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

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Occupational Health and the Chemical Surety Mission• recognition of hazards involved in the operation;• recognition of signs and symptoms of agentexposure;• administration of first aid and self/buddy aid,including CPR;• knowledge of personnel decontaminatingprocedures;• execution of emergency procedures; and• donning and doffing of protective clothingand equipment (such as self-contained breathingapparatus).Refresher training should be conducted at leastannually, and the IMA must review and approve thecourses’ contents and the training personnel.Training programs may focus on chemical warfareagents, but they should also address any additionalphysical and chemical hazards. One example of thesehazards is heat stress caused by wearing butyl protectivegear, as discussed earlier in this chapter. The levelof training should be commensurate with employees’job functions and responsibilities. When feasible, thetraining program should consist of both classroominstruction and hands-on practice. Dry runs of operationaland emergency procedures are often an effectivetraining tool.During training, emphasis must be given to thefirst rule of protection—to protect oneself from injury.Workers should also know the procedure for requestingmedical assistance and should be aware of anypredetermined format for reporting emergencies thatwill expedite the report and response time. Teachingemployees a logical system in which to present thisinformation is extremely helpful. Their reports shouldinclude the nature of the accident or incident as well aswhat has been done for the victims (for example, thenumber of Mark I kits [Meridian Medical TechnologiesInc, Bristol, Tenn] administered). Support personnelcan request additional information as the situationprogresses. The installation will greatly benefit fromactive involvement of the IMA and clinic staff in thistraining.MEDICAL SUPPORT OF THE CHEMICAL PERSONNEL RELIABILITY PROGRAMThe CPRP is a management tool used within theArmy to identify chemical surety duty positions andto manage the personnel assigned to these positions, asdiscussed earlier. It also provides a way to assess the reliabilityand acceptability of employees who are beingconsidered for or assigned to chemical duty positions.The program was established to ensure that personnelassigned to positions involving access to, orresponsibility for, the security of chemical surety materialare emotionally stable, loyal to the United States,trustworthy, and physically fit to perform assignedduties. The certifying official is the commander’srepresentative for the CPRP and is ultimately responsiblefor its administration. This official, with inputfrom the personnel officer and medical personnel,decides whether to qualify or disqualify personnelfor CPRP duties. He or she must also help determinethe appropriate medical surveillance category for eachworker (see above) based on the worker’s potentialfor exposure.During each part of the screening process, evaluatorslook for evidence of potentially disqualifyingfactors that may affect personnel reliability or suitabilityfor CPRP duties. Disqualifying factors of medicalrelevance include alcohol abuse, drug abuse, inabilityto wear protective clothing and equipment requiredby the assigned position, or any significant physicalor mental condition that might be prejudicial to thereliable performance of CPRP duties.The examining physician must notify the certifyingofficial orally and in writing of any medical conditions,including the use of any prescribed medications, thatmay detract from an individual’s ability to performassigned chemical surety duties. In addition, thephysician must provide a recommendation on the employee’ssuitability to continue CPRP duties. Informationthat may affect reliability is referred to as potentialdisqualifying information. These communicationsshould be documented on Standard Form 600. As in allhealthcare, documentation is extremely important and,in this case, subject to examination during a chemicalsurety inspection (Exhibit 18-3).Simply supplying a diagnosis or excerpt from themedical record is not enough to enable the certifyingofficial to make an informed decision; the competentmedical authority must provide a sound medical interpretationand recommendation. The recommendationand supporting documents must be succinct anddecisive, and should also note any lack of potentialdisqualifying information. The recommendationshould state one of the following: (a) no restriction,(b) restrictions or limitations on duties, (c) temporarydisqualification, or (d) permanent disqualification. Potentiallydisqualifying information must be providedin a sealed envelope marked “EXCLUSIVE FOR” thecertifying official. Temporarily disqualified personnelremain in the CPRP, and their medical records mustbe treated in the same manner as the medical recordsof other employees in the program.A chemical-duty position roster lists all individuals605
Medical Aspects of Chemical WarfareEXHIBIT 18-3ADMINISTRATIVE DOCUMENTATION TO SUPPORT A CHEMICAL SURETY INSPECTIONArmy RegulationsAR 11-34, 15 Feb 90AR 40-3, 18 Oct 07AR 40-5, 25 May 07AR 40-13, 1 Feb 85AR 40-63, 1 Jan 86AR 40-66, 21 Jun 06AR 40-68, 26 Feb 04AR 40-400, 13 Oct 06AR 50-6, 26 Jun 01AR 385-10, 23 Aug 07AR 385-40, 1 Nov 94AR 385-61, 12 Oct 01AR 385-64, 1 Feb 00AR 600-85, 24 Mar 06The Army Respiratory Protection ProgramMedical, Dental and Veterinary CarePreventive MedicineMedical Support—Nuclear/Chemical Accidents and IncidentsOphthalmic ServicesMedical Record Administration and Health Care DocumentationClinical Quality ManagementPatient AdministrationChemical SuretyArmy Safety ProgramAccident Reporting and RecordsThe Army Chemical Agent Safety ProgramUS Army Explosives Safety ProgramArmy Substance Abuse Program (ASAP)Department of the Army Pamphlets and Technical Bulletins MedicalDA PAM 40-8, 4 Dec 90 Occupational Health Guidelines for the Evaluation and Control of Occupational Exposure toNerve Agents GA, GB, GD, and VXDA PAM 40-173, 03 Jun 03 Occupational Health Guidelines for the Evaluation and Control of Occupational Exposuresto Mustard Agents H, HD, and HTDA PAM 40-501, 10 Dec 98 Hearing Conservation ProgramDA PAM 50-6, 26 Mar 03 Chemical Accident or Incident Response and Assistance (CAIRA) OperationsDA PAM 385-61, 27 Mar 02 Toxic Chemical Agent Safety StandardsTB MED 502, 15 Feb 82 Respiratory Protection ProgramTB MED 507, 7 Mar 03 Heat Stress Control and Heat Casualty ManagementTB MED 509, 24 Dec 86 Spirometry in Occupational Health SurveillanceField ManualsFM 3-11.5, Apr 06FM 402.285, Sep 07FM 4-02.7, 2004CBRN DecontaminationNBC DecontaminationHealth Service Support in a Nuclear, Biological, and Chemical EnvironmentPersonnel Documents• Table of Distribution and Allowances with mission statement for medical treatment facility or activity• Intraservice support agreement between tenant health clinic and the host installation• Job descriptions with performance standards (or support forms for active duty)• Scopes of practices• Individual or categorical credentials for health care practitioners• Current certificates of licensure for physicians and nurses• Advanced Trauma Life Support/Advanced Cardiac Life Support certification for physicians (nurses optional)• Basic life support certification for all personnel with patient care responsibilities• Certificate of completion of Medical Management of Chemical and Biological Casualties Course for physiciansMemoranda of Understanding and Mutual Aid Agreements• With local civilian hospitals or ambulance services• With the supporting medical center or medical department activity• Between Army Medical Command and Army Medical Research and Materiel Command (or other majorArmy commands, if appropriate)Standing Operating Procedures• Spirometry• Audiometry• Vision screening(Exhibit 18-3 continues)606
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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 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 578 and 579: 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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Medical Aspects of Chemical Warfare (2008) - The Black Vault

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