Managing The Consequences Of A Chemical Attack

Managing the Consequences of a Chemical Attack

A Quick Reference

Prepared by Deputy Chief Ted Jarboe and District Chief Bob Stephan Montgomery County, MD, Department of Fire and Rescue Services

Chemical Warfare Agents (CWA)

Nerve Agents

• GA Tabun
• GB Sarin
• GD Soman
• GF (no name)
• VX (no name)

* All are heavier than air and can be absorbed through eyes/lungs/skin.

Major signs/symptoms of exposure

• pinpoint pupils (miosis)
• runny nose/salivation
• tightness of the chest, coughing
• jerking and twitching
• difficulty breathing
• nausea/vomiting/diarrhea
• sudden loss of consciousness
• convulsion/apnea

Blood Agents

• AC Hydrogen Cyanide
• CK Cyanogen Chloride

* AC is lighter than air and CK is heavier than air.

Signs/Symptoms of inhalation exposure

• headaches
• strong stimulated breathing
• loss of consciousness
• convulsions, apnea

(Note: normal pupil size/no secretion)

Besides these effects, CK may cause burning/stinging on contact with eyes, exposed skin or respiratory tract.

Blister Agents

• HD Sulfur Mustard (delayed effect)
• HN Nitrogen Mustard (delayed effect)
• L Lewisite (immediate effect)

* All are heavier than air and can be absorbed through eyes/lungs/skin.

Signs/Symptoms of exposure

• reddening of eyes/gritty irritation
• reddening of skin
• severe itching/burning of skin
• blisters with/without pain
• sore throat, hoarseness
• dry cough/nausea/vomiting

* Signs/symptoms may not be present until 2-24 hours after exposure to mustard agents

Choking Agents

• CG Phosgene
• PS Chloropicrin
• CL Chlorine

* All are heavier than air.

Signs/symptoms of exposure

• mild irritation of eyes, nose, throat (immediate)
• shortness of breath, coughing, frothy secretions (2-24 hours later)
• nausea/vomiting
• pulmonary edema

Caution: Riot control agents have more severe irritant effects on the eyes, nose, throat, with some shortness of breath and coughing immediately after exposure.

Points to Remember

1. Be aware of potential terrorist targets.
2. Nerve, blood, blister and choking agents are heavier than air, except hydrogen cyanide.
3. The respiratory tract and eyes are particularly suspectible to chemical agent exposure. Pinpoint pupils, dimness of vision, pain above the eyes, and tightness in chest are signs/symptoms of nerve agent exposure.
4. The immediate and ongoing use of SCBA (with minimal skin protection) will ensure survivability in a vapor hazardous environment.
5. An incident involving a chemical agent is still a hazmat incident.
6. Plan for decontamination of mass casualties; however, vapor exposure requires only the removal of clothing in a clean environment.
7. Consider benefit of using positive-pressure ventilation (PPV) and/or foam to dilute or suppress a chemical agent.
8. Remember, a terrorist-related incident is a crime scene. Coordinate activities with law enforcement officers in the interest of safety, security and preservation of evidence.
9. Coordinate/manage requested/not requested outside resources.

On Scene

1. Place apparatus upwind/upgrade.
2. Use SCBA and wear protective clothing.
3. Be alert for signs of secondary devices.
4. Avoid contact with any pool of liquid.
5. Isolate/deny entry to area.
6. Observe/report signs/symptoms of agent exposure. Ask victims about symptoms, experiences and what happened.
7. Triage/decontaminate/treat victims.
8. Alert hospitals immediately of possible mass casualties.
9. Decontaminate victims exposed to a liquid agent by removing all of their clothes and/or applying copious quantities of water or household bleach solution diluted to 0.5%,* whichever is practicable . (The use of 0.5% bleach solution is noted in the Medical Management of Chemical Casualties Handbook, 2nd edition, September 1995. Aberdeen Proving Ground, MD.) Protect eyes and face of the victims. (Use bleach for nerve and blister agents only.) If bleach is used, rinse off solution thoroughly with water after 10-15 minutes. For vapor exposure only or as a precautionary measure, remove victims' clothes to at least their underwear
10. Remember a terrorist attack is a crime scene. Preserve evidence where practical.
11. Request the hazmat team if it has not already been dispatched.
12. Request more resources immediately if the incident has already exceeded the capability of on scene resources or is likely to escalate.

Review this reference periodically to improve information recall.

Managing the Consequences of a Chemical Attack

Command Action Guidelines

• Park command vehicle upwind/upgrade and not too close.
• Set up the command post in a place away from direct involvement with casualties and personnel either in a:

1. Mobile command unit or
2. Fixed facility

Give detailed situation report and establish level II command:

1. Estimate number of casualties, designate an exclusion zone.
2. Alert all personnel to use their SCBA and personal protective clothing.
3. Don your own SCBA and be prepared to use it.

Request more resources immediately:

1. Additional alarms
2. EMS/fire task forces
3. Hazmat unit
4. Bomb squad
5. Air supply unit(s)
6. Command vehicle
7. Disaster medical response team

Establish and maintain direct telephone line or discreet radio channel to ECC. Consider task force alarms as individual groups to manage specific functions. Assign a company(ies) to the command post for staff and command support. Consider need for a forward command post. Emphasize the possibility of secondary devices. Request the senior ranking law enforcement officer to report to and remain at the command post to:

1. coordinate evacuation
2. cordon area
3. provide scene security
4. designate and maintain scene access for arriving and departing ambulances, medic units, and other emergency apparatus
5. serve as a liaison with the FBI.

Establish sectors immediately and ensure use of vests:

1. EMS control officer (oversees the following officer positions: triage, treatment, disposition, EMS communications, transportation, and resources)
2. Safety
3. Hazmat
4. Public information officer
5. Decontamination
6. Accountability
7. Rehabilitation
8. Staging
9. Operations

Have radio channels assigned to sectors to improve both operational control and efficiency. Alert hospitals to imminent mass casualties. (Many may arrive in their own vehicles.) Request buses to transport ambulatory patients. Request the collapse rescue team to set up portable tents to serve as field hospitals and to set up field communications system. Assign the disaster medical response team to staff and manage the field hospital(s) for patient triage and treatment. Consider using other hazmat teams to assist with decontamination at the scene, field hospital(s), and/or area hospitals. Establish pre-decontamination areas to temporarily control citizens who may need decontamination. Separate people who are symptomatic from those who are not. Use tank water from one or more pumpers for gross decontamination of patients. Set up and staff separate decontamination sites for civilians and emergency services personnel. Be prepared to direct and/or coordinate the inflow of resources from local, state, and federal agencies. Assign a liaison officer to assist with coordination. Consider impact of using positive-pressure ventilation (PPV) or fixed ventilation system to control spread of chemical agent vapors. Determine where vapors will be exhausted and cordon area. Make arrangements for replacement of contaminated personal protective equipment (PPE). Remember that the incident is also a crime scene. Preserve suspected evidence where practicable. Request canteen(s) for food and rehydration fluids. Consider the need for interpreters.

Review this reference periodically to improve recall.

Next: Managing The Mass-Casualty Incident.

For further information or for copies of the Command Action Guidelines, write:

Montgomery County Department of Fire & Rescue Services
101 Monroe St., 12th Floor
Rockville, MD 20850
or telephone (301) 217-2437