Annex 1: General Management of Casualties contaminated by Chemical Compounds
This paper deals with the specific management of casualties poisoned by selected chemical compounds. Although the management of poisoning for individual chemical agents may be specific, the initial management is the same and has been summarised below:
Airway - the airway of the casualty must be maintained at all times. In the unconscious casualty this may involve simple basic airway manoeuvres plus suction of the copious secretions associated with chemical poisoning. Occasionally, there may be a requirement for advanced airway management, such as tracheal intubation, to protect the airway from the excessive secretions and to prevent aspiration of regurgitated stomach contents.
Breathing must be carefully observed until full decontamination and recovery have occurred. Supplemental oxygen will speed the recovery from volatile chemical poisoning. If breathing becomes compromised it must be supported by artificial ventilation with supplemental oxygen using a self-inflating resuscitation bag-valve-mask or automatic ventilator. Entrained air must be filtered when ventilating casualties in a contaminated environment.
Circulation must be carefully observed and monitored. Non-invasive blood pressure, pulse oximetry and ECG monitoring are all useful indicators of circulatory function. The early establishment of intravenous access will aid the administration of fluids and drugs.
Disability should be assessed using the simple AVPU scale (Alert, responds to Voice, responds to Pain, Unresponsive). This assessment should be repeated at frequent intervals to assess the progress of the casualty.
Drugs, especially the specific antidotes, should be administered as per the description in the text.
Exposure of the casualty is essential not only to assess physical damage but to remove all clothes that have been contaminated by the chemical.
Environment. It is important to remember that the primary management described above may be severely limited by the need of the rescuer to wear protective clothing. Therefore only those skilled in these techniques and trained in protective clothing should enter and treat casualties in a contaminated area. All others should await the casualties' arrival in cold/clean zone, following decontamination.
It should be remembered that the identification of the chemical and therefore its specific antidote might take some time. However this must not delay the basic medical management of the casualty.
