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

Medical Aspects of Chemical WarfareSummaryTriage of chemical agent casualties is a dynamicprocess based on the same principles as the triageof conventional casualties, with the same goal ofmaximizing survival. The triage officer must provideimmediate care to those who need it to survive; however,the officer is also faced with the task of deferringtreatment for some casualties or delaying the treatmentof those with minor injuries or who do not needimmediate medical intervention. The triage officershould judiciously use valuable resources on casualtieswho are certain to die or those who will survivewithout medical care. At the first level of medical careon a battlefield, medical capabilities are very limited.When chemical agents are present or suspected, medi-cal capabilities are further diminished because earlycare is given by the medical care provider and to thecasualty in protective clothing. Decontamination, atime-consuming process, must be carried out beforethe casualty receives more definitive care, even at thisinitial level. At the rear level of care, or at a hospitalin peacetime, medical capabilities are much greater,and decontamination is anticipated to have been accomplishedprior to casualty arrival.Triage should be based on knowledge of medical assets,the casualty load, and, at least at unit-level MTFs,the evacuation process. Most importantly, the triageofficer must have full knowledge of the natural courseof an injury and its potential complications.REFERENCES1. Rund DA. Triage. St. Louis, Mo: Mosby Company; 1981: 310.2. US Department of the Army. Health Service Support in a Theater of Operations. Washington, DC: DA; 1991. FM 8-10.3. US Department of the Army. Force Health Protection in a Global Environment. Washington, DC: DA; 2003. FM 4-02.4. Veatch RM. Disaster preparedness and triage: justice and the common good. Mt Sinai J Med. 2005; 72(4):236-241.5. Medical management and treatment in chemical operations. In: US Departments of the Army, Navy, Air Force, andMarine Corps. Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries. Washington, DC: DoD;1995: Appendix C. FM 8-285, NAVMED P-5041, AFJMAN 44-149, FMFM 11-11.6. Triage. In: Burris DG, FitzHarris JB, Holcomb JB, et al, eds. Emergency War Surgery. 3rd rev ed. Washington, DC: Departmentof the Army, Office of The Surgeon General, Borden Institute; 2004: Chap 3.7. US Departments of the Army, Navy, and Air Force. NATO Handbook on the Medical Aspects of NBC Defensive Operations.Washington, DC: DoD; 1996: Chap 11. AMedP-6(B), FM 8-9, NAVMED P-5059, AFJMAN 44-151. Available at: http://www.fas.org/nuke/guide/usa/doctrine/dod/fm8-9/toc.htm. Accessed on October 18, 2007.8. 29 CFR, Part 1910.120.9. Occupational Safety and Health Agency. OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass CasualtyIncidents Involving the Release of Hazardous Substances. Washington, DC: OSHA; 2005. Available at: http://www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html. Accessed September 10, 2007.10. US Department of the Army. Medical Evacuation in a Theater of Operations: Tactics, Techniques, and Procedures. Washington,DC: DA; 2000. FM 8-10-6.11. Cone DC, Koenig KL. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur JEmerg Med. 2005;12:287-302.12. START triage plan for disaster scenarios. ED Manag. 1996;8:103-104.13. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma.1989;29:623-629.524