Combat Life Saver

Lesson 22
ADMINISTER FIRST AID TO
CHEMICAL AGENT CASUALTIES

Compiled and edited by,

2LT John C. Miller, PA-C
 Lesson 22
ADMINISTER FIRST AID TO
CHEMICAL AGENT CASUALTIES

INTRODUCTION

You have already demonstrated your ability to initiate

emergency care to a casualty suffering from nerve
agent poisoning. In this lesson, you will learn to
determine whether additional atropine is needed by
the nerve agent casualty and, if needed, to
administer additional injections of atropine. You will
also learn to provide aid to victims of other chemical
agents, that is, blister agents, blood agents, and
choking agents.
 ADMINISTER FIRST AID TO
CHEMICAL AGENT CASUALTIES

• TASK
Identify signs and symptoms of chemical agent
poisonings and their treatments.
• CONDITIONS
Given written items pertaining to the identification and
treatment of chemical agent casualties.
• STANDARD
Score 70 or more points on the 100-point written
examination.
 IDENTIFY SIGNS AND SYMPTOMS OF
SEVERE NERVE AGENT POISONING

• Signs of mild nerve agent poisoning such as a runny

nose, drooling, tightness in the chest, cramps, and
nausea.
• Strange and confused behavior.
• Wheezing, coughing, and gurgling sounds while
breathing,
• Severely pinpointed pupils.
• Red eyes with tears present.
• Vomiting.
 IDENTIFY SIGNS AND SYMPTOMS OF
SEVERE NERVE AGENT POISONING

• Severe muscular twitching (spasms).

• Loss of bladder and bowel control.
• Convulsion.
• Unconsciousness.
• Respiratory failure (not breathing).
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Remember: Provide care to casualties only after you

have masked, put on your own protective clothing,
and decontaminated your own exposed skin (if
needed).
• Question:
✑ How long do I wait after administering the three Mark I kits
and CANA?
• Response:
✑ Five minutes.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Squat, insert your gloved hand beneath the casualty's

hood, and take his carotid pulse using two fingers
(not your thumb).
• Question:
✑ Why squat instead of kneeling?
• Response:
✑ If you kneel, the chemical agents on the ground will reduce
your protective clothing's ability to protect you.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Question:
✑ The casualty requires additional atropine if his pulse is under
how many beats per minute?
• Response:
✑ If it is under 90 beats per minute.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Administer Additional Atropine

• Remove an atropine autoinjector from your aid bag,
tear the clear plastic protective bag, and remove the
autoinjector.
• Form a fist around the autoinjector with your
dominant hand.
• Grasp the yellow safety cap with your other hand.
Pull the yellow safety cap away from the body of the
autoinjector.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Place the green end of the autoinjector against and at

a 90 degree angle to the injection 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 make the autoinjector
function.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Question:
✑ How long do you leave the needle in the muscle?
• Response:
✑ At least 10 seconds.
• Remove injector from casualty.
• Question:
✑ What should I do with the used injector?
• Response:
✑ Attach the used autoinjector to the casualty's outer clothing
(pocket flap) to inform medical personnel what medication
the casualty received and how much he received.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Question:
✑ How long should you wait between injections, assuming that
his pulse rate is still below 90 beats per minute?
• Response:
✑ Five minutes.
• Administer Additional CANA
• Administer a second CANA if the casualty is still
suffering convulsions 5 to 10 minutes after
administering the first CANA. If the casualty still has
convulsions 5 to 10 minutes later administer a third
CANA.
 TREAT A CASUALTY WITH SEVERE NERVE
AGENT POISONING

• Question:
✑ What is the maximum number of CANA autoinjectors you
should administer to a casualty.
• Response:
✑ Three.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO BLISTER AGENTS

Blister agents act primarily on the eyes, respiratory

tract, and skin. The eyes are very sensitive and are
usually the first to be affected by blister agents. Signs
and symptoms affecting the skin and respiratory track
may not appear for several hours following exposure.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO BLISTER AGENTS

• Eyes
• Sensitivity to light.
• Gritty feeling in eyes.
• Inflammation of the inner eyelids.
• Swelling and spasms of the eyelids.
• Watery eyes.
• Pain.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO BLISTER AGENTS

• Skin
• Itching.
• Swelling and redness.
• Blisters.
• Pain. (If lewisite or phosgene oxide, pain is
immediate and intense.)
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO BLISTER AGENTS

• Respiratory Tract
• Throat irritation (dry, burning sensation).
• Harsh cough and hoarse voice.
• Phlegm (mucous discharge) or frothy sputum.
• Runny nose and frequent sneezing.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO BLISTER AGENTS

Other
• Headache.
• Nausea and vomiting.
• Diarrhea.
 TREAT A CASUALTY EXPOSED TO A
BLISTER AGENT

• After the casualty is masked, quickly flush the

casualty's eye if liquid blister agent is present in the
eye. If agent is present in both eyes, flush both eyes.
• Remove and open the casualty's canteen.
• Have the casualty take a deep breath and hold it.
• Lift the casualty's mask from his chin so his eyes are
exposed.
• Tilt the casualty's head to one side so the eye to be
flushed is lower than the other eye.
• Have the casualty open his lower eye.
 TREAT A CASUALTY EXPOSED TO A
BLISTER AGENT

• Pour the water from the canteen gently into the lower
eye, pouring from the inner edge of the eye to the
outer edge.
• Continue to flush the eye with water until the blister
agent has been flushed from the eye.
• If both eyes are contaminated, tilt the casualty's head
so the other eye is now lower than the flushed eye
and flush the second eye in the same manner.
• Replace the casualty's mask. Have him clear his
mask resume normal breathing.
 TREAT A CASUALTY EXPOSED TO A
BLISTER AGENT
• Question:
✑ What should you do once you have removed any liquid
blister agent from the casualty's eyes?
• Response:
✑ Decontaminate the casualty's face and exposed skin, then
evacuate the casualty as soon as practical.
• Question:
✑ Assume blisters have formed on the casualty's unprotected
forearms. Should you decontaminate the blisters?
• Response:
✑ Do not decontaminate or break the blistered areas.
✑ Washing eyes may not result in symptoms going away. Do
not reflush.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO CHOKING AGENTS

Choking agents are chemical agents that attack the

lungs and cause them to fill with fluid. Early signs and
symptoms will subside rapidly and allow the casualty
to carry on with his combat mission if needed. If the
casualty was exposed to a sufficient amount of
choking agent, late signs and symptoms usually
appear 4 to 24 hours after initial exposure.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO CHOKING AGENTS

• Early Signs and Symptoms of Exposure to Choking

Agents
• Tears.
• Dry throat.
• Tightness in the chest.
• Choking cough.
• Nausea or vomiting.
• Headache.
 IDENTIFY SIGNS AND SYMPTOMS OF
EXPOSURE TO CHOKING AGENTS
• Late Signs and Symptoms of Exposure to Choking
Agents
• 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 arrest.
 TREAT A CASUALTY EXPOSED TO
CHOKING AGENTS

• Mask the casualty.

• Instruct a casualty with early signs and symptoms of
choking agent poisoning to sit until the signs and
symptoms have subsided if the military situation
permits. Have the casualty evaluated by medical
personnel when possible.
• If a casualty shows late signs and symptoms, have
him rest in a sitting position and keep him warm.
Evacuate him as soon as possible.
 IDENTIFY SIGNS AND SYMPTOMS OF
BLOOD AGENT POISONING

• Blood agents interfere with the body's ability to use

oxygen. They may also attack the lungs like choking
agents. Signs and symptoms of choking agent
poisoning include:
• Dizziness and headache.
• Cherry-red skin.
• Irritation of the eyes, nose, and throat.
• Nausea and vomiting.
• Slow pulse (bradycardia).
 IDENTIFY SIGNS AND SYMPTOMS OF
BLOOD AGENT POISONING

• Fast and deep breathing in the initial phase, followed

by shallow breathing and faintness due to a decrease
of usable oxygen.
• Convulsions.
• Respiratory arrest.
• Cardiac arrest.
 TREAT A CASUALTY WITH
BLOOD AGENT POISONING

• Mask the casualty.

• Evacuate the casualty to the nearest medical
treatment facility as quickly as possible.
 ADMINISTER FIRST AID TO
CHEMICAL AGENT CASUALTIES

CLOSING

Chemical agents are deadly. Immediate treatment

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