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

Occupational Health and the Chemical Surety Missionare essential.The procedure for the decontamination of litter patientscan be found in FM 4-07.7, Health Service Supportin a Nuclear, Chemical and Biological Environment. 18 Theinstallation response force decontaminates patientsand passes them across a hotline to the MRT. At thatpoint, the casualty should be completely clean. Civilianofficials may require a casualty to be “certified clean”before moving the patient off the military installation.This requirement may be addressed through coordinationand training prior to an exercise or an actual CAI.Coordination with the civilian sector through educationand communication is essential to providing arapid and adequate medical response.CAIRA encompasses actions taken to save lives andto preserve health and safety. This support involves acontinuum of medical care, ranging from self/buddyaid in the field to treatment at a tertiary care facility.Because of the nature of some chemical warfare agents,proper care and adequate decontamination must beprovided early to avoid serious injury or death. CAIRAincludes the following levels of medical care:Level I: composed of installation response forcenonmedical installation personnel. The local commanderappoints the incident response force membersand ensures they are provided initial and ongoingtraining as described in DA Pamphlet 50-6, ChemicalAccident or Incident Response and Assistance (CAIRA)Operations. 2 The Office of The Surgeon General andthe US Army Medical Department Center and Schoolare developing a list of essential medical tasks for thisgroup. Additional tasks may be added at the discretionof the IMA or the local commander.Level II: the MRT (composed of installation medicalpersonnel). The MRT leader is a physician and isresponsible for training the team in triage, treatment,stabilization, and evacuation of casualties from the accidentsite to the appropriate medical treatment facility.The MRT must have adequate personnel, supplies, andequipment to provide healthcare to casualties generatedby an MPE. The specific tasks for the MRT leaderand members are specified in DA PAM 50-6, Tables 6-3and 6-4. 2 One MRT member should be issued toxicologicalagent protective gear so he or she may crossthe hotline and provide emergency medical care tocasualties. The remaining members should be availableon the clean side of the hotline to perform triage andto provide immediate care. Current guidance requiresforward medical personnel to be trained in advancedairway skills such as intubation. For military medics,these skills should be (but are not always) taught duringadvanced individual training. Ambulances shouldbe staffed with at least one paramedic, a level of trainingmore advanced than a military medic.Level III: the medical augmentation team, providedby the medical department activity or the medical centerto an installation with a chemical surety mission.This team must have the capability to augment theMRT in the event of an MCE. The medical augmentationteam leader’s responsibilities are also outlined inDA PAM 50-6, Table 6-5. 2Level IV: the chemical casualty site team, providedby USAMRICD, which provides clinical consultationand subject-matter experts in chemical casualty care.A veterinarian may also be a designated member ofthis team. During the initial phases of an exercise,concern is primarily for casualties. In previous serviceresponse force exercises, however, questions have beenasked about the safety of livestock, pets, and wildlife.The veterinarian has proven to be a valuable sourceof information and an asset to this team.The installation commander looks initially to theIMA for medical support and advice. If the CAI exceedsthe installation’s capability, a service response force isprovided to assume control of the situation. The serviceresponse force surgeon assumes operational controlof the MRT, the medical augmentation team, and themedical chemical advisory team at the accident site.DEMILITARIZATION OF CHEMICAL WARFARE AGENTSThe United States has produced and stored astockpile of chemical warfare agents since WorldWar I. These projectiles, rockets , mines, and toncontainers have been maintained at eight depots ineight states: Aberdeen Proving Ground, Maryland(demilitarization completed); Anniston Army Depot,Alabama; Blue Grass Army Depot, Kentucky; NewportChemical Depot, Indiana; Pine Bluff Arsenal,Arkansas; Pueblo Chemical Depot, Colorado; DeseretChemical Depot, Utah; and Umatilla Chemical Depot,Oregon. In the event of a large release of agents, twoneighboring states, Washington and Illinois, mightalso be affected.The majority of chemical agents are stored in bulkcontainers that do not have explosive components, andleaking chemical agents have not presented a healththreat to areas surrounding these depots. However,continuing to store the aging munitions may presenta risk of chemical agent exposure. Of the chemical munitions,the M55 rocket is the most hazardous; undercertain accidental circumstances, it could deliver itschemical payload into the community.In 1985 Congress initiated a program to dispose ofthe entire US stockpile of lethal chemical agents. Therewere multiple reasons for destroying these chemicalwarfare agents:609