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The effects of nerve agents can be reversed by using atropine as an antidote. Atropine blocks the effects of the excess acetylcholine and is most effective for smooth muscles and glands but does not help the skeletal muscles. A drug called pralidoxime chloride (2-PAMC1) is used in conjunction with atropine to treat the skeletal muscles. Convulsions may also occur with exposures to nerve agents and diazepam (Valium) is administered in some instances to help control the convulsions. Local protocols should be established for administration of antidotes based on advice from the local EMS medical director.
Mustard and nerve agents are chemicals and therefore require an appropriate level of chemical protective clothing. Military PPE for battlefield protection against chemical agents is composed of a charcoal suit, protective hood made of butyl rubber protected cloth, butyl rubber gloves with thin cotton inserts, vinyl boots and a powered air-purifying respirator (PAPR).
The PAPR is used instead of self-contained breathing apparatus (SCBA) because of the length of time that the respiratory protection may be needed and the difficulty in changing SCBA bottles in a hazardous atmosphere or under battlefield conditions. The PAPR will remove up to 0.5 mg/m3 of nerve agent GB for up to 16 hours based on the longest time an emergency responder has used the PAPR (tests indicate that the filters and cartridges have the shortest service life against nerve agent GB compared to other lethal chemical agents). The actual expected time of cartridge usage during an incident is up to 12 hours.
One of the major problems that occurs with any type of chemical protective clothing is heat stress (see "Hot Zone Rescue," December 1996). Because of the extended time the PAPR can be worn, the danger of heat stress is great. In reality, responders will be limited in the amount of time spent in the PPE by heat stress potential rather than the limitations of the air supply.
Most chemical agents require warm temperatures for them to pose a vapor problem; thus, if there is vapor, heat stress will be a problem.
Recommended For PPE Wearers
|Temperature||Work Time||Rest Time|
|50-70º F||30-45 min.||10-15-min.|
|70-80º F||20-30 min.||40-60 min.|
|80-100º F||15-20 min.||Indefinite|
The PAPR should not be used in IDLH atmospheres or in atmospheres where the oxygen concentration is less than 16.5 percent. Airborne agent concentration IDLH values have been established for the following nerve agents: GA/GB 0.2 mg/m3; GD 0.06 mg/m3; and VX 0.02 mg/m3 . The PAPR uses a battery-operated blower that is designed to deliver essentially decontaminated air at a slight positive pressure into a full facepiece. The blower draws ambient air through two or three air-purifying elements (filters or chemical cartridges) which remove specific contaminants and deliver the subsequent air through a corrugated breathing tube into a facepiece assembly on the face of the respirator wearer.
There is also commercially available chemical protective clothing that has been tested against live agents and passed for use by emergency responders. The Army PPE is available for civilian use by emergency responders in CSEPP-affected communities. Many emergency responders in those areas, however, have chosen to use a commercial chemical suit with the PAPR rather than the military battle suit. The butyl rubber hood is still required even with the commercial chemical suit.
Unlike most hazardous materials incidents, decontamination for chemical agent releases will focus primarily on contaminated victims. There are likely to be hundreds and even thousands of exposed citizens who may need various levels of decontamination.
The process will be very labor intensive and unlike any other decontamination process responders have previously faced. In some cases, citizens will need to be decontaminated simply for their own peace of mind. Vapor exposures do not require as extensive a decontamination as does liquid exposures. In reality, little contamination occurs from a vapor exposure. The public, however, may perceive a need for decontamination, and it may have to be performed even if only for psychological reasons.
Decontaminating hundreds or thousands of potentially contaminated victims could create a logistical nightmare. Responders in the Chemical Stockpile Program have acquired specially designed decontamination trailers for treating large numbers of citizens. These trailers would work well for mass exposures from terrorist incidents.