combat life saver

Combat Life SaverCombat Life Saver

Lesson 22Lesson 22ADMINISTER FIRST AID TOADMINISTER FIRST AID TO

CHEMICAL AGENT CASUALTIESCHEMICAL AGENT CASUALTIES

Compiled and edited by,2LT John C. Miller, PA-C

Lesson 22Lesson 22ADMINISTER FIRST AID TOADMINISTER FIRST AID TO

CHEMICAL AGENT CASUALTIESCHEMICAL AGENT CASUALTIES

INTRODUCTIONINTRODUCTION

You have already demonstrated your ability to initiate You have already demonstrated your ability to initiate emergency care to a casualty suffering from nerve emergency care to a casualty suffering from nerve agent poisoning. In this lesson, you will learn to agent poisoning. In this lesson, you will learn to determine whether additional atropine is needed by determine whether additional atropine is needed by the nerve agent casualty and, if needed, to the nerve agent casualty and, if needed, to administer additional injections of atropine. You will administer additional injections of atropine. You will also learn to provide aid to victims of other chemical also learn to provide aid to victims of other chemical agents, that is, blister agents, blood agents, and agents, that is, blister agents, blood agents, and choking agents.choking agents.

ADMINISTER FIRST AID TOADMINISTER FIRST AID TOCHEMICAL AGENT CASUALTIESCHEMICAL AGENT CASUALTIES

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

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

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

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFSEVERE NERVE AGENT POISONINGSEVERE NERVE AGENT POISONING

• Signs of mild nerve agent poisoning such as a runny Signs of mild nerve agent poisoning such as a runny nose, drooling, tightness in the chest, cramps, and nose, drooling, tightness in the chest, cramps, and nausea.nausea.

• Strange and confused behavior.Strange and confused behavior.• Wheezing, coughing, and gurgling sounds while Wheezing, coughing, and gurgling sounds while

breathing,breathing,• Severely pinpointed pupils.Severely pinpointed pupils.• Red eyes with tears present.Red eyes with tears present.• Vomiting.Vomiting.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFSEVERE NERVE AGENT POISONINGSEVERE NERVE AGENT POISONING

• Severe muscular twitching (spasms).Severe muscular twitching (spasms).• Loss of bladder and bowel control.Loss of bladder and bowel control.• Convulsion.Convulsion.• Unconsciousness.Unconsciousness.• Respiratory failure (not breathing).Respiratory failure (not breathing).

TREAT A CASUALTY WITH SEVERE NERVETREAT A CASUALTY WITH SEVERE NERVEAGENT POISONINGAGENT POISONING

• RememberRemember: Provide care to casualties only after you : Provide care to casualties only after you have masked, put on your own protective clothing, have masked, put on your own protective clothing, and decontaminated your own exposed skin (if and decontaminated your own exposed skin (if needed).needed).

• QuestionQuestion: : How long do I wait after administering the three Mark I kits How long do I wait after administering the three Mark I kits

and CANA?and CANA?

• ResponseResponse: : Five minutes.Five minutes.


• Squat, insert your gloved hand beneath the casualty's Squat, insert your gloved hand beneath the casualty's hood, and take his carotid pulse using two fingers hood, and take his carotid pulse using two fingers (not your thumb).(not your thumb).

• QuestionQuestion: : Why squat instead of kneeling?Why squat instead of kneeling?

• ResponseResponse: : If you kneel, the chemical agents on the ground will reduce If you kneel, the chemical agents on the ground will reduce

your protective clothing's ability to protect you.your protective clothing's ability to protect you.


• QuestionQuestion: : The casualty requires additional atropine if his pulse is under The casualty requires additional atropine if his pulse is under

how many beats per minute?how many beats per minute?

• ResponseResponse: : If it is under 90 beats per minute.If it is under 90 beats per minute.


• Administer Additional AtropineAdminister Additional Atropine• Remove an atropine autoinjector from your aid bag, Remove an atropine autoinjector from your aid bag,

tear the clear plastic protective bag, and remove the tear the clear plastic protective bag, and remove the autoinjector.autoinjector.

• Form a fist around the autoinjector with your Form a fist around the autoinjector with your dominant hand.dominant hand.

• Grasp the yellow safety cap with your other hand. Grasp the yellow safety cap with your other hand. Pull the yellow safety cap away from the body of the Pull the yellow safety cap away from the body of the autoinjector.autoinjector.


• Place the green end of the autoinjector against and at Place the green end of the autoinjector against and at a 90 degree angle to the injection site. [Normally, the a 90 degree angle to the injection site. [Normally, the injection site is on the outer thigh below the hip and injection site is on the outer thigh below the hip and above the knee. If the casualty is very thin, the upper, above the knee. If the casualty is very thin, the upper, outer quadrant of his buttocks is used as the injection outer quadrant of his buttocks is used as the injection site.]site.]

• Apply firm, even pressure to make the autoinjector Apply firm, even pressure to make the autoinjector function.function.


• QuestionQuestion: : How long do you leave the needle in the muscle?How long do you leave the needle in the muscle?

• ResponseResponse: : At least 10 seconds.At least 10 seconds.

• Remove injector from casualty.Remove injector from casualty.• QuestionQuestion: :

What should I do with the used injector?What should I do with the used injector?

• ResponseResponse: : Attach the used autoinjector to the casualty's outer clothing Attach the used autoinjector to the casualty's outer clothing

(pocket flap) to inform medical personnel what medication (pocket flap) to inform medical personnel what medication the casualty received and how much he received.the casualty received and how much he received.


• QuestionQuestion: : How long should you wait between injections, assuming that How long should you wait between injections, assuming that

his pulse rate is still below 90 beats per minute?his pulse rate is still below 90 beats per minute?

• ResponseResponse: : Five minutes.Five minutes.

• Administer Additional CANAAdminister Additional CANA• Administer a second CANA if the casualty is still Administer a second CANA if the casualty is still

suffering convulsions 5 to 10 minutes after suffering convulsions 5 to 10 minutes after administering the first CANA. If the casualty still has administering the first CANA. If the casualty still has convulsions 5 to 10 minutes later administer a third convulsions 5 to 10 minutes later administer a third CANA.CANA.


• QuestionQuestion: : What is the maximum number of CANA autoinjectors you What is the maximum number of CANA autoinjectors you

should administer to a casualty.should administer to a casualty.

• ResponseResponse: : Three.Three.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO BLISTER AGENTSEXPOSURE TO BLISTER AGENTS

Blister agents act primarily on the eyes, respiratory Blister agents act primarily on the eyes, respiratory tract, and skin. The eyes are very sensitive and are tract, and skin. The eyes are very sensitive and are usually the first to be affected by blister agents. Signs usually the first to be affected by blister agents. Signs and symptoms affecting the skin and respiratory track and symptoms affecting the skin and respiratory track may not appear for several hours following exposure.may not appear for several hours following exposure.


• EyesEyes• Sensitivity to light.Sensitivity to light.• Gritty feeling in eyes.Gritty feeling in eyes.• Inflammation of the inner eyelids.Inflammation of the inner eyelids.• Swelling and spasms of the eyelids.Swelling and spasms of the eyelids.• Watery eyes.Watery eyes.• Pain.Pain.


• SkinSkin• Itching.Itching.• Swelling and redness.Swelling and redness.• Blisters.Blisters.• Pain. (If lewisite or phosgene oxide, pain is Pain. (If lewisite or phosgene oxide, pain is

immediate and intense.)immediate and intense.)


• Respiratory TractRespiratory Tract• Throat irritation (dry, burning sensation).Throat irritation (dry, burning sensation).• Harsh cough and hoarse voice.Harsh cough and hoarse voice.• Phlegm (mucous discharge) or frothy sputum.Phlegm (mucous discharge) or frothy sputum.• Runny nose and frequent sneezing.Runny nose and frequent sneezing.


OtherOther• Headache.Headache.• Nausea and vomiting.Nausea and vomiting.• Diarrhea.Diarrhea.

TREAT A CASUALTY EXPOSED TO ATREAT A CASUALTY EXPOSED TO ABLISTER AGENTBLISTER AGENT

• After the casualty is masked, quickly flush the After the casualty is masked, quickly flush the casualty's eye if liquid blister agent is present in the casualty's eye if liquid blister agent is present in the eye. If agent is present in both eyes, flush both eyes.eye. If agent is present in both eyes, flush both eyes.

• Remove and open the casualty's canteen.Remove and open the casualty's canteen.• Have the casualty take a deep breath and hold it.Have the casualty take a deep breath and hold it.• Lift the casualty's mask from his chin so his eyes are Lift the casualty's mask from his chin so his eyes are

exposed.exposed.• Tilt the casualty's head to one side so the eye to be Tilt the casualty's head to one side so the eye to be

flushed is lower than the other eye.flushed is lower than the other eye.• Have the casualty open his lower eye.Have the casualty open his lower eye.


• Pour the water from the canteen gently into the lower Pour the water from the canteen gently into the lower eye, pouring from the inner edge of the eye to the eye, pouring from the inner edge of the eye to the outer edge.outer edge.

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

• If both eyes are contaminated, tilt the casualty's head If both eyes are contaminated, tilt the casualty's head so the other eye is now lower than the flushed eye so the other eye is now lower than the flushed eye and flush the second eye in the same manner.and flush the second eye in the same manner.

• Replace the casualty's mask. Have him clear his Replace the casualty's mask. Have him clear his mask resume normal breathing.mask resume normal breathing.


• QuestionQuestion: : What should you do once you have removed any liquid What should you do once you have removed any liquid

blister agent from the casualty's eyes?blister agent from the casualty's eyes?

• ResponseResponse: : Decontaminate the casualty's face and exposed skin, then Decontaminate the casualty's face and exposed skin, then

evacuate the casualty as soon as practical.evacuate the casualty as soon as practical.

• QuestionQuestion: : Assume blisters have formed on the casualty's unprotected Assume blisters have formed on the casualty's unprotected

forearms. Should you decontaminate the blisters?forearms. Should you decontaminate the blisters?

• ResponseResponse: : Do not decontaminate or break the blistered areas.Do not decontaminate or break the blistered areas. Washing eyes may not result in symptoms going away. Washing eyes may not result in symptoms going away. Do Do

not reflushnot reflush..

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFEXPOSURE TO CHOKING AGENTSEXPOSURE TO CHOKING AGENTS

Choking agents are chemical agents that attack the Choking agents are chemical agents that attack the lungs and cause them to fill with fluid. Early signs and lungs and cause them to fill with fluid. Early signs and symptoms will subside rapidly and allow the casualty symptoms will subside rapidly and allow the casualty to carry on with his combat mission if needed. If the to carry on with his combat mission if needed. If the casualty was exposed to a sufficient amount of casualty was exposed to a sufficient amount of choking agent, late signs and symptoms usually choking agent, late signs and symptoms usually appear 4 to 24 hours after initial exposure.appear 4 to 24 hours after initial exposure.


• Early Signs and Symptoms of Exposure to Choking Early Signs and Symptoms of Exposure to Choking AgentsAgents

• Tears.Tears.• Dry throat.Dry throat.• Tightness in the chest.Tightness in the chest.• Choking cough.Choking cough.• Nausea or vomiting.Nausea or vomiting.• Headache.Headache.


• Late Signs and Symptoms of Exposure to Choking Late Signs and Symptoms of Exposure to Choking AgentsAgents

• Anxiety.Anxiety.• Wheezing.Wheezing.• Rapid, shallow breathing.Rapid, shallow breathing.• Weak, but rapid, pulse (tachycardia).Weak, but rapid, pulse (tachycardia).• Serious attacks of coughing that produce white or Serious attacks of coughing that produce white or

yellowish fluid, sometimes frothy and tinted with blood.yellowish fluid, sometimes frothy and tinted with blood.• Cyanosis (bluish tint to lips and nailbeds).Cyanosis (bluish tint to lips and nailbeds).• Shock.Shock.• Respiratory arrest.Respiratory arrest.

TREAT A CASUALTY EXPOSED TO TREAT A CASUALTY EXPOSED TO CHOKING AGENTSCHOKING AGENTS

• Mask the casualty.Mask the casualty.• Instruct a casualty with early signs and symptoms of Instruct a casualty with early signs and symptoms of

choking agent poisoning to sit until the signs and choking agent poisoning to sit until the signs and symptoms have subsided if the military situation symptoms have subsided if the military situation permits. Have the casualty evaluated by medical permits. Have the casualty evaluated by medical personnel when possible.personnel when possible.

• If a casualty shows late signs and symptoms, have If a casualty shows late signs and symptoms, have him rest in a sitting position and keep him warm. him rest in a sitting position and keep him warm. Evacuate him as soon as possible.Evacuate him as soon as possible.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFBLOOD AGENT POISONINGBLOOD AGENT POISONING

• Blood agents interfere with the body's ability to use Blood agents interfere with the body's ability to use oxygen. They may also attack the lungs like choking oxygen. They may also attack the lungs like choking agents. Signs and symptoms of choking agent agents. Signs and symptoms of choking agent poisoning include:poisoning include:

• Dizziness and headache.Dizziness and headache.• Cherry-red skin.Cherry-red skin.• Irritation of the eyes, nose, and throat.Irritation of the eyes, nose, and throat.• Nausea and vomiting.Nausea and vomiting.• Slow pulse (bradycardia).Slow pulse (bradycardia).

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFBLOOD AGENT POISONINGBLOOD AGENT POISONING

• Fast and deep breathing in the initial phase, followed Fast and deep breathing in the initial phase, followed by shallow breathing and faintness due to a decrease by shallow breathing and faintness due to a decrease of usable oxygen.of usable oxygen.

• Convulsions.Convulsions.• Respiratory arrest.Respiratory arrest.• Cardiac arrest.Cardiac arrest.

TREAT A CASUALTY WITH TREAT A CASUALTY WITH BLOOD AGENT POISONINGBLOOD AGENT POISONING

• Mask the casualty.Mask the casualty.• Evacuate the casualty to the nearest medical Evacuate the casualty to the nearest medical

treatment facility as quickly as possible.treatment facility as quickly as possible.

ADMINISTER FIRST AID TOADMINISTER FIRST AID TOCHEMICAL AGENT CASUALTIESCHEMICAL AGENT CASUALTIES

CLOSINGCLOSING

Chemical agents are deadly. Immediate treatment Chemical agents are deadly. Immediate treatment can help chemical agent casualties to survive until can help chemical agent casualties to survive until they can be evacuated to a medical treatment facility they can be evacuated to a medical treatment facility where they can receive medical treatment. where they can receive medical treatment. Remember to take adequate protective measures Remember to take adequate protective measures yourself before helping a casualty who has been yourself before helping a casualty who has been overcome by chemical agents.overcome by chemical agents.This lesson is tested in the written multiple-choice This lesson is tested in the written multiple-choice examination.examination.

QuestionsQuestions