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

Medical Aspects of Chemical WarfareINTRODUCTIONMedical officers assigned to US Army arsenals, depots,or other installations that store chemical warfareagents face a number of unique challenges concerningchemical surety. The clinics supporting these installations,although frequently staffed by occupationalmedicine specialists, may still be managed by primarycare physicians or even general medical officers withno specialty training. These providers must care forboth military and civilian workers as well as mastermyriad additional duties unique to chemical weaponsstorage sites, including managing complex medicalprograms that support chemical surety and accidentor incident response. In addition, many installationsare actively demilitarizing chemical munitions. Theseoperations run parallel with, but independent of,chemical surety operations. Chemical surety systemsmanage chemical agents throughout their life cycleswhile maintaining operational performance, whichadds other challenges to chemical surety medical supportprogram directors (CSMSPDs)—one of many titlesphysicians may earn as they provide medical supportto employees working on tasks from storage to thefinal disposal of chemical agents. Providers must beon orders from their medical commanders to performCSMSPD duties, as well as those duties outlined below,in ways that ensure accountability and responsibilityfor operations.In this chapter, a chemical agent is defined as achemical substance intended for use in military operationsto kill, seriously injure, or incapacitate a personthrough its physiological effects. Riot control agents,chemical herbicides, smoke, and flames are not officiallydefined as chemical agents, but installations withchemical agents may contain varying amounts of thesesubstances. Chemical surety (a term that encompassesboth safety and security) operations employ a systemof controls, procedures, and actions that contribute tothe safe and secure storage, transportation, and demilitarizationof chemical agents and their associatedweapon systems. Chemical surety material is definedin Army Regulation (AR) 50-6, Chemical Surety, as“chemical agents and their associated weapon system,or storage and shipping containers that are either adoptedor being considered for military use.” 1(p43)Although the chemical agents discussed are uniqueto the military, the hazards to employees are commonto many industries. Examples include acetylcholinesteraseinhibitors (the operative mechanism of nerveagents) used in pesticides and carbonyl chloride (phosgene)used in the production of foams and plastics.Both are transported daily on the nation’s highwaysand railways. In addition to these chemical threats,chemical storage depots carry out other operationsthat pose potential physical hazards similar to thosefound in other industries (eg, excessive noise, heatstress, and lifting). When they were being produced,military chemical munitions had different intendeduses, packaging, and methods of storage than industrialchemicals (and are typically more hazardous), sothey required different controls.Military chemical agent workers can find informationon chemical surety operations in a variety ofresources, including ARs, which implement Armylaws, and Department of the Army pamphlets (DAPAMs), which provide additional technical guidance.The most useful documents for the CSMSPD are AR50-6, Chemical Surety 1 ; DA PAM 50-6, Chemical Accidentor Incident Response and Assistance [CAIRA] Operations 2 ;DA PAM 40-8, Occupational Health Guidelines for theEvaluation and Control of Occupational Exposure to NerveAgents GA, GB, GD, and VX 3 ; and DA PAM 40-173,Occupational Health Guidelines for the Evaluation andControl of Occupational Exposure to Mustard Agents H,HD, and HT. 4 Safety publications AR 385-61 5 and DAPAM 385-61 6 also contain medical guidance. The installationmedical authority (IMA) must be aware of anyinterim or implementation guidance or Department ofDefense directives, instructions, or memoranda thataffect operations. The IMA should maintain a closerelationship with the installation and legal offices ofthe supporting medical treatment facility.Military installations are often physically isolatedand are located a considerable distance fromthe medical center or medical department activityresponsible for providing support and consultation.The preventive/occupational medicine physiciansat these hospitals are responsible for providing thenecessary support and are a source of informationand guidance. The level of chemical and occupational-specificmedical expertise at the supportingtreatment facility varies; however, the depot-levelphysician should be a subject-matter expert on thetreatment of chemical surety exposures and perhapseven on occupational medicine. Assets and time areseldom available to train a general medical officer inthe unique occupational setting of depot operations(Exhibit 18-1).According to DA PAM 50-6, 2 medical officerssupporting chemical surety operations are requiredto complete the Toxic Chemical Training Coursefor Medical Support Personnel (given by the USArmy Chemical Materials Agency) and the MedicalManagement of Chemical and Biological CasualtiesCourse (given by the US Army Medical Research594