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First Aid for Nerve Agents

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary



First Aid for Nerve Agents

Section III. NERVE AGENTS

7-6. Background Information

a. Nerve agents are among the deadliest of chemical agents They can be delivered by artillery shell, mortar shell, rocket, missile landmine, and aircraft bomb, spray, or bomblet. Nerve agents enter the body by inhalation, by ingestion, and through the skin. Depending on the route of entry and the amount, nerve agents can produce injury or death within minutes. Nerve agents also can achieve their effects with small amounts. Nerve agents are absorbed rapidly, and the effects are felt immediately upon entry into the body. You will be issued three Nerve Agent Antidote Kits, Mark I. Each kit consists of one atropine autoinjector and one pralidoxime chloride (2 PAM Cl) autoinjector (also called injectors) (Figure 7-1).

b. When you have the signs and symptoms of nerve agent poisoning, you should immediately put on the protective mask and then inject yourself with one set of the Nerve Agent Antidote Kit, Mark I. You should inject yourself in the outside (lateral) thigh muscle or if you are thin, in the upper outer (lateral) part of the buttocks.

c. Also, you may come upon an unconscious chemical agent casualty who will be unable to care for himself and who will require your aid. You should be able to successfully--

    (1) Mask him if he is unmasked.

    (2) Inject him, if necessary, with all his autoinjectors.

    (3) Decontaminate his skin.

    (4) Seek medical aid.

7-7. Signs/Symptoms of Nerve Agent Poisoning (081-831-1030 and 081-831-1031)

The symptoms of nerve agent poisoning are grouped as MILD--those which you recognize and for which you can perform self-aid, and SEVERE--those which require buddy aid.

a. MILD Symptoms (081-831-1030).

  • Unexplained runny nose.

  • Unexplained sudden headache.

  • Sudden drooling.

  • Difficulty seeing (blurred vision).

  • Tightness in the chest or difficulty in breathing.

  • Localized sweating and twitching (as a result of small amount of nerve agent on skin).

  • Stomach cramps.

  • Nausea.

b. SEVERE Signs/Symptoms (081-831-1031).

  • Strange or confused behavior.

  • Wheezing, difficulty in breathing, and coughing.

  • Severely pinpointed pupils.

  • Red eyes with tearing (if agent gets into the eyes).

  • Vomiting.

  • Severe muscular twitching and general weakness.

  • Loss of bladder/bowel control.

  • Convulsions.

  • Unconsciousness.

  • Stoppage of breathing.

7-8. First Aid for Nerve Agent Poisoning (081-831-1030 and 081-831-1031)

The injection site for administering the Nerve Agent Antidote Kit, Mark I (see Figure 7-1), is normally in the outer thigh muscle (see Figure 7-2). It is important that the injections be given into a large muscle area. If the individual is thinly-built, then the injections must be administered into the upper outer quarter (quadrant) of the buttocks (see Figure 7-3). This avoids injury to the thigh bone.

WARNING

    There is a nerve that crosses the buttocks, so it is important to inject only into the upper
    outer quadrant (see Figure 7-3). This will avoid injuring this nerve. Hitting the nerve can
    cause paralysis.

a. Self-Aid (081 831-1030).

    (1) Immediately put on your protective mask after identifying any of the signs/symptoms of nerve agent poisoning (paragraph 7-7).

    (2) Remove one set of the Nerve Agent Antidote Kit, Mark I.

    (3) With your nondominant hand, hold the autoinjectors by the plastic clip so that the larger autoinjector is on top and both are positioned in front of you at eye level (see Figure 7-4).

    (4) With the other hand, check the injection site (thigh or buttocks) for buttons or objects in pockets which may interfere with the injections.

    (5) Grasp the atropine (smaller) autoinjector with the thumb and first two fingers (see Figure 7-5).

CAUTION

    DO NOT cover/hold the green (needle) end with your hand or fingers--you might
    accidentally inject yourself.

    (6) Pull the injector out of the clip with a smooth motion (see Figure 7-6).

WARNING

The injector is now armed. DO NOT touch the green (needle) end.

    (7) Form a fist around the autoinjector. BE CAREFUL NOT TO INJECT YOURSELF IN THE HAND!

    (8) Position the green end of the atropine autoinjector against the injection site (thigh or buttocks):

      (a) On the outer thigh muscle (see Figure 7-7).

OR

      (b) On the upper outer portion of the buttocks (see Figure 7-8).

    (9) Apply firm, even pressure (not a jabbing motion) to the injector until it pushes the needle into your thigh (or buttocks).

WARNING

    Using a jabbing motion may result in an improper injection or injury to the thigh or
    buttocks.

NOTE

    Firm pressure automatically triggers the coiled spring mechanism. This plunges the
    needle through the clothing into the muscle and injects the fluid into the muscle tissue.

    (10) Hold the injector firmly in place for at least ten seconds. The ten seconds can be estimated by counting "one thousand and one, one thousand and two," and so forth.

    (11) Carefully remove the autoinjector.

    (12) Place the used atropine injector between the little finger and the ring finger of the hand holding the remaining autoinjector and the clip (see Figure 7-9). WATCH OUT FOR THE NEEDLE!

    (13) Pull the 2 PAM C1 autoinjector (the larger of the two injectors) out of the clip (see Figure 7-10) and inject yourself in the same manner as steps (7) through (11) above, holding the black (needle) end against your thigh (or buttocks).

    (14) Drop the empty injector clip without dropping the used autoinjectors.

    (15) Attach the used injectors to your clothing (see Figure 7-11). Be careful NOT to tear your protective gloves/clothing with the needles.

      (a) Push the needle of each injector (one at a time) through one of the pocket flaps of your protective overgarment.

      (b) Bend each needle to form a hook.

WARNING

    It is important to keep track of all used autoinjectors so that medical personnel can
    determine how much antidote has been given and the proper follow-up treatment can be provided, if needed.

    (16) Massage the injection site if time permits.

WARNING

    If within 5 to 10 minutes after administering the first set of injections, your heart begins
    to beat rapidly and your mouth becomes very dry, DO NOT give yourself another set
    of injections. You have already received enough antidote to overcome the dangerous
    effects of the nerve agent. If you are able to walk without assistance (ambulate), know
    who you are and where you are, you WILL NOT need the second set of injections.
    (If not needed, giving yourself a second set of injections may create a nerve agent
    antidote overdose, which could cause incapacitation.) If, however, you continue to
    have symptoms of nerve agent poisoning for 10 to 15 minutes after receiving one set
    of injections, seek a buddy to check your symptoms. If your buddy agrees that your
    symptoms are worsening, administer the second set of injections.

NOTE (081-831-1030)

    While waiting between sets (injections), you should decon your skin, if necessary, and
    put on the remaining protective clothing.

b. Buddy aid (081-831-1031)

A soldier exhibiting SEVERE signs/symptoms of nerve agent poisoning will not be able to care for himself and must therefore be given buddy aid as quickly as possible. Buddy aid will be required when a soldier is totally and immediately incapacitated prior to being able to apply self-aid, and all three sets of his Nerve Agent Antidote Kit, Mark I, need to be given by a buddy. Buddy aid may also be required after a soldier attempted to counter the nerve agent by self-aid but became incapacitated after giving himself one set of the autoinjectors. Before initiating buddy aid, a buddy should determine if one set of injectors has already been used so that no more than three sets of the antidote are administered.

    (1) Move (roll) the casualty onto his back (face up) if not already in that position.

WARNING

    Avoid unnecessary movement of the casualty so as to keep from spreading the
    contamination.

    (2) Remove the casualty's protective mask from the carrier.

    (3) Position yourself above the casualty's head, facing his feet.

WARNING

    Squat, DO NOT kneel, when masking a chemical agent casualty. Kneeling may force
    the chemical agent into or through your protective clothing, which will greatly reduce the
    effectiveness of the clothing.

    (4) Place the protective mask on the casualty.

    (5) Have the casualty clear the mask.

    (6) Check for a complete mask seal by covering the inlet valves. If properly sealed the mask will collapse.

NOTE

    If the casualty is unable to follow instructions, is unconscious, or is not breathing, he will
    not be able to perform steps (5) or (6). It may therefore, be impossible to determine if
    the mask is sealed. But you should still try to check for a good seal by placing your
    hands over the valves.

    (7) Pull the protective hood over the head, neck, and shoulders of the casualty.

    (8) Position yourself near the casualty's thigh.

    (9) Remove one set of the casualty's autoinjectors.

NOTE (081-831-1031)

    Use the CASUALTY'S autoinjectors. DO NOT use YOUR autoinjectors for buddy aid;
    if you do, you may not have any antidote if/when needed for self-aid.

    (10) With your nondominant hand, hold the set of autoinjectors by the plastic clip so that the larger autoinjector is on top and both are positioned in front of you at eye level (see Figure 7-4).

    (11) With the other hand, check the injection site (thigh or buttocks) for buttons or objects in pockets which may interfere with the injections.

    (12) Grasp the atropine (smaller) autoinjector with the thumb and first two fingers (see Figure 7-5).

CAUTION

    DO NOT cover/hold the green (needle) end with your hand or fingers--you may
    accidentally inject yourself.

    (13) Pull the injector out of the clip with a smooth motion (see Figure 7-6).

WARNING

The injector is now armed. DO NOT touch the green (needle) end.

    (14) Form a fist around the autoinjector. BE CAREFUL NOT TO INJECT YOURSELF IN THE HAND.

WARNING

    Holding or covering the needle (green) end of the autoinjector may result in accidentally injecting yourself.

    (15) Position the green end of the atropine autoinjector against the injection site (thigh or buttocks):

      (a) On the casualty's outer thigh muscle (see Figure 7-12)

NOTE

The injections are normally given in the casualty's thigh.

WARNING

    If this is the injection site used, be careful not to inject him close to the hip, knee, or thigh bone.

OR

      (b) On the upper outer portion of the casualty's buttocks (see Figure 7-13).

NOTE

    If the casualty is thinly built, reposition him onto his side or stomach and inject the
    antidote into his buttocks.

WARNING

    Inject the antidote only into the upper outer portion of his buttocks (see Figure 7-13).
    This avoids hitting the nerve that crosses the buttocks. Hitting this nerve can cause
    paralysis.

    (16) Apply firm, even pressure (not a jabbing motion) to the injector to activate the needle. This causes the needle to penetrate both the casualty's clothing and muscle.

WARNING

    Using a jabbing motion may result in an improper injection or injury to the thigh or
    buttocks.

    (17) Hold the injector firmly in place for at least ten seconds. The ten seconds can be estimated by counting "one thousand and one, one thousand and two," and so forth.

    (18) Carefully remove the autoinjector.

    (19) Place the used autoinjector between the little finger and ring finger of the hand holding the remaining autoinjector and the clip (see Figure 7-9). WATCH OUT FOR THE NEEDLE!

    (20) Pull the 2 PAM Cl autoinjector (the larger of the two injectors) out of the clip (see Figure 7-10) and inject the casualty in the same manner as steps (9) through (19) above, holding the black (needle) end against the casualty's thigh (or buttocks).

    (21) Drop the clip without dropping the used autoinjectors.

    (22) Carefully lay the used injectors on the casualty's chest (if he is lying on his back), or on his back (if he is lying on his stomach), pointing the needles toward his head.

    (23) Repeat the above procedure immediately (steps (9) through (22)), using the second and third set of autoinjectors.

    (24) Attach the three sets of used autoinjectors to the casualty's clothing (see Figure 7-14). Be careful NOT to tear either your or the casualty's protective clothing/gloves with the needles.

      (a) Push the needle of each injector (one at a time) through one of the pocket flaps of his protective overgarment.

      (b) Bend each needle to form a hook.

WARNING

    It is important to keep track of all used autoinjectors so that medical personnel will be
    able to determine how much antidote has been given and the proper follow-up treatment
    can be provided, if needed.

    (25) Massage the area if time permits.

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