointfor transport to the base medical facility. The Air Forceincorporates the split mission-oriented protectiveposture (MOPP) concept, dividing an air base into sectorsor control zones, each operating under a differentMOPP level depending on its contamination threat.Under this plan, one area of the base may be contaminatedwithout affecting the operations of the entirebase. 6 Casualties are retrieved from the contaminatedzones by medical first responders in protective ensembleand transported to the base medical facility orbase casualty holding area. Depending on the maturityof the base, the medical support can consist of a smallportable expeditionary aeromedical rapid responsepackage, a basic Expeditionary Medical Support(EMEDS) package, or a larger EMEDS plus 10- or 25-bed package, which evolves into an Air Force theaterhospital. Casualty care includes patient decontamination,triage, clinical care, movement or quarantine onthe air base, and aeromedical evacuation. 7 EMEDS canbe configured to have an FRC capability (level II) ora theater hospital capability (level III or IV) based onthe number of air-transportable medical equipmentand personnel packages deployed to meet operationalrequirements. EMEDS equipment packages consist oftentage and medical equipment that can be added toan EMEDS basic package to increase service and bedcapacity. The EMEDS basic package can be deployedas a “collectively protected” Air Force medical facilityto provide shelter in a chemically or biologically contaminatedenvironment. 7 In these collective protectionconfigurations the EMEDS facilities are fitted withchemical protective liners and air handling units thatfilter hazardous agents. An EMEDS facility is designedto remain in operation for days after a chemical attack490
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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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xxii
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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 461 and 462: 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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Medical Aspects of Chemical Warfare (2008) - The Black Vault

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