Immediate casualty

These materials are fourth generation chemical warfare agents. They contain one or more quaternary amine centers that increase the ability of the agent to penetrate into neuromuscular junctions. They are relatively simple to synthesize although the starting materials are not commonly available. Because they produce negligible vapor, they are somewhat difficult to deliver in a manner that will produce immediate casualties. 

The AMP is under the overall control of the director of medical rescue (DSM) who is usually a fire service medical officer (these are a feature of the French system). Running of the AMP is the responsibility of aphysician, chosen by the DSM, whose responsibilities include triage, immediate casualty care and evacuation of the patients to designated hospitals (le grand noria). 

The classical concept of military medical care has been that a chain of surface or ground evacuation is available. Using helicopter evacuation, immediate casualty collection points may be bypassed so that wounded personnel can be taken directly to well-equipped hospital facilities located relatively far to the rear reducing the need for an extensive ground evacuation system. However, reorganization of the medical evacuation system in which the intermediate elements are deleted, based primarily upon the proposed use of helicopter evacuation, may not be possible or desirable. Helicopter evacuation may become severely limited if nuclear weapons are used extensively, and the success of helicopter evacuation is certainly affected by weather conditions and enemy air capabilities. Therefore, a ground based evacuation system must be planned for since it could easily become the primary means of evacuation. 

Immediate casualties who require lifesaving care within a short time, when that care is available and of short duration. This care may be a procedure that can be done within minutes at an emergency treatment station by a corpsman (eg, relief of airway obstruction) or may be acute lifesaving surgery. 

Even if the explosion of a dirty bomb caused few immediate casualties, there is the fear of long-term health risks as well as the astronomical cost of cleanup of a site contaminated by radioactive material. 

Should a terrorist attack involve chemical agents, such as the highly toxic organophosphate compounds sarin, VX, or tabun, the NPS stockpiles also could be used to aid immediate casualties with atropine injections (which can be used to counteract the efiects of some nerve agents), respirators, and other treatments. In addition, hospitals and clinics are routinely well supplied with these and other treatments that can save many lives very quickly. In the case of VX, however, risk of contamination to so-called first responders will be great, and decontamination measures must be considered lest more people become inadvertently exposed. 

If required, immediate casualty decontamination for biological agents can be carried out effectively with detergent and water. Surfaces and equipment should be carefully disinfected with an appropriate detergent or bleach solution. Medical utensils will ideally be of the single-use, disposable t)q>e. Multi-use items will need cleaning and disinfection as appropriate, such as steam heating in autoclaves. 

Skin and eye toxicity. 633mg-min/m3 will produce casualties by eye injury. On bare skin PD is about 90% as blistering as HD (distilled mustard), but it is decompd immediately by wet clothing... 

Phosgene was used tactically as a delayed or immediate action casualty gas. It was first employed by the Germans in WWI (Dec, 1915) in cylinders under the name D-Stoff. The French iater (1916) employed phosgene as an artillery shell filler (Collingite). During the remainder of the war it was the Allies principal war gas, used also in trench mortars, bombs, and projector drums (Ref 2)... 

Delayed- or immediate-action casualty agent, depending upon dosage rate. 

Decontaminate the casualty ensuring that all nerve agents have been removed. If nerve agents have gotten into the eyes, irrigate the eyes with water or 0.9% saline solution for at least 15 minutes. Irrigate open wounds with water or 0.9% saline solution for at least 10 minutes. However, do not delay treatment if thorough decontamination cannot be undertaken immediately. 

If HL (C03-A010) is involved, then exposure of the skin will produce an immediate burning sensation, which may be quickly followed by reddening of the skin (erythema). In addition to other latent effects, casualties exposed to HL may also develop signs of systemic arsenic toxicity including diarrhea, damage to the liver, kidneys, nervous system, and the brain. 

There are no recommendations for triaging casualties exposed to bicyclophosphates. However, in general, anyone who has been exposed should be transported to a medical facility for evaluation. Individuals who are asymptomatic and have not been directly exposed to the agent can be discharged after their names, addresses, and telephone numbers have been recorded. They should be told to seek medical care immediately if symptoms develop. 

Casualties/personnel Remove all clothing immediately. Even clothing that has not come into direct contact with the agent may contain "trapped" vapor. To avoid further exposure of... 

Casualties/personnel Do not attempt to brush the agent off the individual or their clothing as this can aerosolize the agent. Remove all clothing immediately. To avoid further exposure of the head, neck, and face to the agent, cut off potentially contaminated clothing that must be pulled over the head. Wash the skin surface and hair at least three times with copious amounts of soap and water. Do not delay decontamination to find warm or hot water if it is not readily available. Rinse with copious amounts of water. If there is a potential that the eyes have been exposed, irrigate with water or 0.9% saline solution for a minimum of 15 minutes. 

A casualty with cardiovascular collapse or severe hyperthermia. Immediate attention to ventilation, hemodynamic status, and temperature control could be life-saving. 

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