Medical Aspects of Assistance and Protection against Chemical Weapons

Main Clinical Signs and Symptoms

Medical personnel should familiarise themselves with the main clinical signs and symptoms of chemical warfare casualties.

This will allow them to determine a clinical diagnosis and start the triage process, assigning priority for decontamination and medical treatment.

 

Clinical Manifestations Vary

The nature and timing of these clinical manifestations will vary with the duration and concentration of exposure, and with the route of exposure, which should be considered in the differential diagnosis and triage process.

Example: nerve agents and cyanides (blood agents) absorbed by inhalation have rapid onset of effects and need immediate treatment.

Indirect Effects of Chemical Exposure

Differential diagnosis should also consider the indirect effects of chemical exposure, including heat stress from wearing protective equipment, psychological effects, and even side effects from antidotes. This is particularly important when exposure to an agent has not taken place but antidotes have been administered.

Example: auto-injectors with nerve agent poisoning antidotes.

Differential diagnosis and triage may also be complicated in cases of mixed casualties who have both conventional and chemical injuries.

Antidotes

Antidotes are available for some chemical warfare agents, however, their availability will depend on local, regional and national medical doctrines, policies, and regulations.

When specific antidotes are not available, therapy will be limited to supportive care.

Triage

In a chemical mass casualty situation medical resources will be overwhelmed.

Triage is a medical decision process used to arrange patients in order of priority, to ensure the most effective use of limited medical resources and minimise morbidity and mortality.

Triage is used to assign priority for treatment, evacuation, and decontamination.

One of the most commonly used systems for chemical triage contains four categories: Immediate, Delayed, Minimal, and Expectant.

Practical Guide for Medical Management

The OPCW’s Practical Guide for Medical Management of Chemical Warfare Casualties includes information on specific antidotes for chemical weapon agent poisoning, triage of chemical casualties, and other useful information regarding medical management of chemical weapons victims.