Lesson 2.

Medical and tactical characteristics

of damage sites caused by urgent and exigent cases

Kanan Yusif-zada, MD, PhD, MBA

Content

1 Medical and tactical characteristics of bacteriological

(biological) lesion focus.

2 Medical and tactical characteristics of chemical lesion focus.

Strong poisonous substances.

3 Medical and tactical characteristics of nuclear lesion focus.

4 Medical and tactical characteristics of combined lesion focus .

Page 2 of 36
Assessment of the established situation of the medical service allows to:

clarify the number of the injured;

accurately determine duties of the medical service, type and volume of the
medical aid;

determine the demand in the medical service forces and means;

select more effective form of treatment and evacuation measures for
elimination of established sites of ES.

Page 3 of 36
 Mass destruction sites fall into 4 groups:
bacteriologic
chemical
nuclear
combined destruction sites

Page 4 of 36
1 Medical and tactical characteristics of bacteriological
(biological) lesion focus.

Bacteriological weapons pathogenic microorganisms used for the

contamination of human beings, animals and plants, their toxins, as well as
means of their delivery to the target.

Applied by several methods:

by using an aerosol, through infected insects and rodents;

through subversive actions (water and food);
toxic substances with bacterial toxins

Page 5 of 36
Specific peculiarities of bacteriological weapon:

High efficiency potential (capable of infecting human beings and animals with
small doses).
Latent stage.
Contagiosity (transmissibility from a sick to a healthy individual).
Long-term impact and resistance to environment.
Determination of difficulties in detection, relation to food environment and
resistance to antibiotics.
Large number of agents.
Strong psychological effect.
Low costs of preparation (as compared with nuclear and chemical weapons).

Page 6 of 36
A number of factors shall be considered in the assessment of the
situation established in the bacteriologic damage site:

type and method of application of applied infectious agents;

timely detection;
area of the contaminated zone and expected area of contamination;
meteorological situation;
season;
number and density of the population;
nature of constructions;
provision of population with protective equipment;
number of the vaccinated population;
provision of the population with non-specific and specific means of prevention
and treatment.

Page 7 of 36
 Calculation of expected medical losses in case of application of a
bacteriological weapon becomes complicated for several reasons:

I. Agents of several infectious diseases may be applied at the same time.

II. Different resistance of different people to contagion and specific features
of each microorganism and virulence factor.
III. Increase of sanitary losses due to transmission (secondary) of the disease
from the thick to healthy individuals. This makes it possible to make
accurate calculation of sanitary losses.

25-50% of the general number of the population may initially become infected
in the result of exposure to bacteriological means.

Page 8 of 36
 When it detects signs of the use of these weapons
immediately put on gas masks (respirators, masks, as
well as a means to protect the skin).

Page 9 of 36
2 Medical and tactical characteristics of chemical lesion focus.
Strong poisonous substances.

Toxic substances (TS), means of their delivery (transportation) to the target

and application are called chemical weapons.

Specific properties of TS:

easily spread in environment;
continuous damaging effect;
diversity of the clinical picture and development dynamics of intoxication;
Partial penetration of TS into organism through respiratory, digestive and
transcutaneous ways;
dependence of development of intoxications on the ways of penetration of TS into
organism;
psychoemotional effect;
necessity to use protective equipment
Page 10 of 36
Classifications of toxic substances
Classification of TS based on leading clinical symptoms:
Nerve agents (organophosphorous substances- POS) - sarin, soman, Vx-gases.
Asphyxiating - phosgene, diphosgene etc.
Skin-resorptive - yprite, lewisite etc.
Psychochemical (psychotomimetics) - "BZ", LSD etc.
Irritants - adamsite, chloracetophenone, chloropicrin etc.
Blood and nerve - cyanic acid, chlorine cyanide etc.

Classification of TSs based on the impact:

Killing TS - sarin, soman, Vx-gases etc.
Temporarily disabling TS - adamsite, chloropicrin, BZ, LSD etc.

Page 11 of 36
Chemical contamination site mass damage to people, animals and
plants caused by the chemical weapon and area seriously contaminated with
toxic substances.

Chemical situation situation caused by the use of the chemical weapon.

Page 12 of 36
 Assessment of chemical situation shall be carried out based on the
following initial information:
Type and time of application of TS
Means of application of TS
Area of application of TS
Wind speed and direction
Air and soil temperature

Sanitary losses among the population present in the chemical damage site may
be up to 80-90%

Page 13 of 36
After the assessment of the chemical situation Civil Defense
Medical Service (CDMS) head and chief of the staff:
inform CDMS agencies about the contamination of the area and air with
toxic substance;
analyse and make conclusions regarding the working ability of population
and agencies for the elimination of chemical damage sites;
determine the most suitable activity options;
select safer regions for the accommodation of the population and
agencies;
determine the time within which it is necessary for people to remain in
protective equipment;
determine the rules of sanitary cleansing of people contaminated with TS
and decontamination of machinery.
Page 14 of 36
CDTS agencies' staff shall perform the following in chemical
damage site:
chemical and medical survey;
first medical aid to the injured and their evacuation from the site;
sanitary cleansing of persons contaminated with TS;
decontamination of the used machinery, property, as well as clothes of the
injured for medical purposes and other works.

Page 15 of 36
3 Medical and tactical characteristics of nuclear lesion focus.

Nuclear weapon ordnance having damaging nuclear energy impact

in the result of nuclear explosion reaction.

Damaging effects of a nuclear explosion is based on the energy released

in nuclear reactions explosive.

Page 16 of 36
In August 1945, Destroyed city of Hiroshima
American pilots were
dropped atomic bombs
on the Japanese cities
of Hiroshima and
Nagasaki.
In total, killed more
than 200 thousand
people.

Page 17 of 36
Nuclear explosion may result in the blast wave
appearance of 5 kinds of harmful (50%)

impacts:

thermal or
electromagn
light
etic impulse
radiation
(1%)
(35%)
Nuclear
explosion
energy

radioactive penetrating
contaminati (ionizing)
on of land radiation
(10%) (4%)

Page 18 of 36
Blast wave
Consists of severely compressed and heated air flow spreading to all
directions at a speed higher that sound speed.

Hearth of nuclear destruction, depending on the pressure in the shock front is divided into
zones of destruction.

Page 19 of 36
 Thermal (light) radiation
Light radiation is a strong visible ultraviolet and infrared radiation emitted by a
fireball appearing in case of nuclear explosion.

Emission of Thermal Radiation in Two Pulses in an Air Blast

Page 20 of 36
Thermal (light) radiation

The burns are in degrees:

1st: Not serious painful and reddening of skin.
Continues for minutes to hour.
2nd: Dermal tissue damage Pain and reddening with
blisters. Regenerating ability, no scars. Possible
infection.
3rd: Tissue death throughout skin No regeneration
w/o grafting. Scarring, serious risk of infection, and
serious fluid loss.
4th: Destroys tissue below skin, muscle, connective
tissue Can cause exposed flesh to flash into
steam, flaying exposed body area to the bone.

Page 21 of 36
Penetrating (ionizing) radiation

Penetrating radiation consists of invisible gamma rays and neutrons spreading

around the explosion site in case of nuclear explosion.
Impact of penetrating radiation is assessed as a swallowed dose and measured in
Grays (Gr), Roentgen (R), and rad units of measurement. Lasts only 10-25
seconds. Within this short period, unprotected people and animals may get
radiation injury.

Severity degrees of radiation disease: Clinical course of acute radiation disease:

Dose 1-2 Gr I (mild) degree
Dose 2-4 Gr II (medium degree of severity)
Dose 4-6 Gr III (severe) degree
Dose 6 Gr IV (very severe) degree
1 period of initial reactions (min to hours);
2 latent period (1-6 days);
3 acute period;
4 convalescence period (complex
treatment or bone transplantation

Page 22 of 36
Penetrating (ionizing) radiation

The action of ionizing radiation:

a - on the human body (penetrate through);
b - on various materials.

Half attenuation of penetrating radiation

provides:
a layer of concrete thickness of 10 cm (1);
a brick (2);
a normal soil 14 cm thick (3);
30 cm thick wood (4)
a) b)

Page 23 of 36
Radioactive contamination of land
The extent of radioactive contamination depending on the distance from the epicenter:

1. moderate infection zone

(length of approximately
300-400 km);
2. severe infection zone
(150-200 km);
3. dangerous infection zone
(90-100 km);
4. zone of extremely
dangerous infection
(9-10 km)

Page 24 of 36
 Effects of Nuclear Radiation On the Human Body

Most critical organs are divided into 3 groups by

sensitivity:
Red bone marrow and genital glands.
Thyroid gland, liver, kidneys, lungs and muscular system.
Skin cover and done tissue

Page 25 of 36
Electromagnetic impulse

Overvoltage caused by explosions are able to:

destroy electrical and cause burnout elements of electricity striking staff

radio devices and radio or mass operation protection
Page 26 of 36
Electromagnetic impulse
To determine the nature of destructions, amount and condition of rescue
operations, damage site is divided into four circular areas

Page 27 of 36
Page 28 of 36
*Source: Nuclear Weapons, 1959
Page 29 of 36
Electromagnetic impulse

Assessment of the conditions in the nuclear damage site shall consider

radiation situation which is one of the main elements of the site.

Assessment of radioactive situation allows to:

calculate the expected radiation dose;
determine term of operation of agencies in damage zones;
determine time of entrance of agencies into damage zones;
determine the time of escape from sites;
choose the most favorable option of operation for economic entities
and medical facilities.

Page 30 of 36
Table 1. Estimated losses among unprotected population of a nuclear damage site
Destruction Nonrecoverable
General losses, % Sanitary losses, %
zones losses, %
Complete 90 80 10
Severe 50 35 15
Moderate 40 10 30
Light 15 15

Table 2. Structure of estimated sanitary losses in case of application of a nuclear weapon

Damages Amount (%) Note

Thermal burns 26.4.-25.
Mechanical injuries 26.4.-50.
Radiation damages 26.4.-15.
Including central
Combines damages 45-55 nervous system (CNS)
disorders

Page 31 of 36
Page 32 of 36
4 Medical and tactical characteristics of combined lesion focus

In modern times, there is a risk of simultaneous and successive application of

nuclear, chemical and bacteriological weapons may be applied in the following
combinations:
nuclear and chemical;
nuclear and bacteriological;
chemical and bacteriological;
nuclear and bacteriological;
mass destruction weapon (MDW) and conventional weapons.

Page 33 of 36
Combined damages in the result of impact of several weapons on human
organism:
mechanical injuries, burns, radiation damages;
mechanical injuries, intoxications, infectious diseases;
radiation damages, mechanical injuries, burns etc.

Page 34 of 36
Unlike peace time, activity of CDMS in wartime is very complex and severe:
frequent changes in general conditions requiring changes in the method, mode
and place of work;
mass sanitary losses occurring within short period of time (among which
combined damages, multiple trauma and joint injuries will prevail);
increase of the risk of appearance and spread of ordinary infectious diseases in
connection with decrease in the sanitary-epidemiologic and financial and living
conditions of residential areas;
aggravation of the course of a number of pathologic processes (pneumonia,
gastric ulcer, pulmonary tuberculosis etc.);
psychological effect of modern weapons, especially, MDW, on people;
significant increase of rear pathologies in peace time (radiation disease, trench
foot, ttnus etc.).
Page 35 of 36
Thank you!