Decontamination Station Organization In general, the decontamination station, or “dirty” area, receives casualties contaminated with a chemical agent. The arrangement of this area will vary with the site of the medical unit and the facilities available for decontamination. Each ship will have a minimum of at least two decontamination stations, insofar as the hull design permits. The “dirty” areas should be topside or in some well-ventilated space. Personnel manning these areas should be provided with protective equipment. In the “dirty” area, casualties will be decon- taminated, undressed, showered, and passed along to clean areas. Both areas should be clearly marked as either “clean” or “contaminated,” as appropriate. Decontami- nation kits, protective ointment, and an abundant supply of soap and water must be provided. In addition, standard first-aid items should be on hand. When possible, improvise supports (e.g., small boxes, blocks of wood, etc.) for stretchers to keep them raised off the deck. Handling of Contaminated Casualties The spread of contamination to uncontaminated personnel or to spaces not set aside to receive contami- nation must be avoided. Contaminated personnel, clothing, or equipment must be kept out of uncontam- inated areas since the subsequent decontamination of such spaces is quite difficult. Contaminated clothing and gear must be placed in designated dump areas and, whenever practically possible, kept in metal cans with tightly fitting covers. Supplies The Medical Officer or Senior Medical Depart- ment Representative (SMDR) is responsible for maintaining adequate supplies for decontamination and treatment of CBR casualties. Medical decon- tamination supplies are supplied to ships on a personnel -strength basis, as listed in current Authorized Medical Allowance List (AMAL). The decontamination supply cabinets will be kept locked, and the keys will be in custody of the Damage Control Assistant (DCA). Cabinets and chests will b e s t e n c i l e d w i t h a r e d c r o s s a n d m a r k e d “DECONTAMINATION MEDICAL SUPPLIES.” CHEMICAL AGENTS Chemical agents are grouped under several classifications. The broadest classification we will use is based on the general effect produced (i.e., severe casualty, harassment, or incapacitation). Within each general group, there are further breakdowns, the most convenient of which (from a medical point of view) is the classification by physiologic effect. Chemical agents may also be classified as lethal or nonlethal. Nonlethal agents will not kill you. Lethal agents are those that result in a 10 percent or greater death rate among casualties. They are further classified as persistent or nonpersistent, depending on the length of time they retain their effectiveness after dissemination. In the following paragraphs, we discuss the agents that produce the greatest number of fatalities and casualties among personnel who have been exposed to them. Nerve Agents Nerve agents produce their effect by interfering with normal transmission of nerve impulses in the parasympathetic autonomic nervous system. Physically, nerve agents are odorless, almost colorless liquids, varying greatly in viscosity and volatility. They are moderately soluble in water and fairly stable unless strong alkali or chlorinating compounds are added. They are very effective solvents, readily penetrating cloth either as a liquid or vapor. Other materials, including leather and wood, are fairly well penetrated. Butyl rubber and synthetics, such as polyesters, are much more resistant. Pharmacologically, the nerve agents are cholinesterase inhibitors (interfering with normal transmission of nerve impulses in the parasympathetic autonomic nervous system). Their reaction with cholinesterase tends to be irreversible, and reaction time varies with the agent. SIGNS AND SYMPTOMS OF EXPOSURE.— Nerve-agent intoxication can be readily identified by its characteristic signs and symptoms. If a vapor exposure has occurred, the pupils will constrict, usually to a pinpoint. If the exposure has been through the skin, there will be local muscular twitching where the agent was absorbed. Other symptoms will include rhinorrhea, dyspnea, diarrhea and vomiting, convulsions, hypersalivation, drowsiness, coma, and unconsciousness. TREATMENT.—Specific therapy for nerve agent casualties is atropine, an acetylcholine blocker. When exposed, each member of the Navy and Marine Corps is issued three 2 mg autoinjectors of atropine and three 600 mg autoinjectors of 2-PAM Cl. DO 8-5