nerve agents

1LPC/CBRN 24 Jan 06 C191W047/1

Nerve AgentsNerve Agents


IntroductionIntroduction

Chemical weapons Chemical weapons have been around for have been around for decades.decades.

Nerve agents among Nerve agents among the most deadly.the most deadly.

Manufactured by Manufactured by simple techniques.simple techniques.

Raw materials are Raw materials are inexpensive and inexpensive and readily available.readily available.


Overview of Nerve AgentsOverview of Nerve Agents

Developed in Germany.Developed in Germany. Only known Only known

battlefield use is in battlefield use is in the Iran-Iraq the Iran-Iraq conflict.conflict.

Many countries Many countries have the technology have the technology to develop nerve to develop nerve agents.agents.

Terrorist attacks in Japan.Terrorist attacks in Japan.



Hazards in liquid and Hazards in liquid and vapor state.vapor state.

Dispersed from missiles, Dispersed from missiles, bombs, spray tanks, land bombs, spray tanks, land mines, and other mines, and other munitions.munitions.



Acetylcholine (ACh) is a Acetylcholine (ACh) is a neurotransmitter in the neurotransmitter in the nervous system.nervous system.

Acetylcholinesterase Acetylcholinesterase (AChE) (an enzyme) (AChE) (an enzyme) stops the action of Ach.stops the action of Ach.

Nerve agents bind to Nerve agents bind to AChE.AChE.

ACh builds up and ACh builds up and continues to act.continues to act.


Normal ACh TransmissionNormal ACh Transmission Nerve to Nerve Nerve to Nerve

ACh



ACh


Normal ACh TransmissionNormal ACh Transmission Nerve to Skeletal Muscle-Stimulation Nerve to Skeletal Muscle-Stimulation

10

LPC/CBRN 24 Jan 06 C191W047/1

Normal ACh TransmissionNormal ACh TransmissionNerve to Smooth Muscle-StimulationNerve to Smooth Muscle-Stimulation

11


Normal ACh TransmissionNormal ACh Transmission Nerve to Glands-Normal secretions Nerve to Glands-Normal secretions

12


Impulse Termination: Impulse Termination: The Role of AChEThe Role of AChE

ACh

AChE

13


Exposure to Nerve AgentExposure to Nerve Agent

ACh

AChE

14


Exposure to Nerve Agent-Binds Exposure to Nerve Agent-Binds AChE- causing excessive AChE- causing excessive

stimulationstimulation

ACh

AChE

15


Nerve Agents Effects: Nerve Agents Effects: Skeletal Muscle-Over stimulationSkeletal Muscle-Over stimulation

ACh

AChE

16


Impulse Termination: Impulse Termination: The Role of AChE-The Role of AChE-Stops stimulationStops stimulation

ACh

AChE

17


Nerve Agents Effects:Nerve Agents Effects: Smooth and Cardiac Muscle Smooth and Cardiac Muscle

ACh

AChE

18


Nerve Agents Effects on Glands- Nerve Agents Effects on Glands- Increased SecretionsIncreased Secretions

ACh

AChE

19


Nerve Agent CharacteristicsNerve Agent Characteristics

Liquid unless exposed Liquid unless exposed to extreme heat or cold.to extreme heat or cold.

Volatility.Volatility. Colorless to light Colorless to light

brown.brown. Odorless.Odorless. Routes of entry.Routes of entry.

20


Levels of Exposure and Levels of Exposure and Clinical EffectsClinical Effects

Depends of dosage Depends of dosage and route of exposure.and route of exposure.

Vapor effects are Vapor effects are different than liquid different than liquid effects.effects.

21


Level of Exposure - MildLevel of Exposure - Mild

VaporVapor::

– Causes effects in eyes, Causes effects in eyes,

nose and lungs- local nose and lungs- local

and/or systemic effectand/or systemic effect LiquidLiquid::

– Systemic Systemic

gastrointestinal effectgastrointestinal effect

22



Rhinorrhea - may be Rhinorrhea - may be

the first sign.the first sign. Frontal headache/eye Frontal headache/eye

pain.pain. Difficulty in seeing.Difficulty in seeing. Tightness in chest.Tightness in chest.

23



Difficulty breathing.Difficulty breathing. Drooling.Drooling. Localized sweating.Localized sweating. Muscle twitching.Muscle twitching.

24


Level of Exposure - SevereLevel of Exposure - Severe The signs and symptoms of mild nerve The signs and symptoms of mild nerve

agent exposure may occur plus:agent exposure may occur plus: Nausea, vomiting, diarrheaNausea, vomiting, diarrhea Severe muscle twitchingSevere muscle twitching SeizuresSeizures Loss of bladder and bowel controlLoss of bladder and bowel control Confused behavior, followed by LOCConfused behavior, followed by LOC Respiratory failure > deathRespiratory failure > death

25


Time Interval of EffectsTime Interval of Effects VaporVapor: seconds to : seconds to

minutes. No delay minutes. No delay period.period.

Liquid: delay in Liquid: delay in symptoms 1-30 symptoms 1-30 minutes. Small liquid minutes. Small liquid exposure - symptoms exposure - symptoms up to 18 hours.up to 18 hours.

26


Treatment Steps: Self-AidTreatment Steps: Self-Aid Protect yourself - put on your protective mask.Protect yourself - put on your protective mask. Give the alarm.Give the alarm. Perform a hasty Perform a hasty

self-evaluation.self-evaluation. Administer antidote if Administer antidote if

signs and symptoms signs and symptoms are noted: are noted:

27


Treatment Steps: Self-AidTreatment Steps: Self-Aid Use one MARK I Nerve Agent Antidote Kit Use one MARK I Nerve Agent Antidote Kit

(NAAK):(NAAK):

Use one Antidote Treatment, Nerve Agent Use one Antidote Treatment, Nerve Agent Auto-injector (ATNAA): Auto-injector (ATNAA):

28


Treatment Steps: Self-AidTreatment Steps: Self-Aid

Never administer more than one NAAK Never administer more than one NAAK or ATNAA to yourself.or ATNAA to yourself.

If you needed more than one NAAK/ If you needed more than one NAAK/ ATNAA, you would be too incapacitated ATNAA, you would be too incapacitated to know it.to know it.

29


Treatment Steps: Self-AidTreatment Steps: Self-Aid

Decontaminate skin if Decontaminate skin if necessary.necessary.

Put on protective clothing Put on protective clothing (MOPP level 4).(MOPP level 4).

Seek buddy-aid or Seek buddy-aid or medical care.medical care.

JSLISTJSLIST

30


Mark I NAAKMark I NAAK Includes:Includes:

– Atropine 2mgAtropine 2mg - blocks effects of acetylcholine - blocks effects of acetylcholine and produces symptom relief.and produces symptom relief.

– 2-PAM-Cl 600 mg2-PAM-Cl 600 mg - blocks transmission of - blocks transmission of nerve agent.nerve agent.

31


ATNAAATNAA Includes:Includes:

– Atropine 2.1 mgAtropine 2.1 mg..– 2-PAM-Cl 600 mg2-PAM-Cl 600 mg..

32


Treatment Steps: Buddy-AidTreatment Steps: Buddy-Aid

Protect yourself; then:Protect yourself; then:– Mask the casualtyMask the casualty– Check casualty and surrounding area for Check casualty and surrounding area for

expended auto-injectorsexpended auto-injectors– Administer total of 3 MARK I NAAK/ATNAA; Administer total of 3 MARK I NAAK/ATNAA;

use the casualties’ sets.use the casualties’ sets.

33


Treatment Steps: Buddy-AidTreatment Steps: Buddy-Aid Protect yourself (cont’d):Protect yourself (cont’d):

– Administer 1 Convulsant Administer 1 Convulsant Antidote for Nerve Agent Antidote for Nerve Agent (CANA) injector (CANA) injector

– Decontaminate the Decontaminate the casualtycasualty

– Assess effectiveness of Assess effectiveness of treatment (atropinization treatment (atropinization and cessation of and cessation of convulsions)convulsions)

34



Additional atropine can be given at Additional atropine can be given at 15 minute 15 minute intervalsintervals until signs of nerve agent poisoning until signs of nerve agent poisoning decrease:decrease:– Heart rate is above 90 beats per minuteHeart rate is above 90 beats per minute– Bronchial secretions are reducedBronchial secretions are reduced– Salivation is reducedSalivation is reduced

35



Additional CANA, up to a total of 3, can be Additional CANA, up to a total of 3, can be given at given at 5 to 10 minute intervals5 to 10 minute intervals if convulsions if convulsions persistpersist

36


CANA InjectorCANA Injector

Contains diazepam (anti-Contains diazepam (anti-seizure medication).seizure medication).

Given to all casualties Given to all casualties requiring 3 MARK I sets.requiring 3 MARK I sets.

Soldier medic may carry Soldier medic may carry extra CANA injectors and extra CANA injectors and may give additional may give additional CANA injectors in a CANA injectors in a seizing casualty.seizing casualty.

37



Secure used injectors to the Secure used injectors to the casualty’s upper left pocket casualty’s upper left pocket flap of the BDO; flap of the BDO; left pocket on the sleeve of left pocket on the sleeve of the JSLIST. the JSLIST.

Record all treatment given Record all treatment given on the casualty’s FMC. on the casualty’s FMC.

Evacuate and provide Evacuate and provide assisted ventilations, if assisted ventilations, if necessary.necessary.

38


Side Effects of AtropineSide Effects of Atropine

MildMild: dry mouth, skin : dry mouth, skin flushing, drowsiness, flushing, drowsiness, decreased combat decreased combat performance.performance.

SevereSevere: drowsiness, : drowsiness, fatigue, visual blurring, fatigue, visual blurring, increased heat injury increased heat injury risk.risk.

39


Medication Side EffectsMedication Side Effects

2-PAM-Cl2-PAM-Cl::Mild visual changesMild visual changes

CANACANA::

Decreased combat Decreased combat performanceperformance

40


Nerve Agent PretreatmentNerve Agent Pretreatment

1990 (Gulf War I), US 1990 (Gulf War I), US military fields military fields pyridostigmine bromide pyridostigmine bromide (NAPP) as a pretreatment (NAPP) as a pretreatment for nerve agent exposure.for nerve agent exposure.

NOT an antidote - not NOT an antidote - not taken taken afterafter exposure. exposure.

Mild side effects.Mild side effects.

41


Nerve Agent PretreatmentNerve Agent Pretreatment

Medication to be Medication to be taken at least taken at least 8 hours 8 hours prior to exposureprior to exposure..

Service members Service members issued one NAPP in issued one NAPP in high risk areas.high risk areas.

Chain of command Chain of command issues orders to start issues orders to start the NAPP.the NAPP.

42


SummarySummary

Nerve Agent Nerve Agent

CharacteristicsCharacteristics

Signs and Symptoms Signs and Symptoms

of Nerve Agent of Nerve Agent

ExposureExposure

Treatment StepsTreatment Steps

Nerve Agent Nerve Agent

PretreatmentPretreatment

43


Questions?Questions?

nerve agents

Education

nerve agents lpccbrn

nerve agent lpccbrn

reduced lpccbrn

c191w0471 jslist

role of ache lpccbrn

cardiac muscle lpccbrn

excessive stimulation

nerve agents effects