| Section
III. NERVE AGENTS
7-6. Background Inform
a. Nerve agents are
among the deadliest of chemical agents. They can be delivered by artillery shell,
mortar shell, rocket, missile, landmine, and aircraft bomb, spray, or bomblet.
Nerve agents enter the body by inhalation, by ingestion, and through the skin.
Depending on the route of entry and the amount, nerve agents can produce injury
or death within minutes. Nerve agents also can achieve their effects with small
amounts. Nerve agents are absorbed rapidly, and the effects are felt immediately
upon entry into the body. You will be issued three Nerve Agent Antidote Kits,
Mark I. Each kit consists of one atropine autoinjector and one pralidoxime chloride
(2 PAM Cl) autoinjector (also called injectors) (Figure 7-1).
b.
When you have the signs and symptoms of nerve agent poisoning, you should
immediately put on the protective mask and then inject yourself with one set of
the Nerve Agent Antidote Kit, Mark I. You should inject yourself in the outside
(lateral) thigh muscle or if you are thin, in the upper outer (lateral) part of
the buttocks.
c. Also, you may come upon an unconscious chemical agent
casualty who will be unable to care for himself and who will require your aid.
You should be able to successfully—
(1) Mask him if he is unmasked.
(2)
Inject him, if necessary, with all his autoinjectors.
(3) Decontaminate his
skin.
(4) Seek medical aid. 7-7.
Signs/Symptoms of Nerve Agent Poisoning (081-831-1030 and 081-831-1031)
The symptoms of nerve agent poisoning are grouped as MILD—those which you recognize
and for which you can perform self-aid, and SEVERE—those which require buddy aid.
a.
MILD Symptoms (081-831-1030).
• Unexplained runny nose.
•
Unexplained sudden headache.
• Sudden drooling.
• Difficulty seeing
(blurred vision).
• Tightness in the chest or difficulty in breathing.
•
Localized sweating and twitching (as a result of small amount of nerve agent on
skin).
• Stomach cramps.
• Nausea.
b. SEVERE Signs/Symptoms
(081-831-1031).
• Strange or confused behavior.
• Wheezing,
difficulty in breathing, and coughing.
• Severely pinpointed pupils.
•
Red eyes with tearing (if agent gets into the eyes).
• Vomiting.
•
Severe muscular twitching and general weakness.
• Loss of bladder/bowel
control.
• Convulsions.
• Unconsciousness.
• Stoppage
of breathing. 7-8.
First Aid for Nerve Agent Poisoning (081-831-1030) and (081-831-1031)
The injection site for administering the Nerve Agent Antidote Kit, Mark I (see
Figure 7-1), is normally in the outer thigh muscle (see Figure 7-2). It is important
that the injections be given into a large muscle area. If the individual is thinly-built,
then the injections must be administered into the upper outer quarter (quadrant)
of the buttocks (see Figure 7-3). This avoids injury to the thigh bone.
 WARNING
There
is a nerve that crosses the buttocks, so it is important to inject only
into the upper outer quadrant (see Figure 7-3). This will avoid injuring this
nerve. Hitting the nerve can cause paralysis. 
a.
Self-Aid (081-831-1030).
(1) Immediately put on your protective mask after
identifying any of the signs/symptoms of nerve agent poisoning (paragraph 7-7).
(2)
Remove one set of the Nerve Agent Antidote Kit, Mark I.
(3) With your nondominant
hand, hold the autoinjectors by the plastic clip so that the larger autoinjector
is on top and both are positioned in front of you at eye level (see Figure 7-4).
(4)
With the other hand, check the injection site (thigh or buttocks) for buttons
or objects in pockets which may interfere with the injections.
(5) Grasp the
atropine (smaller) autoinjector with the thumb and first two fingers (see Figure
7-5).
CAUTION
DO
NOT cover/hold the green (needle) end with your hand or fingers—you might accidentally
inject yourself. 
(6)
Pull the injector out of the clip with a smooth motion (see Figure 7-6).
WARNING
The
injector is now armed. DO NOT touch the green (needle) end. 
(7)
Form a fist around the autoinjector. BE CAREFUL NOT TO INJECT YOURSELF IN THE
HAND!
(8) Position the green end of the atropine autoinjector against the injection
site (thigh or buttocks):
(a) On the outer thigh muscle (see Figure
7-7).
OR
(b)
On the upper outer portion of the buttocks (see Figure 7-8).
(9)
Apply firm, even pressure (not a jabbing motion) to the injector until it pushes
the needle into your thigh (or buttocks).
WARNING
Using
a jabbing motion may result in an improper injection or injury to the thigh or
buttocks. NOTE
Firm
pressure automatically triggers the coiled spring mechanism. This plunges the
needle through the clothing into the muscle and injects the fluid into the muscle
tissue. (10)
Hold the injector firmly in place for at least ten seconds. The ten seconds can
be estimated by counting “one thousand and one, one thousand and two,” and so
forth.
(11) Carefully remove the autoinjector.
(12) Place the used atropine
injector between the little finger and the ring finger of the hand holding the
remaining autoinjector and the clip (see Figure 7-9). WATCH OUT FOR THE NEEDLE!
(13)
Pull the 2 PAM C1 autoinjector (the larger of the two injectors) out of the clip
(see Figure 7-10) and inject yourself in the same manner as steps (7) through
(11) above, holding the black (needle) end against your thigh (or buttocks).
(14)
Drop the empty injector clip without dropping the used autoinjectors.
(15)
Attach the used injectors to your clothing (see Figure 7-11). Be careful NOT to
tear your protective gloves/clothing with the needles.
(a) Push the needle
of each injector (one at a time) through one of the pocket flaps of your protective
overgarment.
(b) Bend each needle to form a hook. WARNING
It
is important to keep track of all used autoinjectors so that medical personnel
can determine how much antidote has been given and the proper follow-up treatment
can be provided, if needed
(16)
Massage the injection site if time permits. WARNING
If
within 5 to 10 minutes after administering the first set of injections, your heart
begins to beat rapidly and your mouth becomes very dry, DO NOT give yourself another
set of injections. You have already received enough antidote to overcome the dangerous
effects of the nerve agent. If you are able to walk without assistance (ambulate),
know who you are and where you are, you WILL NOT need the second set of injections.
(If not needed, giving yourself a second set of injections may create a nerve
agent antidote overdose, which could cause incapacitation.) If, however, you continue
to have symptoms of nerve agent poisoning for 10 to 15 minutes after receiving
one set of injections, seek a buddy to check your symptoms. If your buddy agrees
that your symptoms are worsening, administer the second set of injections. NOTE
(081-831-1030)
While waiting between sets (injections), you should decon
your skin, if necessary, and put on the remaining protective clothing. b.
Buddy aid (081-831-1031).
A soldier exhibiting SEVERE signs/symptoms of
nerve agent poisoning will not be able to care for himself and must therefore
be given buddy aid as quickly as possible. Buddy aid will be required when a soldier
is totally and immediately incapacitated prior to being able to apply self-aid,
and all three sets of his Nerve Agent Antidote Kit, Mark I, need to be given by
a buddy. Buddy aid may also be required after a soldier attempted to counter the
nerve agent by self-aid but became incapacitated after giving himself one set
of the autoinjectors. Before initiating buddy aid, a buddy should determine if
one set of injectors has already been used so that no more than three sets of
the antidote are administered.
(1) Move (roll) the casualty onto his back (face
up) if not already in that position. WARNING
Avoid
unnecessary movement of the casualty so as to keep from spreading the contamination. (2)
Remove the casualty’s protective mask from the carrier.
(3) Position yourself
above the casualty’s head, facing his feet. WARNING
Squat,
DO NOT kneel, when masking a chemical agent casualty. Kneeling may force the chemical
agent into or through your protective clothing, which will greatly reduce the
effectiveness of the clothing. (4)
Place the protective mask on the casualty.
(5) Have the casualty clear the
mask.
(6) Check for a complete mask seal by covering the inlet valves. If properly
sealed the mask will collapse. NOTE
If
the casualty is unable to follow instructions, is unconscious, or is not breathing,
he will not be able to perform steps (5) or (6). It may, therefore, be impossible
to determine if the mask is sealed. But you should still try to check for a good
seal by placing your hands over the valves. (7)
Pull the protective hood over the head, neck, and shoulders of the casualty.
(8)
Position yourself near the casualty’s thigh.
(9) Remove one set of the casualty’s
autoinjectors. NOTE
(081-831-1031)
Use the CASUALTY’S autoinjectors. DO NOT use YOUR autoinjectors
for buddy aid; if you do, you may not have any antidote if/when needed for self-aid. (10)
With your nondominant hand, hold the set of autoinjectors by the plastic clip
so that the larger autoinjector is on top and both are positioned in front of
you at eye level (see Figure 7-4).
(11) With the other hand, check the injection
site (thigh or buttocks) for buttons or objects in pockets which may interfere
with the injections.
(12) Grasp the atropine (smaller) autoinjector with the
thumb and first two fingers (see Figure 7-5). CAUTION
DO
NOT cover/hold the green (needle) end with your hand or fingers–you may accidentally
inject yourself. (13)
Pull the injector out of the clip with a smooth motion (see Figure 7-6). WARNING
The
injector is now armed. DO NOT touch the green (needle) end. (14)
Form a fist around the autoinjector. BE CAREFUL NOT TO INJECT YOURSELF IN THE
HAND. WARNING
Holding
or covering the needle (green) end of the autoinjector may result in accidentally
injecting yourself. (15)
Position the green end of the atropine autoinjector against the injection site
(thigh or buttocks):
(a) On the casualty’s outer thigh muscle (see Figure
7-12). NOTE
The
injections are normally given in the casualty’s thigh. WARNING
If
this is the injection site used, be careful not to inject him close to the hip,
knee, or thigh bone. 
OR
(b)
On the upper outer portion of the casualty’s buttocks (see Figure 7-13).
NOTE
If
the casualty is thinly built, reposition him onto his side or stomach and inject
the antidote into his buttocks. WARNING
Inject
the antidote only into the upper outer portion of his buttocks (see Figure 7-13).
This avoids hitting the nerve that crosses the buttocks. Hitting this nerve can
cause paralysis. 
(16)
Apply firm, even pressure (not a jabbing motion) to the injector to activate the
needle. This causes the needle to penetrate both the casualty’s clothing and muscle.
WARNING
Using
a jabbing motion may result in an improper injection or injury to the thigh or
buttocks. (17)
Hold the injector firmly in place for at least ten seconds. The ten seconds can
be estimated by counting “one thousand and one, one thousand and two, ” and so
forth.
(18) Carefully remove the autoinjector.
(19) Place the used autoinjector
between the little finger and ring finger of the hand holding the remaining autoinjector
and the clip (see Figure 7-9). WATCH OUT FOR THE NEEDLE!
(20) Pull the 2 PAM
CL autoinjector (the larger of the two injectors) out of the clip (see Figure
7-10) and inject the casualty in the same manner as steps (9) through (19) above,
holding the black (needle) end against the casualty’s thigh (or buttocks).
(21)
Drop the clip without dropping the used autoinjectors.
(22) Carefully
lay the used injectors on the casualty’s chest (if he is lying on his back), or
on his back (if he is lying on his stomach), pointing the needles toward his head.
(23)
Repeat the above procedure immediately (steps 9 through 22), using the second
and third set of autoinjectors.
(24) Attach the three sets of used autoinjectors
to the casualty’s clothing (see Figure 7-14). Be careful NOT to tear either your
or the casualty’s protective clothing/gloves with the needles.
(a) Push
the needle of each injector (one at a time) through one of the pocket flaps of
his protective overgarment.
(b) Bend each needle to form a hook. WARNING
It
is important to keep track of all used autoinjectors so that medical personnel
will be able to determine how much antidote has been given and the proper follow-up/treatment
can be provided, if needed. 
(25)
Massage the area if time permits.
Continue
to Other Agents | 
