Decontamination Station OrganizationIn general, the decontamination station, or “dirty”area, receives casualties contaminated with a chemicalagent. The arrangement of this area will vary with thesite of the medical unit and the facilities available fordecontamination.Each ship will have a minimum of at least twodecontamination stations, insofar as the hull designpermits. The “dirty” areas should be topside or in somewell-ventilated space. Personnel manning these areasshould be provided with protective equipment.In the “dirty” area, casualties will be decon-taminated, undressed, showered, and passed along toclean areas. Both areas should be clearly marked as either“clean” or “contaminated,” as appropriate. Decontami-nation kits, protective ointment, and an abundant supplyof soap and water must be provided. In addition, standardfirst-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 CasualtiesThe spread of contamination to uncontaminatedpersonnel 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 ofsuch spaces is quite difficult. Contaminated clothingand gear must be placed in designated dump areas and,whenever practically possible, kept in metal cans withtightly fitting covers.SuppliesThe Medical Officer or Senior Medical Depart-ment Representative (SMDR) is responsible formaintaining adequate supplies for decontaminationand treatment of CBR casualties. Medical decon-tamination supplies are supplied to ships on apersonnel -strength basis, as listed in current AuthorizedMedical Allowance List (AMAL).The decontamination supply cabinets will be keptlocked, and the keys will be in custody of the DamageControl Assistant (DCA). Cabinets and chests willb 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 AGENTSChemical agents are grouped under severalclassifications. The broadest classification we will useis based on the general effect produced (i.e., severecasualty, harassment, or incapacitation). Within eachgeneral group, there are further breakdowns, the mostconvenient of which (from a medical point of view) isthe classification by physiologic effect. Chemicalagents may also be classified as lethal or nonlethal.Nonlethal agents will not kill you. Lethal agents arethose that result in a 10 percent or greater death rateamong casualties. They are further classified aspersistent or nonpersistent, depending on the length oftime they retain their effectiveness after dissemination.In the following paragraphs, we discuss the agentsthat produce the greatest number of fatalities andcasualties among personnel who have been exposed tothem.Nerve AgentsNerve agents produce their effect by interferingwith normal transmission of nerve impulses in theparasympathetic autonomic nervous system.Physically, nerve agents are odorless, almost colorlessliquids, varying greatly in viscosity and volatility.They are moderately soluble in water and fairly stableunless strong alkali or chlorinating compounds areadded. They are very effective solvents, readilypenetrating cloth either as a liquid or vapor. Othermaterials, including leather and wood, are fairly wellpenetrated. Butyl rubber and synthetics, such aspolyesters, are much more resistant.Pharmacologically, the nerve agents arecholinesterase inhibitors (interfering with normaltransmission of nerve impulses in the parasympatheticautonomic nervous system). Their reaction withcholinesterase tends to be irreversible, and reactiontime varies with the agent.SIGNS AND SYMPTOMS OF EXPOSURE.—Nerve-agent intoxication can be readily identified byits characteristic signs and symptoms. If a vaporexposure has occurred, the pupils will constrict,usually to a pinpoint. If the exposure has been throughthe skin, there will be local muscular twitching wherethe agent was absorbed. Other symptoms will includerhinorrhea, dyspnea, diarrhea and vomiting,convulsions, hypersalivation, drowsiness, coma, andunconsciousness.TREATMENT.—Specific therapy for nerveagent casualties is atropine, an acetylcholine blocker.When exposed, each member of the Navy and MarineCorps is issued three 2 mg autoinjectors of atropineand three 600 mg autoinjectors of 2-PAM Cl.DO8-5
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