Casualties medical treatment

B. Treat NBC Casualties. Medical treatment facilities should be prepared to treat the wide range of injuries and the possible large number of casualties from NBC weapons. 

Currently, scientists and experts from many countries are working on development and implementation of a readiness for anti terrorist actions. In addition to chemical weapons, terrorists can use various toxic chemicals from chemical industry, agriculture or products released from terrorist acts on industrial facilities. The arsenal of chemical agents that can be used as terrorist agents is practically unlimited. The focus of this workshop was assessment of scientific concepts and practical means for management of chemical agent casualties in the area of terrorist attack with emphasis on improving the medical treatment and decontamination. These problems were analyzed from an interdisciplinary perspective. 

IMMEDIATE A casualty classified as immediate has an injury that will be fatal of he does not receive immediate care. In a non-mass casualty situation, he would be the first casualty to receive care. However, in a mass casualty situation, particularly in a far-forward medical treatment facility, he may not receive this care. The required care may not be available at that echelon (e.g., a casualty may need major chest surgeryjor the time needed to provide the care may be so prolonged that other casualties would suffer. 

EXPECTANT The expectant casualty is one for whom medical care cannot be provided at the medical treatment facility and cannot be evacuated for more advanced care in time to save his life. This category is used only during mass casualty situations. This category does not mean that these casualties will receive medical care. 

In the civilian setting, natural disasters such as tornadoes, hurricanes, fires, and explosions produce large numbers of casualties that cannot be treated immediately in emergency rooms and hospitals. A delay in medical treatment in the aftermath of disasters is often not available to remote geographic locations due to long distances from facilities, loss of power and essential services, or just the huge numbers involved and the enormity of the situation. 

Garigan, T. (1996). Medical treatment of chemical warfare casualties. Accessed May 15, 2006. Uniformed Services Academy of Family Physicians. Okinawa, Japan (available from URL http www.usalp. org/ op med/ fieldcl inical/chemcascare. html). 

Koenig, KL, Goans, RE, Hatchett, RJ, et al. Medical Treatment of Radiological Casualties Current Concepts. Annals of Emergency Medicine, 45(6) 643-652, 2005... 

Mustard-related death occurs in about 3% of the casualties who reach a Medical Treatment Facility of those who die, most die 4 or more days after exposure (Gilchrist, 1928). Of the casualties who died, 84% required at least 4 days of hospitalization. The causes of death are pulmonary insufficiency from airway damage, superimposed infection, and sepsis. Rarely, the amount of mustard will be overwhelming and cause death within 1-2 days in these circumstances, death will be due to neurological factors or massive airway damage (Graef et al., 1948 Heully and... 

If any mustard remains on the skin, thorough decontamination later will prevent the further spreading to other areas. After several hours, spreading will have occurred because oily substances flow on warm skin. Decontamination now, however, will prevent mustard from spreading to personnel who handle the casualty and possible contamination of medical treatment facilities (MTFs). By the time skin lesions develop, most mustard will have been absorbed and fixed to tissue. Unless the site was occluded, the remaining unabsorbed agent will have evaporated. 

FIGURE 24.2 Representative diagram of a casualty treatment site. (From U.S. Army Medical Research Institute of Chemical Defense, Chemical Casualty Care Division, June 2001.) Hot Line= possible hquid contamination downwind (left side of line), negative liquid contamination upwind (right side of line). N.B. Possible positive vapor present on either side of hot line. VCL — vapor-control line possible positive vapor on downwind side of line (left side of line), negative vapor on upwind side of line (right side of line). EMT, emergency medical treatment MTF, medical treatment facility. 

The primary focus of the proposed book is the introduction of scientific concepts and practical means for management of chemical agent casualties from terrorist attacks with emphasis on improving the medical treatment. The main topics include ... 

Detection and identification of the chemical agent at the scene of a terrorist incident is quite possible to carry out with joint efforts of chemists and healthcare providers, but it must not be accomplished at the expense of rapid and appropriate medical treatment of chemical casualties. It is precisely a delayed onset of the treatment that often results in death of exposed individuals and further complications in disease course of survivals. There are certainly many chemical agents for which there are no known treatments. We should not expect that terrorists would choose the agents for which we are prepared, and for which we have effective treatment, even if they are the easiest to create and disperse, such as sarin. The problem is likely to be approached by superimposing a response to a terror... 

Because of the specific nature of chemical warfare agents in terms of their lethal or disabling effects and overwhelming number of casualties needing medical treatment in chemical attacks or terroristic use of chemical warfare agents, an effective medical system for management of chemical casualties can save lives of so many patients. 

The first rule for medical personnel must be that they protect themselves. Failure to use appropriate procedures or protective equipment places the individual, health care workers and the medical treatment facility at risk. During a mass casualty incident, many people require medical care neither health care personnel nor health care facilities can be compromised. 

The medical management plan for the exercise was first treatment for casualties in the Emergency Medical Treatment (EMT) point as well as in the field hospital according to the special protocol for mass casualties management containing ... 

Medical treatment protocol (type and dose of antidotes and other medications) for casualties with various level of exposure... 

Additional atropine beyond the initial 6 mg carried by the service member will most assuredly be needed promptly in a severely poisoned casualty. Sided (1997) recommends that an additional 4 mg of atropine be given immediately, for a total initial dose of 10 mg. If the patient is in a medical treatment facility, the atropine should be given IV if that is possible and... 

Comstock CC and Krop S (1948). German first aid kits for treatment oftabun (GA) casualties. Medical Division Report No. 151. Edgewood Arsenal, MD, USA Army Chemical Center. 

Blast Injuries. There are two types of blast forces that occur in a nuclear detonation blast wave direct blast wave overpressure forces and indirect blast wind drag forces. The most important blast effects, insofar as production of casualties will be those due to the blast wind drag forces. Casualties requiring medical treatment from direct blast effects are produced by overpressures between 1.0 and 3.5 atmospheres. However, other effects (such as indirect blast injuries and thermal injuries) are so predominate that patients with only direct blast injuries make up a small part of the patient workload. 

B. Radiation Injury Probable. Anorexia, nausea, and vomiting are the primary prodromal symptoms associated with radiation injury. Priority for further evaluation will be assigned after all life-threatening injuries have been stabilized. Casualties in this category will not require any medical treatment within the first few days for their radiation injuries. Evidence to support the diagnosis of significant radiation injury in the absence of bums and trauma may be obtained from lymphocyte assays taken over the next 2 days. If the evidence indicates that a significant radiation injury was received, these casualties need to be monitored for pancytopenic complications. 

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