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

Triage of Chemical Casualtiesnose) should be classified as immediate and administeredthe contents of three Mark I or ATNAA kitsplus diazepam.Phosgene and VesicantsCasualties of phosgene (or any peripherally actinglung-damaging agent) or vesicants who have moderateor severe respiratory distress should be placed in theimmediate group when intense ventilatory and otherrequired support is immediately available. In a battalionaid station or other unit-level MTF, these supportsystems may not be available immediately, and wouldprobably not be available during transport to a largemedical facility. In general, limited assets would best beused for casualties more likely to benefit from them.CyanideA cyanide casualty who is convulsing or who hasbecome apneic minutes before reaching the medicalstation and has adequate circulation should be in theimmediate group. If circulation remains adequate, theadministration of antidote may be all that is requiredfor complete recovery. However, since death may occurwithin 4 to 5 minutes of exposure to a lethal doseof cyanide unless treatment is immediate, this type ofcasualty is unlikely to be seen in an MTF.Incapacitating AgentsCasualties with cardiovascular collapse or severehyperthermia following the exposure to incapacitatingagents such as BZ (3-quinuclidinyl benzilate) shouldbe placed in the immediate category.DelayedNerve AgentsCasualties who require hospitalization but have noimmediate threat to life should be placed in the delayedgroup. This is generally limited to a casualty who hassurvived a severe nerve agent exposure, is regainingconsciousness, and has resumed spontaneous respiration.These casualties will require further medical carebut cannot be held in the unit-level MTF for the timenecessary for recovery.VesicantsCasualties with a vesicant burn between 5% and50% of body surface area (if by liquid) or with eye involvementrequire hospitalization but not immediatelifesaving care. These casualties must be observed forpulmonary symptoms and hemopoietic complications.Pulmonary complications generally occur about thesame time that dermal injury becomes apparent.Peripherally Acting Lung-Damaging AgentsCasualties who have been exposed to peripherallyacting pulmonary agents such as phosgene withdelayed onset of respiratory distress (> 4 hours afterexposure) can be placed in the delayed category. Forcasualties with significant exposure, evacuation shouldnot be delayed because pulmonary edema can rapidlybecome life threatening. Medical intervention must beinitiated quickly for the casualty to survive (as notedabove; however, this care may not be available).CyanideCasualties exposed to cyanide vapor who havesurvived for 15 minutes can be categorized as minimalor delayed.Incapacitating AgentsCasualties showing signs of exposure to an incapacitatingagent (such as BZ; see Chapter 12, IncapacitatingAgents) usually does not have a life-threatening injury,but must be evacuated because of long recovery times.A casualty who has had a very large exposure, however,and is convulsing or has cardiac arrhythmias requiresimmediate attention if it can be made available.MinimalNerve AgentsA nerve agent casualty who is walking and talkingand has only mild effects from the agent vapor (suchas miosis, rhinorrhea, or mild-to-moderate respiratorydistress) should be categorized as minimal. If anytreatment is indicated, the contents of one or moreMark I or ATNAA kits will suffice. A casualty whohas administered self-aid for these effects may needno further therapy and can often be returned to dutyin 24 hours or sooner, if the degree of miosis does notinterfere with performance of duty.VesicantsA vesicant casualty with a small area of burn—generally less than 5% of body surface area in a noncriticalsite (but the critical size depends on the site[see Chapter 8, Vesicants])—or minor eye irritationcan be placed in the minimal category and possiblyreturned to duty after treatment. Lesions covering521