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

Medical Aspects of Chemical WarfareFig. 14-5. An example of a wet-bulb globe thermometer(WBGT).Photograph: Courtesy of US Army Medical Research Institutefor Chemical Defense, Chemical Casualty Care Division,Aberdeen Proving Ground, Md.and drink water. Masks that allow team members todrink without mask removal should be used. Hydrationunits, such as Camelbaks (Camelbak, Petaluma,Calif), can be worn under hooded masks and suits.Casualty Number and Agent CharacteristicsCurrent technology to thoroughly decontaminatepatients is linear in design, and critical narrowing point“bottlenecks” are inevitable as patients are processedthrough a decontamination line. To reduce congestion,more decontamination lanes are added, which requiresmore personnel. Larger numbers of casualties alsorequire more medical personnel to provide adequatecare. Other novel ideas to hasten decontamination,particularly in a civilian setting, are to distributepersonal decontamination solutions to casualties, allowingthem to decontaminate themselves and others,as is done by military service members conductingimmediate decontamination on the battlefield. Theaim is to readily reduce the amount of contaminant onthose exposed until a more through decontaminationcan be performed.The type of agent encountered dictates the immediatehazard to life and limb as well as the level ofdecontamination necessary before a patient can enteran MTF. Many people believe that all patients exposed,or potentially exposed, to a chemical agent must bethoroughly washed. Ideally, if it does not delay life savingmedical care, a comprehensive shower with warmwater and soap (liquid castile soap or baby shampoo)should be performed if time and circumstances permit.Situations where clothing removal alone might sufficeinclude (a) exposure to vapor only, when agent istrapped in clothing and hair but is not on the skin; (b)cold weather situations when individuals are wearingthick clothing and the ambient temperature is 35°F(1.6°C) or below, creating a significant risk of freezing,or even below 65°F (18.3°C), when hypothermiais a greater possibility in injured people, especially ifwarm water is not available. In these cases the individualshould be moved promptly to a warm area for amore thorough wash after clothing removal, or decontaminationshould be provided for exposed skin areasonly. 37,38 An appreciation of these facts and knowledgeof agent characteristics listed in Table 14-3 are criticalfor medical and decontamination personnel.Fitness LevelWorkers who are not physically fit will fatiguefaster and require more periods of rest. They may alsobe more prone to musculoskeletal injury. The medicalmanagement of chemical casualties can be verylabor-intensive when patient lifts and litter carriesare performed, especially while patient handlers arewearing PPEs or when no special ergonomic equipment(eg, roller systems, wheeled litter carriers) isavailable. Those who do not have adequate musclestrength will quickly fatigue after the movement ofonly a few litter patients. Moderate and heavy work,as is done by medical and decontamination workers,dramatically increases the strain on the cardiovascularsystem, and individuals who are not physically fit areat a greater risk for cardiovascular events. Those whoare more physically fit will be able to wear their protectiveensembles longer while incurring less cardiopulmonaryrisk. Personnel who are fit have enhancedpulmonary function compared to those who are lessfit, allowing better oxygen exchange during exertionin protective masks. Personnel who have suffered heatstroke in the past are likely to be more susceptibleto recurrence. OSHA mandates that all individualsdesignated to wear personal protective gear receive496