Home Podcasts THMG170 – Fourth Generation Chemical Agents, Part II

THMG170 – Fourth Generation Chemical Agents, Part II

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

Complete Show Notes

4:00 Decontamination and FGAs

  • After exposure to FGAs, it’s essential to decontaminate the patient’s skin and hair
  • Decontamination is a medical intervention that should be performed as soon as possible to prevent absorption of an agent
  • 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
  • Removal of clothing and personal effects is a vital step in reducing 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
  • Contain suspected or confirmed contaminated clothing in tightly closed plastic bags – best to double-layer the clothing in 6 mm polypropylene bags if possible
  • Patient clothing and personal effects should also be secured for law enforcement purposes
  • Blotting skin with a paper towel, dry wipe, or other dry cloth also helps contribute to effective decontamination
  • Primary Response Incident Scene Management (PRISM) guidelines recommend 10 seconds of blotting followed by 10 seconds of rubbing the contaminated area of skin
  • This dry decontamination step can be performed by patents and, along with clothing removal, should be performed as quickly as possible
  • If reactive skin decontamination lotion (RSDL) is available, you can use it for spot decontamination
  • Use a high volume, low-pressure shower (with soap if available) and gently rub the contaminated areas with a soft cloth or sponge; post-shower, actively dry the area with a clean towel
  • Don’t delay decontamination by waiting for specialized products like soap or RSDL
  • Don’t use bleach to decontaminate skin
  • FGAs are not readily degraded by water, so avoid direct contact with runoff
  • The EPA issued a statement in 2000 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

16:40 Long-Term Medical Treatment for FGAs

  • Treatment section of the government’s FGA document states: “Meticulous attention to supportive and symptomatic care is 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.”
  • This is important to keep in the back of your mind when responding to FGA incidents
  • Interesting side note: government document also suggests incinerating the waste if possible

19:40 PPE Selection for FGAs

  • In England, they used the recommended PPE in their real-world test, and no one got hurt
  • FGAs aren’t necessarily different than other chemical warfare agents, but it’s important to know what the suggestions are
  • For our EMS and hospital friends:
    • Use two pairs of single use nitrile examination gloves with extended cuffs
    • Outer gloves should be a minimum of 7 mm thickness at the palm, and inner gloves should be a minimum of 5 mm thickness at the palm
    • Change gloves ever 15 minutes or when they get soiled
    • You can also use one pair of single use disposable 15 mm nitrile or 14 mm butyl rubber gloves
    • Change every 2 hours or when soiled
  • Document also states the following: Hospital staff can use “single use disposable surgical or isolation gowns, single use disposable aprons that cover the torso to the level of the mid-calf, and single use disposable sleeves. Gown should pass ANSI/AAMI PB70 Level 3 or 4 requirements, and apron and sleeves should be constructed of fabric that provides protection against VX.”
  • Hospital staff can also use disposable coveralls made of the same material that would be compatible with VX, along with a single use full face shield
  • At minimum, you should be wearing 2 pairs of nitrile medical gloves, a gown, and eye or face protection and stay away from body fluids

22:10 Identifying FGAs

  • The current technology is rather limited when it comes to identifying and metering for FGAs
  • M8 paper is a good option – it will initially turn yellow/green or green/blue, and over the course of 10 minutes, will shift to a more definite yellow color
  • If you look at the pictures in the document, it looks like a yellow halo with dark green in the middle

23:15 PPE Selection and FGAs

  • PPE selection is similar to any other chemical nerve agents
  • We recommend Level A 1991 and 1994 suits

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