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

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Occupational Health and the Chemical Surety MissionInstitute of Chemical Defense [USAMRICD]). Bothcourses are offered at Aberdeen Proving Ground,Maryland, and provide the basic concepts needed torecognize the clinical signs and symptoms of chemicalagent exposure and the appropriate therapeuticinterventions for treating and managing chemicalagent casualties. The Toxic Chemical Training Coursealso presents material on the medical challenges ofsupporting demilitarization operations.Understanding patients’ occupational healthcareneeds is an integral part of a physician’s practice.This responsibility includes identifying occupationaland environmental health risks, treating disease andinjury, and counseling patients on preventive behavior.Occupational health alone is time consuming; theoccupational health nurse, the industrial hygienist,and other clinic staff members can help performrequired tasks. Although industrial hygienists arenot often assigned to health clinics, they are an essentialpart of the healthcare team. The industrialhygienist maintains a hazard inventory that containsconventional hazards as well as a list of chemicalagents located at the installation. They routinelydesign primary prevention strategies and frequentlyoversee hearing conservation, respiratory protection,and occupational vision programs. The informationprovided by the hygienist is necessary to evaluate awork environment and to determine the appropriatefrequency of periodic medical examinations. Closeand frequent coordination with this individual isimperative for developing knowledge of the worksiteand the subsequent development of a medicalsurveillance program.In addition to the industrial hygiene and safetypersonnel, medical personnel must work in accordwith the command, supervisors, personnel officers,and employees who handle chemical agents. Maintainingthese relationships is frequently difficult, but byidentifying and addressing concerns of both managementand individual workers, medical personnel canestablish a basis for formulating appropriate preventivemedical measures.Exhibit 18-1ADVISING AGENCIES FOR the TREATMENT OF CHEMICAL AGENT INJURYAgencyThe preventive or occupational medicine department ofthe supporting medical department activity ormedical centerUS Army Center for Health Promotion and PreventiveMedicineUS Army Chemical Materials AgencyProponency Office for Preventive MedicineUS Army Medical Research Institute of Chemical DefenseUS Army Reserve Unit for Chemical/BiologicalConsequence ManagementUS Army Materiel CommandContact InformationSpecific to locationDirector, Occupational and Environmental Medicine/MCHB-TS-M5158 Blackhawk RoadAberdeen Proving Ground, Maryland 21010-5403Command Surgeon/AMSCM-RD5183 Blackhawk Road, Bldg E-4585Aberdeen Proving Ground, Maryland 21010-5424Surety Medicine Consultant/DASG-PPM-NC5111 Leesburg Pike, Suite 538Falls Church, Virginia 22041-3258MCMR-CDM3100 Ricketts Point RoadAberdeen Proving Ground, Maryland 21010-5400Detachment Surgeon1309 Continental Avenue, Suite KAbingdon, Maryland 21009-2336AMCSG/Deputy Command Surgeon9301 Chapek RoadFort Belvoir, Virginia 22060595
Medical Aspects of Chemical WarfareTHE CHEMICAL AGENT WORKPLACEChemical agent operations are conducted in avariety of job settings, including storage depots,demilitarization facilities, research laboratories, andtransportation units. Before a chemical agent employeecan be placed in a job, a physician must consider theoccupational and environmental health risks associatedwith the position. The physician must understandthe various workplaces in which chemical agentoperations are performed to effectively identify thecorresponding risks.The chemical agent worker uses different kinds ofpersonal protective equipment (PPE) and engineeringcontrols based on the work environment. The use ofprotective clothing itself can create significant hazards,such as heat stress, physical and psychologicalstress, and impaired vision, mobility, and communication.The physician must understand these PPEsand engineering controls in order to select the mostappropriate preplacement examination and medicalsurveillance for the initial and continued safety of theworker. DA PAM 385-61 6 defines the protection levels(A through D) for chemical agent workers and lists thepersonal protective clothing and equipment requiredfor each level. The following text and accompanyingfigures describe the various types of chemical agentworkplaces.The purpose of the US Army Chemical MaterialsAgency is to protect and safely store the nation’s agingchemical weapons. The agency works toward the effectiverecovery, treatment, and ultimate elimination ofthe nation’s chemical warfare materials, and it managesa national inventory control point and national maintenancepoint to ensure that the stockpile is maintainedsafely during its remaining storage life. Chemical depotworkers routinely check storage containers for potentialdegradation and leaks. During these inspections,the workers operate in Level A protective clothing, thedemilitarization protective ensemble, which consistsof a totally encapsulated, positive-pressurized suit(Figure 18-1). A mask (manufactured by Mine SafetyAppliances Company, Pittsburgh, Pa) and backpack,both certified by the National Institute of OccupationalSafety and Health and the Occupational Safety andHealth Administration, are contained within the suitto provide a continual air supply via an umbilical cord.The suit is also equipped with a self-contained emergencybreathing system in case the hose air supply iscompromised. The workers wear butyl rubber bootsand gloves over the ensemble as an additional layerof protection and can communicate with each otherand the control station by way of a radio internal tothe demilitarization protective ensemble.Another mission of the Chemical Materials Agencyis to manage the safe treatment and disposal of chemicalagents and weapons. To accomplish this mission,the agency uses various technological tools, many ofFig. 18-1. A team of chemical workers wears Level A protectiveclothing, the demilitarization protective ensemble,which provides the greatest level of protection against agentexposure.Photograph: Courtesy of US Army Chemical Materials Agency,Aberdeen Proving Ground, Md. Available at http://www.cma.army.mil/multimediagallery. Accessed December 2005.Fig. 18-2. Two chemical agent operators wear Level C protectiveclothing and use a glovebox as they drain mustardagent from ton containers in the neutralization process at theAberdeen Chemical and Biological Agent Disposal Facility.Photograph: Courtesy of US Army Chemical MaterialsAgency, Aberdeen Proving Ground, Md. Available at http://www.cma.army.mil/multimediagallery. Accessed December2005.596
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The Coat of Arms1818Medical Departm
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Textbooks of Military MedicinePubli
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MEDICAL ASPECTS o fCHEMICAL WARFARE
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ContentsContributorsForeword by The
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ContributorsMICHAEL ADLER, PhDResea
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DONALD M. MAXWELL, MSResearch Chemi
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ForewordThe US military has been co
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PrefaceA significant concern for th
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PrologueThe original edition of Med
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xxii
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Medical Aspects of Chemical Warfare
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Nerve AgentsChapter 5NERVE AGENTSFR
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Nerve AgentsAbout 10,000 to 30,000
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Nerve Agentsphorofluoridate (DFP) w
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Nerve AgentsFig. 5-2. This schemati
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Nerve AgentsExhibit 5-1 continuedis
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Nerve Agentsactivity but only 15% t
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Nerve AgentsTABLE 5-3CHEMICAL, PHYS
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Nerve AgentsTABLE 5-4EFFECTS OF EXP
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Nerve Agentsaffecting the other eye
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Nerve Agentsmay cause severe rhinor
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Nerve Agentsof jerks and tremor.Cen
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Nerve Agentsand they were decreased
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Nerve Agentsnerve agent toxicity on
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Nerve Agentspatient. Decontaminatio
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Nerve AgentsFig. 5-5. The Mark I ki
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Nerve Agentsadministered intramuscu
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Nerve Agentsthat hydroxamine reacti
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Nerve AgentsOral administration may
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Nerve AgentsTABLE 5-7RECOMMENDED TH
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Nerve Agentsimpairment such as whee
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Nerve Agentssuboptimal, manner. The
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Nerve Agentsthan those who did not.
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Nerve Agentssible for binding nerve
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Nerve Agentsfor comparison was not
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Nerve AgentsTABLE 5-11EFFECTS OF PY
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Nerve Agentstivity of smooth muscle
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Nerve Agents38. Grob D, Lilienthal
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Nerve Agents77. McDonough JH, Shih
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Nerve Agents117. McLeod CG Jr, Sing
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Nerve Agents154. Tryphonas l, Veino
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Nerve Agents193. Funckes AJ. Treatm
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Nerve Agents235. Suzuki T, Morita H
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Nerve Agents274. Pellegrini JE, Bak
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PROCESSMedical Aspects of Chemical
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Triage of Chemical CasualtiesChapte
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Triage of Chemical Casualtiesreceiv
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Triage of Chemical Casualtiesentran
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Triage of Chemical Casualtiescatego
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Triage of Chemical CasualtiesIn a f
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Triage of Chemical Casualtiesnose)
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Triage of Chemical CasualtiesWith n
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Triage of Chemical Casualties14. Sa
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Decontamination of Chemical Casualt
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Page 568 and 569: Decontamination of Chemical Casualt
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• Analyze using GC-MS with methan
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Abbreviations and AcronymsAbBreviat
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Abbreviations and AcronymsPADPRP: p
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