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

Medical Aspects of Chemical Warfarememoranda of agreement with local agencies. Thenature of the chemical agents being stored or demilitarizedrequires that preparations be made for receivingand treating casualties beyond the capability ofthe installation clinic. Although stabilization maybe handled at the clinic, hospitalization will requireoutside facilities. Local hospitals may be reluctant toaccept chemical casualties even after decontamination,and existing memoranda of agreement shouldfacilitate the transfer and encourage the hospitals todo preaccident planning and training. Ultimately, theMRT leader is responsible for certifying that a patientas decontaminated.Much of the coordination required for outsideagreements is managed through command channels.The medical officer and medical administrator canaccomplish much, however, through contact with themedical facilities and emergency medical personnelwho will respond to an installation emergency. Coordinationand interaction between civilian and militarymedical resources should be a continuous process. TheIMA must take the lead to ensure that limited postresources are adequately augmented by off-post medicalfacilities. The staffing and treatment capabilities ofoff-site emergency medical facilities should be verifiedto ensure that appropriate resources are available.Although an IMA has limited time to coordinate withlocal healthcare providers and administrators, suchcommunication is extremely valuable.The IMA, having completed the Toxic Agent TrainingCourse and the Medical Management of Chemicaland Biological Casualties Course prior to reportingfor duty, is responsible for training enlisted personneland civilian healthcare providers. Evacuation plans,coordination with off-post civilian medical facilities,memoranda of agreement, and periodic inventories(with restocking of supplies and equipment) arealso the responsibility of the IMA. In addition toindividual training, collective training in the formof drills should become a routine part of the clinicschedule. Training of civilian resources is coordinatedthrough the Chemical Stockpile Emergency PreparednessProgram, centered at the Edgewood Areaof Aberdeen Proving Ground, Maryland. Only thesuccessful completion of all these types of planningand training ensure readiness for proper managementof a chemically contaminated patient. Clinicsat depots with a chemical surety mission shouldhave an area designated for the decontamination ofexposed patients; this area is necessary to provideearly medical care that will limit the degree of thecasualty’s exposure. Generally, the treatment areafor these patients is separate from the normal patienttreatment areas. Although these facilities are rarelyused for an actual chemically contaminated patient,an ongoing effort must be made to keep these roomsat 100% operational capability. To maintain this capability,the medical staff must develop comprehensiveand detailed standard operating procedures.In the event of a CAI, emergency medical care willinitially be provided by nonmedical workers responsiblefor removing casualties from the site of injurythrough a personnel decontamination station and tothe waiting medical team. Further evacuation may berequired, either to the installation medical facility or toan off-post medical treatment facility. The fundamentalpathophysiological threats to life (namely, airwaycompromise, breathing difficulties, and circulatoryderangement) are the same for chemical casualties asthey are for casualties of any other type, but all personneltreating chemical injuries require additionaltraining. At the least, nonmedical workers requiretraining in self/buddy-aid. The installation responseforce is responsible for providing the immediate safety,security, rescue, and control at the CAI site to savelives and reduce exposure to hazards. The IMA mustapprove the training program for both workers andthe installation response force and must review theirlesson plans for accuracy and completeness. The essentialsof this training include recognizing signs andsymptoms of agent exposure, first aid, self/buddy-aid,individual protection, personnel decontamination(including decontamination of a litter patient), andevacuation of casualties.To develop appropriate emergency medical plans,it is necessary to know the chemical agents included,number of personnel involved in the incident, locationof the work area, a summary of work procedures,and the duration of the operation. This information isavailable through the installation commander or thecertifying official. In addition, the most probable event(MPE) and maximum credible event (MCE) must bedefined to determine the anticipated casualty loads ineither situation. When dealing with large amounts ofdangerous agents, an MPE is the worst potential eventlikely to occur during routine handling, storage, maintenance,or demilitarization operations that results inthe release of agent and exposure of personnel. AnMCE is the worst single event that could reasonablyoccur at any time, with maximal release of agent frommunitions, bulk container, or work process as a resultof an accidental occurrence. The Office of The SurgeonGeneral is developing guidance for installations toestimate the chemical agent casualties expected froman MPE or an MCE. For planning purposes, medicalstaffing requirements are based on the MPE for theinstallation. Because an MCE is expected to exceedthe capabilities of the installation medical facility,medical contingency plans and coordination with local,state, and federal emergency medical authorities608