Identify signs and symptoms of chemical agent poisonings and their treatments.

Given written items pertaining to the identification and treatment of chemical agent casualties.

Score 70 or more points on the 100-point written examination.

FM 8-285, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

STP 8-91B15-SM-TC, MOS 91B, Medical Specialist.

Chemical agents affect specific body functions and systems. Chemical agents are classified by their effect on the body and by their military use. Toxic chemical agents are used to produce serious injury or death. Chemical agents include nerve agents, blister agents, choking agents, and blood agents. The protective mask and clothing (MOPP gear) provide protection against chemical agents. If you are a combat lifesaver in a conflict in which chemical agents are used, your first action must be to protect yourself (mask, administer Mark I kit if needed, decontaminate exposed skin if needed, and put on protective clothing). You must also be ready to identify and render the appropriate aid to fellow soldiers who may have been exposed to chemical agents as your combat mission allows.

NOTE: Some of the information in para 22-2 and 22-3 summarize information presented in lesson 4, PERFORM FIRST AID FOR A NERVE AGENT INJURY,

in Subcourse IS0824. Refer to IS0824 for additional information.

Nerve agents are usually liquid or gas (vapor). They affect the nerves, muscles, and central nervous system of the body. They are quickly absorbed by the body and their effects can be felt immediately. Nerve agent poisoning can be either mild or severe. A casualty with mild nerve agent poisoning will usually be able to take protective measures (put on mask, decontaminate exposed skin, administer a Mark I nerve agent antidote kit to himself, and put on the rest of his protective clothing). A casualty with severe nerve agent poisoning will not be able to help himself and must receive aid quickly if he is to survive.

Signs and symptoms of mild nerve agent poisoning (unexplained runny nose, sudden headache, dizziness, drooling, tightness in the chest, muscular twitching, stomach cramps, nausea, and reduced vision) may or may not precede signs and symptoms of severe nerve agent poisoning. Signs and symptoms of severe nerve agent poisoning include:

Strange and confused behavior.

Wheezing, coughing, and gurgling sounds while breathing.

Severely pinpointed pupils.

Red eyes with tears present.

Vomiting.

Severe muscular twitching (spasms).

Loss of bladder and bowel control.

Convulsion.

Unconsciousness.

Respiratory arrest (not breathing).

If the casualty is not masked, put his protective mask on him.

After the casualty is masked and placed on his side (swimmer position), administer the casualty's three Mark I nerve agent antidote kits and one CANA (convulsant antidote for nerve agent) autoinjector. Attach used autoinjectors to his clothing. There is no waiting period between the kits, nor between the third kit and CANA.

The casualty must be decontaminated. If possible, have another soldier decontaminate the casualty's face, mask interior, and exposed skin using the casualty's M291 decontamination kit as the mission permits. This will leave you free to check and treat other casualties.

Evacuate the casualty to the nearest medical treatment facility (usually a battalion aid station) as soon as possible. If the casualty cannot be evacuated immediately, have the casualty checked by the medic as soon as possible. If you remain with the casualty, continue to monitor the casualty and administer additional atropine and CANA as needed.

You have five atropine autoinjectors in your aid bag. These atropine autoinjectors are used if the three Mark I kits administered to the casualty are not sufficient to control the casualty's symptoms. No additional 2-PAM chloride is administered. A casualty who has received sufficient atropine should have a decrease in the amount of secretions and be breathing more easily. If the casualty is still experiencing a large amount of secretion or difficulty breathing administer more atropine..

The casualty is on his side in the swimmer position.

Tear the clear plastic protective bag and remove the autoinjector.

Grasp the body of the autoinjector with the thumb and first two fingers of your dominant hand. As you would a pen or pencil.

Grasp the yellow safety cap with your other hand.

Pull the yellow safety cap away from the body of the autoinjector. The autoinjector is now ready to function.

CAUTION: Do not touch the green (needle) end of the autoinjector during the process. Touching the green end could cause the autoinjector to function prematurely.

Holding the autoinjector with the thumb and two fingers place the green (needle) end of the autoinjector against the injection site (same site as used for Mark I autoinjectors) at a 90^o angle to the site. Normally, the injection site is on the outer thigh below the hip and above the knee. If the casualty is very thin, the upper, outer quadrant of his buttocks is used as the injection site.

Apply firm, even pressure to the autoinjector until the needle functions (clicks). The needle will penetrate the casualty's clothing and automatically inject the medication into the casualty's muscle.

CAUTION: Do not use a jabbing motion to inject the medication into the muscle.

Hold the autoinjector in place for at least 10 seconds to ensure that all of the medication has been injected; then pull the autoinjector needle out of the muscle at the same 90^o angle. Temporarily lay the used autoinjector on the casualty's side.

Attach the used autoinjector to the casualty's outer clothing, usually a pocket flap of his protective outer garment. Push the needle of the autoinjector through the back of the pocket flap and bend the needle to form a hook. (Used autoinjectors inform medical personnel how much medication the casualty has received.)

CAUTION: Take care to avoid puncturing or tearing your protective gloves while securing the autoinjector.

Administer a second CANA autoinjector if the casualty is still suffering convulsions 5 to 10 minutes after receiving the first CANA. Attach the used autoinjector to the casualty's clothing.

If convulsions are still present 5 to 10 minutes after the second CANA, administer a third CANA. Do not administer more than three CANA auto-injectors.

Attach used autoinjectors to the casualty's clothing.

Blister agents can be delivered either as a liquid or as a gas (vapor). Blister agents include mustard (HD), nitrogen mustard (NH), lewisite (L), and phosgene oxime (CX). Blister agents act primarily on the eyes, respiratory tract, and skin. The effects depend upon the type of agent used, the concentration to which the soldier was exposed, the length of time he was exposed, and the manner (route) the agent entered the body (eyes, skin, and/or respiratory tract). A soldier may be exposed to blister agents for a long time without realizing his danger. Exposure to high concentrations can cause vomiting and diarrhea. Prolonged exposure to high concentrations can be fatal.

The eyes are very sensitive and are usually the first to be affected by blister agents. Signs and symptoms include:

Sensitivity to light.

Gritty feeling in eyes.

Inflammation of the inner eyelids.

Swelling and spasms of the eyelids.

Watery eyes.

Pain.

Signs and symptoms of skin exposure to blister agents usually appear 4 to 6 hours after exposure. However, they may not appear for 24 to 48 hours following exposure. Signs and symptoms include the following.

Itching.

Redness (similar to a sunburn).

Swelling and inflammation.

Blisters.

Pain. (If lewisite or phosgene oxide is the agent, pain is immediate and intense.)

Signs and symptoms of respiratory tract exposure to blister agents usually appear 4 to 6 hours after exposure. However, they may not appear for 24 to 48 hours following exposure. Signs and symptoms include:

Throat irritation (dry, burning sensation).

Harsh cough and hoarse voice.

Phlegm (mucous discharge) or frothy sputum.

Runny nose and frequent sneezing.

Other signs and symptoms that can occur include headache, nausea, vomiting, and diarrhea.

If the casualty is not masked, put his protective mask on him. Remember to squat, not kneel.

If the casualty's eyes were exposed to liquid blister agent, you must take quick action to decontaminate his eyes by flushing them with water or other potable (drinkable) fluid using the following procedures. Leaving liquid blister agent in the eye is more dangerous than exposing the casualty's face to blister vapor.

Remove and open the casualty's canteen.

Have the casualty take a deep breath and hold it. The casualty should keep his mouth closed.

Lift the casualty's mask from his chin to expose his eyes.

Tilt the casualty's head to one side with the eye to be flushed lower than the other eye. (This prevents chemicals from the eye being flushed from flowing into the other eye.)

Have the casualty open his lower eye. (If the casualty has to open both eyes in order to keep the lower eye open, let him.)

Pour the water from the canteen gently into the lower eye. Pour from the inner edge of the eye (end closest to the nose) to the outer edge.

Continue to flush the eye with water until the blister agent has been flushed from the eye.

Tilt the casualty's head so the other eye is now lower than the flushed eye.

Flush the second eye in the same manner.

Replace, reseal, and clear the casualty's mask. Tell him to breathe normally.

Have the casualty decontaminate his face, mask, and exposed skin with his M291 decontamination kit if he is able. If he is not able, have another soldier perform the decontamination procedures for him. The key to successful decontamination is immediate action upon finding the contamination.

CAUTION: If blisters have already formed, do not attempt to decontaminate the blistered areas. The blisters are actually burns. A casualty with blisters over a wide area of his body is considered to be seriously burned.

Evacuate the casualty to the nearest medical treatment facility (usually a battalion aid station) as soon as possible. If the casualty cannot be evacuated immediately, have the casualty checked by the medic as soon as practical.

Choking agents are specifically designed to attack the lungs. They destroy lung tissue and cause the lungs to fill with fluids. This action, sometimes called "dry land drowning", will eventually result in death. Choking agents include phosgene (CG), diphosgene (DP), chlorine (Cl), and chloropicrin (PS). Of these agents, phosgene is the most dangerous and the most likely to be used in a military conflict. Your protective mask gives adequate protection against choking agents.

Early signs and symptoms will subside rapidly and allow the casualty to carry on with his combat mission. A soldier with these signs and symptoms should be monitored to see if late (severe) signs and symptoms develop. Early signs and symptoms include:

Tears.

Dry throat.

Choking cough.

Tightness in the chest.

Nausea.

Vomiting.

Headache.

Late signs and symptoms usually appear 4 to 24 hours after initial exposure if the casualty was exposed to sufficient concentration of the agent or exposed for a sufficient length of time. Late signs and symptoms include:

Anxiety.

Wheezing.

Rapid, shallow breathing.

Weak but rapid pulse (tachycardia).

Serious attacks of coughing that produce white or yellowish fluid, sometimes frothy and tinted with blood.

Cyanosis (bluish tint to lips and nailbeds).

Shock.

Respiratory failure.

If the casualty is not masked, put his protective mask on him. Remember to squat, not kneel.

Sometimes a casualty who has been exposed to choking agents will show no signs or symptoms of exposure. Also, a casualty who previously showed early signs and symptoms of exposure to choking agents may appear to be free of signs and symptoms. If the military situation allows, a casualty who is asymptomatic (no symptoms) should be assigned light duties that will not put stress on his respiratory system. Monitor the casualty for development of signs and symptoms. Have the casualty evaluated by medical personnel as soon as possible.

A casualty with early signs and symptoms of exposure to a choking agent should be allowed to sit until the signs and symptoms have subsided if the military situation permits. Have the casualty evaluated by medical personnel as soon as possible.

Have the casualty rest in a sitting position and keep him warm. Evacuate the casualty as soon as possible.

Blood agents (cyanides) are quick acting agents that interfere with the cells' ability to absorb oxygen. Inhalation is the usual route of entry. Blood agents include hydrocyanic acid (AC) and cyanogen chloride (CK). Some of the signs and symptoms of blood agent poisoning, such as blood-tinted sputum, may also be present since some blood agents also attack the lungs. Exposure to a high concentration of blood agent can cause death within minutes. Signs and symptoms include:

Dizziness and headache.

Cherry-red skin.

Eye, nose, and throat irritation.

Nausea and vomiting.

Slow pulse (bradycardia).

Fast and deep breathing (hyperventilation), followed by shallow breathing and faintness (hypotension). [Hyperventilation is part of the initial excitatory phase of blood agent poisoning. Hypotension, which follows, is caused by a lack of oxygen and is part of the depressive phase of blood agent poisoning.]

Convulsions.

Respiratory arrest.

Cardiac arrest.

If the casualty is not masked, put his protective mask on him. Remember to squat, not kneel.

If possible, get medical help (combat medic). If the combat medic is not immediately available, evacuate the casualty to the nearest medical treatment facility as quickly as possible.