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Exposure to high concentrations of nerve agents may bring on a lack of coordination, mental confusion, and physical collapse so fast that a person may not be able to perform self- aid measures. If this happens, the necessary procedures will have to be done for the casualty (as first aid) by the nearest person who is able to do so. Severe nerve agent exposure may rapidly cause unconsciousness, muscular paralysis, and stoppage of breathing. When this occurs, atropine and 2-PAM chloride injections alone will not save a life. Start artificial ventilation, as a first-aid measure, immediately and continue until you can restore natural breathing or until medical person- nel can take over. Atropine and 2-PAM injections increase the effectiveness of artificial ventilation and should be administered to the casualty as soon as possible. EFFECTS OF BLISTER AGENTS. —Blister agents would probably be used in conjunction with nerve agents. They cause incapacitating rather than lethal effects detectable by the senses. They smell of garlic, fish, or geraniums and may appear as colorless to dark brown oily liquid or droplets. They attack through all body entry points, particularly the eyes and those parts of the body that are warm and moist. A droplet the size of a pinhead can cause a blister the size of a quarter. Blister agents react almost immediately on any part of the body they touch. You must wash the liquid from the eyes in seconds to avoid an injury. Treatment after 2 minutes is of little use. On the skin, depending on the dose received, effects appear from 1 hour to days following exposure. The first signs are a reddening of the skin, like a severe sunburn, followed by an itching or a burning sensation. Blisters appear in a day or less after reddening. Recovery time varies from about 6 days to as long as 8 weeks. Because phosgene oxime (blister agent) reacts rapidly with tissue, decontamination will not be entirely effective after pain has begun. Never- theless, flush the contaminated area as rapidly as possible with large amounts of water to remove any phosgene oxime that has not yet reacted with tissue. Whenever liquid or vaporized blister agents are known, be sure to wear the protective mask. You must deal with liquid blister agents in your eyes or on your skin immediately. You can decontaminate a liquid blister agent in your eye that does not cause immediate pain by rinsing the eye with water for at least 30 seconds. Try to regulate the flow of water so that flushing lasts not less than 30 seconds and not more than 2 minutes. Decontamination with water effectively removes mustard gas and is now the standard procedure for all blister agents. The risk of leaving blister agents in the eye is greater than the risk of exposure to blister agent vapors. The decontamination procedure MUST be performed in spite of the presence of vapor. EFFECTS OF CHOKING AGENTS. Choking agents are less effective than nerve agents; the use is for quick, incapacitating effects. Death may occur within 3 hours. Choking agents are colorless but you can detect them by odor, which smells like new-mown hay or grass. They enter the body when inhaled through the nose or mouth. In low concentrations, there is a delay of 3 hours or more in their effect; in high concentrations, the effect is immediate including the possibility of death within minutes. Irritation of the eyes or a change in the taste of a cigarette might indicate the presence of the choking agent phosgene. Smoking may become tasteless or offensive in taste. If any signs of choking agents occur, hold your breath and put on the protective mask at once. Unless you experience  nausea,  vomiting,  difficulty  in breathing, or more than the usual shortness of breath caused by exertion, continue your normal combat duties. If any of these symptoms occur, you should rest quietly until you are evacuated by medical personnel. EFFECTS OF BLOOD AGENTS.  —Blood agents were not very effective in World War I because the high concentrations necessary to cause death could not be achieved. Modern methods of delivery make their use possible; and because they are less persistent than other agents, they can be immediately used for quick casualty effects. Blood agents are colorless but may have a slight odor of bitter almonds. They attack the body when inhaled or ingested through the nose or mouth. A few breaths can cause incapacitation or death. Incapacitation can occur almost immediately; a lethal dose of vapor can result in death within 15 minutes. In the case of blood agents, speed in self-aid and first-aid measures is essential. Stop breathing and put your mask on at once if you notice any stimulation of breathing; an odor of bitter almonds; or any irritation of the eyes, nose, or throat. The effects of blood agents act so rapidly that within a few seconds you will be unable to 7-27

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