First Aid and Emergency Information

1 Fundamental Criteria for First Aid
2 Basic Measures for First Aid
3 First Aid for Special Wounds
4 First Aid for Fractures
5 First Aid for Climatic Injuries
6 First Aid for Bites and Stings
7 First Aid in Toxic Environments
8 First Aid for Psychological Reactions

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7-9. Blister Agents

Blister agents (vesicants) include mustard (HD), nitrogen mustards (HN), lewisite (L), and other arsenicals, mixtures of mustards and arsenical, and phosgene oxime (CX). Blister agents act on the eyes, mucous membranes, lungs, and skin. They burn and blister the skin or any other body parts they contact. Even relatively low doses may cause serious injury. Blister agents damage the respiratory tract (nose, sinuses and windpipe) when inhaled and cause vomiting and diarrhea when absorbed. Lewisite and phosgene oxime cause immediate pain on contact. However, mustard agents are deceptive and there is little or no pain at the time of exposure. Thus, in some cases, signs of injury may not appear for several hours after exposure.
a. Protective Measures. Your protective mask with hood and protective overgarments provide you protection against blister agents. If it is known or suspected that blister agents are being used, STOP BREATHING, put on your mask and all your protective overgarments.

Large drops of liquid vesicants on the protective overgarment ensemble may penetrate it if allowed to stand for an extended period. Remove large drops as soon as possible.

b. Signs/Symptoms of Blister Agent Poisoning.
(1) Immediate and intense pain upon contact (lewisite and phosgene oxime). No initial pain upon contact with mustard.
(2) Inflammation and blisters (burns)–tissue destruction. The severity of a chemical burn is directly related to the concentration of the agent and the duration of contact with the skin. The longer the agent is in contact with the tissue, the more serious the injury will be.
(3) Vomiting and diarrhea. Exposure to high concentrations of vesicants may cause vomiting anchor diarrhea.
(4) Death. The blister agent vapors absorbed during ordinary field exposure will probably not cause enough internal body (systemic) damage to result in death. However, death may occur from prolonged exposure to high concentrations of vapor or from extensive liquid contamination over wide areas of the skin, particularly when decon is neglected or delayed.
c. First Aid Measures.
(1) Use your M258A1 decon kit to decon your skin and use water to flush contaminated eyes. Decontamination of vesicants must be done immediately (within 1 minute is best).
(2) If blisters form, cover them loosely with a field dressing and secure the dressing.

Blisters are actually burns. DO NOT attempt to decon the skin where blisters have formed.

(3) If you receive blisters over a wide area of the body, you are considered seriously burned. SEEK MEDICAL AID IMMEDIATELY.
(4) If vomiting occurs, the mask should be lifted momentarily and drained—while the eyes are closed and the breath is held–and replaced, cleared, and sealed.
(5) Remember, if vomiting or diarrhea occurs after having been exposed to blister agents, SEEK MEDICAL AID IMMEDIATELY.

7-10. Choking Agents (Lung-Damaging Agents)
Chemical agents that attack lung tissue, primarily causing fluid buildup (pulmonary edema), are classified as choking agents (lung-damaging agents). This group includes phosgene (CG), diaphosgene (DP), chlorine (CL), and chloropicrin (PS). Of these four agents, phosgene is the most dangerous and is more likely to be employed by the enemy in future conflict.
a. Protective Measures. Your protective mask gives adequate protection against choking agents.
b. Signs/Symptoms. During and immediately after exposure to choking agents (depending on agent concentration and length of exposure), you may experience some or all of the following signs/symptoms:
• Tears (lacrimation).
• Dry throat.
• Coughing.
• Choking.
• Tightness of chest.
• Nausea and vomiting.
• Headaches.
c. First Aid Measures.
(1) If you come in contact with phosgene, your eyes become irritated, or a cigarette becomes tasteless or offensive, STOP BREATHING and put on your mask immediately.
(2) If vomiting occurs, the mask should be lifted momentarily and drained—while the eyes are closed and the breath is held–replaced, cleared, and sealed.
(3) Seek medical assistance if any of the above signs/symptoms occur.

If you have no difficulty breathing, do not feel nauseated, and have no more than the usual shortness of breath on exertion, then you inhaled only a minimum amount of the agent. You may continue normal duties.

d. Death. With ordinary field exposure to choking agents, death will probably not occur. However, prolonged exposure to high concentrations of the vapor and neglect or delay in masking can be fatal.

7-11. Blood Agents
Blood agents interfere with proper oxygen utilization in the body. Hydrogen cyanide (AC) and cyanogen chloride (CK) are the primary agents in this group.
a. Protective Measures. Your protective mask with a fresh filter gives adequate protection against field concentrations of blood agent vapor. The protective overgarment as well as the mask are needed when exposed to liquid hydrogen cyanide.
b. Signs/Symptoms. During and immediately after exposure to blood agents (depending on agent concentration and length of exposure), you may experience some or all of the following signs/symptoms:
• Eye irritation.
• Nose and throat irritation.
• Sudden stimulation of breathing.
• Nausea.
• Coughing.
• Tightness of chest.
• Headache.
• Unconsciousness.
c. First Aid Measures.
(1) Hydrogen cyanide. During any chemical attack, if you get a sudden stimulation of breathing or notice an odor like bitter almonds, PUT ON YOUR MASK IMMEDIATELY. Speed is absolutely essential since this agent acts so rapidly that within a few seconds its effects will make it impossible for individuals to put on their mask by themselves. Stop breathing until the mask is on, if at all possible. This may be very difficult since the agent strongly stimulates respiration.
(2) Cyanogen chloride. PUT ON YOUR MASK IMMEDIATELY if you experience any irritation of the eyes, nose, or throat.
d. Medical Assistance. If you suspect that you have been exposed to blood agents, seek medical assistance immediately.

7-12. Incapacitating Agents
Generally speaking, an incapacitating agent is any compound which can interfere with your performance. The agent affects the central nervous system and produces muscular weakness and abnormal behavior. It is likely that such agents will be disseminated by smoke-producing munitions or aerosols, thus making breathing their means of entry into the body. The protective mask is, therefore, essential.
a. There is no special first aid to relieve the symptoms of incapacitating agents. Supportive first aid and physical restraint may be indicated. If the casualty is stuporous or comatose, be sure that respiration is unobstructed; then turn him on his stomach with his head to one side (in case vomiting should occur). Complete cleansing of the skin with soap and water should be done as soon as possible; or, the M258A1 Skin Decontamination Kit can be used if washing is impossible. Remove weapons and other potentially harmful items from the possession of individuals who are suspected of having these symptoms.
Harmful items include cigarettes, matches, medications, and small items which might be swallowed accidentally. Delirious persons have been known to attempt to eat items bearing only a superficial resemblance to food.
b. Anticholinergic drugs (BZ - type) may produce alarming dryness and coating of the lips and tongue; however, there is usually no danger of immediate dehydration. Fluids should be given sparingly, if at all, because of the danger of vomiting and because of the likelihood of temporary urinary retention due to paralysis of bladder muscles. An important medical consideration is the possibility of heatstroke caused by the stoppage of sweating. If the environmental temperature is above 78° F, and the situation permits, remove excessive clothing from the casualty and dampen him to allow evaporative cooling and to prevent dehydration. If he does not readily improve, apply first aid measures for heatstroke and seek medical attention.

7-13. Incendiaries
Incendiaries can be grouped as white phosphorus, thickened fuel, metal, and oil and metal. You must learn to protect yourself against these incendiaries.
a. White phosphorus (WP) is used primarily as a smoke producer but can be used for its incendiary effect to ignite field expedients and combustible materials. The burns from WP are usually multiple, deep, and variable in size. When particles of WP get on the skin or clothing, they continue to burn until deprived of air. They also have a tendency to stick to a surface and must be brushed off or picked out.
(1) If burning particles of phosphorus strike and stick to your clothing, quickly take off the contaminated clothing before the phosphorus burns through to the skin.
(2) If burning phosphorus strikes your skin, smother the flame by submerging yourself in water or by dousing the WP with water from your canteen or any other source. Urine, a wet cloth, or mud can also be used.

Since WP is poisonous to the system, DO NOT use grease or oil to smother the flame. The WP will be absorbed into the body with the grease or oil.

(3) Keep the WP particles covered with wet material to exclude air until you can remove them or get them removed from your skin.
(4) Remove the WP particles from the skin by brushing them with a wet cloth and by picking them out with a knife, bayonet, stick, or other available object.
(5) Report to a medical facility for treatment as soon as your mission permits.
b. Thickened fuel mixtures (napalm) have a tendency to cling to clothing and body surfaces, thereby producing prolonged exposure and severe burns. The first aid for these burns is the same as for other heat burns. The heat and irritating gases given off by these combustible mixtures may cause lung damage, which must be treated by a medical officer.
c. Metal incendiaries pose special problems. Thermite and thermate particles on the skin should be immediately cooled with water and then removed. Even though thermate particles have their own oxygen supply and continue to burn under water, it helps to cool them with water. The first aid for these burns is the same as for other heat burns. Particles of magnesium on the skin burn quickly and deeply. Like other metal incendiaries, they must be removed. Ordinarily, the complete removal of these particles should be done by trained personnel at a medical treatment facility, using local anesthesia. Immediate medical treatment is required.
d. Oil and metal incendiaries have much the same effect on contact with the skin and clothing as those discussed ( b and c above). Appropriate first aid measures for burns are described in Chapter 3.

7-14. First Aid for Biological Agents
We are concerned with victims of biological attacks and with treating symptoms after the soldier becomes ill. However, we are more concerned with preventive medicine and hygienic measures taken before the attack. By accomplishing a few simple tasks we can minimize their effects.
a. Immunizations. In the military we are accustomed to keeping inoculations up to date. To prepare for biological defense, every effort must be taken to keep immunizations current. Based on enemy capabilities and the geographic location of our operations, additional immunizations may be required.
b. Food and Drink. Only approved food and water should be consumed. In a suspected biological warfare environment, efforts in monitoring food and water supplies must be increased. Properly treated water and properly cooked food will destroy most biological agents.
c. Sanitation Measures.
(1) Maintain high standards of personal hygiene. This will reduce the possibility of catching and spreading infectious diseases.
(2) Avoid physical fatigue. Physical fatigue lowers the body’s resistance to disease. This, of course, is complemented by good physical fitness.
(3) Stay out of quarantined areas.
(4) Report sickness promptly. This ensures timely medical treatment and, more importantly, early diagnosis of the disease.
d. Medical Treatment of Casualties. Once a disease is identified, standard medical treatment commences. This may be in the form of first aid or treatment at a medical facility, depending on the seriousness of the disease. Epidemics of serious diseases may require augmentation of field medical facilities.

7-15. Toxins
Toxins are alleged to have been used in recent conflicts. Witnesses and victims have described the agent as toxic rain (or yellow rain) because it was reported to have been released from aircraft as a yellow powder or liquid that covered the ground, structures, vegetation, and people.
a. Protective Measures. Individual protective measures normally associated with persistent chemical agents will provide protection against toxins. Measures include the use of the protective mask with hood, and the overgarment ensemble with gloves and overboots (mission-oriented protective posture level-4 [MOPP 4]).
b. Signs/Symptoms. The occurrence of the symptoms from toxins may appear in a period of a few minutes to several hours depending on the particular toxin, the individual susceptibility, and the amount of toxin inhaled, ingested, or deposited on the skin. Symptoms from toxins usually involve the nervous system but are often preceded by less prominent symptoms, such as nausea, vomiting, diarrhea, cramps, or burning distress of the stomach region. Typical neurological symptoms often develop rapidly in severe cases, for example, visual disturbances, inability to swallow, speech difficulty, muscle coordination, and sensory abnormalities (numbness of mouth, throat, or extremities). Yellow rain (mycotoxins) also may have hemorrhagic symptoms which could include any/all of the following:
• Dizziness.
• Severe itching or tingling of the skin.
• Formation of multiple, small, hard blisters.
• Coughing up blood.
• Shock (which could result in death).
c. First Aid Measures. Upon recognition of an attack employing toxins or the onset (start) of symptoms listed above, you must immediately take the following actions:
(1) Step ONE. STOP BREATHING, put on your protective mask with hood, then resume breathing. Next, put on your protective clothing.
(2) Step TWO. Should severe itching of the face become unbearable, quickly—
• Loosen the cap on your canteen.
• Remove your helmet. Take and hold a deep breath and remove your mask.
• While holding your breath, close your eyes and flush your face with generous amounts of water.

DO NOT rub or scratch your eyes. Try not to let the water run onto your clothing or protective overgarments.

• Put your protective mask back on, seat it properly, clear it, and check it for seal; then resume breathing.
• Put your helmet back on.

The effectiveness of the M258A1 Skin Decon Kit for biological agent decon is unknown at this time; however, flushing the skin with large amounts of water will reduce the effectiveness of the toxins.

(3) Step THREE. If vomiting occurs, the mask should be lifted momentarily and drained–while the eyes are closed and the breath is held—and replaced, cleared, and sealed.
d. Medical Assistance. If you suspect that you have been exposed to toxins, you should seek medical assistance immediately.

7-16. Radiological
There is no direct first aid for radiological casualties. These casualties are treated for their apparent conventional symptoms and injuries.


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