Exposure to high concentrations of nerveagents may bring on a lack of coordination,mental confusion, and physical collapse so fastthat a person may not be able to perform self-aid measures. If this happens, the necessaryprocedures will have to be done for the casualty(as first aid) by the nearest person who is able todo so.Severe nerve agent exposure may rapidly causeunconsciousness, muscular paralysis, and stoppageof breathing. When this occurs, atropine and2-PAM chloride injections alone will not save alife. Start artificial ventilation, as a first-aidmeasure, immediately and continue until you canrestore natural breathing or until medical person-nel can take over. Atropine and 2-PAM injectionsincrease the effectiveness of artificial ventilationand should be administered to the casualty as soonas possible.EFFECTS OF BLISTER AGENTS. —Blisteragents would probably be used in conjunctionwith nerve agents. They cause incapacitatingrather than lethal effects detectable by the senses.They smell of garlic, fish, or geraniums and mayappear as colorless to dark brown oily liquid ordroplets. They attack through all body entrypoints, particularly the eyes and those parts of thebody that are warm and moist. A droplet the sizeof a pinhead can cause a blister the size of aquarter. Blister agents react almost immediatelyon any part of the body they touch. You mustwash the liquid from the eyes in seconds to avoidan injury. Treatment after 2 minutes is of littleuse. On the skin, depending on the dose received,effects appear from 1 hour to days followingexposure. The first signs are a reddening of theskin, like a severe sunburn, followed by an itchingor a burning sensation. Blisters appear in a dayor less after reddening. Recovery time varies fromabout 6 days to as long as 8 weeks.Because phosgene oxime (blister agent) reactsrapidly with tissue, decontamination will not beentirely effective after pain has begun. Never-theless, flush the contaminated area as rapidly aspossible with large amounts of water to removeany phosgene oxime that has not yet reacted withtissue.Whenever liquid or vaporized blister agentsare known, be sure to wear the protective mask.You must deal with liquid blister agents in youreyes or on your skin immediately.You can decontaminate a liquid blister agentin your eye that does not cause immediate painby rinsing the eye with water for at least 30seconds. Try to regulate the flow of water so thatflushing lasts not less than 30 seconds and notmore than 2 minutes. Decontamination with watereffectively removes mustard gas and is now thestandard procedure for all blister agents.The risk of leaving blister agents in the eye isgreater than the risk of exposure to blister agentvapors. The decontamination procedure MUSTbe performed in spite of the presence of vapor.EFFECTS OF CHOKING AGENTS. —Choking agents are less effective than nerveagents; the use is for quick, incapacitating effects.Death may occur within 3 hours. Choking agentsare colorless but you can detect them by odor,which smells like new-mown hay or grass. Theyenter the body when inhaled through the nose ormouth. In low concentrations, there is a delayof 3 hours or more in their effect; in highconcentrations, the effect is immediate includingthe possibility of death within minutes.Irritation of the eyes or a change in the tasteof a cigarette might indicate the presence of thechoking agent phosgene. Smoking may becometasteless or offensive in taste. If any signs ofchoking agents occur, hold your breath and puton the protective mask at once. Unless youexperience nausea, vomiting, difficulty inbreathing, or more than the usual shortness ofbreath caused by exertion, continue your normalcombat duties. If any of these symptoms occur,you should rest quietly until you are evacuatedby medical personnel.EFFECTS OF BLOOD AGENTS. —Bloodagents were not very effective in World War Ibecause the high concentrations necessary to causedeath could not be achieved. Modern methods ofdelivery make their use possible; and because theyare less persistent than other agents, they can beimmediately used for quick casualty effects. Bloodagents are colorless but may have a slight odorof bitter almonds. They attack the body wheninhaled or ingested through the nose or mouth.A few breaths can cause incapacitation or death.Incapacitation can occur almost immediately; alethal dose of vapor can result in death within 15minutes.In the case of blood agents, speed in self-aidand first-aid measures is essential. Stop breathingand put your mask on at once if you notice anystimulation of breathing; an odor of bitteralmonds; or any irritation of the eyes, nose, orthroat. The effects of blood agents act so rapidlythat within a few seconds you will be unable to7-27
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