Home Podcasts THMG170 – Fourth Generation Chemical Agents, Part II

THMG170 – Fourth Generation Chemical Agents, Part II


In this episode, Bob and Mike conclude their exploration of fourth generation chemical agents.

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  1. So were going to go threw the decon recommendations on the document. Were doing this because some of it might be a little different, or your SOP for cwa might be a little different so we’re going to talk about exactly what they say.
    1. After FGA exposures, decontaminating patients’ skin and hair is essential. Decontamination is a medical intervention and should be performed as soon as possible to prevent absorption of agent. However, even after a delay of hours or days, decontamination may still reduce harm to the patient and the risk of secondary exposure to other people.  
    2. Removal of clothing and personal effects is a vital step to reduce ongoing and secondary exposure and can remove significant amounts of chemical contamination. Pay particular attention to how clothing is removed in order to minimize the spread of contamination.  
    3. Containment of suspected or confirmed contaminated clothing in tightly closed plastic bags, double layered in 6 mil polypropylene bags if possible, is critical. Patient clothing and personal effects should be secured for law enforcement purposes.  
    4. Blotting skin with a paper towel, dry wipe, or other dry cloth will also contribute to effective decontamination. Primary Response Incident Scene Management (PRISM) guidance recommends 10 seconds of blotting followed by 10 seconds of rubbing the contaminated area of skin. This dry decontamination step can be performed by patients themselves and, along with clothing removal, should be done as early as possible. Disrobing and blotting skin with a paper towel, dry wipe, or other dry cloth can remove significant amounts of chemical contamination.
    5. If Reactive Skin Decontamination Lotion (RSDL) is available, it is recommended for spot decontamination.  
    6. Water should be utilized per established decontamination protocols after disrobing, ideally with a high-volume, low-pressure shower, including soap if available, gentle rubbing with a soft cloth or sponge, and active drying with a clean towel after the shower. Do not delay decontamination awaiting specialized products such as soap or RSDL.
    7. Avoid using hand sanitizer or other products containing alcohol, as they may enhance absorption of FGAs.  
    8. Do not use bleach to decontaminate skin.
      1. Infact its a good idea not to use bleach on your skin ever.
        1. What about people who bleach,,,um certain parts of their body
          1. Ya no we’re not talking about changing our ring tone here.
    9. FGAs are not readily degraded by water; thus, avoid direct contact with runoff.  The U.S. Environmental Protection Agency (EPA) issued a statement in 2000 generally allowing responders to prioritize actions to save human lives and protect health. After imminent threats are addressed, responders should immediately take all reasonable steps to contain contamination (including decontamination runoff) and mitigate environmental consequences.
  2. Now we’re not going to dive deep into medical treatment long term. However there is an interesting side note in the treatment section that states. “Meticulous attention to supportive and symptomatic care is the key to patient management. FGA exposures may be resistant to initial and typically recommended medication doses, requiring significantly higher doses and a longer duration of repeated dosing than other nerve agent exposures”
    1. Which is really good to know out in the field that our typical doses might be good enough and we may need more. Not saying to go against your protocols but if you have the flexibility it might be worth keeping in the back of your mind.
    2. If you really want to dive more into the treatment aspect of this follow the link in the show notes. We aren’t medical pros so i really wouldn’t even be able to tell you which treatment is different because it’s FGA vs a typical nerve agent.
  3. Small side note in this document. Now i don’t know if this is true for all CWA but this document suggest for disposal is to incinerate the waste. Now i got to be honest with you I don’t see this being anyone decision that is going to be listening to this show. I have a feeling that by the time we get to that phase of the operation we will be so far into the federal government response it won’t even be funny. But it is an interesting side note.
  4. Now in England they used the recommended PPE in that real world test no one got hurt. Again it not necessary different than that of other CWA but it is probably different than your prtocals so it good to know what the suggestion is. Now these are for patients who have been decoded and your giving treatment so here for you my EMS and hospital friends
    1. Two pairs of single use nitrile examination gloves with extended cuffs. Outer gloves should be a minimum of 7 mil thickness at the palm and inner gloves should be minimum of 5 mil thickness at the palm. Change gloves every 15 in or or when they get soiled.  OR
    2. OR ONe pair of single use disposable 15 mil nitrile or 14 mil butyl rubber gloves, change every 2 hours or when soiled
    3. Now this is more what we have seen in hospitals “Single use disposable surgical or isolation gown, a single use disposable apron that covers the torso to the level of the mid calf. And single use disposable sleeves. Gown should pass ANSI/AAMI PB70 level 3 or 4 requirement and apron and sleeves should be constructed of fabric  that provides protection against VX.
    4. OR single use disposable coverall. The should be made of the same material that would be compatible with VX. as well as a single use full face shield
  5. Now that best case scenario,  at a minimum you should be wearing 2 pairs of nitrile medical gloves, gown, eye or face protection, stay away from body fluids!
  6. Ok now for some info that most of us will be using. The identification of samples
    1. The current technology is limited with respect to in the field.
      1. M8 paper may be give us a good recognition. It will initially turn yellow/green or greenish blue and over the course of 10 min will all shift to a more wellow color. If you look at the pictures on the document it almost look like a dark green in the middle with a yellow halo around.
  7. Ok now a little on our PPE
    1. Pretty much the same as other nerve
      1. Were looking at level A and A 1994 suit.
        1. Thoughts on which you would choose.

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