Table of
Contents
NATO HANDBOOK ON
THE MEDICAL ASPECTS
OF NBC DEFENSIVE
OPERATIONS
AMedP-6(B)
PART III - CHEMICAL
Table of Contents
LIST OF FIGURES
LIST OF TABLES
CHAPTER 1 - INTRODUCTION
101. Definition
102. Historical
103. General Factors Influencing the Employment and Choice of Chemical Agents
104. Characteristics
105. Terminology
106. Routes of Absorption
CHAPTER 2 - NERVE AGENTS
SECTION I - GENERAL
201. Introduction
202. Physical and Chemical Properties
203. Detection
204. Protection
205. Decontamination
206. Mechanism of Action
207. Pathology
SECTION II - EFFECTS OF NERVE AGENTS
208. Signs and Symptoms
209. Effects of Nerve Agent Vapour
210. Effects of Liquid Nerve Agent
211. Systemic Effects of Nerve Agent Poisoning
212. Muscarinic Effects of Nerve Agent Poisoning
213. Nicotinic Effects
214. Central Nervous System Effects
215. Cumulative Effects of Repeated Exposure
216. Cause of Death
SECTION III - TREATMENT OF NERVE AGENT POISONING
217. Diagnosis and Therapy of Nerve Agent Poisoning
218. Treatment
219. Pretreatment
220. Post-Exposure Therapy
221. Emergency Field Therapy
222. Pharmacological Treatment of Nerve Agent Poisoning
223. Atrophine
224. Oximes
225. Anticonvulsants
226. Supportive Care
CHAPTER 3 - VESICANTS (BLISTER AGENTS)
SECTION I - MUSTARD AND NITROGEN MUSTARDS
301. Introduction
302. Mustard Agents
303. Physical and Chemical Properties
304. Detection
305. Protection
306. Decontamination
307. Mechanism of Action
308. Toxicity
SECTION II - CLINICAL-PATHOLOGICAL EFFECTS
309. Eyes
310. Skin
311. Respiratory Tract
312. Bone Marrow
313. Gastrointestinal Tract
314. Systemic Action
SECTION III - TREATMENT OF MUSTARD LESIONS
315. Prophylaxis
316. Therapy
317. Eye Lesions
318. Skin Lesions
319. Respiratory Tract Lesions
320. Systemic Effects
321. Burns Caused by High Doses of Vapour
322. Burns Caused by Low Doses of Vapour
323. Sensitisation Due to Multiple Exposures to Mustard
324. Disposition of Casualties
325. Trunk and Neck
326. Arms
327. Hands
328. Lower Extremities
329. Genitalia
330. Systemic Effects of Cutaneous Burns
331. Secondary Bacterial Infection in Blister Agent Burns
332. Course and Prognosis
333. Long Term Effects of Mustard Gas Poisoning
SECTION IV - ARSENICAL VESICANTS - LEWISITE
334. Introduction
335. Physical and Chemical Properties
336. Detection
337. Protection
338. Decontamination
339. Mechanism of Action
SECTION V - CLINICAL-PATHOLOGICAL EFFECTS
340. Eyes
341. Skin
342. Respiratory Tract
343. Systemic Effects
SECTION VI - TREATMENT OF LEWISITE LESIONS
344. General
345. Eyes
346. Skin
347. Systemic
348. Indication for Systemic Treatment
349. Types of Treatment
350. Therapy
351. Course and Prognosis
SECTION VII - HALOGENATED OXIMES
352. Introduction
353. Physical and Chemical Properties of Phosgene Oxime
354. Detection
355. Protection
356. Decontamination
357. Mechanism of Action
358. Clinical-Pathological Effects
359. Treatment
360. Course and Prognosis
CHAPTER 4 - LUNG DAMAGING AGENTS (CHOKING AGENTS)
SECTION I - GENERAL
401. Introduction
SECTION II - PHOSGENE
402. Physical and Chemical Properties
403. Detection
404. Protection
405. Decontamination
406. Mechanism of Action
407. Clinical-Pathological Effects
408. Signs and Symptoms
409. Treatment
410. Course and Prognosis
CHAPTER 5 - CYANOGEN AGENTS (BLOOD AGENTS)
SECTION I - GENERAL
501. Introduction
SECTION II - HYDROGEN CYANIDE
502. Properties
503. Detection
504. Protection
505. Decontamination
506. Mechanism of Action
507. Signs and Symptoms
508. Treatment
509. Case Management
510. Treatment Approaches
511. Drugs That Bind Cyanide Ions
512. Provision of Sulphur Groups
513. Additional Therapy
514. Course and Prognosis
SECTION III - CYANOGEN HALIDES
515. Introduction
516. Physical and Chemical Properties
517. Detection
518. Decontamination
519. Mechanism of Action
520. Pathology
521. Signs and Symptoms
522. Treatment
523. Course and Prognosis
CHAPTER 6 - INCAPACITANTS
SECTION I - GENERAL
601. Introduction
602. CNS Depressants
603. CNS Stimulants
604. Detection
605. Protection
606. Decontamination
SECTION II - CNS DEPRESSANTS - BZ (3-QUINOCLINIDINYL BENZOATE) AND SIMILAR COMPOUNDS
607. Detection
608. Protection
609. Properties
610. Mechanism of Action
611. Signs and Symptoms
612. Treatment
SECTION III - CNS STIMULANTS - LSD (D-LYSERGIC ACID DIETHYLAMIDE)
613. Properties
614. Detection
615. Protection
616. Mechanism of Action
617. Pathophysiology
618. Signs and Symptoms
619. Treatment
620. Course and Prognosis
621. Other Agents
CHAPTER 7 - RIOT CONTROL AGENTS
SECTION I - GENERAL
701. Introduction
SECTION II - LACHRYMATORS
702. CS (Orthochlorobenzlidene Malononitrile)
703. Properties
704. Detection
705. Protection
706. Decontamination
707. Mechanism of Action
708. Pathology
709. Signs and Symptoms
710. CS Exposure Symptoms
711. First Aid
712. Therapy
713. Course and Prognosis
714. CR (Dibenzoxazepine)
715. CN (Chloracetophenone)
716. Properties
717. Mode of Action and Toxic Effects
718. Signs and Symptoms
719. First Aid
720. CA (Bromobenzl Cyanide) and BA (Bromoacetone)
SECTION III - VOMITING AGENTS
721. Introduction
722. Properties
723. Detection
724. Protection
725. Mechanism of Action
726. Pathology
727. Signs and Symptoms
728. Treatment
729. Course and Prognosis
CHAPTER 8 - SMOKES, FUELS, AND INCENDIARY MATERIALS
SECTION I - SMOKES
801. Introduction
802. Zinc Chloride Smokes
803. Protection
804. Clinical-Pathological Effects
805. Treatment
806. Prognosis
807. Chlorosulphonic Acid (CSA)
808. Symptoms
809. Treatment
810. Prognosis
811. Titanium Tetrachloride (FM)
812. Mode of Action
SECTION II - FLAME MATERIALS
813. General
814. Red and White Phosphorus
815. Self Aid
816. Medical Aid
817. Thermite
818. Treatment
819. Magnesium
SECTION III - HYDROCARBON FUMES
820. General
821. Physical and Chemical Properties
822. Protection
823. Mechanism of Action
824. Signs and Symptoms
825. Treatment
SECTION IV - INCENDIARY DEVICES - COMBUSTIBLE HYDROCARBON INCENDIARIES
826. Introduction
827. Flame-Thrower Attack
828. Casualties
829. Protection
830. Treatment
831. Fire-Bomb Attack
832. Casualties
833. Treatment
CHAPTER 9 - HERBICIDES
SECTION I - GENERAL
901. Introduction
SECTION II - 2, 4, -D AND 2, 4, 5-T
902. Toxicity
903. Biochemistry
904. Mechanism of Action
905. Signs and Symptoms
906. Treatment
SECTION III - CACODYLIC ACID
907. Toxicity
908. Biochemistry
909. Mechanism of Action
910. Signs and Symptoms
911. Treatment
SECTION IV - PICLORAM
912. Toxicity
913. Mechanism of Action
914. Signs and Symptoms
915. Treatment
CHAPTER 10 - RECOGNITION OF A CHEMICAL CASUALTY
1001. Introduction
1002. General
1003. Recognition of a Casualty of Chemical Opertions
1004. Questioning Casualties
1005. Types of Casualties
CHAPTER 11 - MEDICAL SUPPORT IN CHEMICAL OPERATIONS
SECTION I - INTRODUCTION
1101. General
1102. Objectives of Medical Support in Chemical Operations
1103. Characteristics of Chemical Agents
1104. Contamination Control
1105. Mass Casualties
1106. Medical Decision Making
1107. Triage
SECTION II - CASUALTY MANAGEMENT PHASES
1108. General
1109. Phase I - Pre-Attack
1110. Phase II - Immediate Post-Attack/Self Aid
1111. Phase III - Buddy Aid
1112. Phase IV - Initial Medical Care
1113. Phase V - Life Support/Stabilisation
1114. Phase VI - Evacuation
1115. Phase VII - Casualty Decontamination
1116. Phase VIII - Definitive Care
1117. Phase IX - Disposition
SECTION III - COMBINED INJURIES
1118. Introduction
SECTION IV - NON PERSISTENT AGENTS
1119. Injury Complicated by Exposure to a Non Persistent Nerve Agent
1120. Injury Complicated by Exposure to Lung Damaging Agents
1121. Injury Complicated by Exposure to Cyanogen Agents
SECTION V - PERSISTENT AGENTS
1122. Injury Complicated by Persistent Nerve Agents
1123. Injury Complicated by Contamination with Vesicant Agent
SECTION VI - OTHER CONSIDERATIONS
1124. Collective Protection
1125. Head Wounds
1126. Heat Stress
CHAPTER 12 - DISPOSITION OF CONTAMINATED FOOD AND WATER
SECTION I - GENERAL
1201. Introduction
SECTION II - EFFECTS OF CHEMICAL AGENTS ON FOOD AND WATER
1202. General
1203. Penetration
1204. Effect on Food
1205. Effect on Crops
1206. Effect on Livestock
SECTION III - PROTECTION OF FOOD AND WATER AGAINST CONTAMINATION WITH CHEMICAL AGENTS
1207. Packaging Materials
1208. Disposition of Packaged and Stored Supplies
SECTION IV - MONITORING FOR CONTAMINATION
1209. Monitoring Food
SECTION V - DECONTAMINATION OF FOOD AND WATER
1210. Classification of Supplies
1211. Water
1212. Monitoring Water
1213. Decontamination of Water
ANNEX A - BIOCHEMICAL ACTION OF NERVE AGENTS
ANNEX B - PHARMACOLOGY OF OXIMES
ANNEX C - SUMMARY OF THE EFFECTS OF CHEMICAL AGENTS
REFERENCES
GLOSSARY
LIST OF EFFECTIVE PAGES
