- Are highly potent and logistically feasible.
- Produce their effects mainly by altering or disrupting the higher regulatory activity of the CNS.
- Produce effects that last for hours or days rather than momentary or fleeting.
- Do not seriously endanger life, except in exceedingly high doses.
- Produce no permanent injury.
The two types likely to be encountered are CNS depressants and CNS stimulants.
(1) Central nervous system depressants are compounds that have a predominant effect of depressing or blocking the activity of the CNS; often by interfering with the transmission of information across synapses. An example of this type of agent is BZ. The action of acetylcholine, both peripherally and centrally, appears to be blocked by BZ. Low doses disrupt higher integrative functions of memory, problem solving, attention, and comprehension. High doses produce toxic delirium that destroys the ability to perform any military task. Within the CNS, BZ seems to produce its effects in the same way as atropine. Small doses cause sleepiness and decreased alertness with elevated heart rate, dry skin and eyelids, drowsiness, increased pupil size, and elevated skin temperatures. Progressive intoxication is marked by an inability to respond effectively to the environment (4 to 12 hours), followed by increasing activity and random/unpredictable behavior (12 to 96 hours). Because the patient cannot sweat, heat stress becomes a problem.
(2) Central nervous system stimulants are agents that cause excessive nervous activity, often by boosting or facilitating transmission of impulses across synapses. The effect is to "flood" the cortex and other higher regulatory centers with too much information, making concentration difficult and causing indecisiveness and an inability to act. These include LSD, psilocybin, and mescaline. Intoxication shows sympathetic stimulation (rapid heart rate, sweaty palms, pupillar enlargement, and cold extremities) and mental excitation (nervousness, trembling, anxiety, and inability to relax or sleep); feelings of tension, exhilaration, heightened awareness, paranoid ideas, and profound states of terror may also occur.
A-14. Management of Chemical Agent Patients
a. Management. Movement of chemical agent casualties can spread the contamination to clean areas. All casualties are decontaminated as far forward as the situation permits. All patients must be decontaminated before they are admitted into a clean MTF. The admission of one contaminated patient into an MTF will contaminate the facility; thereby reducing its treatment capabilities.
b. Mass Casualty. A mass casualty situation is presented when chemical agents are employed. Additional HSS personnel and equipment must be provided in a short period of time if the level of care is to be maintained. Treatment at far forward MTFs is limited to life- or limb-saving care. Patients that can survive evacuation to the next level of care are not treated at the forward facility. This provides time for treating those patients that cannot survive the evacuation time.
c. Decontamination. Decontamination is an individual and unit responsibility. However, some individuals may arrive at the MTF that have not been decontaminated or that become contaminated en route to the MTF. These individuals must be decontaminated at the MTF before they are admitted to prevent contamination of the MTF and exposure of medical personnel to the chemical. See [Appendix G] for detailed information on patient decontamination procedures.
d. Treatment. Field Manuals 8-9 and 8-285 provide treatment procedures for chemical agent patients.