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

Medical Aspects of Chemical WarfareINTRODUCTIONA number of countries around the world havethe capability to use chemical weapons, and terroristgroups around the world display great interestin these weapons and the willingness to use them.Within the past 2 decades, incidents of chemicalweapons use in armed conflict, most notably duringthe Iran-Iraq War, have been well documented. Themost recent threat of such use was during the PersianGulf War, when US forces were possibly exposed toboth chemical and biological agents. 1 However, thethreat is no longer restricted to the battlefield. Recentevents such as the September 11, 2001, terrorist attackon the World Trade Center in New York City and thePentagon in Washington, DC, and subsequent nationalthreat warnings, have raised fears of a future terroristincident involving chemical agents. An essential partof preparedness to ensure continued operations in achemical environment, whether in armed conflict orduring a terrorist attack, is adequate equipment. Suchequipment must encompass detection and warning,personal protection, decontamination, and treatment.Only an integrated approach to these aspects of protectioncan ensure an effective response in a chemicalwarfare environment with a minimum degradation inhuman performance. 1,2The primary item of protection is the personal respirator,designed to protect individuals against volatileagents and aerosols. The respirator must be carefullyfitted to ensure minimal leakage, and individuals mustbe well trained in donning masks (a maximum timeof ≤ 9 sec is desirable). In addition to the respiratoryhazard, many chemical agents are dermally active,requiring that a proper overgarment, usually containingan activated charcoal layer to adsorb chemicalagent, be donned, along with protective glovesand footwear. The complete ensemble can seriouslydegrade individual performance; a 50% reduction inmission-related task performance has routinely beenmeasured in tests. In addition to physical performancedegradation, psychological problems in someindividuals wearing the complete ensemble, owing toits claustrophobic effects, have been reported. 3 Thissubject is discussed separately in the attachment atthe end of this chapter.The rapid “detection and warning” of chemicalagent use is critical to force protection. 4,5 Usually, thechemical agent will be delivered via an aerial or missileattack, or in an upwind release causing a cloudof agent to pass over a troop concentration. Becausethe effects of agents can sometimes occur in lessthan a minute, timely detection is required to permitall potentially exposed forces to adopt an adequateposture. Detection equipment is also used to confirmagent hazard reduction, which facilitates reducingthe mission-oriented protective posture (MOPP)level and removal of protection equipment—the “allclear” signal.Decontamination of equipment, facilities, andpersonnel is also required after an attack if effectivemilitary operations are to be maintained. Some ofthis decontamination burden can be mitigated bythe use of effective collective protection equipment,which can allow continuing operations, such ascommunications and medical care, within protectedfacilities.This chapter is not intended as an all-encompassingoverview of chemical defense equipment; rather,it will describe the items and operations of greatestinterest to the medical community. The followingsections address in detail each of the protection areasdescribed above. Current equipment items are featured,and items in development that are designedto overcome the deficiencies of current equipmentare briefly described. Sufficient technical data areincluded to allow healthcare professionals to becomefamiliar with the equipment’s operation, components,and the limitations. Several sources that provide additionaldetail are available, including the writtenreferences and expert consultants to this chapter.Possibly of more value to the healthcare professionalare chemical, biological, radiological, and nuclear(CBRN) officers who are an integral part of eachcombat element and can provide detailed advice aswell as hands-on assistance.One criterion for the selection of protective equipmentitems is suitability for joint service use; differencesbetween the missions of air and ground crewsmust be accommodated. As new and better chemicaldefense equipment is developed and made availableto the forces, several principles must be followed foran optimal outcome:• Intelligence must continually identify newagents that may be used against combat forcesand ensure that the defense equipment meetsthe new threats.• A viable, active training program must bemaintained.• Medical input into operations while participantsare wearing protective equipment is vitalto maintenance of a combat operation. Plannedrest periods consonant with work loads andMOPP gear will allow continuing operationseven in a contaminated environment.560