STATUS OF USAMRDC CHEMICAL CASUALTY CARE

File: 970101_sep96_decls28_0023.txt
Page: 0023
Total Pages: 24

Subject: STATUS OF USAMRDC CHEMICAL CASUALTY CARE                        

Unit: OTSG        

Parent Organization: HSC         

Box  ID: BX003201

Folder Title: STATUS OF USAMRDC CHEMICAL CASUALTY CARE SUPPORT                                                

Document Number:       1001

Folder Seq  #:         67








                       Three key concepts underlie management of persons at risk for ARDS resulting from
                toxic battlefield inhalation exposures. First, a subjective feeling of shortness of breath
                should be taken seriously early after such an exposure even in the face of completely normal
                physical, X-ray, blood gas, and other laboratory findings. Second, these normal findings may
                persist during a latent period of up to 4 hours after potentially lethal exposures. Third,
                physical activity during the latent period may convert a potentially survivable exposure into
                a lethal one, so that rest may literally be lifesaving.

                       A high index of suspicion and willingness to institute early positive airway pressure
                therapy by CPAP mask or if needed, by PEEP after intubation is thought by most
                consultants to be the best therapeutic approach. If ARDS develops, the quality of intensive
                pulmonary care becomes critical for survival. The weight of expert opinion is now solidly
                against the use of corticosteroid therapy after phosgene exposure, as proposed in FM 8-285,
                p. 5.3. Two specific exposures where steroid therapy is thought to be of potential benefit
                are to the oxides of nitrogen and to HC smoke. In addition, steroid therapy may be
                effective in reversing refractory bronchospasm that has not responded to nonsteroidal
                bronchodilators.


                13.    DECONTAMINATION (See the provided guide and FM 8-285, Appendix E)

                       There is no formal, step-by-step published doctrine on decontamination procedures
                for chemically contaminated patients, as opposed to the decontamination of uninjured
                soldiers as described in FM 3-5. It is generally recognized that medical units are not
cale deliberate patient decontamination operations
                without help from the supported unit.

                       A severe  problem with our current position is the unfortunate mindset that patient
                decontamination is not a medical mission, but something that the supported unit, or the
                chemical company, or someone else should take care of. This mindset is especially
                damaging in maneuver battalions and companies where one look at the intensive manpower
                needed for doctrinal personnel decontamination convinces commanders and their medics
                that they can't do the job.

                       Based on Gulf War experience, the reality is that patient decontamination must be
                done as far forward as possible to save lives, prevent spread of agent on the same casualty
                and to others, and to simplify medical care. By viewing a formal 40-person decontamination
                station as the only solution, one can easily make a simple process too hard to execute.
                       Like all other battle casualties, most chemical casualties will normallv arrive in small,
                steady numbers rather than an overwhelming flood.              Dealing with one or several
                contaminated casualties does not require a large team or special equipment beyond a
                container of 0.5% chlorine solution and a clean litter. One person downwind from your
                treatment area, working without elaborate monitoring devices can rapidly administer
                antidotes, strip off all a casualty's clothing, wash him thoroughly with 0.5% chlorine solution,

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Document 24 f:/Week-36/BX003201/STATUS OF USAMRDC CHEMICAL CASUALTY CARE SUPPORT/status of usamrdc chemical casualty care:12249609312729
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003201
Unit = OTSG
Parent Organization = HSC
Folder Title = STATUS OF USAMRDC CHEMICAL CASUALTY CARE SUPPORT
Folder Seq # = 67
Subject = STATUS OF USAMRDC CHEMICAL CASUALTY CARE
Document Seq # = 1001
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 24-DEC-1996