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081-831-1044 (SL1) - Perform First Aid for Nerve Agent Injury

Standards: Administered correctly the antidote to self, or administered three sets of MARK l nerve agent antidote autoinjectors or three ATNAAs followed by the CANA to a buddy following the correct sequence.

Conditions: You and your unit have come under a chemical attack.  You are wearing protective overgarments and/or mask, or they are immediately available.  There are casualties with nerve agent injuries.  Necessary materials and equipment:  chemical protective gloves, overgarments, overboots, protective mask and hood, mask carrier, and nerve agent antidote autoinjectors.  The casualty has three sets of MARK l nerve agent antidote autoinjectors or three antidote treatment nerve agent autoinjector (ATNAAs) and one convulsant antidote for nerve agents (CANA) autoinjector.

Standards: Administered correctly the antidote to self, or administered three sets of MARK l nerve agent antidote autoinjectors or three ATNAAs followed by the CANA to a buddy following the correct sequence.

 

Performance Steps

Note.  The ATNAA system is a nerve agent antidote device that will be used by the armed forces.  A single ATNAA delivers both the atropine and 2 Pam Cl.  The ATNAA will replace the MARK I when supplies are exhausted.  Procedures for administering ATNAA will be contained in FM 4-25.11 (FM 21-11) and FM 8-285.

Note.  When performing first aid on a casualty, seek medical aid as soon as possible.  Do not stop the first aid;  if the situation allows, send another person to find medical aid.

1.   Identify mild signs and symptoms of nerve agent poisoning.

a. Unexplained runny nose.

b. Unexplained sudden headache.

c. Excessive flow of saliva (drooling).

d. Tightness of the chest causing breathing difficulties.

e. Difficulty seeing (blurred vision).

f.  Muscular twitching around area of exposed or contaminated skin.

g. Stomach cramps.

h. Nausea.

Note.  For the above signs and symptoms first aid is considered to be self-aid.

2.   React to the chemical hazard.

a. Put on your protective mask.

Note.  Seek overhead cover or use a poncho to provide cover, mission permitting.  Do not put on additional protective clothing at this time.  Give yourself the nerve agent antidote first.  Then, decontaminate exposed skin areas and put on remaining protective clothing.

b. Give the alarm.

3.   Administer nerve agent antidote to self (self-aid), if necessary.

a. MARK I.

(1)  Prepare to administer one atropine injection.

(a)   Remove one set of MARK I from your protective mask carrier, from the pocket of the MOPP suit, or from another location as specified by your unit SOP.

(b)   With one hand, hold the set of injectors by the plastic clip with the big injector on top.

(c)   With the other hand, check the injection site in order to avoid buttons and objects in pockets where injecting.  For injections into the thigh, grasp the trouser cargo pocket and pull forward, clearing possible obstructions from the site.

(d)   Grasp the small injector without covering or holding the needle (green) end, and pull it out of the clip with a smooth motion.

(e)   Form a fist around the autoinjector with the needle end (green) extending beyond the little finger end of the fist. Be careful not to inject yourself in the hand.

Note.  If the injection is accidentally given in the hand, another small injector must be obtained and the injection given in the proper site.

(f)    Place the needle end of the injector against the outer thigh muscle.  For injections into the thigh, grasp the trouser cargo pocket and pull forward, clearing possible obstructions from the site.

Note.  The injection can be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.

Note.  Very thin soldiers should give the injection in the upper outer part of the buttocks.

CAUTION: When injecting antidote in the buttocks, be very careful to inject only into the upper, outer quarter of the buttocks to avoid hitting the major nerve that crosses the buttocks.  Hitting the nerve may cause paralysis.

(2)  Administer the atropine injection.

(a)   Push the injector into the muscle with firm, even pressure until it functions.

Note.  A jabbing motion is not necessary to trigger the activating mechanism.

(b)   Hold the injector firmly in place for at least 10 seconds.

(c)   Remove the injector from your muscle and carefully place the used injector between two fingers of the hand holding the plastic clip.

(3)  Prepare to administer one 2 PAM Cl injection.

(a)   Pull the large injector out of the clip and form a fist around the autoinjector with the needle end extending beyond the little finger.

(b)   Place the needle (black) end of the injector against the injection site.

(4)  Administer the 2 Pam Cl injection.

(a)   Push the injector into the muscle with firm, even pressure until it functions.

(b)   Hold the injector firmly in place for at least 10 seconds.

b. ATNAA.

(1)  Prepare to administer one ATNAA.

(a)   Remove one ATNAA from your protective mask carrier, from the pocket of the MOPP suit, or from another location as specified by your unit SOP.

(b)   Remove the autoinjector from the pouch.

(c)   With your dominant hand, hold the ATNAA in your closed fist with the green needle end extending beyond the little finger in front of you at eye level.

(d)   With your nondominant hand, grasp the safety (gray) cap with the thumb and first two fingers.

CAUTION: Do not cover or hold the needle end with your hand, thumb, or fingers.  You may accidentally inject yourself.

(e)   Pull the safety cap off the bottom of the injector with a smooth motion and drop it to the ground.

(f)    With the nondominant hand, check the injection site in order to avoid buttons and objects in pockets where injecting.  For injections into the thigh, grasp the trouser cargo pocket and pull forward, clearing possible obstructions from the site.

(g)   Hold the ATNAA in your closed fist with the green needle end pointing out by your little finger.

(h)   Place the needle end of the injector against the outer thigh muscle.

Note.  Very thin soldiers should give the injection in the upper outer part of the buttocks.

Note.  The injection can be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.

CAUTION: When injecting antidote in the buttocks, be very careful to inject only into the upper, outer quarter of the buttocks to avoid hitting the major nerve that crosses the buttocks.  Hitting the nerve may cause paralysis

(2)  Administer the injection.

(a)   Push the injector into the muscle with firm, even pressure until it functions.

Note.  A jabbing motion is not necessary to trigger the activating mechanism.

(b)   Hold the injector firmly in place for at least 10 seconds.

(c)   Remove the injector from your muscle.

4.   Secure the used injectors.

a. Drop the plastic clip (MARK I) without dropping the used injectors.

b. Use a hard surface to bend each needle to form a hook without tearing protective gloves or clothing.

c. Push the needle of each used injector (one at a time) through one of the pocket flaps of the protective overgarment.

5.   Decontaminate skin if necessary.

Note.  Information on this step is provided in Task 031-503-1013.

6.   Put on remaining protective clothing.

Note.  Information on this step is covered in Task 031-503-1015

WARNING: If, within 5 to 10 minutes after administering the first set of injections, your heart begins beating rapidly and your mouth becomes very dry, do not administer another set of injections

7.   Seek buddy-aid or medical aid.

Note.  After you have given yourself the first set of MARK I injections or one ATNAA, you most likely will not need additional antidote if you are ambulatory and know who and where you are.  If needed, additional injections will be given only by a buddy, a combat lifesaver, or medical personnel.

8.   Identify severe signs and symptoms of nerve agent poisoning.

a. Strange and confused behavior.

b. Gurgling sounds made when breathing.

c. Severely pinpointed pupils.

d. Red eyes with tearing.

e. Vomiting.

f.  Severe muscular twitching.

g. Loss of bladder and/or bowel control.

h. Convulsions.

i.   Unconsciousness or stoppage of breathing.

Note.  If the casualty is exhibiting severe symptoms, assistance (buddy-aid) is required by the individual to complete first aid treatment.

9.   Mask the casualty if necessary.

WARNING: Do not kneel at any time while providing aid to the casualty.  Contact with the ground could force the chemical into or through the protective clothing

Note.  Reposition the casualty on his back, if necessary, to mask the individual.

a. Place the mask on the casualty.

b. If the casualty can follow directions, have him clear the mask.

c. Check for a complete mask seal by covering the inlet valves of the mask.

d. Pull the protective hood over the head, neck, and shoulders of the casualty.

e. Position the casualty on the right side, similar to a swimmer position, with the head slanted down so the casualty will not roll back over.

10. Administer first aid to a nerve agent casualty (buddy-aid).

a. MARK I.

(1)  Prepare to administer one atropine injection.

(a)   Position yourself near the casualty's thigh.

(b)   Remove all three sets of autoinjectors and the single CANA autoinjector from the casualty's mask carrier, BDU pocket, or from another location as specified by your unit SOP.  Place the autoinjectors and CANA on the casualty's side.  DO NOT place the unused devices on the ground.

(c)   With one hand, hold the set of injectors by the plastic clip with the big injector on top.

(d)   With the other hand, check the injection site to avoid buttons and objects in pockets.  For injections into the thigh, grasp the trouser cargo pocket and pull forward (toward you), clearing possible obstructions from the site.

(e)   Grasp the small injector and pull it out of the clip with a smooth motion.

(f)    Hold the injector in your closed fist with the green needle end pointing out by your little finger without covering the needle end.

(g)   Place the needle end of the injector against the casualty's outer (lateral) thigh muscle.

Note.  The injection can be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.

Note.  Very thin soldiers should be given the injections in the upper outer part of the buttocks.

WARNING: When injecting antidote in the buttocks, be very careful to inject only into the upper, outer quarter of the buttocks to avoid hitting the major nerve that crosses the buttocks.  Hitting the nerve may cause paralysis.

(2)  Administer the atropine injection.

(a)   Push the injector into the muscle with firm, even pressure until it functions.

(b)   Hold the injector in place for at least 10 seconds.

(c)   Remove the injector from the muscle and carefully place the used injector between two fingers of the hand holding the clip.

(3)  Prepare to administer one 2 PAM Cl injection.

(a)   Pull the large injector out of the clip and hold the injector in your closed fist with the black needle end pointing out by your little finger without covering the needle end.

(b)   Place the needle (black) end of the injector against the injection site.

(4)  Administer the 2 PAM Cl injection.

(a)   Push the injector into the muscle with firm, even pressure until it functions.

(b)   Hold the injector in place for at least 10 seconds.

(c)   Drop the clip without dropping injectors.

(d)   Lay the used injectors on the casualty's side.

Note.  Repeat steps 10a (1) through 10a (4) until the casualty has received a total (including self-administered) of three sets of antidote injections.

b. ATNAA

(1)  Prepare to administer one ATNAA.

(a)   Obtain three or all remaining ATNAAs and one CANA from the casualty's protective mask carrier, from the pocket of the MOPP suit, or from another location as specified by your unit SOP.

(b)   Remove one ATNAA from the pouch.

(c)   With your dominant hand, hold the ATNAA in your closed fist with the green needle end pointing out by your little finger, in front of you at eye level.

(d)   With your nondominant hand, grasp the safety (gray) cap with the thumb and first two fingers.

CAUTION: Do not cover or hold the needle end with your hand, thumb, or fingers.  You may accidentally inject yourself

(e)   Pull the safety cap off the bottom of the injector with a smooth motion and drop it to the ground.

(f)    With the nondominant hand, check the injection site in order to avoid buttons and objects in pockets where injecting.  For injections into the thigh, grasp the trouser cargo pocket and pull forward, clearing possible obstructions from the site.

(g)   Hold the ATNAA in your closed fist.

(h)   Place the needle end of the injector against the outer thigh muscle.

Note.  The injection may be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.

Note.  Very thin soldiers should be given the injection in the upper outer part of the buttocks

CAUTION: When injecting antidote in the buttocks, be very careful to inject only into the upper, outer quarter of the buttocks to avoid hitting the major nerve that crosses the buttocks.  Hitting the nerve may cause paralysis

(2)  Administer the injection.

(a)   Push the injector into the muscle with firm, even pressure until it functions.

Note.  A jabbing motion is not necessary to trigger the activating mechanism.

(b)   Hold the injector firmly in place for at least 10 seconds.

(c)   Remove the injector from the muscle.

(d)   Place the used injector on the casualty's side.

(3)  Repeat the procedure for a total of three ATNAAs.

11. Administer the anticonvulsant, CANA.

a. Prepare to administer the CANA injection.

(1)  Tear open the protective plastic packet and remove the injector.

(2)  With your dominant hand, hold the injector in your closed fist with the black needle end pointing out by your little finger.

(3)  With the other hand, pull the safety cap off the injector base to arm the injector.

CAUTION: Do not touch the black (needle) end.  You could accidentally inject yourself.

(4)  Place the black end of the injector against the casualty's injection site.

b. Administer the CANA injection.

(1)  Push the injector into the muscle with firm, even pressure until it functions.

(2)  Hold the injector in place for at least 10 seconds.

12. Secure the used injectors.

a. Using a hard surface bend each needle to form a hook without tearing protective gloves or clothing.

b. Push the needle of each used injector (one at a time) through one of the pocket flaps of the casualty's protective overgarment.

13. Decontaminate the casualty's skin, if necessary.

Note.  This information is covered in Task 031-503-1013.

14. Seek medical aid.

Evaluation Preparation: 

Setup:  You must use nerve agent antidote injection training aids to train and evaluate this task.  Actual autoinjectors will not be used.  For self-aid, have the soldier dress in MOPP 2.  Have the soldier wear a mask carrier containing a mask and the training nerve agent autoinjectors.  For buddy-aid, have the soldier being tested and the casualty dress in MOPP 2.  Have the casualty lie on the ground wearing the mask carrier containing a mask and the training nerve agent autoinjectors.

Brief Soldier:  For step 1, tell the soldier to state, in any order the mild symptoms of nerve agent poisoning.  The soldier must state seven of the eight symptoms to be scored GO.  Then, tell the soldier that he has mild symptoms and to take appropriate action.  After the soldier completes step 4, ask what should be done next.  Then ask what he should do after putting on all protective clothing.  Score steps 5 through 7 based on the soldier's responses.  For step 8, tell the soldier to state, in any order, the severe symptoms of nerve agent poisoning.  The soldier must state eight of the nine symptoms to be scored GO.  Tell the soldier to treat the casualty for nerve agent poisoning.  After the soldier completes step 11, ask what else he should do.  Score steps 12 and 13 based on the soldier's responses.

 

Performance Measures

GO

NO GO

1.   Identified mild signs of nerve agent poisoning.

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2.   Reacted to the chemical hazard.

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3.   Correctly administered the nerve agent antidote to self.

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4.   Secured the used injectors.

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5.   Decontaminated skin, if necessary.

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6.   Donned remaining protective clothing.

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7.   Sought help (buddy-aid).

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8.   Identified severe signs of nerve agent poisoning.

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9.   Masked the casualty.

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10. Correctly administered nerve agent antidote to the casualty.

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11. Secured the used injectors.

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12. Decontaminated the casualty's skin if necessary.

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13. Sought medical aid.

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14. Performed steps 1 through 12 in the correct sequence.

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Evaluation Guidance:  Score the soldier GO if all the performance measures are passed.  Score the soldier NO GO if any of the performance is failed.  If the soldier scores NO GO, show what was done wrong and how to do it correctly.

References

 

Required

Related

 

 

DVC 08-36

 

 

DVC 08-37

 

 

FM 4-25.11

 

 

FM 8-285