Chem Casualty Care Division PDF

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PRODUCTS:
Computer Based Training Courses. Find out more... Now Available Online! Field Training Exercise Guide USAMRIID - Medical Management of Biological Casualties Training Material Site Map Security & Privacy Notice
CURRENT NEWS:
FCBC 2-6 February 2004. Sign up here! MCBC 7-12 March 2004. Sign up here! V. 4.00 CD-ROM MMCC Supplemental Training Materials Supporting Homeland Defense: Training for Chemical Casualty Management (Article) Detailed summary of courses and products: Summary Guide
Courses Courses
Quick Links: Take me to...

PRODUCTS:
Computer Based Training Courses. Find out more... Now Available Online! Field Training Exercise Guide USAMRIID - Medical Management of Biological Casualties Training Material Site Map Security & Privacy Notice
CURRENT NEWS:
FCBC 2-6 February 2004. Sign up here! MCBC 7-12 March 2004. Sign up here! V. 4.00 CD-ROM MMCC Supplemental Training Materials Supporting Homeland Defense: Training for Chemical Casualty Management (Article) Detailed summary of courses and products: Summary Guide
Courses Courses
Our Mission
Our mission is to educate medical professionals and first responders in the management of chemical casualties and to provide consultation to military and civilian authorities.
Awards
About Us
The Chemical Casualty Care Division (CCCD), located at Aberdeen Proving Ground, MD is a division of the United States Army Medical Research Institute of Chemical Defense (USAMRICD). The USAMRICD is one of six medical research laboratories and institutes operated by the United States Army Medical Research and Materiel Command (USAMRMC). Under sponsorship of the US Army Medical Department Center and School (AMEDDC&S), The Office of The Surgeon General and Medical NBC Online, our staff of physicians and other highly qualified military and civilian personnel, organize and implement a post-graduate education program for medical professionals and training for first responders in the management of chemical agent casualties.
These courses are offered on site, off site, and through distributed learning. Many of the courses are offered for CEU/ CME credits. For course descriptions refer to the In House Courses, Distance Learning, and Satellite Broadcast pages. For in house course schedules refer to the 2003-2004 Schedule page. Serving as advisors to the Chemical-Biological Rapid Response Team (C/BRRT), Domestic Emergency Support Team (DEST), and Foreign Emergency Support Team (FEST), we provide casualty management training and expert consultation on-scene to the incident commander and other military and civilian authorities in the event of a chemical warfare agent release. In addition, we provide ongoing support to programs such as the Domestic Preparedness Program.
Our Partners
The CCCD works closely with the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) located in Fort Detrick, MD to conduct the Medical Management of Chemical and Biological Casualties course (MCBC). Participants spend three days at USAMRICD for the chemical portion of the course and three days at USAMRIID for the biological casualties portion of the training.
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Contact Us
Address
USAMRICD ATTN MCMR-UV-ZM 3100 Ricketts Point Road Aberdeen Proving Ground, MD 21010-5400
Phone/Fax
Commercial: 410-436-2230 Fax: 410-436-3086 DSN: 584-2230
Email
For questions about our in-house courses, products, distance learning and other general questions, please email the Chemical Casualty Care Division at CCC@apg. amedd.army.mil For questions regarding public affairs and media requests, please email the USAMRICD Public Affairs Officer at MRICD.PAO@apg.amedd.army.mil
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Links
By clicking on any of these links, you will be exiting the Chemical Casualty Care Division website. When clicked, these links will open in a new browser window
NBC Links
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Air Force Medical Management of Chemical and Biological Casualties Air Force Publishing Army Medical Department Battle Simulation Center Biological Agent Fact Sheets Biological Agent Vaccine Information - Anthrax Biological Agent Vaccine Information - Smallpox CB Information Analysis Center (CBIAC) Center for Disaster and Humanitarian Assistance Medicine (USUHS) Chemical/Biological/Radiological Incident Handbook (October 1998) Chemical and Biological Arms Control Institute Chemical and Biological Terrorism Threat Chemical Weapons Convention Countering the Anthrax Threat Deputy Assistant to the Secretary of Defense for Counterproliferation/Chemical and Biological Defense Federation of American Scientists: Working Group on Biological and Toxin Weapons FirstGov Harvard Sussex Program on CBW Armament and Arms Limitation International Society for Infectious Diseases Material Safety Data Sheets SBCCOM MedLine Plus - Anthrax Medical NBC Online
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Navy Chemical and Biological Defense NOVA Online - Bioterror Occupational Safety and Health Administration Tempest Chem-Bio.com United States Army Medical Department Center and School (AMEDD) United States Army Medical Research Institute of Chemical Defense (USAMRICD) United States Army Medical Research Institute of Infectious Diseases (USAMRIID) Weapons of Mass Destruction Courses - Terrorism and Consequence Management G310 Courses include Nuclear, Chemical (Sarin and VX), and Biological Scenerios
Military Sites
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Armed Forces Radiobiology Research Institute (AFRRI) Defense Link, U.S. Department of Defense The Logistics Support Activity (LOGSA) MarineLINK NavyOnLine United States Army Chemical School United States Army Home Page United States Army Research Lab United States Army Soldier and Biological Chemical Command (SBCCOM)
Government Sites
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Center for Defense Information Centers for Disease Control and Prevention (CDC) Federal Bureau of Investigation FEMA Website United States Department of Justice
Homeland Defense
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Chemical Emergency Preparedness and Prevention Department of Homeland Security Disaster Help - Interactive Disaster Information Clearing House Domestic Preparedness - Department of Justice Domestic Preparedness.com Emergency Management Center Emergency Response to Terrorism: Self-Study. Focuses mostly on command and control rather than clinical issues (PDF Format) National Disaster Medical System (NDMS) SBCCOM's Homeland Defense Website Toxic Chemical Training Course Weapons of Mass Destruction Civil Support Team Page WMD First Responders
Health Links
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Achoo - Internet Health Care Directory American Red Cross CDC's BioTerrorism Readiness Plan: A Template for Health Care Facilities, good medical info and useful contacts (FBI and State Health Departments) (PDF Format) Integrated Medical Curriculum (IMC) is the first integrated medical curriculum that links together the study of anatomy, physiology, histology, pharmacology, immunology and medical ethics via the Internet. InteliHealth is a joint venture of Aetna U.S. Healthcare and Johns Hopkins University and Health System. Established in 1996, InteliHealth has become one of the leading health information companies in the world. MEDSCAPE New York State Nurses Association U.S. Public Health Service Commissioned Corps Virtual Navy Hospital World Health Organization
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What is medically related NBC training? Where can you get hands on training?
Course Registration
Register for USAMRICD inhouse courses, web courses, and satellite broadcasts
Course Overview Where can you find web or video based training?
Find out about Air Force and Army medically related NBC courses
What reference materials are available? How can I get CEUs for this training?
Obtain Products
Obtain reference material, CDs and other information about NBC.
Reference Material
NBC Information / Resources
U. S. Army Medical Research Institute of Chemical Defense ATTN: MCMR-UV-ZM 3100 Ricketts Point Rd. Aberdeen Proving Ground, MD 21010-5400 Visit USAMRICD at http://ccc.apgea.army.mil Contact the USAMRICD Air Force Liaison
Disclaimer
These products are intended to be used as reference materials. The Medical Research Institute of Chemical Defense is not responsible for any instruction provided with this material.
What is Medically Related Nuclear, Biological, Chemical (NBC) Training?

Casualties from chemical, biological, or radiological agents pose many unique challenges to the medical care provider. Medically related NBC training differs from standard NBC training. Standard NBC training includes instruction on self aid and buddy care, the wear and preventative maintenance of protective gear, and decontamination procedures for the healthy individual. Medically related training may include these topics but it additionally includes information on the signs and symptoms of agent exposure, training in patient triage, and instruction on decontamination procedures. Graduate or advanced level medically related NBC training will additionally emphasize the complex pharmacological and physiological aspects of treatment.
Where can you find web or video based training?
Where Can You Get Hands On Medical NBC Training?

What is medically related NBC training? Where can you get hands on training? Medically related NBC training is offered by each of the military services. The programs are listed below. Admission to some of these programs is limited to members of a specific military service or those with particular medical skills. Click on the site to find out more about that program and directly link to the organization's web site.
United States Air Force Contingency / Counter-Terrorism Casualty Decontamination (DCON), course B3AZYDECON
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Who can attend: This course is open to those who are assigned as the chief and assistant chief of an Air Force decontamination team. It is only open to officers and enlisted who fill these leadership positions.
United States Army Field Management of Chemical and Biological Casualties (FCBC) Course
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Who can attend: This course is open to members of all military services. Air Force Medics, any skill level, and nonmedical members assigned to Air Force decontamination teams (unit type code FFGLB) are eligible to attend this training.
United States Army Medical Management of Chemical and Biological
Casualties (MCBC) Course

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Who can attend: This course is open to members of all military services. It is designed for physicians, physicians assistants, and nurses assigned to deployable expeditionary medical support (EMEDS) packages and decontamination teams (unit type code FFGLB), emergency room physicians and senior medical technicians, flight surgeons who respond as part of a disaster team or Air Force medical providers who serve as casualty management officers. Independent duty medics and Air Force skill level 5 (journeyman) and 7 (craftsman) medics assigned to decontamination teams can also attend this course.
United States Navy Chemical, Biological, Radiological and Environmental (CBRNE) Casualty Management Training Team Course
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Who can attend: This course is open to members of those units who request the training team to visit their installation. They primarily train Naval units.
Web and Video Based Training

What is medically related NBC training? Where can you get hands on training? The United States Army Medical Research Institute of Chemical Defense (USAMRICD) Chemical Casualty Care Division (CCCD) offers a variety of on line and video courses for continuing medical education credit. These are available, free of charge, to members of all military services. Click below for the link. You must first log in to the CCCD web site to register for course credit. Computer Based Training (CBT) on line Click here for a variety of web based instruction lessons on the treatment of chemical agent casualties. These include modules on nerve agents, vesicants, and other topics. Each module is worth 3-12 category 1 continuing medical education (CME) credits that you can earn right now. Video Series Instruction Click here for a variety of video instruction programs related to chemical casualty care. These video tapes can be ordered for your team, medical facility, or for self study. You can register for the courses on the CCCD web site and then view the video tapes when they arrive. After viewing the tapes, and taking an on line examination, you will be awarded from 12-16 CME credits depending on the program viewed. Live Satellite Courses. Click here to find the schedule for future live satellite training courses.
Air Force NBC Reference Download Sites

The following are recommended sources for the latest version of the documents on this page. Click on the source link of your choice below.
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Air Force Publications Document Search Page To insure the most current edition, check the AF publications advanced search and type in the number of the document without spaces (example: AFI32-4001 instead of AFI 32-4001). Air Force Commander's Chem / Resource Web Site USAF Counter Proliferation Center Chemical Page Air Force Concept of Operations (CONOPS) Reference Site Link to Army References, General Dennis J. Reimer Training & Doctrine Digital Library Link to Other References
Air Force NBC Reference List Below are useful Air Force NBC related documents. They are not directly linked, so you must access them through the sites listed above. Those documents with * are highly recommended for Air Force NBC Casualty Control Officers and those in charge of Air Force NBC decontamination teams.
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AFI 32-4001, Disaster Preparedness Planning and Operations (Civil Engineer) AFJMAN (Joint Manual) 44-151, NATO Handbook on the Medical Aspects of NBC Defensive Operations *AFMAN 10-2602, Nuclear, Biological, Chemical, and Conventional (NBCC) Defense Operations and Standards (Operations) AFMAN 10-2603, Counter-nuclear, Biological, Chemical, and Conventional (NBCC) Defense Commander's Guide AFMAN 32-4004, Emergency Response Operations (Civil Engineer) AFMAN 32-4005, Personal Protection and Attack Actions (Civil Engineer) *AFMAN 32-4006, Nuclear, Biological, and Chemical (NBC) Mask Fit and Liquid Hazard Simulant Training (Civil Engineer) AFMAN 32-4017, Civil Engineer Readiness Technician's Manual for NBC Defense *AFMAN 44-149/ FM 8-285, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries (Medical) *AFMAN (I) 3-2.47 (In Draft Form)/FM 4-02.7 Multiservice Tactics, Techniques, and Procedures for Health Service Support in a NBC Environment *AFMAN (I) 44-156, Treatment of Biological Warfare Casualties *AFMAN 44-161, Treatment of Nuclear and Radiological Casualties AFR 355-7. Potential Military Chemical/Biological Agents and Compounds *AFTTP 3-42.3, Health Service Support in Nuclear, Biological, and Chemical Environments *AFTTP(I) 3-2.37, Multiservice Tactics, Techniques, and Procedures for NBC Aspects of Consequence Management AFPAM 10-219 VOL 1, Contingency and Disaster Planning (Operations) AFPAM 10-219 VOL 2, Preattack and Predisaster Preparations (Operations) AFPAM 10-219 VOL 3, Post attack and Post disaster Procedures (Operations) AFPAM 10-219 VOL 10, Contingency Training Guide and Task Standard (Operations) AFPD 10-26, Counter NBC Operational Preparedness (Operations)
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AFPD 32-40, Disaster Preparedness (Civil Engineering) AFH 10-2502 (Air Force Handbook), USAF Weapons of Mass Destruction (WMD) Threat Planning and Response Handbook AFH 32-4014 Air Force Operations in a Chemical / Biological Environment AFI 41-106, Medical Readiness Planning and Training IC 2000-1 TO AFI 41-106, Medical Readiness Planning and Training AFI 31-210, The Air Force Antiterrorism / Force Protection (AT/FP) Program Standards AFI 10-2501, Full Spectrum Threat Response (FSTR) Planning and Operations *AF CONOPS for the Wartime Medical Decontamination Team (WMDT) *JP 3-11, Joint Doctrine for Operations in NBC Environments *Medical Management of Chemical Casualties Handbook, 3rd Edition, July 2000 (Available from USAMRICD Chemical Casualty Care Division, it is also provided to those who attend MCBC)
Obtaining Medical Continuing Education Units

What is medically related NBC training? Where can you get hands on training? There are a wide variety of educational opportunities in the area of medically related nuclear, biological, chemical (NBC) training. Below is a list of continuing education credits for available courses. Click on the link to connect to the appropriate web site to find out more information. Courses You Can Attend United States Air Force Contingency / Counter-Terrorism Casualty Decontamination (DCON), course B3AZYDECON Contact Hour Credits: The participant receives a certificate noting 5 days of course attendance. Those who are emergency medical technicians can apply for continuing education credit. Attendance is restricted to Air Force decontamination team chiefs and assistants.
Field Management of Chemical and Biological Casualties Contact Hour Credits: At the completion of training, the individual will receive a certificate noting 40 contact hours.
Medical Management of Chemical and Biological Casualties At the completion of training, the individual will receive a certificate noting 46.75 credit hours of AMA PRA category 1 credit. Physicians can obtain 46.75 hours category 1 credit toward AMA Physician's Recognition Award. Nurses can earn 54.1 contact hours.
United States Navy Chemical, Biological, Radiological and Environmental (CBRNE) Casualty Management Training Team Course Contact Hour Credits: At the completion of training, the individual will receive a
certificate noting 20.5 hours Category 1 CME units, nurses 22.5 hrs CME, Medical Corpsmen 22.5 contact hours. Training Opportunities At Your Home Base Video Series Instruction Click here for a variety of video instruction programs related to chemical casualty care. These video tapes can be ordered for your team, medical facility, or for self study. All of these are free of charge to military members. You can register for the courses on the Chemical Casualty Care Division web site and then view the video tapes when they arrive. After viewing the tapes, and taking an on line examination, you will be awarded from 12 - 16 continuing medical education (CME) credits depending on the program viewed.
Computer Based Training (CBT) on line Click here for a variety of web based instruction lessons on the treatment of chemical agent casualties. These include modules on nerve agents, vesicants, and other topics. Each module is worth 3-12 category 1 CME credits for physicians and others. They are all free of charge.
Live Satellite Courses Click here to find the schedule for future live satellite training courses where you can earn 2 CME credits for each part of the series.
United States Air Force Contingency / Counter-Terrorism Casualty Decontamination (DCON), course B3AZYDECON
Who can attend: This course is only opened to those officers and enlisted who are assigned as the chief and assistant chief of an Air Force decontamination team.
Purpose of the training: To train the trainer so that participants can take information back to their medical decontamination teams and teach team members. Course Location: Conducted at Brooks Air Force Base, San Antonio, Texas.
Funding / Contact: Slots are funded through the united States Air Force School of Aerospace Medicine (USAFSAM). Contact your medical training NCO or USAFSAM. Course Time: The five day course is held three times a year. Each course allows for a maximum of 25 students.
Course Content: NBC agents, decontamination and monitoring equipment, decontamination procedures, decontamination lab, a field triage lab, and field decontamination lab (per Air Force doctrine).
Contact Hour Credits: At the completion of the course, the individual will receive a certificate noting 5 days of training. Visit USAFSAM web site, click here
United States Army Field Management of Chemical and Biological Casualties (FCBC) Course Who can attend: This course is open to members of all military services. Air Force Medics and nonmedical members assigned to Air Force decontamination teams (unit type code FFGLB), expeditionary medical support (EMEDS) packages, emergency rooms, and medical disaster response teams are eligible to attend this training.
Purpose of the training: To provide the participant with a detailed knowledge of chemical and biological agents, prehospital medical management strategies, triage, and how to set up a field decontamination area (per Army doctrine). Participants return to their units with knowledge and materials to train others.
Course Location: Conducted at the United States Army Medical Research Institute of Chemical Defense (USAMRICD) Chemical Casualty Care Division (CCCD), Aberdeen Proving Ground, Maryland (Edgewood Area).
Funding / Contact: Slots are available to Air Force members who obtain funding from their squadron or wing. The course is free of charge, but the unit will need to pay per diem, transportation to/from home base to the Baltimore Washington Airport, and hotel cost (approx $58 per day). Individuals can request a slot by contacting CCCD and faxing a letter, signed by their squadron commander that verifies, 1) Squadron funding is approved for this training and, 2) The applicant is either assigned to the unit medical decontamination team, an EMEDS package, works in the unit emergency room, or is part of the medical disaster response team. Course Time: The five day course is conducted five times a year. Each course is open to a maximum of 125 students. Course Content: Chemical and biological agents, decontamination and monitoring equipment, decontamination procedures, an animal treatment lab, field triage lab, field intubation and IV line insertion lab, atropine injection lab, a field training exercise to set up and operate a field decontamination line (per Army doctrine). An Air Force advisor is available to discuss Air Force decontamination doctrine if requested. Contact Hour Credits: At the completion of training, the individual will receive a certificate noting 40 credit hours.
Visit Chemical Casualty Care Division web site
United States Army Medical Management of Chemical and Biological Casualties (MCBC) Course Who can attend: This course is open to members of all military services. It is designed for physicians, physicians assistants (PA), and nurses assigned to deployable expeditionary medical support (EMEDS) packages and decontamination teams (unit type code FFGLB), emergency room physicians and senior medical technicians, flight surgeons who respond as part of a disaster team, or Air Force medical providers who serve as Casualty Management Officers. Independent duty medics and Air Force skill level 5 (journeyman) and 7 (craftsman) medics assigned to decontamination teams can also attend this course. This course is also appropriate for Bioenvironmental Engineers / Public Health Officers assigned to Biological Augmentation Teams (BAT).
Where can you find web or video based training? What reference materials are available? How can I get CEUs for this training?
Purpose of the training: To provide the participant with an in depth knowledge of chemical and biological agents, prehospital and in hospital medical management strategies, triage, and an overview of how to set up a field decontamination area (per Army doctrine). Participants return to their units with knowledge and materials to train others. Course Location: Conducted at two locations. One half of the course is held at the United States Army Medical Research Institute of Chemical Defense (USAMRICD) Chemical Casualty Care Division (CCCD) Aberdeen Proving Ground, Maryland, ( Edgewood Area) and the other half of the course is conducted at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland. Funding / Contact: 16 Slots per year (4 slots per course, for physicians or nurses) are fully funded through Headquarters Air Force, Physician's Education Branch at Randolph Air Force Base Texas. The phone number is DSN: 665-2638 / 2639, COMM (210) 565-2638/2639. Physicians and nurses should apply for these slots first. All Air Force members going to a MCBC course should go through Physician's Education Branch, even if they are to be funded by their own unit, so they can be entered into the Army Training System computer. Additional slots are available to Air Force members on a space available basis to those who request them directly from CCCD. To attend in a space available slot the individual must obtain funding from their squadron or wing. The course is free of charge, but the unit will need to pay per diem, air transportation from the home base to/from Baltimore Washington Airport, and hotel cost (approx $58 per day at Edgewood and $68 per day at Fort Dietrich). Individuals can request a slot by contacting CCCD and faxing a letter, signed by their Squadron Commander which verifies that, 1) Squadron funding is approved for this training and, 2) The applicant is assigned to either the unit medical decontamination team (FFGLB) as a medical provider, to an EMEDS package as a medical provider or public health officer, are appointed as a unit Casualty Management Officer, or are a physician, PA, or nurse who works in the unit emergency room.
Course Time: The six day course is held at least four times a year. Each course is open to a maximum of 140 students.
Course Content: Chemical and biological agents, decontamination and monitoring equipment, overview of decontamination procedures, an animal treatment lab, field triage lab, field intubation and IV line insertion lab, atropine injection lab, and a lab that provides a hands on overview of a field decontamination line (per Army doctrine). An Air Force advisor is available to discuss Air Force decontamination doctrine if requested. Contact Hour Credits: At the completion of training the individual will receive a certificate noting 46.75 credit hours of AMA PRA category 1 credit. Physicians can obtain 46.75 hours category 1 credit toward AMA Physician's Recognition Award. Nurses can earn 54.1 contact hours. Visit Chemical Casualty Care Division web site
United States Navy Chemical, Biological, Radiological and Environmental (CBRNE) Casualty Management Training Team Course Who can attend: This course is open to members of those units who request the training team. Purpose of the training: To train medical providers in medical aspects of CBRNE. Course Location: At specified military installations.
Funding / Contact: Funding to attend these sessions must be provided by the individual's squadron or wing. Contact the Navy POC for more information on how to participate in this training.
Course Time: Three day course. Conducted at least three times a year. Course Content: Brief history of CBRNE, agent characteristics, toxodynamics, effects, diagnosis, medical management, triage, decontamination, return to duty.
Contact Hour Credits: At the completion of training the individual will receive a certificate noting 20.5 hours Category 1 continuing medical education (CME) units, nurses 22.5 hrs CME, Medical Corpsmen 22.5 contact hours. Visit Navy NBC web site
Courses Courses
Video Courses
Medical Management of Chemical and Biological Casualties (MCBC) Videotape Course
Our In House Medical Management of Chemical and Biological Casualties Course (MCBC) is available in video format. This videotape course is NOT intended to replace the on-site MCBC Course offered each quarter at the US Army Medical Research Institute of Chemical Defense (USAMRICD) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). Rather, the videotape series is designed for refresher training of Department of Defense (DoD) medical personnel and as an alternate way of obtaining the core didactic material when attendance at the on-site course is not feasible. The majority of the chemical agent lectures were filmed during the MCBC Course presented at Aberdeen Proving Ground, Maryland in March 1998. The biological agent lectures were extracted from the satellite broadcast of The Medical Management of Biological Casualties program presented in September 1998.
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Read the following for course details: MCBC Brochure CME/CEU credit information: Continuing Education Download facilitator guide: Course Facilitators Ordering information: Obtaining Products
CME/CEU credit is available for this course from 21 JAN 2003 through 31 MAR 2003.
Biological & Chemical Warfare and Terrorism: Medical Issues and Response Satellite Videotape Course (28 - 30 NOV 2001)
Biological & Chemical Warfare and Terrorism: Medical Issues and Response Videotape Course 2001 is a 6 tape, 12 hour course including didactic material, interviews and scenario discussions. The course presents an overview of biological agents, chemical agents, and discusses the management of a biological or chemical warfare or terrorist event with experts. On-line registration, examination and certification are available for this course, making it an excellent course for sustainment training. Follow the links below to obtain additional information about the course.
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Read the following for course details: Videotape Course CME/CEU credit information: Continuing Education Facilitator Information: Facilitators Ordering information: Obtaining Products Another Viewing Option: Watch Broadcast Online
Medical Response to Chemical Warfare and Terrorism Satellite Videotape Course (5 - 7 DEC 2000)
Medical Response to Chemical Warfare and Terrorism Videotape Course - 2000 is a 6 tape, 12 hour course including didactic material, interviews and scenario discussions. Program topics include: review of the history, physical properties, clinical effects and treatment of chemical warfare agents, case studies of actual exposures, interviews with scientists discussing their cutting edge research in medical countermeasure development, updates on treatment and field management and a recorded question and answer session. On-line registration, examination and certification are available for this course, making it an excellent course for sustainment training. If you wish to facilitate this course, download the facilitators guide. Follow the links below to obtain additional information about the course.
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Read the following for course details: Videotape Course CME/CEU credit information: Continuing Education Download Course Materials: Course Materials Obtain and View Tapes Obtaining Products Register and Take Exam: Registration and Exam
Courses Courses
Medical Management of Chemical and Biological Casualties Course (MCBC) #6H-F26 (School codes 877 / 879)
The Medical Management of Chemical and Biological Casualties Course (MCBC), 6H-F26, is conducted jointly by the US Army Medical Research Institute of Chemical Defense (USAMRICD) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The course is designed for Medical Corps and Nurse Corps officers, physician assistants, Medical Service Corps officers in specialties 67B,C, or E, and other selected medical professionals. Classroom instruction, laboratory and field exercises prepare graduates to effectively manage casualties of chemical and biological agent exposure. Classroom discussion includes: the history and current threat of chemical and biological agent use, the characteristics of threat agents, the pathophysiology and treatment of agent exposure, principles of field management of threat agent casualties. In the laboratory, attendees gain valuable, hands-on experience by participating in the resuscitation of a lab animal exposed to a nerve agent simulant. In the field, attendees practice the principles of personal protection, triage, treatment and decontamination of chemical casualties. During this exercise, attendees learn the capabilities and limitations of Mission Oriented Protective Posture (MOPP) when treating casualties in a contaminated environment. This 6-day course is offered eight times each year at Ft. Detrick and Aberdeen Proving Ground, Maryland. Application for this course is via the Army Training Requirements and Resources System (ATRRS). Requests for attendance should be made through your training branch. The course is also available via several distance-learning products, including satellite broadcast; and videotape series. The course is approved postgraduate education for physicians and nurses, and is approved military education for entry on the Officer Record Brief. Dates of upcoming courses are listed below. For more information, contact the Chemical Casualty Care Division, USAMRICD at DSN 584-2230/3393, CML (410) 436-2230/3393, DSN FAX 584-3086, CML (410) 436-3086, e-mail: ccc@apg.amedd.army.mil, or write to: Commander, USAMRICD, ATTN: MCMR-UV-ZM (Chemical Casualty Care Division), 3100 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400. Click here for Registration Information
(FY) 2004 Course Schedule 2-7 November 2003 (Closed) 7-12 March 2004 16-21 May 2004 12-17 September 2004 Updated on 10/29/03
(FY) 2005 Course Schedule Coming Soon
Courses Courses
Registration Information For In-House Courses

Effective 1 August 2003, registration fees will be charged for all Non DoD (Department of Defense) civilian students: MCBC In-House Course - Registration Fee FCBC In-House Course - Registration Fee
Medical Management of Chemical and Biological Casualties (MCBC) Military Personnel:

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Active Army: Fill out a Training Form (DA3838) and send it through the chain of command. Then forward it to the appropriate career branch: Commander, USAPERSCOM, ATTN: TAPC-OPH-(?) (the ? depicts the appropriate branch, i.e. MC, AN, MS, etc.) 200 Stovall Street, Alexandria, VA 22332-0417. Upon approval by the respective career branch, names are entered into the Army Training Requirements and Resources System (ATRRS) by your branch. Letters of invitation and funding are sent to those selected approximately 30 days prior to the course. Receipt of a welcome packet assures you a seat in the course. Army Reserves: Request a seat in the course through your reserve unit. Names must be entered into the ATRRS to ensure a seat. National Guard: Applicants should apply through their State Plans, Operations and Training Office, their unit or contact the National Guard in Arlington, VA. Names must be entered into the ATRRS. Navy: Request a seat in the course by contacting Naval Operational Medicine Institute (NOMI), ATTN: N2 Operational Medicine Training Directorate, 220 Hovey Road, Pensacola, FL 32508-1047, Telephone: 850-452-8266/2252, DSN 922-8266/2252. Upon approval, your name will then be entered into the ATRRS, based on available slots.
Air Force: Request a seat in the course by contacting the training office at Randolph Air Force Base. The training office will ensure that the names are entered into the ATRRS based on available slots. Telephone: 210-565-2638 DSN 665-2638.
Non Military Personnel:

Effective 1 August 2003, the following registration fees will be charged for all Non DoD (Department of Defense) civilian students: MCBC In-House Course - $850.00 If you need more information, please contact us at (410) 436-2230.
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Civilian Personnel: Government employed civilian personnel must fill out a DD1556. This form should be submitted through the chain of command for approval and sent to the respective CPO Training Office. CPO offices have the capability of entering names into the ATRRS. All Other Civilian Personnel: Submit a written request to our office which includes your name, social security number, home address, phone number, email address, job description, job title, and point of contact. Fax: 410-436-3086.
Public Health Service (PHS):

Applicants should apply through the Commissioned Corps Readiness Force training program at http://oep.osophs.dhhs.gov/ccrf/training.htm
Field Management of Chemical and Biological Casualties (FCBC) Military Personnel:

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Submit a written request, approved by commanding officer, on organization letterhead to our office which includes: name, rank, social security number, address, phone number, email address, job description, job title, and point of contact. Fax: 410-436-3086 (DSN 5843086). Please submit requests 60 days prior to course. Course materials will be e-mailed/mailed approximately 30 days prior to the course. Navy: Request a seat in the course by contacting Naval Operational Medicine Institute (NOMI), ATTN: N2 Operational Medicine Training Directorate, 220 Hovey Road, Pensacola, FL 32508-1047. Telephone: 850-452-8266/2252, DSN 922-8266/2252.
Non Military Personnel:

Effective 1 August 2003, the following registration fees will be charged for all Non DoD (Department of Defense) civilian students:
FCBC In-House Course - $250.00 If you need more information, please contact us at (410) 436-2230.
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Submit a written request to our office which includes your name, address, phone number, email address, job description, job title, and point of contact. Fax: 410-436-3086. Please submit requests 60 days prior to course. Course materials will be mailed approximately 30 days prior to the course. If additional information is needed, please contact the Chemical Casualty Care Division, (410) 436-2230, DSN 584-2230.
Courses Courses
Course Credit
Many of the courses offered through the Chemical Casualty Care Division are available for CME/CEU credits. All credit amounts listed in the table below are based on attendance. If you have any questions regarding these courses, please contact the Chemical Casualty Care Division. Course Release Date/ Expiration Date Estimated Time of Completion Physicians Nurses Other (Medical Corps (Military (AN/ (DC, VC, SP/PA, officers, MD, DO) NC) Civilian (RN) MS, Senior Medical NCOs, EMT, LPN)
Medical Management of Chemical and Biological Casualties Course (In House) CME Accreditation Statement Credit available from 14 FEB 2003 - 13 FEB 2004 Field Management of Chemical and Biological Casualties (In House) Medical Management of Chemical and Biological Casualties (MCBC) Videotape Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03
N/A
N/A
46.75 category 54.6 CEU 1 credits toward contact hours the AMA Physicians Recognition Award 40 credit hours for attending the course 40 credit hours for attending the course
Certificate of attendance for 46.75 credit hours of AMA PRA category 1 credit 40 credit hours for attending the course Certificate of completion for 15.50 hours of AMA PRA category 1 CME credit
N/A
N/A
Release Date 24 JUN 2001 Expiration Date - 23 JUN 2004
15.50 hours
15.50 category 18.6 CEU 1 credits toward contact hours the AMA Physician's Recognition Award
Biological & Chemical Warfare and Terrorism: Medical Issues and Response Satellite Videotape Course (28 - 30 NOV 2001) CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Medical Response to Chemical Warfare and Terrorism 2000 Satellite Videotape Course (5 - 7 DEC 2000) CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Medical Management of Nerve Agent Casualties Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Medical Management of Vesicant Agent Casualties Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Medical Management of Pulmonary Agent Casualties Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Medical Management of Cyanide Agent Casualties Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03
Release Date 24 JAN 2003 Expiration Date - 23 JAN 2005
13 hours
13 category 1 credits toward the AMA Physicians Recognition Award
15.6 CEU contact hours
Certificate of attendance for 12 credit hours of AMA PRA category 1 credit
10.25 hours
10.25 category 12.3 CEU 1 credits toward contact hours the AMA Physicians Recognition Award
Certificate of completion for 10.25 hours of AMA PRA category 1 CME credit
Release Date 28 OCT 2002 Expiration Date - 27 OCT 2004
4 hours
4 category 1 credits toward the AMA Physicians Recognition Award 3 category 1 credits toward the AMA Physicians Recognition Award 3 category 1 credits toward the AMA Physicians Recognition Award 3 category 1 credits toward the AMA Physicians Recognition Award
4.8 CEU contact 4 hours of AMA hours PRA category 1 CME credit
Release Date 8 NOV 2002 Expiration Date - 7 NOV 2004
3 hours
3.6 CEU contact Certificate of hours completion for 3 hours of AMA PRA category 1 CME credit
Release Date 10 FEB 2003 Expiration Date - 9 FEB 2005
3 hours
3 hours
Medical Management of Incapacitating and Riot Control Agent Casualties Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Triage of Chemical Agent Casualties Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03 Virtual Field Training Exercise Course CME Accreditation Statement Credit available from 01 OCT 03 - 31 DEC 03
Release Date 31 MAR 2003 Expiration Date - 30 MAR 2005
2 hours
2 category 1 credits toward the AMA Physicians Recognition Award 3 category 1 credits toward the AMA Physicians Recognition Award 12 category 1 credits toward the AMA Physicians Recognition Award
Release Date 31 MAR 2003 Expiration Date - 30 MAR 2005 Release Date 24 JAN 2003 Expiration Date - 23 JAN 2005
3 hours
3.6 CEU contact Certificate of hours completion for 3 hours of AMA PRA category 1 CME credit 14.4 CEU contact hours Certificate of completion for 12 hours of AMA PRA category 1 CME credit
12 hours
Courses Courses
Medical Management of Chemical and Biological Casualties

The course is conducted jointly by the US Army Medical Research Institute of Chemical Defense (USAMRICD) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The MCBC Course is designed for physicians, nurses and other medical professionals. Classroom, laboratory, and field instruction focuses on pathophysiology, diagnosis and treatment of chemical and biological casualties. There is no fee for participating; however, advance registration is required and space is limited. More info...
Course Credits Registration Information Course Schedule Class Photos
Courses Courses
Upcoming Events
In House Field Management of Chemical and Biological Casualties Course
(FCBC) 2-6 February 2004 Aberdeen Proving Ground, MD Click here for Registration Information
In House Medical Management of Chemical and Biological Casualties Course

(MCBC) 7-12 March 2004 Abedeen Proving Ground, MD and Fort Detrick MD Click here for Registration Information
2003 - 2004 Schedule For

Medical Management of Chemical and Biological Casualties (MCBC) and Field Management of Chemical and Biological Casualties (FCBC) Click here for Registration Information
Course Title
Date
Location
Availability
(FCBC)
2-6 February 2004
APG, MD
Open
(MCBC)
7-12 March 2004
APG, MD and Ft. Detrick, MD
Open
(FCBC)
19-23 April 2004
APG, MD
Open
(MCBC)
16-21 May 2004
Open
(FCBC)
14-18 June 2004
APG, MD
Open
(MCBC)
12-17 September 2004
Open
(FCBC)
20-24 September 2004
APG, MD
Open
If additional information is needed, please contact the Chemical Casualty Care Division (410) 436-2230 DSN 584-2230. Updated on 10/2/03
Courses Courses
2001
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2002
March 10-12 13-16 10-16 10-16 10-16
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March 12-15 Mar Class May 4-6 May Class 7-10 May Class July 28-30 31 Jul 31 Jul 31 Jul Jul Class - 2 Aug Class - 2 Aug Class - 2 Aug FTX 1
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Mar Mar Mar Mar Mar
Class Class FTX 1 FTX 2 FTX 3
March 8-10 Mar Class 11-14 Mar Class May 4-6 May 7-9 May 4-6 May 4-6 May 4-6 May 4-6 May 4-6 May 4-6 May 4-6 May 4-6 May 7-9 May 7-9 May 7-9 May
May 5-7 May Class 8-11 May Class 5-11 May FTX 1 5-11 May FTX 2 5-11 May FTX 3 5-11 May FTX 4 September 15-17 Sep Class 18-21 Sep Class October 20-22 Oct 23-26 Oct 20-22 Oct 20-22 Oct 20-22 Oct 23-26 Oct 23-26 Oct Class Class FTX 1 FTX 2 FTX 3 FTX 4 FTX 5
August 18-20 Aug Class 18-20 Aug FTX 1 September 7-9 Sep Class 10-13 Sep Class 7-13 Sep FTX 1 7-13 Sep FTX 2 7-13 Sep FTX 3 7-13 Sep FTX 4 7-13 Sep FTX 5 November 16-18 Nov Class 19-22 Nov Class
Class Class FTX 1 FTX 2 FTX 3 FTX 4 FTX 5 FTX 6 FTX 7 FTX 8 FTX 9 FTX 10 FTX 11
September 7-12 Sep Class 7-12 Sep Class
Medical Management of Chemcial and Biological Casualties (MCBC) Photo Archive

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ACCREDITATION INFORMATION AND STATEMENTS
Sponsored by Emergency Medical Training and Preparedness Division of SAIC

The Emergency Medical Training and Preparedness Division of SAIC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Emergency Medical Training and Preparedness Division of SAIC designates this educational activity for a maximum of 46.50 category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity.
TARGET AUDIENCE
This course is designed for medical support providers and for nurses and physicians working in medical facilities in support of the armys demilitarization operations, who may be called upon to treat chemical and biological agent casualties following a catastrophic release from an Army storage or disposal facility.
OBJECTIVES
This course is intended for military medical personnel (physicians, nurses, and physician assistants, and certain corpsmen) and for civilian medical personnel who work around military chemical agents or who might manage military chemical casualties (e.g., in war or after a depot accident). The prerequisite is that the attendee be a health care provider. The objectives for the course are: 1. Recognize the military terms for and the clinical effects of chemical agents. 2. Identify means of therapeutic intervention in both a medical center and a field environment. 3. Comprehend methods of managing contaminated and uncontaminated casualties in a field environment or a fixed medical facility. 4. Understand the historical aspects of chemical agent use in warfare and realize chemical warfare capabilities practiced in the world today by countries or by terrorist groups.
EDUCATIONAL NEEDS
A need was identified to provide training for medical support personnel including nurses and physicians working in medical facilities in support of the armys demilitarization operations, who may be called upon to treat chemical agent casualties.
FACULTY DISCLOSURE
"It is the policy of the Emergency Medical Training and Preparedness Division of SAIC that the sponsor and faculty disclose real or apparent conflict of interest relating to the topics of this educational activity. The sponsor and the faculty have disclosed no real or apparent conflict of interest. This book contains images of numerous types of equipment available to emergency responders. These items are referred to as examples only. This book makes no endorsement or certification of any item or manufacturer of emergency response equipment. In accordance with the ACCME Standards for Commercial Support, the audience is advised that no presentations in this continuing medical education activity contain references to unlabeled nor unapproved uses of drugs or devices. No commercial support is given to this activity.
Courses Courses
Field Management of Chemical and Biological Casualties

The Field Management of Chemical and Biological Casualties Course (FCBC) is conducted by the US Army Medical Research Institute of Chemical Defense (USAMRICD) at Aberdeen Proving Ground, Maryland. FCBC is designed for medical and chemical NCOs, Chemical and Medical Service Corps officers, and civilian first responders. Instruction focuses on emergency treatment, triage, decontamination and evacuation of casualties. More info...
Course Credits Registration Information Course Schedule Class Photos
Courses Courses
Field Management of Chemical and Biological Casualties Course (FCBC), 6H-F27/322-F27.

The Field Management of Chemical and Biological Casualties Course (FCBC) is conducted by the US Army Medical Research Institute of Chemical Defense (USAMRICD) at Aberdeen Proving Ground, Maryland. The course is designed for Medical Service Corps officers (67A), Chemical Corps officers and non-commissioned officers in medical or chemical specialties. Classroom instruction, laboratory and field exercises prepare graduates to become trainers in the first echelon management of chemical and biological agent casualties. Classroom discussion includes: the current global threat of chemical and biological agent use, the characteristics and effects of threat agents, recognition and emergency treatment of agent exposure, principles of triage and decontamination of chemical and biological agent casualties. Small-group exercises reinforce these casualty management principles. In the laboratory, attendees gain valuable, hands-on experience by participating in the resuscitation of a lab animal exposed to a nerve agent simulant. During two days of field training, attendees establish a casualty decontamination site and use the site during scenario-based exercises to manage litter and ambulatory casualties. Using this site, attendees practice principles of personal protection, agent detection, triage, emergency treatment and decontamination of chemical casualties. This five-day course is offered four times each year at USAMRICD, Aberdeen Proving Ground, Maryland. Dates of upcoming courses are listed below. For more information, contact the Chemical Casualty Care Division, USAMRICD at DSN 584-2230/3393, CML (410) 436-2230/3393, DSN FAX 584-3086, CML (410) 436-3086, e-mail: ccc@apg.amedd.army.mil, or write to: Commander, USAMRICD, ATTN: MCMR-UV-ZM (Chemical Casualty Care Division), 3100 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400. Click here for Registration Information (FY) 2004-2005 Course Schedule Coming Soon
(FY) 2003-2004 Course Schedule
2-6 February 2004 19-23 April 2004 14-18 June 2004 20-24 September 2004
Updated 10/2/03
Courses Courses
2001
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2002
January 22-26 Jan Class April 2-6 Apr Class June 4-8 Jun 4-8 Jun 4-8 Jun 4-8 Jun 4-8 Jun 4-8 Jun
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January 28 Jan 28 Jan 28 Jan 28 Jan 28 Jan 28 Jan 28 Jan 28 Jan 28 Jan April 15-19 15-19 15-19 15-19 15-19
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Class FTX 1 FTX 2 FTX 3 FTX 4 FTX 5
1 1 1 1 1 1 1 1 1
Feb Feb Feb Feb Feb Feb Feb Feb Feb
Class FTX 1 FTX 2 FTX 3 FTX 4 FTX 5 FTX 6 FTX 7 FTX 8
February 3-7 Feb Class June 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13 9-13
Apr Apr Apr Apr Apr
Class FTX 1 FTX 2 FTX 3 FTX 4
June 10-14 Jun Class September 16-20 Sep Class 23-27 Sep Class 16-20 Sep FTX 1 16-20 Sep FTX 2 16-20 Sep FTX 3 16-20 Sep FTX 4 16-20 Sep FTX 5 October 16-20 Sep FTX 5
Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun
Class FTX 1 FTX 2 FTX 3 FTX 4 FTX 5 FTX 6 FTX 7 FTX 8 FTX 9 FTX 10 FTX 11 FTX 12 FTX 13
Field Management of Chemical and Biological Casualties (FCBC) Photo Archive

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Courses Courses
Facilitators Information Section

This page is designed to assist facilitators in conducting effective video courses.
Medical Management of Chemical and Biological Casualties Videotape Course

Instructions: Please read the Facilitator Guide. The guide is designed to inform you of facilitator responsibilities, how to obtain course materials, and how to obtain CME credit for the course. The guide also lists the documents you will need in order to facilitate a successful course.
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Read the Facilitator Guide: HTML Format and Adobe PDF Format How to Obtain Course Tapes: Obtaining Products Download Field Training Exercise Guide: Word Format | Adobe PDF Format Microsoft Word Adobe PDF
Enclosures Facilitator Course Application (Enclosure 1) Sample Agenda (Enclosure 2) Student Registration Form (Enclosure 3) Critique Form (Enclosure 4)
Web
Exam (Enclosure 6) Exam Answer Key (Enclosure 7) Available for Facilitators Only and will be mailed to facilitators with the course materials. It is also recommended that you contact the Domestic Preparedness Program for training information and Domestic Preparedness.com for additional DP information.
Biological & Chemical Warfare and Terrorism: Medical Issues and Response Satellite Videotape Course (28 - 30 NOV 2001)
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How to Obtain Course Tapes: Obtain Products Register your site as a viewing facility: Registration Website Participants Registration: Registration Website Take the Online Exam: Online Exam (A certificate will be electronically generated for you to print once you submit the examination/evaluation) Additional Documents: Support Materials Administrators: Administrator Guide
Medical Response to Chemical Warfare and Terrorism 2000 Satellite Videotape Course (5 - 7 DEC 2000)
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How to Obtain Course Tapes: Obtain Products Register your site as a viewing facility. Registration Website Participants Registration: Registration Website Take the Online Exam: Online Exam (A certificate will be electronically generated for you to print once you submit the examination/evaluation) Additional Documents: Supporting Materials Facilitators: Facilitator Guide Powerpoint Review: Review Slides
Courses Courses
Obtain Products
Training Material
Textbook of Military Medicine, Medical Aspects of Chemical and Biological Warfare.
Department of Defense
Military Medical Personnel: Contact the AMEDD Center and School Fax request to (210) 221-4012 Contact the CCCD via email at ccc@apg.amedd.army.mil Contact the CCCD via email at ccc@apg.amedd.army.mil Contact the USAMRIID Phone: (301) 619-4880 Fax: (301) 619-4789
Non-DOD
Contact Government Printing Office Phone: (202) 512-1800
Medical Management of Chemical Casualties Handbook, Third Edition, July 2000. Field Management of Chemical Casualties Handbook, Second Edition, July 2000. Medical Management of Biological Casualties Handbook, Fourth Edition, February 2001 Website: http://usamriid.detrick. army.mil Medical Management of Chemical Casualties Supplemental Training Materials V. 3.00 CD-ROM. More Info...
Contact EAI Corp. Phone: (410) 676-1449 Contact EAI Corp. Phone: (410) 676-1449 Contact DPS at DAPS-Aberdeen Phone: (410) 278-4635 Fax: (410) 278-5080
Contact the CCCD via email at ccc@apg.amedd.army.mil
Contact the CCCD via email at ccc@apg.amedd. army.mil
Medical Management of Biological Warfare Casualties CD-ROM Website: http://usamriid.detrick. army.mil Smallpox: Recognition and Response - Part 1 More Info...
Contact the USAMRIID Phone: (301) 619-4880 Fax: (301) 619-4789
Available through NTIS Order number for the product: AVA20826CDRM The sale price: $30.00 Phone: 1-800-553-6847 Fax: (703) 605-6900 Available through Swank HealthCare on Videotape or CDROM The sale price: $48.00 Phone: 1-800-950-4248 Available through Swank HealthCare on Videotape or CDROM The sale price: $48.00 Phone: 1-800-950-4248 Available through Swank HealthCare on Videotape or CDROM The sale price: $48.00 Phone: 1-800-950-4248 Available through Swank HealthCare on Videotape or CDROM The sale price: $48.00 Phone: 1-800-950-4248 Available through Swank HealthCare on Videotape or CDROM The sale price: $48.00 Phone: 1-800-950-4248 Available through Swank HealthCare on Videotape or CDROM The sale price: $48.00 Phone: 1-800-950-4248 Available through Swank HealthCare on Videotapes or CDROM The sale price: $98.50 Phone: 1-800-950-4248
Contact the USAMRIID Phone: (301) 619-4880 Fax: (301) 619-4789 Contact the CCCD via email at ccc@apg.amedd.army.mil
Advanced Management of Nerve Agent and Sulfur Mustard Casualties - Part 2 More Info...
Vaccines Against Biological Warfare Agents - Part 3 More Info...
Chemical Threat Agents: The Community Provider's Perspective Part 4 More Info...
Toxins as Biological Warfare and Terrorism Agents - Part 5 More Info...
Chemical Threat Agents: What History has Taught Us? - Part 6 More Info... Biological & Chemical Warfare and Terrorism: Medical Issues and Response Satellite Videotape Course. More Info...
Available through Defense Audio Visual Information System
Medical Management of Chemical and Biological Casualties (MCBC) Videotape Course. More Info...
Available through Defense Audio Visual Information System
Available through NTIS Order number for the product: AVA20830VOXO The sale price: $350.00 Phone: 1-800-553-6847 Fax: (703) 605-6900 Available through NTIS Order number for the product: AVA20893VNB6 The sale price: $135.00 Phone: 1-800-553-6847 Fax: (703) 605-6900 Available through NTIS Order number for the product: AVA20825VNB6 The sale price: $195.00 Phone: 1-800-553-6847 Fax: (703) 605-6900 Contact Visionary Productions, Inc. Phone: (850) 784-9942/6002 Fax: (850) 784-3081
Medical Response to Chemical Warfare and Terrorism 2000 Satellite Videotape Course More Info...
1999 Biological Warfare and Terrorism: The Military and Public Health Response Videotape Course Website: http://usamriid.detrick. army.mil 2000 Biological Warfare and Terrorism: Medical Issues and Response Satellite Videotape Course Website: http://usamriid.detrick. army.mil
Courses Courses
Swank HealthCare
Biological & Chemical Warfare and Terrorism: Medical Issues and Response is being offered via video streaming from Swank HealthCare to selected viewing audiences. First, you will need to register through Swank before viewing the broadcast. After registration, if you are approved for viewing, you will be e-mailed a viewing URL (Swank HealthCare), and username and password.
Archived Broadcast
Listed below are the steps to follow: 1. Register and view the program: Swank HealthCare Website a. Select either civilian or military b. Click the Biological & Chemical Warfare and Terrorism: Medical Issues and Response link
MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 VIDEO COURSE
Based on the Live SATELLITE BROADCAST Site Facilitator Guide
TABLE OF CONTENTS
ABOUT THIS GUIDE .................................................................................................................. 3 ROLE OF SITE FACILITATOR ................................................................................................. 4 Overview of Responsibilities............................................................................................ 4 6-TAPE VIDEO SERIES ............................................................................................................. 5 CONDUCTING A SUCCESSFUL VIDEO COURSE ............................................................ 7 Three Weeks Prior to the Course.................................................................................... 7 Two Weeks Prior to the Course ...................................................................................... 7 One Week Prior to the Course ........................................................................................ 8 One Day Prior to the Course............................................................................................ 8 First Day of Course........................................................................................................... 9 30 Minutes Prior to Program Start Time......................................................................... 9 DURING THE VIDEO COURSE .............................................................................................10 AT THE END OF THE LAST DAY ..........................................................................................10 SIGN-IN SHEETS ......................................................................................................................11 FACT SHEET .............................................................................................................................14 CLASSROOM LOCATION SIGN ............................................................................................15 EVALUATION / EXAMINATION ..............................................................................................16
ABOUT THIS GUIDE

This comprehensive guide provides you with all of the necessary instructions for running a successful video course. Because all of the pages in the guide are ready for you to reproduce, we suggest that you single side it when printing. This guide is prepared for a 3-day video course, approximately 4 hours each day. You may choose to view the video series differently. Your own judgment should be used in conjunction with your primary mission when determining a viewing schedule
Dont have time to read the entire guide? We have indicated the critical parts of the guide with ambulance icons.
KEY INFORMATION Videotapes

Tape 1 Tape 2 Tape 3 Tape 4 Tape 5 Tape 6
Topics/Content
Introduction, Pulmonary Agents, and Vesicants Vesicants Nerve Agents, Cyanide Introduction & History Cyanide Field Management Triage (contd), Counterterrorism, Chem Jeopardy, and Q&A
Run Times
1 hr. 54 min. 1 hr. 6 min. 1 hr. 54 min. 1 hr. 40 min. 1 hr. 51 min. 1 hr. 53 min.
ROLE OF SITE FACILITATOR
Thank you for serving as a Site Facilitator for Medical Response to Chemical Warfare and Terrorism 2000 Video Course. You are very important to the success of this course. Your commitment to making sure the program runs smoothly is an integral part of this presentation.
OVERVIEW OF RESPONSIBILITIES
DETAILS FOR THESE TASKS ARE INCLUDED IN THE NEXT PAGES 1. Market the program: Add your name and telephone number to the Fact Sheet, page 14 of this guide, and post it on bulletin boards or in high traffic areas.
Register as a facilitator by visiting http://ccc.apgea.army.mil. Once at the site, click on the banner at the bottom of the page to access the registration area.
Keep track of the total number of participants who register for your facility. 2. Encourage participants to register for the video course by visiting http://ccc.apgea.army.mil. Once at the site, click on the banner at the bottom of the page to access the registration area.
Participants are required to register and take the examination on-line to receive credit for the course. Participants will receive immediate credit after successfully completing the examination. 3. Visit the viewing site to ensure that the equipment is in working order. Ensure that there is sufficient seating capacity for the number of registered students. 4. Make an adequate number of copies of the agenda, room direction sign, and examination. 5. Bring and distribute materials on program days. 6. Facilitate all three sessions.
7. After the last session: Remind participants to take the examination on-line.
AGENDA FOR THE SATELLITE VIDEO COURSE

MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 VIDEO COURSE Presented by U.S. Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground, Maryland Course Director: COL Charles G. Hurst, MC The agent segments listed below will include discussion of: the history of the agent development and use, its physical properties, mechanism of action, and clinical effects and treatment. Interviews with clinicians who have treated exposures as well as interviews with scientists researching medical countermeasures and case studies or scenarios will be presented. Tape 1 Presents an overview of Pulmonary Agents and Vesicants
Tape 2 Presents an overview of Vesicants
Tape 3 Presents an overview of Nerve Agents and Cyanide
Tape 4 Presents an overview of Cyanide (contd)
Tape 5 Present discussions on Field Management The field management segment will include discussion and demonstration of decontamination issues, triage issues, and mass-casualty management issues. These 6
issues will be discussed from both the military and domestic preparedness perspectives. Tape 6 Present discussions Field Management (contd) and Antiterrorism The antiterrorism segment will include discussion of the structure, operations, and capabilities of crisis and consequence management organizations with reference to both military and domestic preparedness perspectives.
Final Examination
CONDUCTING A SUCCESSFUL VIDEO COURSE Three Weeks Prior to the Course

1. Copy the Fact Sheet on page 14 and post it in various locations to promote the video course. Distribute the sheet to interested persons. A downloadable fact sheet is also located on the Internet at http://ccc.apgea.army.mil. Click on the Satellite 2000 link. Then click on the Course Materials link.
2. Reserve a viewing site and identify the site contact. Schedule the viewing site for the three days that you will be viewing the videotapes. Ensure the site can accommodate the expected number of attendees. Reserve a room with tables and chairs, TV monitor(s), and VCR. 3. Identify a technical contact at the viewing site for possible assistance before and during the video course. 4. Tell the site and technical contact you would like to make a site visit 2 weeks prior to the course.
Two Weeks Prior to the Course

1. 2. Call your viewing site contact and make an appointment to visit the site. During the visit, complete the following: Meet the technical contact that will be available during the viewing of the videotapes. Know the location of restrooms, snack bar, telephone, etc. Know the procedure for handling emergencies (technical contact, fire exits, etc.). Know facility rules concerning smoking, food, etc. Obtain permission and locations to post classroom location signs. See the sample contained in this guide on page 15. Arrange for use of a photocopy machine to reproduce student materials. Make arrangements for comfortable tables and chairs, preferably arranged in classroom style. Note parking arrangements and availability. 8
Ensure TV monitors or projection screens are appropriate sizes for the audience. Get maps or directions to the site and become familiar with them. 3.
Monitor number of participants in relation to room capacity. Make changes to your on-line facility information.
One Week Prior to the Course

1. Download course materials. Be sure you have a sufficient number of student materials.
Remember, students will be taking the examination on-line. Student materials can be obtained at the Chemical Casualty Care Division website at http://ccc.apgea.army.mil. 2. Monitor number of participants in relation to room capacity. Make changes to your online facility information. Review instructions (included in this guide) for completing registration and evaluation forms. Make copies of Sign-In sheets for each session. You will need these sheets to update your on-line student roster. Remind the site contact of any special classroom arrangements. Review the video course agenda.
3.
4.
5. 6.
One Day Prior to the Course

1. Assemble the following to bring to your viewing site: Copies of all student materials. These are available on the Internet at http://ccc.apgea.army.mil. Click on the 2000 Satellite Broadcast link. Then click on the Course Materials link. Site Facilitators Guide, available on the internet at http://ccc.apgea.army.mil. Click on the 2000 Satellite Broadcast link. Then click on the Course Materials link. A sufficient number of signs identifying the entrance(s) to your viewing site. Name, telephone number and pager number of your sites technical contact. Sign-In sheets. Participant roster. 9
First Day of the Course

1. 2. 3. 4. Bring a generous supply of humor and patience to deal with potential problems. Arrive 1 hour early to post signs, check the room, set up course materials, etc. When participants arrive, welcome them and have them sign-in. Ask participants if they have registered on-line. If they have not, encourage them to do so at http://ccc.apgea.army.mil. Click on the Satellite banner at the bottom of the page. Once in the registration area, click on the participant button on the left of the screen.
30 Minutes Prior to Program Start Time

1. Introduce yourself and your agency (see the script below), and identify yourself as the training facilitator for the three-day video course. Provide students with the location of restrooms, vending machines, pay phones, and other pertinent information related to the facility. Inform them of any rules regarding food or beverages in the viewing area, and ensure students have parked in approved areas. Below is a suggested script. Welcome, my name is . I represent the will be your Site Facilitator for each of our sessions. Go over instructions for how the course will operate on a daily basis. Review registration and examination procedures. (agency). I
2.
The final exam is an open book examination and can be taken on-line after registration is completed. The restrooms/snack bar are located .
If any of you have parked in the zone, you may want to move your car. This is the only parking place where you might get a ticket or be towed. You can find plenty of parking in the zone. This video course is based on the live Satellite Broadcast that was presented on 5-7 December 2000. 3.
Instruct students on registration procedures. Individuals must register on-line and are expected to go back on-line to complete the evaluation and examination. After completing the exam, students will print their Continuing Education certificate from their computer.
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DURING THE VIDEO COURSE
During local group activities, encourage participants to work on scenarios presented in the video series. Printable versions of the activities are available at http://ccc.apgea.army.mil. Click on the 2000 Satellite Broadcast link and then on the Course Materials link.
DAY 2 AND DAY 3 OF THE VIDEO SERIES
Remind students to sign-in. Encourage participation in the scenarios during the course. Remind students of the registration/examination procedures.
AT THE END OF THE LAST DAY
h h
Remind students that individuals must register on-line and go back on-line and complete the evaluation and examination. After completing the exam, students will print their Continuing Education certificate from their computer. Important Remind participants that they must answer evaluation questions to receive credit. Collect sign-in sheets. Inform students that the registration and test must be completed in order to receive course credit. (Utilization of on-line registration and exams are mandatory.) Thank participants for their attendance. Remove the signs you posted. Thank your viewing and technical site contacts.
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MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 VIDEO COURSE SIGN-IN SHEET Day #1:
Site Facilitator: Site: State: Name E-Mail Phone
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Medical Response to Chemical Warfare and Terrorism 2000 Video Series

Based on the Live Satellite Broadcast
Sponsored by the U.S. Army Medical Command
Military and civilian medical systems must be prepared to care for casualties of battlefield or terrorist use of chemical agents. In support of that mission, the United States Army Medical Research Institute of Chemical Defense (USAMRICD) presented its second annual live satellite broadcast on the Medical Response to Chemical Warfare and Terrorism 2000 on 5-7 December 2000. The video course is targeted to clinical health care professionals but is appropriate for all personnel involved in the management and care of persons exposed to chemical agents. The course will inform and educate health care professionals and first responders serving the military and supporting civil defense/domestic preparedness programs about chemical agents and the proper medical responses in the event of intentional or accidental chemical agent exposure. It also will discuss battlefield management, decontamination of casualties, and personal protective equipment. Discussions on antiterrorism are integrated throughout. The program features discussions with world-renowned scientists, researchers, clinicians and counterterrorism experts.
6-Set Video Series

TAPE 1 Introduction, Pulmonary Agents, Vesicants TAPE 2 - Vesicants (contd) TAPE 3 - Nerve Agents, Cyanide Intro & His tory TAPE 4 - Cyanide TAPE 5 - Field Management TAPE 6 - Triage (contd), Counterterrorism, Chemical Jeopardy, Q&A
Accreditation Statement:
The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity.
Credit Designation Statement:

The U.S. Army Medical Command designates this educational activity for a maximum of 12 hours in category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
At the conclusion of this program, The viewers should. - Be able to list the 4 major chemical agent classes . and discuss the key effects of each on the human . . organism - Be able to identify the key elements of pre-hospital . medical management for each of the 4 major . . . . chemical agent classes - Be able to identify cutting edge diagnostics and ...therapeutics for vesicants and nerve agents - Be able to identify and describe each of the three ...tiers of response to a disaster
Individual Registration Instructions

To receive credit for the course, facilitators and participants must register online by visiting
http://ccc.apgea.army.mil. Once at the site, click on the Medical Response to Chemical Warfare and Terrorism 2000 banner at the bottom of the page to access the facilitator and participant registration website. From this website, both facilitators and participants can register for the program. Facilitators can register their site and participants can register under that particular site. Participants should call or email the site facilitator immediately after making your selection to reserve your seat and to confirm your registration.
For more information visit us at http://ccc.apgea.army.mil
Viewing Site: ____________________________ Site Facilitator: __________________________ Phone Number: __________________________
Obtaining Video Series registering, please call the If you are having difficulties DoD Contact the Chemical Casualty Care Division at Chemical Casualty Care Division at (410) 436-2230. ccc@apg.amedd.army.mil Non-DoD Available through NTIS at http://www.ntis.gov, phone 1-800-553-6847, order number AVA20893VNB6, cost $135.00
There is no commercial support associated with this educational activity.
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What:
Medical Response to Chemical Warfare and Terrorism 2000 Video Course
Where: Building Room #
Date:
Time:
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MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 FINAL EVALUATION AND EXAMINATION The following are 8 course critique questions. Please read each of the statements and select the response that best reflects your feelings about the course. Following the critique, are 32 questions regarding the medical management of chemical agent casualties. Please read each question thoroughly and select the answer that is the MOST appropriate choice. MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 SATELLITE BROADCAST COURSE CRITIQUE 1. a. b. c. a. 2. a. b. c. d. e. 3. a. b. c. d. e. 4. a. b. c. d. e. This course was a valuable educational activity. Agree No Opinion Disagree Not applicable Which of the following topics would you like covered more extensively in the future? Pulmonary Agents Nerve Agents Cyanide Vesicants Field Management (Equipment/Decontamination/Triage/Evacuation/Protection) Which part of the course was the most interesting to you? Pulmonary Agents Cyanide Vesicants Nerve Agents Field Management and Antiterrorism What was your overall impression of the course? Superior Excellent Good Satisfactory Poor
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5.
I prefer to attend satellite broadcast training as opposed to regular classroom training because: It fits into my work schedule I prefer the format and structure It allows me to avoid extensive travel There is a significant cost savings for me I do not prefer satellite broadcast training What was the most important factor in your decision to participate in this satellite broadcast? Content Continuing Education Required to take the course Supervisor recommended Other The promotional material for the broadcast adequately described the training and its content. Agree No Opinion Disagree Not applicable The pre-registration process for participation in the broadcast was user friendly. Agree No Opinion Disagree Not applicable
a. b. c. d. e. 6.
a. b. c. d. e. 7.
a. b. c. d. 8. a. b. c. d.
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MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 SATELLITE BROADCAST COURSE EXAMINATION 9. Protective equipment is assigned an OSHA ranking (A through D) based on the following Level of dermal protection afforded Level of respiratory protection afforded How uncomfortable it is to wear A and B All of the above Of the following, the earliest indicator of pulmonary edema in a casualty exposed to a respiratory agent is: An abnormal arterial-blood-gas (ABG) test Dyspnea (shortness of breath) A pattern of scattered infiltrates with Kerley B lines on PA and lateral chest radiographs Dullness to percussion on physical examination Wheezing In a person severely intoxicated by nerve agent, atropine administration should be titrated to which of the following? Clinical reduction of bronchospasm and secretions Clinical restoration of normal heart rate and blood pressure Clinical reduction of skeletal muscle fasciculations and twitching Clinical reduction of gastrointestinal distress and spasm Clinical resolution of miosis and eye pain All of the following are true regarding the radiomimetic effect of sulfur mustard on bone marrow EXCEPT: Assessment of the cellular components of the blood can be used to identify the severity of sulfur mustard exposure. Early decline in numbers of lymphocytes predict subsequent decline in the platelet count. Very early (1-2 hrs.) simple measurement of the total white blood cell count can be used to predict severity of exposure and need for early evacuation. Following a severe exposure to sulfur mustard, lymphocyte count rapidly decreases, while the number of granulocytes increases.
a. b. c. d. e. 10.
a. b. c. d. e. 11.
a. b. c. d. e. 12.
a. b. c. d.
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13.
It is important to decide whether a patient is exposed to nerve agent vapor or to nerve agent liquid agent because: The strength of bleach chosen depends upon whether the agent is a vapor or a liquid. Clinical effects from liquid exposure may be delayed. Wearing the mask may not be necessary if the agent is liquid. Diazepam is never given for exposure to nerve-agent vapor. Which of the following is true concerning peripherally acting pulmonary agents? Symptoms never precede signs. They cause clinical effects that mimic adult respiratory distress syndrome (ARDS). Irritation of the nose and mouth with coughing and bronchospasm generally excludes these agents. Their peripheral airway effects are probably caused by hydrochloric acid. In most cases, prophylactic administration of antibiotics is a reasonable medical option. An individual who is vomiting and fasciculating reports nerve agent exposure. He does not have miosis (pinpoint pupils). An appropriate response includes which of the following: Discharge from care Administer nerve agent antidotes Observe for pinpoint pupils before administering antidote A and C above None of the above A cyanide casualty who is not breathing but still has a pulse just entered your Battalion Aid Station. He/she: Should be given the three separate antidotes in the military cyanide antidote kit. Should receive sodium thiosulfate followed by sodium nitrite. Should be considered expectant. Should immediately have blood drawn to determine the level of cyanide in the blood. Should be given sodium nitrite followed by sodium thiosulfate. Someone with severe systemic effects from a nerve agent should initially receive: Three MARK I kits One Diazepam Three MARK I kits and diazepam One MARK I kit Three Mark I kits and an additional 2 mg of atropine
a. b. c. d. 14. a. b. c. d. e. 15.
a. b. c. d. e. 16.
a. b. c. d. e. 17. a. b. c. d. e.
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18.
Which of the following is a necessary part of management for a casualty who has inhaled sulfur mustard? Enforced rest and observation for signs and symptoms of pulmonary edema Immediate intubation Close monitoring of arterial blood gases Close observation for the development of partial or complete airway obstruction Prophylactic administration of antibiotics Decontamination should be performed Inside the receiving medical facility (e.g., ER) Downwind from the receiving medical facility Before any medical care is rendered By fully qualified medical personnel Of the following, what is the first indication of inhalation of very high concentrations of phosgene? Abnormal arterial blood gases Chest tightness Coughing, hoarseness, and eye irritation Cyanosis Convulsions The two categories of agents that pose the greatest threat on a modern battlefield are: Nerve agents and cyanide Vesicants and riot agents Riot agents and nerve agents Vesicants and nerve agents Pulmonary agents and vesicants Effects after severe cyanide inhalation typically include which of the following? Miosis, bronchial hypersecretion, and nausea. Brief hyperventilation, loss of consciousness, convulsions, followed by respiratory and subsequent cardiac failure. Convulsions, vomiting, and flaccid paralysis. Muscle weakness, cyanosis, and secretions. Sudden loss of consciousness after a latent period of up to 60 minutes.
a. b. c. d. e. 19. a. b. c. d. 20.
a. b. c. d. e. 21.
a. b. c. d. e. 22. a. b. c. d. e.
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23.
Cyanide is considered an important terrorist threat, but not an effective battlefield agent because: Cyanide is more effective in enclosed spaces. Cyanide is slightly less dense than air. Cyanide is widely used in the chemical industry. Cyanide is very volatile. All of the above In a mass casualty scenario, a casualty exposed 2 hours ago to sulfur mustard vapor now has facial erythema, red eyes, marked difficulty breathing, and a productive cough. This casualty should most appropriately be triaged as: Urgent Immediate Delayed Minimal Expectant The most important purpose of the emergency medical treatment station on the dirty side of the hotline (U.S. Army decontamination model) is: To provide full definitive medical treatment for immediate casualties. To stabilize patients well enough to survive the decontamination process. To remove gross chemical agent contamination from small areas prior to full decontamination. To provide a definitive diagnosis of serious poisoning and other conditions in order to expedite later medical care on the clean side of the hot line. To allow observation of delayed casualties while they are waiting to proceed through litter decontamination. A casualty who collapsed 2 minutes ago and is convulsing: Should be restrained until convulsions cease. Could be a nerve-agent casualty or a cyanide casualty. Should be ventilated before antidotes are given if the diagnosis is nerve agent poisoning. Should be triaged as expectant. Is not a nerve agent casualty if miosis is not present (i.e., if the pupils are not pinpoint). Which of the following is true about centrally and peripherally acting pulmonary acting agents? They may be reliably distinguished by their various odors. Their site(s) of action in the respiratory tract are determined primarily by their water solubility and their chemical reactivity. Even in high concentrations, a centrally acting agent such as mustard is unlikely to produce pulmonary edema. 22
a. b. c. d. e. 24.
a. b. c. d. e. 25.
a. b. c. d. e.
26. a. b. c. d. e. 27.
a. b. c.
d.
Their clinical effects are usually seen within 2 hours of exposure.
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28.
A casualty was exposed to both nerve agent vapor and liquid 2 hours ago. The casualty immediately developed pinpoint pupils, shortness of breath, tearing, and nasal secretions. The casualty quickly donned a mask, was removed from the area of exposure, and underwent ambulatory decontamination. The casualty now has miosis. How would you manage this patient? Tell him/her that the miosis will resolve within 2 to 4 days. Triage as minimal. Would not expect him/her to get worse, since he/she is no longer being exposed to agent. Observe him/her for 12 to 24 hours. Administer one or two Mark Is to counter the miosis. The most important reason(s) for setting up a casualty decontamination site is to: Remove the sources of chemical vapor and liquid hazard Protect the receiving medical facility and staff from chemical contamination Medically stabilize casualties A. and B. All of the above Which of the following is TRUE concerning cyanide? A dependable warning of the presence of AC is its characteristic odor of bitter almonds. As a blood agent, cyanide binds avidly to the oxyhemoglobin in blood. Cyanosis is diagnostic of the presence of cyanide. Cyanide prevents cellular utilization of oxygen. Once breathing has stopped, a cyanide casualty should be triaged as expectant. Why should all levels of care be prepared to conduct casualty decontamination? Potentially contaminated patients may present themselves directly to the nearest facility. Casualties may skip echelons of care. Lower echelons may not have the resources necessary to decontaminate the casualties requiring evacuation. A. and B. All of the above
a. b. c. d. e. 29. a. b. c. d. e. 30. a. b. c. d. e. 31. a. b. c. d. e.
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32. a. b. c. d. e. 33.
What is/are the essential component(s) of initial chemical casualty decontamination? Decontamination with bleach Remove the patient from the contaminated environment Remove the contaminant from the patient A and B B and C Personnel operating in protective gear, OSHA level C and higher, are at significant increased risk for Heart attack Contamination Heat stress Dehydration C and D above What are important questions to ask when deciding what type of protective gear to use? What is the nature of the threat (respiratory or dermal, hi or lo concentration)? Is supplemental air or oxygen required? How long will it be worn? Is there a legal requirement to be met? All of the above The Armys M256 detector ticket samples for chemical agent vapors. It detects all of the following EXCEPT: Nerve agents Pulmonary agents Vesicants Cyanides The medical response to chemical terrorism against a US city or military installation differs from the medical response to chemical agents on the battlefield in which of the following ways? Different antidotes are used There is less need to protect medical facilities against contamination on the battlefield Civilian responders may not be able to provide emergency medical treatment on the dirty side of the hot line (warm zone), whereas military responders probably can do this None of these are true All of these are true
a. b. c. d. e. 34.
a. b. c. d. e. 35.
a. b. c. d. 36.
a. b. c. d. e.
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37.
Which statement is true concerning responsibility for a chemical terrorist incident in the United States? Once the Federal authorities are on the scene, they are in charge. Local authorities remain in charge unless the military arrives, at which time the military will be in charge. Once State authorities arrive, they will accept responsibility from local authority. Local authorities remain in charge throughout the incident. Each incident is a unique event and responsibility will be different depending upon circumstances. The medical services of which agencies of the US Federal Government have specified roles to play in responding to a chemical terrorist incident? Active duty military Military reservists The National Guard Department of Veterans Affairs (VA) All of these Under the Federal Response Plan, the Department of Justice is the lead Federal agency during crisis management. What is true concerning the consequence management phase? The Department of Justice remains in charge of Federal response. The Federal Emergency Management Agency (FEMA) is the lead Federal Agency for consequence management. Since the incident started as crisis management it will remain a crisis management incident throughout. During consequence management, the Federal authorities will supersede local ones. None of these. What is true regarding the threat of chemical terrorism in the United States? The FBI receives more chem./bio terrorism threats every year than conventional bomb threats. Most alleged perpetrators of chemical terrorism in the United States are foreigners. All potential chemicals of terrorist interest in the United States are illegal to buy on the open market. The amount of money dedicated to fighting chemical terrorism in the United States has plateaued or declined. Dual-use technology is a good way to conceal a chemical terrorist program.
a. b. c. d. e.
38.
a. b. c. d. e. 39.
a. b. c. d. e. 40. a. b. c. d. e.
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Courses Courses
United States Army Medical Research Institute of Chemical Defense Presents:
Military and civilian medical systems must be prepared to care for casualties of battlefield or terrorist use of chemical agents. In support of that mission, the United States Army Medical Research Institute of Chemical Defense (USAMRICD) presents its second annual satellite broadcast on the Medical Response to Chemical Warfare and Terrorism 2000. This video series is based on the live three-day satellite broadcast that aired on 5-7 Dec 2000. This program will inform and educate health care professionals and first responders serving the military and supporting civil defense/domestic preparedness programs about chemical agents and the proper medical responses in the event of intentional or accidental chemical agent exposure. It will also discuss battlefield management, decontamination of casualties, and personal protective equipment. Discussions on antiterrorism will be integrated throughout. The program will feature discussions with world-renowned scientists, researchers, clinicians and counter-terrorism experts. This program combined the best of the broadcast presented in 1999 with exciting updates and cutting edge science, diagnostics, and therapeutics. The course is targeted to clinical health care professionals but is appropriate for all personnel involved in the management and care of persons exposed to chemical agents. Accreditation Information Program Information
Accreditation Information
Accreditation Statement
The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity. This CME activity was planned and produced in accordance with ACCME Essentials.
Credit Designation
The U.S. Army Medical Command designates this educational activity for a maximum of 12 hours in category 1 credit towards the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Statement of Need
The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians assistants, and certain corpsmen) with the information that they can use to manage chemical agent casualties, both in the field and in a fixed facility. The course is also required for medical personnel at depots where chemical agents are stored.
Learning Objectives
At the conclusion of this activity, participants should be able to:
q q q q
List the 4 major chemical agent classes and discuss the key effects of each on the human organism Identify the key elements of pre-hospital medical management for each of the 4 major chemical agent classes Identify cutting edge diagnostics and therapeutics for vesicants and nerve agents Identify and describe each of the three tiers of response to a disaster
Intended Audience
This educational activity is designed to provide military medical personnel (physicians, nurses, physicians assistants, and certain corpsmen) with information that they can use to manage chemical agent casualties, both in the field and in a fixed facility.
Disclosure of Faculty Relationships

As a sponsor accredited by the ACCME, it is the policy of the U.S. Army Medical Command to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. For this educational activity, no faculty reported any information to disclose.
Acknowledgment of Commercial Support

Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the U.S. Army Medical Command name implies review of educational format design and materials only. Original Release Date: 26 February 2001 Expiration Date: 25 February 2003 Estimated Time to Complete: 12 hours Educational Format: This Educational activity is presented in a video format. Additional support materials are attached that contain additional reading and the course evaluation and post-test. Continuing education credit will be awarded upon successful completion of the examination. Review of all six tapes is required to receive credit.
Program Information
Tapes 1 and 2
Presents an overview of Pulmonary Agents and Vesicants The agent segments will include discussion of: the history of the agent development and use, its physical properties, mechanism of action, clinical effects and treatment. Interviews with clinicians who have treated exposures as well as interviews with scientists researching medical countermeasures and case studies or scenarios will be presented. The day will conclude with a LIVE call-in session to a panel of respected experts who will discuss audience questions and concerns.
Tapes 3 and 4
Presents an overview of Nerve Agents and Cyanide The agent segments will include discussion of: the history of the agent development and use, its physical properties, mechanism of action, clinical effects and treatment. Interviews with clinicians who have treated exposures as well as interviews with scientists researching medical countermeasures and case studies or scenarios will be presented. The day will conclude with a LIVE call-in session to a panel of respected experts who will discuss audience questions and concerns.
Tapes 5 and 6
Field Management and Antiterrorism The field management segment will include discussion and demonstration of decontamination issues, triage issues, and mass-casualty management issues. These issues will be discussed from both the military and domestic preparedness perspectives. The antiterrorism segment will include discussion of the structure, operations, and capabilities of crisis and consequence management organizations with reference to both military and domestic preparedness perspectives. The day will conclude with a LIVE call-in session to a panel of respected experts who will discuss audience questions and concerns.
Courses Courses
United States Army Medical Research Institute of Chemical Defense Presents:
Register and Take Exam
Course Materials
Facilitator Guide Student Materials Information about the videotape course and specific instructions for conducting a successful video course. PDF Packet of materials designed for students. The packet includes a detailed agenda, a variety of resources for learning, and several reference charts. Available in Word or PDF. A printable version of the examination. PDF version Register and take exam: Online Examination Field Management of Chemical Casualties Handbook Medical Management of Chemical Casualties Handbook The Medical NBC Battle Book - USACHPPM Tech Guide 244 (PDF) Textbook of Military Medicine, Medical Aspects of Chemical and Biological Warfare Publications on Pyridostigmine and Defense Against Toxin Weapons. Click Here Want to know how to obtain handbooks, textbooks, or CD-ROMS? Want to learn about the courses we offer, and how to register for them? Open this PDF document.
Examination
Handbooks
Textbook Additional References
Educational Products
SPONSORED BY THE US ARMY MEDICAL COMMAND Accreditation Statement

The US Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The US Army Medical Command designates this activity for a maximum of 15.50 category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
Statement of Need
The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with the information that they can use to manage chemical and biological agent casualties, both in the field and in a fixed facility. The planning is based on the Department of Defense Medical Readiness Strategic Plan which states: Medical Management of Chemical and Biological Casualties Course shall be a tri-service course and expanded to meet the tri-service deployment requirements. The MMCBC Course shall be required for the selected primary care physicians (ER, GMO, peds, family practice, internal medicine), PAs, nurse practitioners, special forces medics, and independent duty corpsmen. The MMCBC Course skills shall be sustained (3-5 year) via CD ROM, VTT, VTC, correspondence, in-house course, road shows. DAPAM 50-6, May 17 1991, Chapter 6-3: Concept of Operations. "The Medical Response Team leader (whether permanently or temporarily assigned in this capacity) will attend Medical Management of Chemical Casualties Course conducted by U.S. Army Medical Research Institute of Chemical Defense (USAMRICD)."
The course is also required for medical personnel at depots where chemical and biological agents are stored. A requirement for this course is also identified in the AMEDD Life Cycle Information, DoD mandated, IR 611.101, Quad Defense Review, GAO Report on NBC. This course is also required in the Medical Corps Clinical track on Career Training Life Cycle of Physicians.
Learning Objectives
At the conclusion of this activity, participants should be able to: Recognize the military terms for and the clinical effects of chemical and biological agents. Identify means of therapeutic intervention in both a medical center and a field environment. Identify methods of managing contaminated and uncontaminated casualties in a field environment or a fixed medical facility. Identify the historical aspects of chemical agent use in warfare and realize chemical and biological warfare capabilities practiced in the world today by countries or by terrorist groups.
Intended Audience
This course is designed for Medical Corps and Nurse Corps officers, physician assistants, Medical Service Corps officers in specialties 67B, C, or E, and other selected medical professionals.
Information About This Enduring Material:

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 24 June 2001 23 June 2005 15.50 hours This educational activity is presented in a video format. Additional support materials are at http://ccc.apgea.army.mil/courses/video/facilitators.htm#mcbcvideo
Faculty
Jonathan Newmark, MC Chief, Operations Branch, CCCD, USAMRICD COL Newmark serves as staff neurologist at WRAMC, Washington, DC, and as associate professor neurology at the USUHS, Bethesda, MD. He is also consultant to the Pentagon for BNC issues. Theodore Cieslak, MC Staff Pediatrician, BAMC COL Cieslak is a staff pediatrician who is currently the Chief, Department of Pediatrics at Brooke Army Medical Center. He is the Deputy Consultant, Biodefense Issues for the Army Surgeon General's Office. He has over 55 publications. Roger Baxter, AN Nurse Anesthetist, WRAMC COL Baxter served for 3 years as the XO for the CCCD at USAMRICD, as the Course Director for the Field Management of Chemical and Biological Casualties Course and an instructor for the Medical Management of Chemical and Biological Casualties Course. James Madsen, MC Dep Dir, Occupational and Environmental Medicine Rs LTC Madsen is a board-certified anatomic and clinical pathologist. Her served from 1992 to 1994 as consultant and inspection team physician for the On Site Inspection Agency, inspecting chemical warfare production facilities in Russia. Charles Hurst, M.D. Chief, CCCD, USAMRICD Dr. Hurst is board certified in dermatology. He is chief of the Chemical Casualty Care Division. He also retains a part-time dermatology practice at the Pentagon Health Clinic. Frederick Sidell, M.D. Consultant on Chemical Casualties Dr. Sidell is an expert in the filed of chemical casualties, and is considered an expert on the continuing education of physicians. As a Doctor of Medicine with a Bachelor of Science in Chemistry, his publications are well over 30.

As a sponsor accredited by the ACCME, it is the policy of the US Army Medical Command to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) or any commercial product(s) discussed in an educational presentation. For this activity, no faculty reported any information to disclose.
Disclosure of Unlabeled/Unapproved Uses of Drugs or Devices (if applicable)

In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more presentations in this continuing medical education activity do not contain reference(s) to unlabeled or unapproved uses of drugs or devices.
Acknowledgement of Commercial Support

Disclaimer Statement (optional)

The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the US Army Medical Command name implies review of educational format design and materials only.
Instructions for Securing CME Credit

This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: 1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the Current Activities & Registration button on the left hand banner. Select 2003 in the Fiscal Year drop down box. Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0774 Medical Management of Chemical and Biological Casualties Video Course. Note the date for this course is quarterly. A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. A window will come up Thanking your for your registration.
First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button.
6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Chemical and Biological Casualties Video Course 2003-0774 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

Credit Designation
The US Army Medical Command designates this educational activity for a maximum of 13.0 category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
Statement of Need
Learning Objectives
Intended Audience

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 24 January 2003 23 January 2005 12 hours This educational activity is presented in a video format. Additional support materials are at http://ccc.apgea.army.mil/courses/video/facilitators.htm#mcbcvideo
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: 1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the Current Activities & Registration button on the left hand banner. Select 2003 in the Fiscal Year drop down box. Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0772 Biological & Chemical Warfare & Terrorism: Medical Issues and Response Satellite Videotape Course. Note the date for this course is quarterly. A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. A window will come up Thanking your for your registration.
First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button.
6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Biological & Chemical Warfare & Terrorism: Medical Issues and Response Satellite Videotape Course 2003-0772 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.)
11.) 12.)

Credit Designation
The US Army Medical Command designates this educational activity for a maximum of 10.25 category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
Statement of Need
Learning Objectives
Intended Audience

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 24 January 2003 23 January 2005 12 hours This educational activity is presented in a video format. Additional support materials are at http://ccc.apgea.army.mil/courses/video/facilitators.htm#mcbcvideo
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: 1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the Current Activities & Registration button on the left hand banner. Select 2003 in the Fiscal Year drop down box. Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0771 Medical Response to Chemical Warfare & Terrorism 2000. Note the date for this course is quarterly. A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. A window will come up Thanking your for your registration.
First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button. 6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity.
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Response to Chemical Warfare & Terrorism 2000 Course 2003-0771 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)
Courses Courses
Computer Based Training

We offer a variety of interactive multimedia learning courses that are targeted towards reaching the following objective: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to exposure. Many of these courses are accredited for CME/CEU credits. For credit information, please visit the Course Credits page. Choose a course:
1.
Medical Management of Chemical Casualties Course s Medical Management of: Nerve Agent Casualties Course Vesicant Agent Casualties Course Pulmonary Agent Casualties Course Cyanide Agent Casualties Course Incapacitating and Riot Control Agents Casualties Course
s
Triage of Chemical Agent Casualties Course
2. 3.
Virtual Field Training Exercise Course Chemical Casualties (MMCC) Fundamentals Mini Course
System Requirement: Sound Card, Speakers, Windows Media Player 7.1 and Real Player. This program is best viewed in Internet Explorer (IE) 5.0 or higher.
To access any of these distance learning courses, you must login first.

Credit Designation
The US Army Medical Command designates this educational activity for a maximum of 4 category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
Statement of Need
The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with the information that they can use to manage chemical and biological agent casualties, both in the field and in a fixed facility. The planning is based on the Department of Defense Medical Readiness Strategic Plan which states: DAPAM 50-6, May 17 1991, Chapter 6-3: Concept of Operations. "The Medical Response Team leader (whether permanently or temporarily assigned in this capacity) will attend Medical Management of Chemical Casualties Course conducted by U.S. Army Medical Research Institute of Chemical Defense (USAMRICD)." A requirement for this course is also identified in the AMEDD Life Cycle Information, DoD mandated, IR 611.101, Quad Defense Review, GAO Report on NBC. This course is also required in the Medical Corps Clinical track on Career Training Life Cycle of Physicians. As stated in the planning of the MMCBC course: " The Medical Management of Chemical and Biological Casualties Course skills shall be sustained (3-5 year) via CD-ROM, VTT, VTC, correspondence, in-house course, road shows." This is designed to meet the needs of the required sustainment training.
Learning Objectives
At the conclusion of this activity, participants should be able to: Apply the fundamentals of chemical agent terminology to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure. Apply the fundamentals of mechanism of action to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure. Apply the fundamentals of pathophysiology to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure. Apply the fundamentals of consideration of patient circumstances to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure.
Intended Audience
This course is designed for military personnel (physicians, nurses, physicians assistants, and certain corpsmen).

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 28 October 2002 27 October 2004 4 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty
Michael McMahon, AN Chief, Training and Education, CCCD, USAMRICD MAJ McMahon is a Certified Registered Nurse Anesthetist, presently on staff at Kimbrough Ambulatory Care Center, Fort Meade, MD. He served as a staff anesthetist and adjunct faculty to the US Army Graduate Program in Anesthesia Nursing, TAMC, HI.





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: 1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the Current Activities & Registration button on the left hand banner. Select 2003 in the Fiscal Year drop down box. Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0713 Medical Management of Nerve Agent Casualties Course. Note the date for this course is quarterly. A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. A window will come up Thanking your for your registration.
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Nerve Agent Casualties Course 2003-0713 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

Credit Designation
Statement of Need
Learning Objectives
At the conclusion of this activity, participants should be able to: Apply the fundamentals of chemical agent terminology to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure. Apply the fundamentals of mechanism of action to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure. Apply the fundamentals of pathophysiology to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure. Apply the fundamentals of consideration of patient circumstances to the diagnosis & treatment of vesicant agent casualties & recommend appropriate treatment, decontamination & detection to reduce illness & injury due to vesicant agent exposure.
Intended Audience
This course is designed for military personnel (physicians, nurses, physicians assistants, and certain corpsmen).

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 8 November 2002 7 November 2004 3 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: 1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the Current Activities & Registration button on the left hand banner. Select 2003 in the Fiscal Year drop down box. Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0714 Medical Management of Vesicant Agent Casualties Course. Note the date for this course is quarterly. A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. A window will come up Thanking your for your registration.
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Vesicant Agent Casualties Course 2003-0714 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

The US Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. This CME activity was planned and produced in accordance with the ACCME Essentials.
Credit Designation
The US Army Medical Command designates this activity for a maximum of 3 hours in category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
Statement of Need
Learning Objectives
At the conclusion of this activity, participants should be able to: Given scenarios involving chemical agent casualties, identify the pulmonary agent casualties and the mechanism of action. Given a pulmonary agent casualty identify casualty prognosis and recovery and recommend treatment for the casualty. Given a scenario involving chemical casualties, identify methods for detecting the presence of pulmonary agents, personal protection equipment appropriate for protection against pulmonary agents, and methods for preventing the effects of exposure.
Intended Audience
This course is designed for military medical personnel (physicians, nurses, physicians assistants and certain Corpsmen).

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 10 February 2003 9 February 2005 3 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ 2.) Click on Participants in the picture. 3.) Click the Current Activities & Registration button on the left hand banner. 4.) Select 2003 in the Fiscal Year drop down box. 5.) Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0769 Medical Management of Pulmonary Agent Casualties Course. Note the date for this course is quarterly. 6.) A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. 7.) Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. 8.) A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. 9.) A window will come up Thanking your for your registration. First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button. 6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. 1.)
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Pulmonary Agent Casualties Course 2003-0769 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

Credit Designation
The US Army Medical Command designates this educational activity for a maximum of 3 in category 1 credits toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
Statement of Need
The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with the information that they can use to manage chemical and biological agent casualties, both in the field and in a fixed facility. The course is also required for medical personnel at depots where chemical and biological agents are stored. The planning is based on the Department of Defense Medical Readiness Strategic Plan which states: DAPAM 50-6, May 17 1991, Chapter 6-3: Concept of Operations. "The Medical Response Team leader (whether permanently or temporarily assigned in this capacity) will attend Medical Management of Chemical Casualties Course conducted by U.S. Army Medical Research Institute of Chemical Defense (USAMRICD)." A requirement for this course is also identified in the AMEDD Life Cycle Information, DoD mandated, IR 611.101, Quad Defense Review, GAO Report on NBC. This course is also required in the Medical Corps Clinical track on Career Training Life Cycle of Physicians. As stated in the planning of the MMCBC course: " The Medical Management of Chemical and Biological Casualties Course skills shall be sustained (3-5 year) via CD-ROM, VTT, VTC, correspondence, in-house course, road shows." This is designed to meet the needs of the required sustainment training.
Learning Objectives
At the conclusion of this activity, participants should be able to: Given scenarios involving chemical agent casualties, identify the cyanide agent casualties and the mechanism of action. Given a scenario involving chemical casualties, identify the signs, symptoms and severity of exposure. Identify the prognosis, treatment and recovery for the casualty. Given a scenario involving chemical casualties, identify methods of detecting the presence of cyanide, personal protection equipment appropriate for protection against cyanide, and methods for preventing the effects of exposure.
Intended Audience

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 31 January 2003 30 January 2005 3 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ 2.) Click on Participants in the picture. 3.) Click the Current Activities & Registration button on the left hand banner. 4.) Select 2003 in the Fiscal Year drop down box. 5.) Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0760 Medical Management of Cyanide Agent Casualties Course. Note the date for this course is quarterly. 6.) A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. 7.) Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. 8.) A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. 9.) A window will come up Thanking your for your registration. First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button. 6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. 1.)
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Cyanide Agent Casualties Course 2003-0760 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

Credit Designation
Statement of Need
The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with the information that they can use to manage chemical and biological agent casualties, both in the field and in a fixed facility. The course is also required for medical personnel at depots where chemical and biological agents are stored. The planning is based on the Department of Defense Medical Readiness Strategic Plan which states: DAPAM 50-6, May 17 1991, Chapter 6-3: Concept of Operations. "The Medical Response Team leader (whether permanently or temporarily assigned in this capacity) will attend Medical Management of Chemical Casualties Course conducted by U.S. Army Medical Research Institute of Chemical Defense (USAMRICD)." A requirement for this course is also identified in the AMEDD Life Cycle Information, DoD mandated, IR 611.101, Quad Defense Review, GAO Report on NBC. This course is also required in the Medical Corps Clinical track on Career Training Life Cycle of Physicians. As stated in the planning of the MMCBC course: " The Medical Management of Chemical and Biological Casualties Course skills shall be sustained (3-5 year) via CD-ROM, VTT, VTC, correspondence, in-house course, road shows." This is designed to meet the needs of the required sustainment training.
Learning Objectives
At the conclusion of this activity, participants should be able to: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of incapacitating and riot control agent casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to incapacitating and riot control agent exposure.
Intended Audience

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 31 March 2003 30 March 2005 2 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ 2.) Click on Participants in the picture. 3.) Click the Current Activities & Registration button on the left hand banner. 4.) Select 2003 in the Fiscal Year drop down box. 5.) Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0770 Medical Management of Incapacitating and Riot Control Agent Casualties Course. Note the date for this course is quarterly. 6.) A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. 7.) Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. 8.) A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. 9.) A window will come up Thanking your for your registration. First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button. 1.)
6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Incapacitating and Riot Control Agent Casualties Course 2003-0770 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

Credit Designation
Statement of Need
Learning Objectives
At the conclusion of this activity, participants should be able to: Prioritize casualties exposed to Pulmonary, Nerve, Vesicant, Cyanide, Incapacitating and Riot Control Agents. Given a scenario involving chemical casualties, identify the correct triage category for each casualty based on signs, symptoms and event history.
Intended Audience

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 1 May 2003 30 April 2005 3 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ 2.) Click on Participants in the picture. 3.) Click the Current Activities & Registration button on the left hand banner. 4.) Select 2003 in the Fiscal Year drop down box. 5.) Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0776 Triage of Chemical Agent Casualty Course. Note the date for this course is quarterly. 6.) A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. 7.) Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. 8.) A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. 9.) A window will come up Thanking your for your registration. First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button. 6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. 1.)
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Triage of Chemical Agent Casualty Course 2003-0776 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)

Credit Designation
Statement of Need
The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with the information that they can use to manage chemical and biological agent casualties, both in the field and in a fixed facility. The planning is based on the Department of Defense Medical Readiness Strategic Plan which states: DAPAM 50-6, May 17 1991, Chapter 6-3: Concept of Operations. "The Medical Response Team leader (whether permanently or temporarily assigned in this capacity) will attend Medical Management of Chemical Casualties Course conducted by U.S. Army Medical Research Institute of Chemical Defense (USAMRICD)." The course is also required for medical personnel at depots where chemical and biological agents are stored. A requirement for this course is also identified in the AMEDD Life Cycle Information, DoD mandated, IR 611.101, Quad Defense Review, GAO Report on NBC. This course is also required in the Medical Corps Clinical track on Career Training Life Cycle of Physicians.
The Virtual Field Training Exercise (FTX) Interactive Multimedia Instruction (IMI) was developed to provide interactive patient decontamination operations training to medical units or medical personnel caring for casualties of chemical warfare agents. The FTX IMI is designed to complement the Management of Chemical and Biological Casualties Course whenever a patient decontamination live FTX is not possible.
Learning Objectives
At the conclusion of this activity, participants should be able to: Given a mission scenario, student will be able to select appropriate personnel, equipment, site, and operations order necessary to establish a patient decontamination site. IAW Field Management of Chemical Casualties Handbook (July 2000), US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground. Given a PDS layout, student will be able to position the equipment and personnel required to conduct patient decontamination. ISW Field Management of Chemical Casualties Handbook (July 2000), US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground. Given a chemical agent contaminated casualties, student will be able to process casualties for further care, to include triage, emergency treatment, and decontamination. IAW FM 4-02-7 Health Service Support in a Nuclear, Biological, and Chemical Environments, Tactics, Techniques and Procedures, 01 Oct 2002. FM 8-285 Treatment of Chemical Agent Casualties and Conventional Military Injuries, and Field Management of Chemical Casualties Handbook (July 2000), US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground. Given a patient decontamination site, student will be able to disestablish the PDS while avoiding spread of contamination. IAW FM 3-5 NBC Decontamination, Field Management of Chemical Casualties Handbook (July 2000), US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground.
Intended Audience
This course is designed for military medical personnel (physicians, nurses, physicians assistants and certain Corpsmen); local emergency responders (ems/paramedics, law enforcement personnel, and firefighters) may also benefit from this training.

Date of Issuance: Date of Expiration: Estimated Time to Complete: Educational Format: 24 January 2003 23 January 2005 12 hours This educational activity is presented in a computer based training (CBT) format. Additional support materials are at http://ccc.apgea.army.mil/courses/credits/credits.htm
Faculty





This activity has been granted Continuing Medical Education (CME) units by the Army Medical Department Center and School (AMEDDC&S). They require that MCBC physician attendees (military and civilian) complete on-line pre-registration and post-course evaluation. Should the student fail to complete the required registration and evaluation, CME will not be granted. Registration through (the website) is for CME purposes only. In order to receive credits for this activity you must register on the CME website, prior to attending this activity, and then complete an evaluation from the same CME website after completing the activity. Below are instructions for registering and completing the evaluation. To register for this activity: From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ 2.) Click on Participants in the picture. 3.) Click the Current Activities & Registration button on the left hand banner. 4.) Select 2003 in the Fiscal Year drop down box. 5.) Click the Retrieve button. Scroll down the list of courses and click on ID 2003-0715 Medical Management of Virtual Field Training Exercise Agent Casualties Course. Note the date for this course is quarterly. 6.) A new window will appear with information regarding the course. After reading this information, click Register for Activity in the left banner at the top. 7.) Enter your login id and password and click the Continue button. Note: if you dont have a login and password, skip to First Time Users, below. 8.) A window will appear with your profile information on it. Verify your information is correct. Make any changes necessary. Scroll to the bottom of the window and click the Register Now button. 9.) A window will come up Thanking your for your registration. First Time Users: 1.) Click the New Registrants button. 2.) Enter your SSN, First Name, Last Name, Place of Birth, and Facility where you work and click the Continue Registration Process button. 3.) The Registration form window will appear. On the top left banner, you will see Congratulations! Your new Login ID and Password are Login ID: Password:. Take note of your login ID and Password because you will need it to complete the evaluation. 4.) Complete the registration form and click the Register Now button at the bottom of the form. 5.) You will see a new window with instructions to set your password. You can either keep the same password or enter a new one. After entering the password, twice, click the Reset Password button. 6.) If you have successfully entered a new password, a window will appear indicating your Success. At this point you have been registered for the activity. 1.)
To complete the evaluation for this activity: You may complete the evaluation for this activity after the course is completed. To complete the evaluation, do the following: 1.) 2.) 3.) 4.) 5.) 6.) 7.) From a computer that has Internet access, connect to the following website: https://conus.mods.army.mil/cmeweb/ Click on Participants in the picture. Click the LOGIN!! button on the left hand banner. Its the 6th button from the top. Enter Userid and Password. Note: Userid and Password are NOT case sensitive. Click Login under the Password field. Note: If you have problems connecting to this site, call 1-877-MED-ARMY, MENU 5. Click Update Profile on the left banner. Its the 4th button from the top. Verify existing data in your profile is correct. Fill in the missing fields in your profile. Make any changes necessary. NOTE: MAKE SURE YOUR EMAIL ADDRESS IS CORRECT, BECAUSE YOULL GET YOUR CERTIFICATE VIA EMAIL, WITHIN 60 DAYS FROM THE END OF THE COURSE. Click the Update Profile button at the bottom, to save changes to your Profile. Click on the Evaluations button at the bottom of the left hand banner. Click the Medical Management of Virtual FTX Training Exercise Course 2003-0715 link in the ACTIVITY NAME column in the table. Complete the CME Activity Evaluation and click the Submit Activity Evaluation button on the bottom. Your certificate will be e-mailed to you, using the email address in your Profile.
8.) 9.) 10.) 11.) 12.)
MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE FACILITATORS GUIDE
1. PURPOSE This guide provides instructions for completing the Medical Management of Chemical and Biological Casualties (MCBC) Course by videotape for continuing education credit. 2. APPLICABILITY The MCBC Course is designed primarily for military Medical and Nurse Corps officers, physicians assistants, Medical Service Corps officers in the 67B, C, and E specialties and other medical professionals responsible for the care of chemical or biological agent casualties. This videotape course is NOT intended to replace the on-site MCBC Course offered each quarter at the US Army Medical Research Institute of Chemical Defense (USAMRICD) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). Rather, the videotape series is designed for refresher training of Department of Defense (DoD) medical personnel and as an alternate way of obtaining the core didactic material when attendance at the on-site course is not feasible. The 6.5-day, on-site MCBC course presents the didactic material in greater detail with direct access to subject matter experts and includes a laboratory and field training exercise (FTX). 3. PROPONENT This course is administered by the Chemical Casualty Care Division (CCCD), USAMRICD. Address correspondence to: Commander USAMRICD ATTN: MCMR-UV-ZM 3100 Ricketts Point Road Aberdeen Proving Ground, Maryland 21010-5400 Phone (410) 436-2230 DSN 584-2230 Fax (410) 436-3086 DSN 584-3086
E-mail ccc@apg.amedd.army.mil Internet http://ccc.apgea.army.mil 4. BACKGROUND
The exportable, videotape version of the MCBC Course consists of lectures presented by the CCCD staff from the USAMRICD and by the Operational Medicine Division staff of the USAMRIID. The majority of the chemical agent lectures were filmed during the MCBC Course presented at Aberdeen Proving Ground, Maryland in March 1998. The remaining chemical lectures, i.e. Overview, Decon, and FTX Introduction were filmed after the March course. The biological agent lectures were extracted from the satellite broadcast of The Medical Management of Biological Casualties program presented in September 1998. 5. FACILITATORS ROLE Optimally, the videotape series is presented in its entirety, as a complete course. The Field Training Exercise (FTX) portion of this course is optional. When this course is presented to a group, a facilitator must be designated to administer the course and assume responsibility for the following: a. Complete and return the Facilitators Course Application form (enclosure 1). Upon approval of the application, the course is assigned a Course ID and the Course ID along with the exam answer key is emailed to the facilitator. The Course ID is a unique number based on course site, start date, and end date. The course should be completed within 3 months, i.e., January-March, April-June, JulySeptember, and October-December. See section 12 for further details. b. Obtain videotapes. See section 7 for details. c. Following approval of the application, act as the point of contact and liaison between course attendees and the course proponent (CCCD) before, during and after the course. d. Provide a room of appropriate size and location for presentation of the course. e. Distribute course materials. f. Provide and operate the equipment necessary to view the videotapes. g. Ensure that students view all videotapes according to the agenda (enclosure 2). h. Proctor and score the examination (enclosure 6) and ensure against compromise of exam materials. Indicate on each Student Registration Form the Course ID, if the student completed the exam, and the resulting score. i. Dispose of all exam papers. Participants are NOT permitted to keep the exam. j. Ensure that course registration and critique forms (enclosures 3 and 4) are properly completed and returned to CCCD. k. Distribute Certificates to attendees. l. If an FTX is included, provide an appropriate training area, equipment and station instructors. Brief instructors using the enclosed FTX Guide. Ensure that the FTX is safely and effectively organized and executed. 6. CONTINUING EDUCATION CREDIT Award of continuing education credit for the videotape series is based on its presentation as a complete course. Students must view all videotapes in their entirety. Credit is not awarded for the FTX.
To receive continuing education credit for this course an attendee must: a. b. c. d. e. Complete the registration form. View the videotape series in its entirety. Complete the examination. Complete the critique form. Return a completed registration form and critique form to the facilitator.
The facilitator will send registration and critique forms to CCCD for processing. CCCD will process the completed registration and critique forms and forward the appropriate certificates to the facilitator. Physicians (Medical Corps officers, MD, DO) will receive a certificate that includes the following paragraph:
The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity. The U.S. Army Medical Command certifies that (Name) has participated in the educational activity entitled Medical Management of Chemical and Biological Casualties Video Course on during the period (START DATE END DATE) and is awarded 14.5 hours of category 1 credit toward the AMA Physicians Recognition Award.
Nurses (Nurse Corps officers, RN) will receive a certificate that includes the course title, date, location, and the following paragraph:
This Educational Design I activity, assigned ANC-CHEP #I102 for 17.4 contact hours, has been approved by the US Army Nurse Corps which is accredited as an approver of continuing education in nursing by the American Nurses Credentialing Centers Commission on Accreditation.
All other attendees (eg. Dental and Vet Corps officers, NCO, EMT, LPN, etc.) will receive a certificate that includes the following paragraph:
"The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity. The U. S. Army Medical Command certifies that (NAME) has participated in the educational activity entitled Medical Management of Chemical and Biological Casualties Video Course during the period (START DATE - END DATE). The activity was designated for 14.5 hours of AMA PRA category 1 credit. NOTE: No ADDITIONAL verification of attendance or credit awarded will be provided by CCCD.
7. VIDEOTAPES This course is supplied on a series of videotapes in VHS format. DoD personnel and organizations obtain tapes from the Defense Audio Visual Information System (DAVIS) at http://dodimagery.afis.osd.mil. After accessing the DAVIS website, click on Search and type "Medical Management of Chemical and Biological Casualties Course." Follow the screen instructions for ordering tapes. The title for each tape, along with instructor and viewing time is provided below.
If you have any difficulty obtaining tapes, contact the Chemical Casualty Care Division at (410) 436-2230 DSN 584-2230. Non-DoD facilitators must obtain the tapes through the National Technical Information Service (NTIS). You may visit their website at http://www.ntis.gov or contact NTIS by phone at 1-800-553-6847, fax number 703-605-6900. The order number is AVA20830VOXO and the cost for the tapes is $350.00 per set.
MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE VIDEO MATERIALS
Title Instructor Duration (Minutes) 69 36 86 62 50 52 47 28 50 59 66 55 60 44 79 30 Approximate Total (Hours) Optional Videos FTX Introduction Decontamination Total Including Optional Videos (Hrs) 14.5 16 22 15
Introduction/Overview of Chemical Agents History of The Medical Aspects of Chemical Warfare Nerve Agents and Pretreatment Vesicants Cyanide Pulmonary Agents Incapacitating Agents Riot-Control Agents Triage and Field Management of Chemical-Agent Casualties Counterterrorism and Scenarios Overview of Biological Agents Bacterial Threat - Anthrax Bacterial Threat - Plague Viral Threat - Smallpox Toxin Threat - Botulinum Toxins, Ricin, Staphylococcal Enterotoxin B, Mycotoxin Examination
LTC James M. Madsen, MC Frederick R. Sidell, M.D. Frederick R. Sidell, M.D. LTC Jonathan Newmark, MC COL Charles G. Hurst, MC LTC James M. Madsen, MC LTC Roger D. Baxter, AN LTC James M. Madsen, MC LTC Jonathan Newmark, MC LTC Roger D. Baxter, AN LTC Jonathan Newmark, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC
8. REGISTRATION FORMS Duplicate the registration form (enclosure 3), front and back, and issue a form to each participant. Ensure that all forms are complete and correct. Data on the registration form is used by the CCCD to complete the course certificates. Review the sample completed registration form with participants (enclosure 5). Remind participants that missing, incorrect or illegible entries on the registration form may result in incorrect information on the certificate or delay in receipt of a certificate.
9. STUDENT REFERENCE MATERIAL The two handbooks listed below will be provided by CCCD to each participant. These handbooks condense the core course material into an easy-reference guide, formatted to fit the cargo pocket of the BDU trousers. The number of handbooks shipped to the facilitator will be based on the estimated number of students listed on the application form. Additional reference material is available on line at http://ccc.apgea.army.mil.
Medical Management of Chemical Casualties Handbook, 3rd ed., Chemical Casualty Care Division, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland, July 2000. Medical Management of Biological Casualties Handbook, 4th ed., U.S. Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland, February 2001. 10. EXAMINATION Participants must complete the examination (enclosure 6) to receive credit for attending the course. Facilitators should use the examination key that will be emailed to you to score the exams and to review the correct answers with the participants following the exam. Facilitators may elect to have students score their own exam. Indicate on the registration form that the applicant has completed the exam and the resulting score. Collect and destroy all copies of the examination after the course. 11. FIELD TRAINING EXERCISE (FTX) The FTX Guide that accompanies this course (provided as a separate document) is a detailed description of the FTX completed by participants of the on-site MCBC Course at USAMRICD/USAMRIID. While we recommend that participants complete the FTX, it has been made optional for the videotape course since some organizations lack the necessary personnel and equipment to offer the exercise. Continuing education credit is not awarded for the FTX completed as part of the videotape course. 12. CERTIFICATE OF COURSE COMPLETION / ATTENDANCE Participants who have watched the video course in its entirety, and completed the exam, registration and critique form will receive a certificate of course completion, which includes the appropriate CME information. Completed registration forms and course critiques will be accepted for processing during the first two weeks of January, April, July and October each year. We can only accept materials sent by a facilitator. The CCCD will not process materials sent by individual participants. Certificates of course completion will be mailed to the facilitator within 30 days of the receipt, at CCCD, of registration and critique forms. The facilitator is responsible for distributing certificates to participants.
13. ENCLOSURES 1. 2. 3. 4. 5. 6. Facilitators Course Application Course Agenda Registration Form Critique Form Sample completed registration form Examination
MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE FACILITATORS GUIDE 1. PURPOSE This guide provides instructions for completing the Medical Management of Chemical and Biological Casualties (MCBC) Course by videotape for continuing education credit. 2. APPLICABILITY The MCBC Course is designed primarily for military Medical and Nurse Corps officers, physicians assistants, Medical Service Corps officers in the 67B, C, and E specialties and other medical professionals responsible for the care of chemical or biological agent casualties. This videotape course is NOT intended to replace the on-site MCBC Course offered each quarter at the US Army Medical Research Institute of Chemical Defense (USAMRICD) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). Rather, the videotape series is designed for refresher training of Department of Defense (DoD) medical personnel and as an alternate way of obtaining the core didactic material when attendance at the on-site course is not feasible. The 6.5-day, on-site MCBC course presents the didactic material in greater detail with direct access to subject matter experts and includes a laboratory and field training exercise (FTX). 3. PROPONENT This course is administered by the Chemical Casualty Care Division (CCCD), USAMRICD. Address correspondence to: Commander USAMRICD ATTN: MCMR-UV-ZM 3100 Ricketts Point Road Aberdeen Proving Ground, Maryland 21010-5400 Phone (410) 436-2230 DSN 584-2230 Fax (410) 436-3086 DSN 584-3086
E-mail ccc@apg.amedd.army.mil Internet http://ccc.apgea.army.mil
X:\WEBSITE-CCCD\Documents\facilitatorguidemcbc.doc
rev: 04/22/2002
4. BACKGROUND The exportable, videotape version of the MCBC Course consists of lectures presented by the CCCD staff from the USAMRICD and by the Operational Medicine Division staff of the USAMRIID. The majority of the chemical agent lectures were filmed during the MCBC Course presented at Aberdeen Proving Ground, Maryland in March 1998. The remaining chemical lectures, i.e. Overview, Decon, and FTX Introduction were filmed after the March course. The biological agent lectures were extracted from the satellite broadcast of The Medical Management of Biological Casualties program presented in September 1998. 5. FACILITATORS ROLE Optimally, the videotape series is presented in its entirety, as a complete course. The Field Training Exercise (FTX) portion of this course is optional. When this course is presented to a group, a facilitator must be designated to administer the course and assume responsibility for the following: a. Complete and return the Facilitators Course Application form (enclosure 1). Upon approval of the application, the course is assigned a Course ID and the Course ID along with the exam answer key is emailed to the facilitator. The Course ID is a unique number based on course site, start date, and end date. The course should be completed within 3 months, i.e., January-March, April-June, July-September, and October-December. See section 12 for further details. b. Obtain videotapes. See section 7 for details. c. Following approval of the application, act as the point of contact and liaison between course attendees and the course proponent (CCCD) before, during and after the course. d. Provide a room of appropriate size and location for presentation of the course. e. Distribute course materials. f. Provide and operate the equipment necessary to view the videotapes. g. Ensure that students view all videotapes according to the agenda (enclosure 2). h. Proctor and score the examination (enclosure 6) and ensure against compromise of exam materials. Indicate on each Student Registration Form the Course ID, if the student completed the exam, and the resulting score. i. Dispose of all exam papers. Participants are NOT permitted to keep the exam. j. Ensure that course registration and critique forms (enclosures 3 and 4) are properly completed and returned to CCCD. k. Distribute Certificates to attendees. l. If an FTX is included, provide an appropriate training area, equipment and station instructors. Brief instructors using the enclosed FTX Guide. Ensure that the FTX is safely and effectively organized and executed.
rev: 04/22/2002
6. CONTINUING EDUCATION CREDIT Award of continuing education credit for the videotape series is based on its presentation as a complete course. Students must view all videotapes in their entirety. Credit is not awarded for the FTX. To receive continuing education credit for this course an attendee must: a. b. c. d. e. Complete the registration form. View the videotape series in its entirety. Complete the examination. Complete the critique form. Return a completed registration form and critique form to the facilitator.
The facilitator will send registration and critique forms to CCCD for processing. CCCD will process the completed registration and critique forms and forward the appropriate certificates to the facilitator. Physicians (Medical Corps officers, MD, DO) will receive a certificate that includes the following paragraph:
The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity. The U.S. Army Medical Command certifies that (NAME) has participated in the educational activity entitled Medical Management of Chemical and Biological Casualties Video Course on during the period (START DATE - END DATE) and is awarded 14.5 hours of category 1 credit toward the AMA Physicians Recognition Award.
Nurses (Nurse Corps officers, RN) will receive a certificate that includes the course title, date, location, and the following paragraph:
This Educational Design I activity, assigned ANC-CHEP #I102 for 17.4 contact hours, has been approved by the US Army Nurse Corps which is accredited as an approver of continuing education in nursing by the American Nurses Credentialing Centers Commission on Accreditation.
All other attendees (eg. Dental and Vet Corps officers, NCO, EMT, LPN, etc.) will receive a certificate that includes the following paragraph:
"The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity. The U.S. Army Medical Command certifies that (NAME) has participated in the educational activity entitled Medical Management of Chemical and Biological Casualties Video Course during the period (START DATE - END DATE). The activity was designated for 14.5 hours of AMA PRA category 1 credit. NOTE: No ADDITIONAL verification of attendance or credit awarded will be provided by CCCD.
rev: 04/22/2002
7. VIDEOTAPES This course is supplied on a series of videotapes in VHS format. DoD personnel and organizations obtain tapes from the Defense Audio Visual Information System (DAVIS) at http://dodimagery.afis.osd.mil. After accessing the DAVIS website, click on Search and type "Medical Management of Chemical and Biological Casualties Course." Follow the screen instructions for ordering tapes. The title for each tape, along with instructor and viewing time is provided below. If you have any difficulty obtaining tapes, contact the Chemical Casualty Care Division at (410) 436-2230 DSN 584-2230. Non-DoD facilitators must obtain the tapes through the National Technical Information Service (NTIS). You may visit their website at http://www.ntis.gov or contact NTIS by phone at 1-800-553-6847, fax number 703-605-6900. The order number is AVA20830VOXO and the cost for the tapes is $350.00 per set. MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE VIDEO MATERIALS
Title Introduction/Overview of Chemical Agents History of The Medical Aspects of Chemical Warfare Nerve Agents and Pretreatment Vesicants Cyanide Pulmonary Agents Incapacitating Agents Riot-Control Agents Triage and Field Management of Chemical-Agent Casualties Counterterrorism and Scenarios Overview of Biological Agents Bacterial Threat - Anthrax Bacterial Threat - Plague Viral Threat - Smallpox Toxin Threat - Botulinum Toxins, Ricin, Staphylococcal Enterotoxin B, Mycotoxin Examination Optional Videos FTX Introduction Decontamination Total Including Optional Videos (Hrs) Instructor LTC James M. Madsen, MC Frederick R. Sidell, M.D. Frederick R. Sidell, M.D. LTC Jonathan Newmark, MC COL Charles G. Hurst, MC LTC James M. Madsen, MC LTC Roger D. Baxter, AN LTC James M. Madsen, MC LTC Jonathan Newmark, MC LTC Roger D. Baxter, AN LTC Jonathan Newmark, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC Duration (Minutes) 69 36 86 62 50 52 47 28 50 59 66 55 60 44 79 30 Approximate Total (Hours) 14.5 16 22 15
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8. REGISTRATION FORMS Duplicate the registration form (enclosure 3), front and back, and issue a form to each participant. Ensure that all forms are complete and correct. Data on the registration form is used by the CCCD to complete the course certificates. Review the sample completed registration form with participants (enclosure 5). Remind participants that missing, incorrect or illegible entries on the registration form may result in incorrect information on the certificate or delay in receipt of a certificate. 9. STUDENT REFERENCE MATERIAL The two handbooks listed below will be provided by CCCD to each participant. These handbooks condense the core course material into an easy-reference guide, formatted to fit the cargo pocket of the BDU trousers. The number of handbooks shipped to the facilitator will be based on the estimated number of students listed on the application form. Additional reference material is available on line at http://ccc.apgea.army.mil. Medical Management of Chemical Casualties Handbook, 3rd ed., Chemical Casualty Care Division, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland, July 2000. Medical Management of Biological Casualties Handbook, 4th ed., U.S. Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland, February 2001. 10. EXAMINATION Participants must complete the examination (enclosure 6) to receive credit for attending the course. Facilitators should use the examination key that will be emailed to you to score the exams and to review the correct answers with the participants following the exam. Facilitators may elect to have students score their own exam. Indicate on the registration form that the applicant has completed the exam and the resulting score. Collect and destroy all copies of the examination after the course. 11. FIELD TRAINING EXERCISE (FTX) The FTX Guide that accompanies this course (provided as a separate document) is a detailed description of the FTX completed by participants of the on-site MCBC Course at USAMRICD/USAMRIID. While we recommend that participants complete the FTX, it has been made optional for the videotape course since some organizations lack the necessary personnel and equipment to offer the exercise. Continuing education credit is not awarded for the FTX completed as part of the videotape course.
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12. CERTIFICATE OF COURSE COMPLETION / ATTENDANCE Participants who have watched the video course in its entirety, and completed the exam, registration, and critique form will receive a certificate of course completion, which includes the appropriate CME information. Completed registration forms and course critiques will be accepted for processing during the first two weeks of January, April, July and October each year. At that time, certificates of course completion will be processed and mailed to the facilitator. We can only accept materials sent by a facilitator. The CCCD will not process materials sent by individual participants. The facilitator is responsible for distributing certificates to participants.
13. ENCLOSURES 1. 2. 3. 4. 5. 6. Facilitators Course Application Course Agenda Registration Form Critique Form Sample completed registration form Examination
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FACILITATOR COURSE APPLICATION MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE
Facilitator Last Name: Facilitator First Name: Service: Grade: Rank: Branch:
Materials and certificates will be mailed to the address below. Address:
City: Commercial Phone: Email: Fax: Course Site (Location, city, state): Course Start Date: (DD/MON/YYYY) Approximate Number of Students:
State: DSN Phone:
Zip:
Course End Date: (DD/MON/YYYY)
CCCD Use Only: COURSE ID:
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SAMPLE AGENDA FOR MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE Course Location: (Your Location) (DATE) DAY 1 0800 0900 0940 0950 1130 1140 1240 1340 1440 1440 1450 1540 1610 Introduction/Overview of Chemical Agents History of the Medical Aspects of Chemical Warfare Break Nerve Agents and Pretreatment Break Vesicants Lunch Cyanide Pulmonary Agents Break Incapacitating Agents Riot-Control Agents Fill Out Critique LTC James Madsen, MC LTC Jonathan Newmark, MC LTC James Madsen, MC LTC Roger D. Baxter, AN COL Charles G. Hurst, MC Fredrick R. Sidell, M.D. LTC Jonathan Newmark, MC LTC James Madsen, MC Fredrick R. Sidell, M.D.
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DAY 2 0800 0900 1000 1015 1130 1200 1240 1340 1420 Triage and Field Management of Chemical-Agent Casualties NBC Counterterrorism and Scenarios Break Overview of Biological Agents Bacterial Threat- Anthrax Bacterial Threat- Plague Lunch Viral Threat- Smallpox Toxin Threat - Botulinum Toxins Ricin, Staphylococcal Enterotoxin B, Mycotoxin Fill Out Critique DAY 3 0800 0830 0930 1030 1230 Examination Decontamination (Optional) Introduction to the Field Exercise (Optional) Field Training Exercise (Optional) Fill Out Critique LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Roger D. Baxter, AN LTC Jonathan Newmark, MC
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STUDENT REGISTRATION FORM

MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE
SEE BELOW FOR PRIVACY ACT STATEMENT Last Name: First Name: MI:
See Codes on Page 2 to complete the following section.

Service: Grade: Rank: Branch:
Social Security Number:
Sex:
Foreign National: Yes No
Street Address:
City: Telephone (DSN): Email Address: Job Title:
State: Commercial:
Zip:
TO BE COMPLETED BY FACILITATOR: COURSE ID: EXAM COMPLETED: SCORE: YES NO
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SERVICE CODES
AA ARNG USAR AF AFR ANG USMC USN USNR PHS FN CIV Active Army Army National Guard Army Reserves Air Force Air Force Reserves Air Force National Guard Marine Corps Navy Navy Reserves Public Health Services Foreign Nationals Civilian
BRANCH CODES
AN CM DC MC MS NC VC Army Nurse Corps Chemical Corps Dental Corps Medical Corps Medical Service Corps Nurse Corps (Navy and Air Force) Veterinary Corps IDC 18D 91B 91C ENL SP Independent Duty Corpsman (Navy) Special Forces Medic (Army) Medic LPN Enlisted (except for 91B and 91C) Specialist Corps (e.g. Army Physicians Assistant) PA Physicians Assistant (excluding Army) MISC (for branch codes not specified Above)
PRIVACY ACT STATEMENT

Title 5 to the U.S. Code authorizes collection of this information. The primary use of this information is by management and your personnel office to record your attendance in this course. Additional disclosures of the information may be: To the Office of Personnel Management or General Account Office when the information is required for evaluation of training; to the General Services Administration in connection with its responsibilities for records management; to a Federal, State, or local law enforcement agency when your agency becomes aware of a violation or possible violation of civil or criminal law; and to a Federal agency when conducting an investigation on you for employment or security reasons. Where the employee identification number is your social security number, collection of this information is authorized by Executive Order 9397. Furnishing the information on this form, including your social security number, is voluntary, but failure to do so may result in misplacement of your record of attendance. If your agency uses the information furnished on this form for purposes other than these indicated above, it may provide you with an additional statement reflecting these purposes.
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CRITIQUE MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE Course ID:
Please rate the sections as follows: 1. Outstanding 2. Excellent 3. Good 4. Fair 5. Poor
DAY 1
LECTURE/SPEAKER Introduction/Overview of Chemical Agents History of the Medical Aspects of Chemical Warfare Nerve Agents/Pretreatment Vesicants Cyanide Pulmonary Agents Incapacitating Agents Riot Control Agents CONTENT _________ _________ _________ _________ _________ _________ _________ _________ PRESENTATION ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ SUITABILITY ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ OVERALL ________ ________ ________ ________ ________ ________ ________ ________
DAY 2
LECTURE/SPEAKER Triage and Field Management Of Chemical -Agent Casualties NBC Counterterrorism and Scenarios Overview of Biological Agents Bacterial Threat- Anthrax Bacterial Threat- Plague Viral Threat - Smallpox Toxin Threat- Botulinum Toxins, Ricin, Staphylococcal Enterotoxin B, Mycotoxin CONTENT _________ _________ _________ _________ _________ _________ PRESENTATION ______________ ______________ ______________ ______________ ______________ ______________ SUITABILITY ___________ ___________ ___________ ___________ ___________ ___________ OVERALL ________ ________ ________ ________ ________ ________
_________
______________
___________
________
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DAY 3
LECTURE/SPEAKER Examination Introduction to the FTX Field Training Exercise CONTENT _________ _________ _________ PRESENTATION ______________ ______________ ______________ SUITABILITY ___________ ___________ ___________ OVERALL ________ ________ ________
************************************************************************************************************* 1. Did this course satisfy your requirements? How - or why not?
2. If you were Course Director, what changes would you make?
3. Do you have any other criticisms/comments?
4. Do you feel that this program was fair, balanced and free of commercial bias?
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SAMPLE COMPLETED STUDENT REGISTRATION FORM

SEE BELOW FOR PRIVACY ACT STATEMENT Last Name: DOE First Name: JOHN MI: A

Service: AA Grade: O5 Rank: LTC Branch: MC
Social Security Number:
111-11-1111
Sex:
Foreign National: Yes No
Street Address:
COMMANDER USAMRICD ATTN MCMR UV ZM 3100 RICKETTS POINT RD.
City:
ABERDEEN PROVING GROUND
State:
MD
Zip:
21010-5400
Telephone (DSN): 584-2230 Job Title: INSTRUCTOR
Commercial:
(410) 436-2230
TO BE COMPLETED BY FACILITATOR: COURSE ID: EXAM COMPLETED: SCORE: YES NO
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SERVICE CODES
AA ARNG USAR AF AFR ANG USMC USN USNR PHS FN CIV Active Army Army National Guard Army Reserves Air Force Air Force Reserves Air Force National Guard Marine Corps Navy Navy Reserves Public Health Services Foreign Nationals Civilian
BRANCH CODES
AN CM DC MC MS NC VC Army Nurse Corps Chemical Corps Dental Corps Medical Corps Medical Service Corps Nurse Corps (Navy and Air Force) Veterinary Corps IDC 18D 91B 91C ENL SP Independent Duty Corpsman (Navy) Special Forces Medic (Army) Medic LPN Enlisted (except for 91B and 91C) Specialist Corps (e.g. Army Physicians Assistant) PA Physicians Assistant (excluding Army) MISC (for branch codes not specified Above)

Title 5 to the U.S. Code authorizes collection of this information. The primary use of this information is by management and your personnel office to record your attendance in this course. Additional disclosures of the information may be: To the Office of Personnel Management or General Account Office when the information is required for evaluation of training; to the General Services Administration in connection with its responsibilities for records management; to a Federal, State, or local law enforcement agency when your agency becomes aware of a violation or possible violation of civil or criminal law; and to a Federal agency when conducting an investigation on you for employment or security reasons. Where the employee identification number is your social security number, collection of this information is authorized by Executive Order 9397. Furnishing the information on this form, including your social security number, is voluntary, but failure to do so may result in misplacement of your record of attendance. If your agency uses the information furnished on this form for purposes other than these indicated above, it may provide you with an additional statement reflecting these purposes.
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The Medical Management of Chemical and Biological Casualties Video Course Comprehensive Final Exam
Following are 40 questions regarding the medical management of biological and chemical casualties. Please read each question thoroughly and mark the answer on your answer sheet only that is the MOST appropriate choice. 1. The clinical manifestations of Venezuelan Equine Encephalitis can consist of the following: a. b. c. d. A benign influenza-like illness A severe febrile encephalitis with a 20% fatality rate A febrile illness consisting of headaches, myalgias, vomiting, diarrhea, and lethargy which lasts 35 days and has an overall case fatality rate of less than 1% All of the above
2. The biological warfare agent that the United States is most concerned that Saddam Hussein might use against our troops in the Persian Gulf is: a. b. c. d. e. Clostridium botulinum Vibrio cholerae Yersinia pestis Bacillus anthracis Francisella tularensis
3. The following measures were instituted to protect our troops in the Persian Gulf against weaponized Bacillus anthracis during the Gulf War: a. b. c. d. Ciprofloxacin in a 5-day blister pack was issued to each soldier to begin taking immediately after exposure and was to be continued for 30 days if a true exposure occurred Soldiers deemed to be at highest risk of exposure were given two doses of the licensed vaccine two weeks apart early in January 1991 All soldiers in the theater would have eventually received three doses of the licensed vaccine, as more was made, if the conflict had continued for several months All of the above
4. The biological threat agent with the potential for producing the greatest number of deaths in a battlefield field environment is: a. b. c. d. Q Fever Tularemia Anthrax Staphylococcal Enterotoxin B
5. In the event of a biological agent attack, the impact on the health care system would most likely include all except: a. b. c. d. Fear and potentially panic Overwhelming casualty numbers Overwhelming demand for intensive care modalities High potential for patient to provider spread of the disease agent
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6. The single greatest risk for medical staff caring for Viral Hemorrhagic Fever patients is: a. b. c. d. e. Small-particle aerosols generated from pulmonary secretions Small-particle aerosols resulting from arterial blood shed at high pressure Droplets that may deposit on conjunctivae Needle-stick injuries Acquiring illness from same vector/reservoir that infected the patient
7. Vaccines that could be useful in protecting military personnel exist for all of the following hemorrhagic fever viruses except: a. b. c. d. Argentine hemorrhagic fever Rift Valley fever Yellow fever Ebola virus
8. Which is not correct of biological toxins: a. b. c. d. Can easily defeat the protective mask Not easily absorbed through the skin Some are more toxic than the classical chemical agents As a group the toxins have numerous mechanisms of action
9. Ricin: a. b. c. d. Is produced by a sea snail Causes different lesions intravenously than by inhalation Is much more lethal than the botulinum toxin Precursor materials are scarce in tropical areas of the world
10. Which of the following is false regarding treatment of plague: a. b. c. d. e. Chloramphenicol is the first drug of choice used to treat plague meningitis Face-to-face contacts of pneumonic plague victims should be given prophylaxis with a tetracycline Emergence of antibiotic-resistant Yersinia pestis is a common problem in the treatment of plague Streptomycin is the drug of choice for treating both bubonic and pneumonic plague Both A and C
11. Plague Vaccine, USP: a. b. c. d. Is a live-attenuated whole-cell preparation yielding life-long protection via a single inoculation Is proven to be effective in immunizing and protecting troops for rapid deployment (within one month) Is virtually unchanged since its development 50 years ago Is a component vaccine made with recombinant DNA technology
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12. The most effective particle size range of an infectious aerosol is: a. b. c. d. Less than one micron One to five microns Seven to twelve microns Greater than 20 microns
13. The best time for disseminating an effective aerosol is: a. b. c. d. Just before sunrise, dusk, or at night During daylight in order to maximize the number of people outside of their homes and buildings When the wind is blowing 20-30 mph in order to quickly and effectively distribute the infectious aerosol None of the above
14. All of the following statements regarding Q fever are true, except: a. b. c. d. Infection may be initiated by as few as 10 organisms The incubation period is constant, regardless of whether the infecting inoculum is large or small The signs and symptoms of Q fever are non-specific, so the diagnosis requires a high index of suspicion and/or compatible epidemiological history Administration of the vaccine should be preceded by a skin test
15. Most BW agents produce sufficiently distinct clinical signs that a health care provider could make a reasonable clinical assessment without laboratory support. a. b. True False
16. Patients with illnesses due to most biological warfare agents can be safely cared for using Standard Precautions (gown, gloves, surgical masks, eye protection). a. b. True False
17. How may Investigational New Drugs (Vaccines) be administered according to FDA regulation: a. b. c. d. They may be given as any other drug is given They must be given under protocol with informed consent They may be given under a protocol but informed consent is not required They may be given by the military as any other drug is given but must be given to the general public under protocol and informed consent
18. Tularemia is considered a possible aerosol agent because: a. b. c. d. e. It requires a low infecting dose It causes a severe febrile illness with up to 30% mortality It resists all known antibiotics All vaccines are ineffective against it Both A and B are correct
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19. The lethal effects of inhalational anthrax occur primarily in which of the following anatomic sites: a. b. c. d. Lungs Kidneys Mediastinum Brain
20. An epidemic is likely to be a biological warfare attack if: a. b. c. d. There are a record number of cases and a high attack rate A low number of cases and a 100% attack rate Two or more unusual diseases occur in an area in a combined epidemic Both A and C are correct
21. Which of the following is true concerning LD50, the Ct product, and LCt50? a. b. c. d. e. They estimate the amount of agent with a 50% chance of killing an individual Effects from a given Ct product are essentially unaffected by rate and depth of breathing Both LD50 and LCt50 estimate how much agent would kill 50% of an exposed group As the LD50 and LCt50 get smaller, the agent potency (toxicity) decreases as well The LCt50 of mustard is greater than the average LCt50 of cyanide
22. Of the following, the earliest indicator of pulmonary edema in a casualty exposed to a respiratory agent is: a. b. c. d. e. an abnormal arterial-blood-gas (ABG) test dyspnea (shortness of breath) a pattern of scattered infiltrates with Kerley B lines on PA and lateral chest radiographs dullness to percussion on physical examination. wheezing
23. Which of the following is true concerning cyanide? a. b. c. d. e. A dependable warning of the presence of AC is its characteristic odor of bitter almonds As a blood agent, cyanide binds avidly to the oxyhemoglobin in blood Cyanide reacts strongly with certain transitional metals and with sulfur donors Because cyanide prevents cellular utilization of oxygen, supplemental oxygen is not indicated Once breathing has stopped, a cyanide casualty should be triaged as expectant
24. In a person severely intoxicated by nerve agent, atropine administration should be titrated to which of the following? a. b. c. d. e. Clinical reduction of bronchospasm and secretions Clinical restoration of normal heart rate and blood pressure Clinical reduction of skeletal-muscle fasciculations and twitching Clinical reduction of gastrointestinal distress and spasm Clinical resolution of miosis and eye pain
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25. Differences between sulfur mustard and Lewisite include which of the following? a. b. c. d. e. Mustard patients usually need more vigorous fluid resuscitation than do Lewisite patients Lewisite is approximately 5 to 8 times more toxic than is sulfur mustard The latent period of Lewisite is longer than that of sulfur mustard Pulmonary edema is more likely with Lewisite than with sulfur mustard Lewisite has a higher boiling point than does sulfur mustard
26. It is important to decide whether agent exposure is to vapor or to liquid because: a. b. c. d. e. only vapors produce eye effects the strength of bleach chosen depends upon whether the agent is a vapor or a liquid clinical effects from liquid exposure may be delayed wearing the mask may not be necessary if the agent is liquid diazepam is not indicated for exposure to nerve-agent vapor
27. Which of the following is true concerning peripherally acting pulmonary agents? a. b. c. d. e. Symptoms never precede signs They cause clinical effects that mimic adult respiratory distress syndrome (ARDS) Irritation of the nose and mouth with coughing and bronchospasm effectively excludes these agents Their peripheral effects are probably caused by hydrochloric acid In most cases, prophylactic administration of antibiotics is a reasonable medical option
28. The M256 detector ticket will detect vapors of which of the following? a. b. c. d. e. Nerve agents and cyanide only Nerve, cyanide, and vesicant agents Cyanide, mustard, and only the G nerve agents Vesicants and nerve agents only None of the above
29. For a casualty exposed on the skin to liquid mustard two hours ago, skin decontamination: a. b. c. d. e. should be omitted, since the damage occurred during the first two to five minutes should be done using 5% instead of 0.5% hypochlorite should be done only to protect health-care workers should be done to inactivate mustard in blisters, since mustard in fluid is very persistent should be done to protect the patient from continuing exposure and to protect health-care workers
30. Which of the following is true about incapacitating agents? a. b. c. d. e. The agent once weaponized by the U.S. was a highly persistent liquid Bradycardia (heart rate "slow as a snail") is one of the characteristic presenting signs Classic central-nervous-system effects include abstract geometric hallucinations Administration of a specific antidote is almost always indicated in confused or combative casualties Iraq is suspected of having stockpiled large amounts of one of these agents in the 1980s.
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31. Which of the following is the standard U.S. military treatment for cyanide poisoning on the battlefield? a. b. c. d. e. Sodium nitrate followed by sodium thiosulfite Amyl nitrite followed by sodium nitrate and then sodium thiosulfite 100% oxygen administered concomitantly with sodium thiosulfate Sodium nitrite, sodium thiosulfite, and diazepam Sodium nitrite and sodium thiosulfate
32. Someone with severe systemic effects from a nerve agent should initially receive: a. b. c. d. e. Three MARK I kits (NAAKs) Diazepam (CANA) Three MARK I kits (NAAKs) and diazepam (CANA) One MARK I kit (NAAK) Three Mark I kits (NAAKs) and an additional 2 mg of atropine
33. Which of the following statements concerning sulfur mustard is true? a. b. c. d. e. Mustard is a recognized carcinogen Body surface area involved with skin burns is highly correlated with mortality Mustard dissolves quickly in aqueous solutions such as sweat Hands were among the body sites most frequently burned by mustard in World War I Mustard penetrates skin rapidly but typically takes several hours to damage skin cells
34. The M40 protective mask with its C2A1 canister: a. b. c. d. e. Depends upon a HEPA particulate filter as a barrier to cyanide, G agents, and phosgene Will protect the wearer against carbon monoxide and low concentrations of oxygen Is to be donned, cleared, and checked in up to 15 seconds Uses zinc-impregnated charcoal to adsorb molecules of chemical-agent vapor and gas Is only rarely associated with increased work of breathing and shortness of breath
35. Central effects differ from peripheral effects in that central effects: a. b. c. d. e. Seldom exhibit a latent period Do not usually result from exposure to phosgene or PFIB Should be suspected when a casualty reports being short of breath Cause gurgling from pulmonary-edema fluid rising in the airways Usually produce noise from turbulent airflow
36. At a battalion aid station (BAS), a casualty who was exposed 30 minutes ago to nerve-agent vapor and liquid and who is now reporting mild dyspnea (which is resolving) should be triaged as: a. b. c. d. e. urgent immediate delayed minimal expectant
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37. Pre-exposure administration of pyridostigmine bromide: a. b. c. d. e. is given when ordered by the senior medical officer in the division is given to create a reserve force of protected AChE is most appropriate when the threat agent is known to be GF is associated with a high incidence of debilitating side effects increases survival even when antidotes are not given after nerve-agent exposure
38. Effects after cyanide inhalation typically include which of the following? a. b. c. d. e. Miosis, bronchial hypersecretion, and nausea Brief hyperventilation and initial increases in heart rate and blood pressure Convulsions, vomiting, and flaccid paralysis Muscle weakness, cyanosis, and secretions Sudden loss of consciousness after a latent period of up to 60 minutes
39. A specific antidote for incapacitating agents is: a. b. c. d. e. neostigmine pyridostigmine physostigmine pralidoxime none of the above
40. The clean treatment area should be: a. b. c. d. e. upwind from the area of contamination downwind from contamination in order to take advantage of detector systems in place uncovered whenever possible to prevent dripping of agent from overhead cover downwind from the PDS as close as possible to the hot line
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Courses Courses
This CD-ROM is a comprehensive look at all of our products and training materials. It contains the Medical Management of Chemical Casualties Fundamentals mini course, consisting of PowerPoint presentations, speaker notes and speaker voice-overs for each slide. Lectures cover: history, nerve agents, vesicants, pulmonary agents, cyanide, field management, triage, and decontamination. The mini course is an excellent overview in the medical management of chemical casualties. This CD-ROM also contains interactive multimedia assessment scenarios, the Medical Management of Nerve Agent Casualties interactive module, a Field Training Exercise (FTX) guide, over 100 minutes of scenarios and educational video segments, information about our courses and how to obtain our products, a medical supplies database, a variety of handbooks, textbooks, field manuals, reference articles, and over 100 minutes of video segments. if you have any questions about our CD please e-mail us here
MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES COURSE
FIELD TRAINING EXERCISE INSTRUCTOR GUIDE
CHEMICAL CASUALTY CARE DIVISION US ARMY MEDICAL RESEARCH INSTITUTE OF CHEMICAL DEFENSE
USAMRICD ATTN: MCMR-UV-ZM 3100 Ricketts Point Road Aberdeen Proving Ground, MD 21010-5400 Phone: DSN 584-2230, CML (410) 436-2230 Fax: DSN 584-3086, CML (410) 436-3086 e-mail: ccc@apg.amedd.army.mil Website: http://ccc.apgea.army.mil
IT IS RECOMMENDED THAT THIS DOCUMENT BE PRINTED DOUBLE-SIDED
MCBC FTX INSTRUCTOR'S GUIDE
MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES COURSE FIELD TRAINING EXERCISE INSTRUCTORS GUIDE 1. PURPOSE This Field Training Exercise (FTX) was developed by the Chemical Casualty Care Division (CCCD) to accompany the Medical Management of Chemical and Biological Casualties Course (MCBC) presented at the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD). This guide may be used to develop an FTX for any medical unit training for chemical casualty management. The goal of this exercise is to familiarize course participants with: a) the proper use, capabilities, and limitations of military personal-protective, detection, and decontamination equipment; b) the processes necessary to manage contaminated casualties; and c) the challenges associated with the care of contaminated casualties. Because this is a familiarization exercise, hands-on participation is encouraged, but attendee performance at the stations is not graded. 2. REFERENCES Field Management of Chemical Casualties Handbook, 2nd ed., Chemical Casualty Care Division, USAMRICD, June 2000. Medical Management of Chemical Casualties Handbook, 3rd ed., Chemical Casualty Care Division, USAMRICD, June 2000. Textbook of Military Medicine, Part I, Medical Aspects of Chemical and Biological Warfare, Office of the Surgeon General, Borden Institute, Washington D.C., 1997. US Army Field Manual 8-10-7, Health Service Support in a Nuclear, Biological, and Chemical Environment, 22 April 1993. US Army Soldiers Manual of Common Tasks, 91B. 3. SCOPE This FTX is designed primarily for military physicians, nurses, physician assistants, medics and Chemical Corps personnel. Civilian health care providers may also benefit from this exercise.
4. APPLICABILITY This training applies to all personnel who may be involved in the pre-hospital management of chemical-warfare agent casualties. 5. GENERAL GUIDELINES The components of the exercise are the safety briefing, the MOPP-donning drill, the casualty assessment exercise, and the teaching stations. The teaching stations include: the Emergency Medical Treatment (EMT) Tasks station, the EMT Discussion station, the Litter-Casualty Decontamination station, the AmbulatoryCasualty Decontamination station, and the Hotline station. The FTX is designed for classes of up to 100 students. This same design will work for even larger groups if extra instructors are added to existing stations and/or extra stations are added. The Casualty Assessment Exercise takes about an hour. Each teaching-station rotation takes 20-25 minutes. The entire FTX should take no more than 4 hours. NOTE: Station-Instructor Guides (Appendix A) contain information about station setup, equipment, and major teaching points. Duplicate and distribute these guides to the station instructors before the day of the FTX. Issue the Student Guide to The Field Training Exercise (Appendix B) to participants one or two days before the FTX. Review the Student Guide with the class on the afternoon before, or the morning of, the FTX. a. Site Set-up The list of equipment necessary for the FTX is identified in Appendix C. Most of the equipment needed for this exercise is available at a Battalion Aid Station. The stations should be set up in a lane representing the basic layout of a typical Patient Decontamination Site: the Casualty Assessment area (representing the triage area), followed by the EMT stations, the Decontamination stations, and finally the Hotline station. This FTX may be executed indoors within an area the size of a basketball court if necessary. b. Safety The safety procedures followed during exercises at USAMRICD are described in Emergency Medical Service Standard Operating Procedures (Appendix D). Use your local safety SOP when executing this FTX as part of an exportable course. The CCCD SOP may be used as a template for developing a local safety SOP. Prior to the FTX, confirm that military participants have no medical profile(s) that would preclude wearing the protective mask and Battle Dress Overgarment (BDO). Civilian participants must be medically cleared to wear the protective mask for
training. Request that civilian participants complete and return to the Officer in Charge (OIC) the Protective Mask/Respirator Medical Clearance Form (Appendix E). A physicians signature confirms that the participant is at low risk for medical problems associated with protective mask wear. To reduce the risk of heat injury, the Physical Fitness Uniform should be the uniform of the day during hot weather. Equipment should include the chemical protective mask with hood, BDO, butyl rubber gloves with inserts, overboots, canteen and web belt. Ensure that participants begin the exercise with a full canteen and know where to obtain additional water during the exercise. At a minimum, the following issues should be discussed in a safety briefing presented just prior to the start of the FTX: 1) the potential for heat injury when wearing MOPP gear, 2) the importance of and the procedure for proper hydration, 3) the potential for sharps injury at the EMT Tasks station, 4) the procedure for reporting a true medical emergency during the FTX, 5) the requirement to wear gloves if handling M9 detector tape, and 6) the mandatory use of litter straps and four-man carry if transporting mock casualties by litter. Directions for use of the Wet-Bulb Globe Thermometer (WBGT) are found in Appendix F. Use WBGT data to determine appropriate work-rest cycles during the FTX. c. MOPP Donning Drill If volunteers from the class will act as casualties for the casualty-assessment exercise (see section d., Casualty Assessment Exercise), they should prepare themselves for the casualty-assessment exercise while the remainder of the class completes the MOPP Donning Drill. The stepwise procedure for donning the protective mask and BDO should be demonstrated to the group sometime during the course and/or just before the MOPP Donning Drill. Follow the procedure outlined in the Soldiers Manual of Common Tasks. Give the class 9 seconds to don the protective mask. Assess their performance. Then give the group an additional 8 minutes to don the remainder of the protective ensemble. The station instructors should be available to monitor performance and assist class members who have difficulty completing the task. Remind class members to use the buddy method for donning the gear and checking for correctness of wear. When 8 minutes have elapsed, instructors should assess participants for proper wear of the ensemble. For additional control during the FTX, squads may be identified by color. Following the MOPP donning drill, issue a different-color plastic tape to each squad leader and instruct the leaders to affix a strip of tape to the BDO sleeve of each squad member.
d. Casualty Assessment Exercise In this exercise volunteers enact a chemical exposure scenario from a script (Appendix G), allowing participants to practice the clinical assessment of chemical casualties. Details of the exercise are described in the Casualty Assessment Exercise Instructors Guide (Appendix A). NOTE: Distribute the Casualty Scripts to the volunteers a day or two before the FTX so they can become familiar with their scenario and ask questions about the script. Option 1, casualty assessment as one station in the rotation: If volunteers can be obtained from outside the class, this exercise can be completed as one of the stations in the rotation. Answers to the scenarios can be presented for class discussion after the entire FTX is completed (answers are provided on the casualty script). The discussion normally takes between 30 minutes and an hour. Option 2, casualty assessment as a separate exercise: Class members may be used as volunteer casualties. This exercise, including a discussion of the answers to the exercise, can then be completed after the MOPP Donning Drill and before the station rotations. If possible, no more than four students at a time should assess each casualty. Therefore, for classes with more than sixty participants, two groups of 12 casualties (24 volunteers from the class) should be used. In this case, each of the 12 scenarios is duplicated and enacted by two volunteers in two separate circles. Half of the class assesses one group of 12 casualties while the other half of the class assesses the second group of 12 casualties who enact the same scenarios. 6. LIST OF APPENDICES Appendix A Station-Instructor Guides Casualty Assessment Exercise Emergency Medical Treatment - Tasks Station Emergency Medical Treatment - Discussion Station Litter-Patient Decontamination Station Ambulatory-Patient Decontamination Station Hotline Station Appendix B Student Guide to The Field Training Exercise
Appendix C Equipment List Appendix D Safety Standard Operating Procedures Appendix E Protective Mask/Respirator Medical Clearance Form Appendix F General Instructions, Wet Bulb-Globe Temperature Kit Appendix G Casualty Assessment Exercise Scripts Appendix H Casualty Assessment Exercise Note-Taking Outline
MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES COURSE FIELD TRAINING EXERCISE
APPENDIX A STATION-INSTRUCTOR GUIDES
APPENDIX A - CASUALTY ASSESSMENT EXERCISE STATION GUIDE
CASUALTY ASSESSMENT EXERCISE INSTRUCTORS GUIDE 1. OBJECTIVE For each of 12 simulated casualties, students are given two minutes to assess the casualty, determine a triage category, and recommend management. Students discuss their assessment and management recommendations for these casualties immediately following the exercise or at the end of the FTX. 2. EQUIPMENT NOTE: If Option 2 (see section d., Casualty Assessment Exercise) is used with a large class, double the number of items listed below as necessary to create two circles of 12 casualties. -Casualty Scripts (Appendix G) - 12 litters - MOPP gear and protective masks for 12 mock casualties (if training MOPP is unavailable, casualties should at least wear the protective mask) - Canteens and/or a water point for casualties - One roll of M9 detector tape or masking tape to simulate M9 - 12 blank Field Medical Cards (FMC) - Note-taking outline (Appendix H): enough copies for each student in the class to record data on each casualty. Issue 3 two-sided copies per student. - Sharpened pencils, one for each student in a rotation - Moulage supplies: field dressing x 3, cravat x 3, splint x 1, blood simulant (e.g. Karo syrup with red food coloring added), red greasepaint or rouge, and red marking pen to add spots to M9 tape. - Stopwatch or wristwatch with a second hand - Bullhorn, whistle, or other signaling device to signal a station rotation (optional) 3. PERSONNEL - 1 station instructor / timekeeper - 12 (or 24) volunteers to play mock casualties 4. SET UP Issue training MOPP gear, a protective mask, and a different Casualty Script (Appendix G) to each of the 12 volunteers. The scripts include a scenario, the acting script, the moulage required, data for the FMC, and the answers to the problem. Casualties will require 30-60 minutes to fill out their FMCs, don their MOPP gear, apply moulage, and learn their scripts. Position the 12 litters on the ground in a large circle with enough space between litters to allow small groups of students to gather around each litter. Casualties will
lie on the litters in sequence (#1-12) with their feet facing toward the center of the circle. 5. SAFETY Ensure that the casualties have a ready source of water. Encourage them to rehydrate when not performing their scenario for students. Provide casualties ready access to latrine facilities and permit them to take breaks, if necessary, when not performing their scenario. Instruct casualties to dress comfortably under their BDO. On warm days, for instance, casualties should wear the PT uniform instead of the BDU under their BDO. Advise casualties whose scenarios include wandering around not to resist the students attempts to return the casualty to a litter. 6. IMPORTANT POINTS Issue a pencil and a set of note-taking outlines to each student at the beginning of the rotation. Give the following instructions to the students: You will have 2 minutes to assess each of the 12 casualties. Sources of information about the casualty include the Field Medical Card, the patients history, and careful observation. Casualties have been instructed not to offer information. You must ask the casualty for specific information about his/her condition. Do not attempt a physical examination. The Field Medical Card reflects the objective signs that should be present. Moulage has been added as a prompt to indicate the existence of additional injury and does not necessarily represent the patients condition accurately. The note-taking outline is supplied to help you organize your assessment of the casualty. You may not have time to complete the entire form for each casualty during the two-minute evaluation period. However, since you will be asked to discuss each case following the FTX, make enough notes about each casualty to help you remember the casualty and the management you recommend.
If this exercise is one of the six stations in the rotation (Option 1), proceed as follows: At the beginning of the rotation, position a team of 2-5 students at each of the first several casualties (no more than 4 students per casualty if possible). When the teams are positioned, start the clock and tell them to begin. After 1 minute and 45 seconds, tell the teams to stop and move to the next casualty. Give the teams 15 seconds to move to the next casualty and start the clock again. The teams will rotate clockwise from one casualty to the next until each team has seen all 12 casualties. When the teams complete the assessment of their last casualty, give the signal for all stations to rotate. Collect the pencils from the group and direct them to their next station. You may wish to give some signal to the other station instructors when 5 minutes or 2 minutes remain in a rotation. Do not position students at all 12 casualties at the beginning of a rotation. Casualties would then have no opportunity to take a break. If, for example, there are 60 students in the class, there will be 10 students in each rotation. Two-person teams will start at each of the first five casualties. This means that each casualty will perform his/her scenario five times during each of six rotations (30 times during the FTX). Increasing the size of the teams will reduce the workload for the casualties. However, with larger teams around each casualty, each individual student will find it more difficult to participate in the assessment. The FTX OIC should decide on the balance between team size and number of performances from each casualty. If this exercise is completed separately, before station rotations begin (Option 2), proceed as follows: One day before the FTX: Distribute the Casualty Scripts to volunteers from the class so they can become familiar with their scenario and ask questions about the script. Day of the FTX: Following the safety briefing, the volunteer casualties should prepare themselves for the exercise while the remainder of the class completes the MOPP Donning Drill. Position a team of two to five students at each of the first several casualties. Leave at least four casualties free so that during the exercise, each casualty will have an opportunity to assess the other casualties. Remind the casualties that when they are not performing their scenario they should participate in assessing the other casualties in the circle. When the teams are positioned, start the clock and tell them to begin. After 1 minute and 45 seconds, tell the teams to stop and move to the next casualty. Give the teams 15 seconds to move to the next casualty and start the clock again. The teams will rotate clockwise from one casualty to the next until each team has seen all 12 casualties. When all teams have assessed all 12 casualties: give the class a 15-minute break, reassemble the entire class in a comfortable, shaded area, and discuss the answers for each scenario.
APPENDIX A - EMT - TASKS STATION GUIDE
EMERGENCY MEDICAL TREATMENT TASKS STATION INSTRUCTORS GUIDE 1. OBJECTIVE Students practice the types of clinical tasks normally performed at the EMT station on the dirty side of the hotline: a. practice the proper technique for use of an autoinjector and an M291 SDK; b. in MOPP IV, perform medical tasks that require fine-motor skills (endotracheal intubation and intravenous catheter insertion). 2. EQUIPMENT - 2-4 field tables or litters on litter stands to hold the manikins and equipment. - M291 Skin Decontamination Kits, one per student if possible. Autoinjectors If trainers are used, supply one MARK I Kit (trainer) for each student in a rotation. Trainers must be reset after they are discharged. The reset device is a small, black-plastic ring supplied with the trainer kits. If live (expired) MARK I Kits are used, provide one MARK I Kit for every two students in the FTX. - 1 pair BDO trousers, rolled up, or covering a sandbag to simulate a casualtys thigh (if live autoinjectors are used) - 1 sharps container (if live autoinjectors are used) Intubation equipment One or more intubation manikins. If more than one manikin is used, increase the numbers of the following items accordingly. - 1 laryngoscope with functioning batteries - 2 laryngoscope blades with functioning lamp (one Miller #2 or #3, one MacIntosh #3 or #4) - 1 endotracheal tube, size 8.0 ID with functioning cuff - 1 syringe, 10cc to inflate cuff - 1 stylet - Silicone spray to lubricate endotracheal tube (optional) - 1 bag-valve-mask. Resuscitation Device, Individual, Chemical (RDIC) preferred. Intravenous access equipment One or more IV manikins (arm). If more than one manikin is used, increase the numbers of the following items accordingly. - Intravenous catheters, 18 or 20 gauge, quantity sufficient to allow each student one or two insertion attempts - 1 liter, 0.9% saline solution (do not use glucose-containing solutions in manikin) - 1 liter, 0.9% saline solution with red food coloring added (blood simulant to fill veins of manikin) - 2 intravenous tubing sets - Alcohol prep pads, tape, tourniquet (optional) to add realism - 1 sharps container - Several pair of 7 mil, butyl rubber (tactile, protective) gloves - Trash receptacle
3. PERSONNEL - 2 instructors, preferably with training in intubation and IV therapy (e.g. 91W). If students are practicing with live Mark I kits, one instructors full attention should be focused on this task. 4. SET UP Autoinjectors If trainers are used, students can activate the autoinjector against their own thigh or their buddys thigh. If live autoinjectors are used, students can inject into a pair of rolled up BDO trousers or into a sandbag. For safety, do not permit students access to live autoinjectors until they are to perform the injection. Each student will discharge EITHER an atropine OR a 2-PAM Cl autoinjector. Provide a sharps container. Intubation Check the manikin, the laryngoscope/blade combination, and the endotracheal tube cuff/pilot balloon for proper function. Lubricate the endotracheal tube with silicone spray as necessary. Intravenous access equipment Connect an IV bag containing blood simulant to a manikin arm and fill the veins per manufacturer instructions. Set out IV-start equipment. Provide a sharps container and a trash receptacle. Manikins for all three skills (autoinjector, intubation, and IV) may be placed on litters, field tables, or on the ground (on tarps or shelter halves) if necessary, since medical personnel may be required to perform these skills with the casualty lying on the ground. Provide adequate space between the three tasks and each manikin to allow students easy access and room to maneuver. 5. SAFETY Autoinjectors (live) Before beginning practice with live autoinjectors, warn students not to touch the needle end of the autoinjector (green end for atropine, black end for 2- PAM Cl). Instruct students to hold the autoinjector like a pen, between the thumb and index finger, and to brace the heel of the hand against the casualtys thigh while injecting. Following an instructor demonstration of safe technique, students should step up to this station one at a time. Issue one autoinjector to the student. Closely supervise the students technique as he/she injects the antidote into a BDO or sandbag. The student will place the discharged autoinjector immediately into a sharps container. After the FTX, seal and dispose of sharps container per unit SOP. Any accidental needle sticks will be reported immediately to the FTX OIC.
IV access Ensure the proper use of IV catheters. Do not permit students to recap needles. Needle should be placed immediately into sharps container following successful cannulation of vein. After the FTX, seal and dispose of the sharps container per unit SOP. 6. IMPORTANT POINTS M291 Skin Decontamination Kit If adequate stock is available, issue an M291 SDK to each student. Discuss the purpose and proper use of the kit. Demonstrate and allow students to practice decontaminating their hands with the M291 SDK. For safety, do not require students to decontaminate their face. Instead, demonstrate (without using the actual kit) the technique for decontaminating the face, neck, and ears. Autoinjectors Demonstrate to the group the proper technique for using the autoinjector (see SAFETY section above). If trainers are used, students may then practice on their own. Monitor students to ensure proper technique. Assist them to reset the trainer as necessary. If live MARK I Kits are used: a. One student at a time will step forward to discharge EITHER an atropine OR a 2PAM Cl autoinjector into a sandbag or a rolled-up BDO under the close supervision of the station instructor. b. Instruct the student to: 1) hold the autoinjector between his/her thumb and index finger (like a pen), 2) rest the heel of the hand against the casualtys thigh, 3) push the tip of the injector against the simulated thigh until it fires, 4) hold the injector against the simulated thigh for 10 seconds to insure complete discharge of contents. c. The student will then place the discharged autoinjector immediately into a sharps container. Intubation/intravenous access This station is NOT designed to teach students how to intubate or obtain IV access. This station is NOT designed to test or evaluate these skills. By practicing these tasks in MOPP IV, medical personnel already trained to intubate and/or start IVs can build confidence in their ability to perform critical, patient-care skills even in MOPP gear. Encourage the students who know these skills to attempt them while in MOPP IV. Suggest that they first complete the task wearing the heavy, 25 mil gloves and then repeat the task wearing the tactile, 7 mil gloves.
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APPENDIX A - EMT - DISCUSSION STATION GUIDE
EMERGENCY MEDICAL TREATMENT DISCUSSION STATION INSTRUCTORS GUIDE 1. OBJECTIVE a. Review proper techniques for litter transport of casualties. b. Describe and discuss the dirty EMT station at a Casualty Decontamination Site including its purpose, personnel requirements, equipment available, and types of casualties seen at the station. c. A physician instructor facilitates discussion of the assessment, management, and disposition of a single casualty presenting to the EMT station. 2. EQUIPMENT - 1 litter with safety straps - 2 litter stands - Training MOPP and protective mask for mock casualty(s) 3. PERSONNEL - 1 station instructor (optimally a physician or subject-matter expert) - 1-2 volunteers from outside class, manikin, or student volunteer from each rotation as a simulated casualty. 4. SET UP Place the disassembled litter stands, the litter, and safety straps at the center of the station. The casualty in MOPP IV is placed on the ground some distance away from the station (within view and within 50 feet of the station). 5. SAFETY Ensure that the casualty is safely placed on the litter, safety straps are properly used, the casualty is safely and properly transported, the litter team uses proper lifting techniques and commands, and the litter is safely positioned on litter stands (with the stands inside the litter stirrups). Use these issues as teaching points for Part 1, below. 6. IMPORTANT POINTS PART 1 This station begins with a litter-casualty transport exercise to emphasize proper technique and difficulties associated with performance in MOPP gear. Ask the group leader to select a litter team to retrieve the casualty and another team to set up the litter stands. As the teams execute these tasks, monitor their performance for safety.
When the tasks are complete (casualty properly positioned on the litter stands in front of the group), ask the group to critique the teams performance. Briefly discuss the proper technique for litter-casualty transport. PART 2 Follow the litter-transport exercise with a brief discussion of the dirty EMT station at a Casualty Decontamination Site. Points to emphasize: What categories of patient would be transported from the triage station to the EMT station? IMMEDIATE casualties requiring resuscitation and stabilization prior to decontamination and/or evacuation. MINIMAL casualties who can be easily treated and returned to duty without definitive decontamination at your Casualty Decon Site. Who mans the EMT station? One or two medics at echelon I. What type of treatment is rendered at this station? Simple resuscitative care (i.e. the A-B-C-D-Ds): management of Airway and Breathing, control of hemorrhage and replacement of circulating volume (Circulation), administration of antidotal Drugs (MARK I kit, CANA), and spot Decontamination. What type of equipment is needed at this station? Oropharyngeal airways, ventilatory devices (bag-valve masks, Resuscitation Device, Individual, Chemical [RDIC]), IV therapy supplies (IV fluids, tubing, catheters, etc.), battle dressings, autoinjectors, M291 Skin Decontamination Kits, water, bleach. Remember that any supplies and equipment prepositioned at this station must be used, decontaminated, or disposed of when operations at this site are completed. Therefore, do not position any durable equipment here that cannot be decontaminated. Do not pre-position 100% of the supplies that may be needed. Resupply from the clean side of the Hotline as necessary during operations. PART 3 The third exercise at this station is an instructor-facilitated student discussion of a chemical-casualty treatment scenario. Emphasis should be on a type of casualty that would be treated at the EMT station. Discussion should emphasize resuscitative care to be rendered soon after the exposure. The following is an example of a case scenario often used during the exercises presented at USAMRICD. However, only the imagination and expertise of the station instructor and the time allotted for the station rotation limit the type of casualty to be discussed and the points to be discussed. No moulage is required at this station; e.g., if the casualty would have a dressing, the instructor simply indicates where on the casualty the dressing would be.
Scenario: The casualty, in MOPP IV, arrives at the EMT station by litter. He is awake and responsive, but is obviously struggling to breathe. He is twitching all over. He retches intermittently. There is a bloody, pressure-dressing on his right thigh. The Field Medical Card reads MARK I X one. What is your course of action? Include the A-B-C-D's in your discussion: AIRWAY/BREATHING Since the casualty is struggling to breathe and possibly vomiting into the mask, can you effectively manage the airway if necessary? When and how can you manage the airway and ventilation of this casualty in protective mask? Is intubation an option? When and how? CIRCULATION The casualty could lose significant blood volume into the thigh from the thigh wound (especially if it is associated with a fractured femur). If students fail to assess circulation and proceed immediately to antidote administration, IM antidotes may not produce effective results due to hypoperfusion in the extremities. In addition, attempting positive-pressure ventilation in the setting of low circulating blood volume may inhibit venous return, exacerbate hypotension, and lead to cardiac arrest. Should an IV be started on this casualty in MOPP gear? When and how? DRUGS How many MARK I kits should be administered initially? This is clearly a severe exposure, so giving two or three MARK Is would be justified. Diazepam (CANA) should also be administered. How long must we wait to see an effect from the drugs administered? (5-10 minutes) What therapeutic effects are we seeking from each component of the kit? Atropine drying of secretions, unlabored breathing. 2 PAM chloride improved strength of skeletal muscles (most importantly, the diaphragm). Diazepam prevention or treatment of seizures. Could other routes of drug administration be used? Remember that IV administration of atropine in the setting of hypoxia could produce lethal dysrrhythmias. DECONTAMINATION What is the likely state (liquid? vapor?) of the agent? Where on his or her body was this casualty exposed? (Liquid nerve agent on the BDO driven into the thigh wound by the penetrating missile fragment, but look for other possible sites of exposure and absorption). How does liquid exposure (vs. vapor) affect the onset, type and time course of symptoms? Is spot decontamination appropriate here? Should the wound be decontaminated? How?
APPENDIX A - LITTER-PATIENT DECONTAMINATION STATION
LITTER-PATIENT DECONTAMINATION STATION INSTRUCTORS GUIDE 1. OBJECTIVE Describe the litter-casualty decontamination station and its processes. Demonstrate and practice the step-by-step procedure for contaminated clothing removal and skin decontamination of a litter casualty. 2. EQUIPMENT NOTE: If the class is large and two instructors are available, DOUBLE the number of each item listed below. This will permit two decon teams to decon two casualties per rotation. - 2 litters (preferably decontaminable litters) with safety straps - 2 litter stands - 4 utility pails (2 labeled "5% hypochlorite" and 2 labeled "0.5% hypochlorite") - 4 sponges - 4 large, bandage scissors - 2 J Knives if available (knife - NSN 5110-00-524-6924, replacement blades - NSN 5110-00-098-4326) - 4 butyl rubber aprons, Toxicological Agent Protective (TAP) - 5 sets of training MOPP gear that can be cut from volunteer casualties - large garbage pail with plastic liner 3. PERSONNEL - 1-2 station instructors familiar with the litter-patient decon process - 2-4 volunteers or 5-10 manikins to simulate litter casualties 4. SET UP Four student volunteers from each rotation will perform the functions of the decon team while a fifth student volunteer, a volunteer from outside the class, or a manikin will act as the casualty. If the class is large and two instructors are available, use two decon teams (8 volunteers) to decontaminate two casualties per rotation. In this case, double the set up described below. Place a litter on litter stands. Hang a pail with a sponge inside on each of the four litter poles. Place a volunteer casualty or a manikin in MOPP IV on the litter. Simulate decon using dry sponges or use water to simulate decon solution. Provide TAP aprons and scissors or J knives for 4 volunteers from each rotation.
If manikins are used, dress all of them in MOPP IV before the FTX begins, as time is not available between rotations. If two volunteers are used as casualties, one volunteer will act as the casualty while the other suits up for the next rotation. 5. SAFETY Use a minimum of three persons to lift the casualty from the litter. Ensure that the largest/strongest person is positioned at the casualtys head/shoulders for the lift. Do not use large individuals (>90kg) as volunteer casualties. Instruct casualties to wear a PT uniform rather than BDU under the BDO (to reduce heat stress and in case a student inadvertently cuts an extra layer of clothing when removing the BDO). The J Knife, originally designed to cut seat belts during vehicle extrication, contains two razor blades and can produce serious injury if used carelessly or improperly. Instruct students to take special care when cutting the BDO with knife or scissors to avoid cutting underlying garments or the casualty. Student-volunteers who don a TAP apron will rehydrate before proceeding to the next rotation. 6. IMPORTANT POINTS Location of the litter-casualty decon station: upwind of triage and EMT, downwind of the hotline. Type of casualty brought to this station: CLINICALLY STABLE litterborne casualty. Patients should be medically managed at the EMT station until they are stable enough to undergo the 10-20 minute decon process. The decon process may be managed as an assembly line with a separate station (and team) for clothing removal, skin decon, and confirmation of decon completeness. A simpler and more efficient technique is the patient centered approach. A decon team of four retrieves the patient from the triage or EMT station; completes clothing removal, litter exchange and skin decon at their station; then moves the patient to the hotline for confirmation of decon completeness and a second litter exchange in the shuffle pit. Talk the decon volunteers through each step of the clothing removal and skin decon process. The steps of this process are detailed in the "Litter Casualty Decontamination" section of the Field Management of Chemical Casualties Handbook and in Appendix A of the Medical Management of Chemical Casualties Handbook. During actual decon operations only 0.5% bleach solution or plain water should be used on skin. A 5% solution may be used for equipment such as the mask. Spot decon the BDO and remove personal items from pockets before cutting. Decon scissors after each complete cut (e.g. a sleeve, a trouser leg, front of jacket). Decon
gloves in 0.5% before touching patients skin. Decon front of the TAP apron before removing the next layer of clothing. In most cases, the majority of contamination is removed when the clothing is removed. Skin decontamination can be accomplished by spot decon of critical areas (connection points of the ensemble neck, wrists, waist, ankles; and warm, moist, sensitive skin axillae and groin). This procedure is appropriate when a dry technique, like the M291 kit, is used. However, a full-body wash with water, soapy water, or dilute bleach is nearly as quick and more effective. The most effective technique for skin decontamination is a soap and warm-water wash with friction, followed by a fresh water rinse. This technique may be accomplished even in the field if a shower can be set up using a system such as the M17 Lightweight Decontamination System (LDS). The Field Medical Card is placed in a zip-lock plastic bag, which is then decontaminated with 0.5% bleach and placed in the head harness of the patients mask. Personal items are also placed in a zip-lock bag along with identifying information. The inside of this decontaminated bag is checked with a CAM at the hotline. Dressings are removed along with clothing. Wounds are redressed only if bleeding. Tourniquets are removed after a clean tourniquet is placed proximal to the one being removed. Splints are left in place and soaked with decon solution. Airway management and IV therapy devices are decontaminated and left in place.
APPENDIX A - AMBULATORY-PATIENT DECONTAMINATION STATION
AMBULATORY-PATIENT DECONTAMINATION STATION INSTRUCTORS GUIDE 1. OBJECTIVE Demonstrate/practice the step-by-step process for removal of contaminated clothing and decontamination of ambulatory casualties. 2. EQUIPMENT - 2 litter stands - 6 utility pails - 6 sponges - 3 large, bandage scissors - 1-3 J Knives, if available (knife - NSN 5110-00-524-6924, replacement blades NSN 5110-00-098-4326) - 3 butyl rubber aprons, Toxicological Agent Protective (TAP) - 6 sets of training MOPP gear to be cut from volunteer casualties (optional) - M291 Skin Decontamination Kit - Small zip-lock plastic bag - 1 large garbage pail with plastic liner - 1 cravat (triangular bandage) for arm splint on volunteer casualty - 2 Field Medical Cards - talc powder (Talc, Technical NSN 6810-00-142-9849) or engineer tape (NSN 831500-255-7662) 3. PERSONNEL - 1 or 2 station instructors - 2 volunteers to simulate casualties. Alternatively, volunteers may be selected from the students in each rotation or all of the students in the rotation can be paired into casualty / operator teams. 4. SET UP The lane may be set up as a three-step process: Step 1. Mask / hood decon and hood removal. Draw a simulated shuffle pit using talc or engineer tape. Place 2 buckets with scissors and sponge at this area. Step 2. Clothing removal. Place one or two litter stands here so casualty has something to brace against while overboots and trousers are being removed. Place garbage pail with liner here for removed clothing. Place 2 buckets, scissors and sponges here as well. Step 3. Spot decon and monitoring. Place 2 buckets, scissors, sponges, M291 kit, CAM and M8 paper at this area. If volunteers from outside the class are used, they can take turns donning training MOPP to act as an ambulatory casualty for each rotation.
APPENDIX A - AMBULATORY-PATIENT DECONTAMINATION STATION
5. SAFETY The J Knife contains two razor blades and can produce serious injury if carelessly or improperly used. Instruct students to take special care when cutting the BDO with knife or scissors to avoid cutting underlying garments or the casualty. Volunteers wearing a TAP apron will rehydrate before the next rotation. 6. IMPORTANT POINTS Options for demonstrating the ambulatory decon process: 1. A volunteer from outside the class dons expendable, training MOPP for each rotation. One to three student volunteers from each rotation (one for each step or one who completes the entire process) don a TAP apron and execute the process as instructor describes the steps. The BDO is cut as necessary. 2. Use a student from each rotation as the casualty, remove the MOPP without cutting and ask the volunteer to re-don their BDO at the end of the rotation. 3. Pair up all the students in each rotation. One student of each pair acts as the casualty, the other student becomes the operator. Volunteers complete each step as the instructor describes the clothing removal and decon process. The steps of this process are detailed in the "Ambulatory Casualty Decontamination" section of the Field Management of Chemical Casualties Handbook and in Appendix A, Medical Management of Chemical Casualties Handbook. Place a splint on one casualty to demonstrate the added complexity created by medical devices. Emphasize the following points: - The majority of the casualties will likely be ambulatory. These casualties normally retain (and cross the hotline in) their BDU and combat boots since uniform resupply for so many casualties would be impractical. However, the decon team and OIC may decide to remove all clothing from some or all of these casualties to prevent contamination of the medical treatment facility. - During actual decon operations only 0.5% bleach solution or plain water should be used on skin. A 5% solution may be used for equipment such as the mask. - In some cases the casualties can assist each other with the decon process. - Ambulatory decon may be set up as a lane requiring the casualty to advance to a separate station for each step, or all steps may be performed in one spot. - The Field Medical Card is placed in a zip-lock plastic bag, which is then decontaminated with 0.5% bleach and placed in the head harness of the patients mask. Data is transcribed at the hotline. Personal items are also placed in a ziplock bag along with identifying information. The inside of this decontaminated bag is checked with a CAM at the hotline. Dressings are removed along with clothing. Wounds are redressed only if bleeding. Tourniquets are removed after a clean tourniquet is placed proximal to the one being removed. Splints are left in place and soaked with decon solution. Airway management and IV therapy devices are decontaminated and left in place.
APPENDIX A - HOTLINE STATION GUIDE
HOTLINE STATION INSTRUCTORS GUIDE 1. OBJECTIVE Familiarize students with actions performed at the hotline and equipment used at or near the hotline. 2. EQUIPMENT 2 litters and 2 litter stands for the shuffle pit Field table or a litter on 2 litter stands to display equipment Talc powder or 1 roll of engineer tape to mark hotline and shuffle pits M8 Chemical Agent Detector Paper, 1 book for each student in the rotation if possible - M8A1 and/or M22 Automatic Chemical Agent Detection Alarm (ACADA) - Chemical Agent Monitor (CAM) or Improved Chemical Agent Monitor (ICAM) 3. PERSONNEL This station should be managed by at least two persons to allow one instructor to rest during each rotation or to allow each rotation of students to be subdivided for more effective teaching (see Important Points section below). Instructors familiar with the proper use of the equipment listed above should present this station (e.g. Chemical NCO, 54B). 4. SET UP Draw a simulated hotline using talc powder or engineer tape. Simulate two shuffle pits (one for litter patients, one for ambulatory patients) using powder or tape. The litter-patient shuffle pit should be large enough to allow someone to walk around a litter while remaining inside the pit. Display equipment on a table or a litter. For large groups it may be more effective for one instructor to discuss the hotline with half of the students in each rotation while the other instructor demonstrates the equipment for the other half of the students. Students would switch instructors after 10 minutes. 5. SAFETY When demonstrating the litter exchange step at the shuffle pit, use a minimum of three persons to lift the casualty from the litter. Ensure that the largest/strongest person is positioned at the casualtys head/shoulders for the lift. Do not use large individuals (>90kg) as volunteer casualties. Simulants are sometimes used to demonstrate the color change of M8 Paper. For safety, simulants will not be used during the FTX at USAMRICD. If simulants are used, keep them away from students and follow the manufacturers' guidelines.
6. IMPORTANT POINTS Hotline The hotline separates the downwind decon area, potentially contaminated by liquid agent, from the clean, upwind area. Thirty to sixty meters upwind of the hotline is the vapor control line (VCL). This buffer zone between the hotline and VCL is used to protect occupants of the medical treatment facility (MTF) from potential vapor exposure. The MTF is just upwind of the VCL. Casualties and operators moving between the hotline and VCL must wear a protective mask. Actions at the hotline 1. Litter Exchange: Four students in MOPP IV with TAP apron act as the decon team. Two students in protective mask act as the receiving team on the clean side. One student in protective mask acts as the casualty. Walk these volunteers through the steps of litter exchange in the shuffle pit. 2. Transcribe the Field Medical Card: As part of the above process, have the decon team hold up the casualtys Field Medical Card (inside a sealed plastic bag) while the clean-side team transcribes the information onto a new FMC. 3. Confirm the completeness of decon: Discuss advantages and disadvantages of the various techniques. The CAM may be kept on the clean side and used by the clean-side team at the shuffle pit. Because the CAM detects vapor rather than liquid, requires from 10 to 15 seconds to indicate detected agent, and detects relatively gross amounts of agent, it may not be the optimal technique. M8 paper may be used on critical areas of the body to sample for residual liquid agent. The fact that a thorough decon process has been completed may be confirmation enough. Shuffle pits The shuffle pits are designed to prevent the transfer of liquid contamination across the hotline on the boots of the operators or casualties. Make one pit for litter casualties and one for ambulatory casualties. The pit for litter casualties should be long enough and wide enough to allow team members to walk around a litter while inside the pit. The shallow pits are filled with a mixture of 2 parts Super Tropical Bleach (STB) and 3 parts earth from the pit. At the vapor control line The casualtys mask is removed and his/her face is decontaminated if necessary. The operators may also remove their mask. The casualtys mask is processed for reissue (thorough decon, new filter and new hood). The M8A1 or M22 monitor should be placed at the VCL to warn medical staff of the presence of chemical agent vapor. Litters To avoid cross contamination, groups of litters remain in four separate areas and are circulated only within that area: one group circulates between arriving ambulance and decon lane, another group between decon lane and hotline, the third group between the hotline and medical treatment facility, and the last group between
the MTF and the ambulance departing for higher echelon. Litters are decontaminated between each casualty. M8 Detector Paper Discuss the purpose and proper use of M8 Paper. Indicate possible false positives. Refer students to the color chart on the inside front cover of the M8 Paper book for the color change expected with each agent. Remind students that M8 Paper identifies only liquid hazards. Simulants are sometimes used to demonstrate the characteristic color change that occurs when M8 paper comes in contact with a possible nerve agent or vesicant. For safety, simulants are not used during the FTX at USAMRICD. M8A1 or M22 Alarm Discuss the purpose, the setup, and the proper use of system components. Indicate that the M8A1 detects only nerve agent vapor, whereas the M22 detects both nerve agent and vesicant vapor. Discuss possible false positives. Demonstrate the sound of the alarm. Chemical Agent Monitor Discuss the purpose of the CAM and the agents it can identify. Indicate that the CAM detects only vapor and not liquid hazards. Demonstrate the basic steps required to prepare the CAM for operation. Demonstrate the basic operation of the CAM. Discuss possible false positives and typical problems with operator technique (e.g. interference from upwind vapors, scanning too quickly over the area to be sampled, saturating the detection cell, and contaminating the nozzle with liquid).
APPENDIX B STUDENT GUIDE TO THE FIELD TRAINING EXERCISE
APPENDIX B - STUDENT GUIDE TO THE FTX
STUDENT GUIDE TO THE FIELD TRAINING EXERCISE The goals of this exercise are: 1) to familiarize course attendees with personal protective equipment, its capabilities and limitations, and some of the challenges associated with casualty care in a contaminated environment and 2) to demonstrate the processes required to manage contaminated casualties. Uniform of the day will consist of Battle Dress Uniform (BDU or Utilities) for cold weather or Physical Training Uniform for hot weather, protective mask with hood, Battle Dress Overgarment (BDO), overboots, butyl rubber gloves with inserts, canteen, and web belt. The field training exercise (FTX) consists of six teaching stations: the casualty assessment exercise, the emergency-medical-treatment (EMT) tasks station, the EMT discussion station, the litter-casualty decontamination station, the ambulatorycasualty decontamination station, and the hotline station. As with any FTX, the first rule is safety. You will be in protective clothing during much of the exercise. The potential for heat injury exists. Bring a full canteen to the FTX site. You will be encouraged to drink water. If you start to feel light-headed, nauseated, weak, etc., notify your squad leader or the nearest instructor. Remove your mask, gloves, and BDO jacket, and sit down in the shade. Each squad leader should ensure that each member of his or her squad maintains adequate hydration. MOPP DONNING DRILL Before the FTX begins you will be given a short safety briefing. The briefing will be followed by a MOPP donning drill. You will be given eight (8) minutes to get into MOPP IV. There will be classroom instruction and practical exercises on MOPP donning prior to the FTX. It is very important that your mask fits properly. If it does not, your eyepieces may fog and you will be unable to see. If you have problems donning the protective gear, ask one the instructors for help prior to the FTX. The remainder of the FTX consists of six 20-30 minute stations. The FTX NCOIC will time the modules and announce rotations with a bullhorn or by blowing a whistle. Direct any questions you may have during the FTX to the individual station instructors. STATION I, Casualty Assessment: This station may be completed as a separate exercise using volunteers from the class as simulated casualties. In this case, the instructor will call for volunteers on the day before the FTX. Volunteers will be issued a scenario and a script to practice and reenact for the rest of the class.
There will be twelve simulated casualties at the station. You will be given two minutes to assess each casualty. The station instructor will announce rotation times. You may obtain information about the casualty in three ways: 1) by reading the field medical card (FMC), 2) by taking a history (each casualty has a story, but the casualties are instructed not to offer information unless you ask), and 3) by observing the casualtys behavior and wounds. Remember, however, that none of the casualties are professional actors. The moulage is present only to prompt inquiry and is not designed to be a realistic representation of the casualtys wounds. A note-taking outline will be issued at the start of the exercise to help you organize your assessment of the casualty. It may not be possible to complete the entire form for each casualty during the two-minute evaluation period. Make enough notes to help you remember the casualty and keep your notes for reference during the discussion that follows the exercise. STATION II, Emergency Medical Treatment - Tasks: You will be given the opportunity to accomplish, while in MOPP IV, a series of medically related tasks that may be required at the EMT station: 1. IV administration - Start an IV on a manikin. 2. Endotracheal intubation - Intubate a manikin. 3. Nerve Agent Antidote Kit (MARK I) - Practice injection of a live (expired) or trainer autoinjector on a manikin. WARNING: Pay close attention to the station instructor. Live autoinjectors contain a spring-loaded needle! 4. M291 Skin Decontamination Kit Practice personal decontamination. NOTE: This station is not designed to teach you how to perform tasks 1 and 2, rather give you confidence in your ability to accomplish tasks requiring fine-motor skill and coordination while wearing protective equipment. Non-clinicians may choose to complete only task 3 and 4 or may attempt the other tasks, with instruction, if time permits. STATION III, Emergency Medical Treatment - Discussion: At this station, the instructor will present a typical casualty scenario and facilitate a group discussion of that casualtys emergency management. The instructor will also discuss the role of the dirty EMT station at a Patient Decontamination Site and you will practice litter-carry in MOPP IV.
STATION IV, Litter-Casualty Decontamination: Decontamination of a litter casualty will be discussed and demonstrated. You may be asked to perform this task with the instructors guidance. STATION V, Ambulatory-Casualty Decontamination: Decontamination of an ambulatory casualty will be discussed and demonstrated. You may be asked to perform this task with the instructors guidance. STATION VI, Hotline Station: The purpose and location of the hotline will be discussed. Processes completed at the hotline will be discussed and practiced. Detection equipment used at or near the hotline, including M8 Chemical Agent Detector Paper, the Chemical Agent Monitor (CAM), M8A1 Automatic Chemical Agent Alarm (ACAA) and/or M22 Automatic Chemical Agent Detection Alarm (ACADA) will be demonstrated.
APPENDIX C EQUIPMENT LIST
APPENDIX C - FTX EQUIPMENT LIST
EQUIPMENT LIST NOTE: Quantities are given as minimal-to-optimal numbers. See the Equipment section of each Station Instructor Guide to determine how the following equipment will be distributed and used. - Training MOPP gear (protective mask, BDO jacket, BDO trousers, gloves, overboots) one set for each student in the course - 12 sets of MOPP gear for volunteer casualties if volunteers are taken from outside the class. Five to ten of these sets to be cuff off during the litter and ambulatory casualty decon demonstration if possible. - Canteen and web belt for each student and each casualty - 6-24 litters, decontaminable litters if available - 4 litter straps (two pair) - 8-12 litter stands (four to six pair) - 4-12 butyl rubber aprons, Toxicological Agent Protective (TAP) - 4-12 utility pails - 4-12 cellulose sponges for litter decon demonstration - 4-12 large bandage scissors - 2-4 J knives if possible knife NSN 5110-00-524-6924, replacement blades NSN 5110-00-098-4326 - 2 rolls of M9 Chemical Agent Detector Tape - 1 book of M8 Chemical Agent Detector Paper one book per student if possible - M291 Skin Decontamination Kits one kit for each student - One M8A1 and/or M22 Automatic Chemical Agent Alarm system - 1 Chemical agent Monitor (CAM) or Improved Chemical Agent Monitor (ICAM) - 12-24 blank, Field Medical Cards, DD Form 1360, December 1991 - Moulage supplies: field dressing x 3-6, cravat x 3-6, splint x 1-2, blood simulant (Karo syrup with red food coloring added), red greasepaint or rouge, red marking pen to add spots to M9 tape - Sharpened pencils, one for each student in a rotation - Stopwatch or wristwatch with a second hand - Bullhorn, whistle or other signaling device to signal station rotations (optional) - Triage-Casualty Scripts (Appendix G) - Note-taking Outline (Appendix H) enough copies for each student to record data on each of the twelve assessment exercise casualties (3, two-sided copies per student) - 3 Field Tables (optional) - 1 sharps container (two containers if live autoinjectors are used) - 1-3 large garbage pails with plastic liner Autoinjectors If trainers are used, supply one MARK I Kit (trainer) for each student in a rotation. Trainers must be reset after they are discharged. The reset device is a small, black-plastic ring supplied with the trainer kits. If live (expired) MARK I Kits are used, provide one MARK I Kit for every two students in the FTX.
- 1 pair BDO trousers, rolled up, or covering a sandbag to simulate a casualtys thigh (if live autoinjectors are used) Intubation equipment One or more intubation manikins. If more than one manikin is used, increase the numbers of the following items accordingly. - 1 laryngoscope with functioning batteries - 2 laryngoscope blades with functioning lamps (one Miller #2 or #3, one MacIntosh #3 or #4) - 1 endotracheal tube, size 8.0 ID with functioning cuff - 1 syringe, 10cc to inflate cuff - 1 stylet - Silicone spray to lubricate endotracheal tube (optional) (do not use KY jelly or ointment as lubricant) - 1 bag-valve-mask. Use the Resuscitation Device, Individual, Chemical (RDIC) if available. Intravenous access equipment One or more IV manikins (arm). If more than one manikin is used, increase the numbers of the following items accordingly. - Intravenous catheters, 18 or 20 gauge, quantity sufficient to allow each student one or two insertion attempts - 1 liter, 0.9% saline solution (do not use glucose-containing solutions in manikin) - 1 liter, 0.9% saline solution with red food coloring added (blood simulant to fill veins of manikin) - 2 IV tubing sets - Alcohol prep pads, tape, tourniquet (optional) to add realism - Several pair of 7 mil, tactile, protective gloves - Trash receptacle
APPENDIX D SAFETY STANDARD OPERATING PROCEDURES
APPENDIX D - SAFETY STANDARD OPERATING PROCEDURES
MCMR-UV-ZM I. Title: Emergency Medical Service Standard Operating Procedures (SOP).
8 June, 1998
II. Purpose: To establish a Standard Operating Procedure in case of an environmental or traumatic emergency situation during a Field Training Exercise (FTX) in support of the Medical Management of Chemical and Biological Casualty Care Course (MCBC) and Field Management of Chemical and Biological Casualty Care Course (FCBC). This SOP will be used to facilitate emergency medical service for students or staff along with establishing guidelines to follow during a field training exercise.
III. Applicability: This SOP applies to all personnel participating in the MCBC and FCBC Course as instructors or as personnel providing administrative/logistical/medical support.
IV. Definitions: A. MOPP: Mission-Oriented Protective Posture, the term used to refer to the wearing of various combinations of chemical protective clothing and the chemical protective mask. 1. MOPP 1: Wear of the chemical protective overgarment, with mask slung at side and in its carrier. 2. MOPP 2: Wear of the chemical protective overgarment (with mask slung at side and in its carrier) and the chemical protective boots. 3. MOPP 3: Wear of the chemical protective overgarment, boots, and mask (mask is on face). 4. MOPP 4: Wear of the chemical protective overgarment, boots, mask, and gloves.
B. WBGT: Wet Bulb Globe Temperature, a means for determining a heat stress index called the Wet Bulb Globe Temperature Index (also WBGT), which takes into account the contributions to heat stress from ambient air temperature, humidity, air movement, and radiant heat. 1. For outdoor environments with a solar heat source, WBGT = 0.7 NWB + 0.2 GT + 0.1 TA, where NWB is the temperature of the natural wet bulb, GT is the temperature of the black globe, and TA is the temperature of the dry bulb. 2. For indoor environments (and for outdoor environments without a solar heat source), WBGT = 0.7 NWB + 0.3 GT. 3. Either the WBGT Kit (NSN 6665-01-109-3246) or the WGT Kit (Botsball; NSN 6665-01-1038547) will be used, but the WBGT calculation when using the WGT Botsball will be WBGT = 0.8 WGT + 0.2 DB, where WGT is the WGT reading directly from the WGT Botsball and DB is the dry-bulb temperature, obtained by removing the dial thermometer from the WGT Botsball, keeping the thermometer in the shade for 3 minutes, and then reading the air temperature from the dial thermometer (see Message SGPS-PSP, 23 May 1990; and Appendix B [Work-rest and Water Consumption Tables] of USARIEM Technical Note 91-2). 4. WBGT measurements are to be made at a point 4 feet above ground level.
V. Responsibilities: A. The Course Director (normally Chief, Chemical Casualty Care Division) has the overall responsibility for the MCBC and FCBC and is responsible for the enforcement of this SOP during the Field Training Exercise and for ensuring that 1. The Edgewood Area Health Clinic and Edgewood Emergency Medical Services are aware of the dates for the field training exercise (FTX) for the FCBC and MCBC. 2. The planning of each course includes assurance that FTX stations will be arranged in such a manner to ensure that all FTX participants will have the recurring opportunity to remove their masks and achieve adequate hydration. 3. A medical monitor responsible for the medical supervision of the FTX is present at all times during the FTX. 4. At least one medic or physician responder, with aid bag, is at each FTX. 5. The chain of command is notified at the earliest opportunity of any injuries that occurred during the FCBC and MCBC. B. The NCOIC of the Chemical Casualty Care Division or a designated representative is in charge of the FTX during the MCBC and FCBC and is responsible for ensuring that 1. A cellular phone is maintained at the FTX to be utilized in the event of an emergency. 2. All FTX participants receive instruction concerning safety issues (including heat-stress issues, work-rest cycles, procedures for adequate hydration, and methods for indicating true medical distress) and have the opportunity to ask questions and clarify safety instructions. 3. All FTX participants have the opportunity to report in a confidential manner to the Course Director any medical conditions (including pregnancy) that may preclude full participation in the FTX. 4. All FTX participants are briefed to communicate according to a standard signal all injuries or other relevant medical problems during the FTX. 5. All FTX participants have full canteens at the beginning of each FTX. 6. MOPP wear times, work-rest cycles, and hydration requirements indicated by WBGT considerations are observed by all participants. 7. All medical emergencies are reported to the Course Director. C. The designated medical monitor on site during an FTX will be responsible for 1. Measuring and recording the Wet Bulb Globe Temperature at least every 25 minutes during the FTX. 2. Ensuring that WBGT-dictated work-time information is communicated to FTX station leaders as indicated. 3. Observing course attendees and casualties for evidence of traumatic injury, heat or cold injury, undue fatigue, and other medically relevant conditions.
4. Notifying an MRICD medic or physician responder in the event that a course participant or casualty is in need of medical attention. 5. Reporting all medical emergencies to the NCOIC of the Chemical Casualty Care Division.
D. The responding MRICD medic or physician during an FTX will be responsible for 1. Remaining with the patient until EMS personnel respond on site. 2. Reporting to the medical monitor that a medical emergency has occurred. 3. As medically indicated, accompanying the patient to the Edgewood Clinic to assist and provide background information to the medical officer on duty at the clinic. 4. As medically indicated, remaining with the patient until the individual is medically released by the Edgewood Clinic medical officer or transported to a Harford County hospital. 5. Establishing at least telephonic contact with the Edgewood Health Clinic to determine disposition of the patient and to provide the clinic with a telephonic point of contact at USAMRICD. 6. Establishing telephonic contact with hospital emergency-room staff when a patient is transported off the installation, and providing the hospital with a telephonic point of contact at USAMRICD. E. NCO/Officers in charge of individual stations at the FTX (FOX station, Patient Discussion, NBC, Decon, Triage, IV, Intubation, Blood Pressure, etc. will ensure that 1. As indicated by course design [see V. A. 2.], participants at the appropriate stations will remove their masks, drink water according to the guidelines in Appendix B (Work-rest and Water Consumption Tables) of USARIEM Technical Note 91-2, and refill their canteens before proceeding to the next station. 2. In the case of a medical emergency, appropriate care is begun in the most expeditious manner possible and that the medical monitor is apprised of the situation. VI. Materiel/Equipment to be used: A. Personal equipment for FTX participants. 1. MOPP gear, masks, and carriers. 2. Load-bearing-equipment (LBE)/pistol belt with water-filled canteens. 3. M9 paper for application to outside of MOPP gear.
B. FTX equipment. 1. Station-specific equipment (e.g., intubation mannequins, IV lines and poles, sandbags, Mark I kits). 2. Timer(s) for timing rotations 3. Litters with straps.
4. Moulage chest with moulage equipment, to include false-positive indicator (e.g., DEET) for M9 paper.
C. Medical/communication equipment. 1. Cellular phone. 2. Copy of Appendix B of USARIEM Technical Note 91-2. 3. At each no-mask station, opened containers of water for use by course attendees and station leaders. 4. At the triage circle, an opened container of water with an adequate supply of paper cups. 5. Aid bag containing at a minimum a. Sphygmomanometer with stethoscope. b. Epinephrine autoinjector (e.g., EpiPen). c. Field dressings, including pressure bandages. d. Airway-management equipment: (1) 80- and 90-mm oropharyngeal airways. (2) Tongue blades. (3) Complete bag-valve-mask. 6. Identification material for medical monitor and medic or physician responder(s). 7. Signaling equipment as appropriate to report medical emergencies. 8. WBGT [see IV. B. 3.] and table. VII. Hazards involved: A. The primary hazard during the MCBC or FCBC FTX is heat injury from the heat stress associated with the wear of MOPP gear with or without the mask and associated with exertion during the exercise. The work intensity of activities performed in MOPP during the MCBC FTX by course attendees is not expected to exceed the light category in Table B-1 (Work Intensities of Military Tasks) of Appendix B (Work-rest and Water Consumption Tables) of USARIEM Technical Note 91-2, and the intensity of activities during the FCBC FTX by course attendees is not expected to exceed the moderate category in Table B-1 of USARIEM Technical Note 91-2. In neither the MCBC FTX nor the FCBC FTX is the work intensity of actors simulating casualties expected to exceed the moderate category in Table B-1 of USARIEM Technical Note 91-2. The protective-clothing status of all course participants will be assumed to fall into the category BDO over DBDU in Appendix B of USARIEM Technical Note 91-2. 1. To ensure a proper preventive posture relative to heat stress, the guidelines found in the work-rest and tables in Appendix B of USARIEM Technical Note 91-2 will be followed. For course attendees, the arrangement of FTX stations that include mask removal and hydration is such that at no point will the recommended maximal continuous work time for soldiers wearing BDO over DBDU and performing light work be exceeded. For actors simulating casualties, the arrangement of rest cycles for the actors will be such that at no time will the recommended maximal continuous work time for soldiers wearing BDO of DBDU and performing moderate work be exceeded. 2. To ensure maximal hydration, course attendees at each station where the mask is to be removed will be instructed to drink in accordance with the guidelines in Appendix B (Work-
rest and Water Consumption Tables) of USARIEM Technical Note 91-2 and to refill the canteen before proceeding to the next station.
B. Potential but unlikely hazards of the FTX include skin exposure to M9 paper, which contains the mutagenic dye B-1. The risk of cold injury in MOPP is low. The risk of inhalational or skin exposure to insect repellant or other false-positive M9 indicators during the FTX is judged to be remote.
VIII. Safety Requirements: A. All FTX participants will be briefed on the following before participating in the FTX of the MCBC or FCBC: 1. Proper wear (including donning and removal) of chemical-protective clothing and the chemical-protective mask. 2. Signs and symptoms of heat and cold injury and of dehydration. 3. Preventive measures instituted concerning heat/cold injury and dehydration. 4. Actions to be taken (including use of a standard distress signal and the identity of the medical monitor and of assigned medical responder[s]) in case of a medical emergency.
B. Monitoring will be conducted by the medical monitor in accordance with Sections IV. B. and V. C. of this SOP.
C. Emergency equipment will be constituted in accordance with Section VI. C. of this SOP. D. Special Precautions: Contractors or volunteers supporting the FTX are to read this SOP, indicate by their signatures their understanding of its contents, and be prepared to report to the medical monitor at the FTX any untoward medical events involving themselves or personnel under their supervision.
IX. Procedures: The FTX is to be conducted according to the specific guidelines in the FTX packets available from the Chemical Casualty Care Division. X. Emergency First Aid Treatment: A. FTX participants with minor injuries or minor medical problems and judged by the medical responder to require further medical care will be transported by the safest and most expeditious means (litter, ambulance, other vehicle) to the Edgewood Area Occupational Health Clinic (Bldg. E-4110). FTX participants with severe injuries or illnesses will be treated on site until the arrival of an ambulance for transport to the Edgewood Area Occupational Health Clinic or to another medical facility as appropriate. In the case of serious injury or illness, the medical monitor is to use his or her cellular phone to dial 911 to report the emergency and request assistance.
B. All injuries and illnesses will be reported to the on-site medical monitor regardless of the degree of injury. The medical monitor in turn will report the situation to the NCOIC of the FTX, who has the responsibility of notifying the Course Director. The Course Director will be responsible for the timely submission (within one working day) to the MRICD Safety Office of an accident report (STE Form 1416, Record of Injury) in applicable cases and of timely notification of the Office of the Commander at USAMRICD of all serious injuries or illnesses occurring in association with the FTX.
C. Emergency Numbers Chemical Casualty Care Office (Bldg. E-3106) Training Site Warehouse (Bldg. E-3083) Hoyle Gymnasium (Bldg. E-4210) Edgewood Medical Clinic (Bldg. E-4410) Military Police Hazardous Waste (Bldg. E-4430) Hospitals: Harford Memorial Hospital Fallston General Hospital Walter Reed Army Medical Center 410-436-2230 410-436-3375 410-436-3001 410-436-2222/2125 410-436-3320/4429 410-939-2400 410-879-0500/877-3700 202-576-3501 [DSN 291]
APPENDIX E PROTECTIVE MASK / RESPIRATOR MEDICAL CLEARANCE FORM
APPENDIX E - PROTECTIVE MASK / RESPIRATOR MEDICAL CLEARANCE FORM
PROTECTIVE MASK/RESPIRATOR MEDICAL CLEARANCE FORM Purpose: To identify those individuals who may have medical conditions or past mask/respirator experiences that could preclude use of a mask or respirator in a training environment. Part I (to be completed by the prospective student): 1. Name: _____________________________________________________________ Last First Middle initial 2. Signature: __________________________________________________________ 3. SSN: ________________ Age: ________ Sex: ________ Date: __________
4. Respirator history [please circle Yes or No for each question]: a. Have you ever worn a protective mask or a respirator? b. When wearing a mask, have you ever had problems such as panic, shortness of breath, or excessive heat? c. Have you ever had difficulty wearing any type of chemical protective clothing or protective eye wear? Yes No
Yes
No
Yes
No
5. Medical history [please circle Yes or No for each question]: a. Are you now or have you ever been under a doctors care for heart or lung problems? b. Have you ever had chest pain or severe shortness of breath during brisk walking or during other exercise? c. Do you experience shortness of breath or wheezing in cold weather?
Yes
No
Yes Yes
No No
d. Do you now take or have you ever taken medications for heart or lung problems or for high blood pressure? e. Have you ever been treated by a doctor for asthma, angina (chest pain), diabetes, high blood pressure, or irregular heartbeat? [if yes, please circle all appropriate conditions] f. Have you had a heart attack within the last year?
Yes
No
Yes Yes Yes
No No No
g. Have you been treated for heat exhaustion or heat stroke in the last year? h. Have you ever experience claustrophobia (a panic attack or a sensation of being smothered) while in a tight place such as a tunnel or an elevator or while in crowds? i. Do you ever hyperventilate to the point of feeling faint or passing out during exercise or in stressful situations? Do you wear glasses or contact lenses? Do you have any medical problems or physical limitations that might prevent or delay your donning a protective mask in an emergency?
Yes
No
Yes Yes
No No
j. k.
Yes
No
PROTECTIVE MASK/RESPIRATOR MEDICAL CLEARANCE FORM Part II (to be completed by the health-care provider): 1. Blood pressure: a. Blood pressure (supine / sitting / standing) [please circle one]: Additional measurements as indicated [please specify position, body site (e.g., left arm), and circumstances]: _____ / _____ mm Hg
_____ / _____ mm Hg _____ / _____ mm Hg _____ / _____ mm Hg
b. Is the diastolic blood pressure less than 100 mm Hg?
Yes
No
2. Additional findings: Additional relevant findings from history or physical examination: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 3. Additional testing needed: Based upon my review of the preceding information and my evaluation of this prospective student, it is my professional opinion that her or she does / does not [please circle one] require further medical evaluation. Further testing recommended: _______________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 4. Respiratory clearance: The prospective student whose name appears on page 1 of this form is / is not [please circle one] cleared for the issue of a negative-pressure military chemical protective mask for training purposes only. Name of approving physician: _______________________________________________________ Physician signature: _______________________________________________________________ Date: ___________________________________________________________________________ Location (city and state): ____________________________________________________________
PROTECTIVE MASK/RESPIRATOR MEDICAL CLEARANCE FORM
Note:
The original of this medical screening-and-evaluation form shall be provided to the Chemical Casualty Care Division, USAMRICD, APG-EA, Maryland. Medical clearance is for the use of a negative-pressure military chemical protective mask for training purposes only and shall be effective for up to but not longer than one (1) year from the approval date indicated in section 4 of Part II of this form.
Privacy Act Statement: Authority: Purpose: 5 U.S.C., Section 301; 10 U.S.C., Section 3013 This form is used to record student information in a form accessible to personnel entrusted with the safety of the training of students in chemical casualty care; information provided shall be made available only to a military physician assigned or attached to the Chemical Casualty Care Division, USAMRICD, APG-EA, MD and only for purposes of determining eligibility for field training involving a military chemical protective mask. Personal information on this form is given on a voluntary basis. However, failure to provide this information may preclude participation in the Medical Management of Chemical and Biological Casualties Course (MCBC) or the Field Management of Chemical and Biological Casualties Course (FCBC).
Disclosure:
APPENDIX F GENERAL INSTRUCTIONS WET BULB-GLOBE TEMPERATURE KIT
APPENDIX F - GENERAL INSTRUCTIONS WEL BULB-GLOBE TEMPERATURE KIT
GENERAL INSTRUCTIONS WET BULB-GLOBE TEMPERATURE KIT NSN 6665-00-159-2218 A. The wet bulb-globe temperature kit is an instrument for providing information on hot weather risks to the health of troops undergoing training. The information is displayed on a scale in the form of an index, computed from the weighed readings obtained from three different thermometers. 1. A stationary wet bulb (WB) thermometer exposed to the sun and prevailing wind. 2. A similarly exposed black globe (BG) thermometer with a black sheath over the bulb. The sheath and bulb are inside a transparent perforated plastic shield. 3. A dry bulb (DB) thermometer with its bulb shielded from the direct rays of the sun by a shield painted white. B. The wet bulb-globe temperature index (WBGT Index) is equal to 70% of the wet bulb (WB) temperature reading plus 20% of the black globe (BG) temperature reading plus 10% of the dry bulb (DB) temperature reading and can be computed as follows: WBGT Index = 0.7 WB + O.2 BG + 0.1DB Use of the attached slide rule provides the correct WBGT Index automatically. C. To use the WBGT Index as a control of physical activity, the following guidelines from TB-M.ED-175 are provided. 1. When the WBGT Index reaches 82, discretion should be used in planning exercise for unseasoned personnel. 2. When the WBGT Index reaches 85, strenuous exercises such as marching at standard cadence should be suspended for unseasoned personnel during their first three weeks of training. At this WBGT Index, training activities may be continued on a reduced scale after the second week of training. 3. Outdoor classes in the sun should be avoided when the WBGT Index exceeds 85. 4. When the WBGT Index reaches 88, strenuous exercise should be curtailed for all recruits and other trainees with less than 12 weeks training in hot weather. Hardened personnel after having been acclimatized each season, can carry on limited activity at WBGT indices of 88 to 90 for periods not exceeding six hours a day. D. The WBGT Kit is enclosed in an aluminum case. The case is kept closed with a miniature stainless steel catch. The threaded hole in the bottom of the case is used
to attach the case to a standard lightweight photographers tripod that is not supplied with this kit. 1. The kit is opened by disengaging the catch and lifting the cover. 2. Lift the thermometer assembly up and out (See Figure 1). NOTE: Examine the column of each thermometer. If the liquid has separated, heat the bulb slowly and carefully until the liquid reunites. CAUTION: Never use a match or any kind of open flame to heat a thermometer bulb. Use a warm liquid only. 3. Wet the wet bulb wick thoroughly. NOTE: The wick is cotton and is 5-inches long with a knot I-inch from one end. The end nearer the knot is pushed into the reservoir and the other end is slipped on the thermometer bulb (See Figure 1). The water reservoir should be filled with clear, preferably deionized or distilled water and utilized as indicated. The water should be changed daily and the wick washed with soap and rinsed thoroughly. To avoid error in the measurement of the wet bulb temperature, the water in the reservoir must be free of salt and soap. 4. Hold the kit with the thermometers toward the sun, with the -black globe thermometer closest to the sun. Wait 10 minutes for stabilization of temperatures. 5. Review the instructions on the right side of the slide rule (WET BULB-GLOBE TEMPERATURE INDEX CALCULATOR). Assume for purposes of instruction that the Black Globe (BG) temperature reading is 120, the Wet Bulb (WB) temperature reading is 80, and the Dry Bulb (DB) temperature is 100. a. Move 80 on the Wet Bulb Temperature (WB TEMP) scale so that it is directly under 100 on the Dry Bulb Temperature (DB TEMP) scale. b. Find 120 on the Black Globe Temperature (BC TEMP) scale. c. Read Wet Bulb Globe Temperature Index (WBGT INDEX) at the Black Globe Temperature (BC TEMP). d. If you have performed the slide rule movement correctly, the Index should read 90. e. CAUTION: After use, empty the water reservoir to prevent wetting or rusting of parts in the kit.
f. The kit contains, in addition to the parts shown in Figure 1, the following spare components: 1 each transparent perforated plastic shield, 1 each water reservoir, 18 inch extra wick.
APPENDIX G
CASUALTY ASSESSMENT EXERCISE SCRIPTS
NOTE: Use the new version of the Field Medical Card, DD Form 1360, dated Dec 1991.
APPENDIX G - CASUALTY ASSESSMENT EXERCISE SCRIPTS
PATIENT 1 About 6 hours ago artillery shells started falling near the patients unit location. The Individual Chemical Agent Detector (ICAD) worn by a U.S. Marine Corps liaison officer began to sound off shortly after the attack began and the alarm GAS was given. The patient put on his MOPP gear and then noted his mask was about 25 meters away. While running to get his mask he fell face first into a puddle of what he thought was water with some motor oil in it. After a few minutes he wiped it off with his sleeve but never used the M291 SDK. About 2-3 hours ago his eyes became irritated. About 1 -2 hours ago his face began to burn and itch and his eyes began to hurt very badly. This has progressed to severe erythema and loss of vision about 1 hour ago. MOULAGE: Reddened face. Complete MOPP IV without mask. M9 detector paper on upper right arm, left wrist and right ankle. The M9 paper has red spots. FIELD MEDICAL CARD: Block 3: Place an X on the face and place an X in the block next to burn. Block 9: Write the following in this block; Pain in the face and eyes (2-3 hours) Cant see Block 13: Write the following in this block; Face burn. Block 14: Write the following in this block; No treatment given. ACTING: Constantly complains of pain on face and particularly in the eyes. Also complains that he cannot see. No problems breathing. In distress AGENT SIMULATED: Mustard TRIAGE: Triage category is delayed (certainly not minimal minor injury, rapid return to action, and not an immediate he is in distress, but no life saving measures are needed). ACTION AFTER TRIAGE: There may be a tendency to send this patient to the emergency treatment are for analgesic and/or to watch respiratory status. It is fine that the students think this way. Let the give an analgesic and insure them this patient will be carefully watched through decontamination. Decontamination should be ambulatory (despite loss of vision). PROGNOSIS: This patients prognosis is good. The patient will not return to duty immediately and will recover form the burn. The involvement of the cornea and respiratory tract are unknown and will effect when this patient returns to duty.
PATIENT 2 This patient was dismounted from his M2 Bradley Infantry Fighting Vehicle (BIFV) and was about 10-15 meters away when an enemy anti-armor round impacted on the drivers hatch. The vehicle immediately caught fire and he ran back to assist in rescuing a trapped crewman. The patient attempted to avoid the black smoke by crawling up the ramp. As he dragged the injured crewman from the vehicle he was overcome by the smoke and could not continue the rescue. The soldier was ordered in MOPP IV because the ambulance had to move through a contaminated area. However, he removed his mask secondary to SOB. He has been short of breath (SOB) and increasingly dyspneic for the past 3 hours. His SOB started approximately 4 hours after the attack. MOULAGE: Your moulage (makeup) will be to darken an area under the nose and around the mouth. Complete MOPP IV with mask either in hand or carrying case M9 detector paper on upper right arm, left wrist and right ankle. The M9 paper has red spots. FIELD MEDICAL CARD: Block 3: Circle the mouth and nose and write soot by the circle. Also, place a ? in the box for airway/trache Block4: Place an X in the box for alert/alerte Block5: Write 100 in this block Block 9: Write the following in this block: Breathed smoke from vehicle hit by enemy fire SOB R-30 P-100 SBP- 140 ACTING: You should be standing when the triage officer arrives. Speak haltingly between short, chopphy breaths. You have chest tightness and you are SOB, and it is gradually getting harder to breathe. You cough lightly and only occasionally. AGENT SIMULATED: Perfluoroisobutylene (PFIB). Combustion by-product from the burning of Teflon, which is used on many components, found in modern vehicles. TRIAGE: Carbonaceous soot around airway and given history require this patient should be triaged as immediate for airway intervention-intubation. If unable to intubate secondary to skill level, personnel, or equipment deficiencies, should consider urgent evacuation priority to next echelon if assets available. ACTION AFTER TRIAGE: Quickly check for liquid contamination. Liquid contamination, nerve or vesicant, would not be likely given the particular history, but still need to be excluded before evacuation. PROGNOSIS: This patients prognosis is guarded. Due to the relatively short latent period, the chances of going on to develop fatal pulmonary edema are high. A therapeutic outcome will depend more on early evacuation rather than by any specific medical treatment that can be provided by this echelon of care.
PATIENT 3 History is scanty on this patient. He was found by a medic wandering through the field and falling down, running into things, and in general appearing confused. MOULAGE: None. Complete MOPP IV. M9 detector paper on upper right arm, left wrist and right ankle. FIELD MEDICAL CARD: Block 9: Write the following in this block: Found wandering in the woods. Block 13: Write the following in this block: Blind? Confused? Block 14: Write the following in this block: No treatment given ACTING: Complains that he cannot see. This patient should be carefully coached. He is not confused, disoriented, hallucinating, etc., except in so far as he might be confused and disoriented because of lack of sight (Where am I?, Who are you?). Can give a reasonable history (if asked). Does not know what happened to him except that he was in the middle of chemical attack and suddenly he could not see. Is concerned, but not panicked by the lack of sight. He should be up, wandering around, and in a sense, difficult to manage. AGENT SIMULATED: None TRIAGE: Triage category is minimal, although some may argue for delayed. Minimal because he can be treated on site, rather quickly (hopefully), and returned to action within a few days. A delayed label might suggest that this person could be set aside and neglected or overlooked this is the wrong thing to do with this type of patient. ACTION AFTER TRIAGE: This patient should go to the ambulatory decon line (despite loss of vision). PROGNOSIS: This patients prognosis is good. The patient must be kept close to his unit and given care by psychological technicians. This patient is suffering form battle fatigue or some exotic reaction to the psychological trauma of coping with the fear and anxiety associated with the use of chemical weapons against his unit.
PATIENT 4 Approximately 20-30 minutes ago, this patient was hit in the right outer thigh with bullet/shrapnel and then crawled through some oily liquid. A combat medic found him shortly afterward and applied a pressure dressing. About 5 minutes ago, the soldier started shaking all over (arms, legs, trunk), developed significant SOB, and vomited. When he presents he has a pressure dressing on the leg wound (obviously a wound with much bleeding, but no apparent bone involvement) and signs of moderate, becoming severe, nerve agent intoxication (generalized twitching, nausea and vomiting, copious secretions, gasping for air). MOULAGE: Torn and bloody right upper thigh area of the BDO pants leg. Large bloody field dressing (pressure) on the wound. Vomitus on BDO Complete MOPP level IV. M9 detector paper on upper right arm, left wrist and right ankle. The M9 paper has red spots. FIELD MEDICAL CARD: Block 3: Place X over right outer thigh on figure and mark wound block with an X. Block 4: Place an X in verbal response and pain response. Block 5: Write 110 in this box. Block 9: Write the following in this block: Leg pain (20 min) Generalized twitching (5 min) Secretions (5 min) Retching (5 min) Difficulty breathing (5 min) BP 120/HR 110 Block 13: Write the following in this block: No bone injury (20-30 minutes ago) Block 14: Write the following in this block: Pressure dressing ACTING: You can answer questions well enough to let students know what happened to you You answer questions between efforts to gasp fir breath Generalized twitching and shaking of arms, legs, and body Secretions from mouth and nose (if it can be arranged) Extremely distressed AGENT SIMULATED: Nerve agent (V or G series) TRIAGE: Immediate for chemical; delayed for conventional wound ACTION AFTER TRIAGE: The patient should be taken immediately to the emergency treatment area and given three (3) nerve agent antidote kits followed by one (1) CANA. Watch for recurrence of nerve agent S&S. When stable, proceed to litter decon. PROGNOSIS The patients prognosis is good with immediate treatment.
PATIENT 5 This patient is a medic. About 20 minutes ago he found patient #4 with a leg wound and started to apply a pressure dressing to his leg. Because he had some difficulty performing this task he took off his chemical protective gloves to work better. About 5 minutes ago he began to feel uneasy. A feeling of weakness and nausea, which progressed until now when he presents with great difficulty breathing, generalized tremors, twitches, retching, and large amounts of secretions, followed this. MOULAGE: Complete MOPP IV. M9 detector paper on upper right arm, left wrist and right ankle. The M9 paper has red spots. FIELD MEDICAL CARD: Block 1: Write medic Block 9: Write the following in this block: No wounds Twitching (5 min) Difficulty breathing (5 min) Retching (5 min) Secretions (5 min) Block 14: Write the following in this block: No treatment ACTING: Shaking/twitching Grasping for air Secretion (mouth and nose -?) Retching and vomiting (it can be arranged) Semiconscious (this and trouble breathing make it difficult for him to talk) AGENT SIMULATED: Nerve agent (V or G series) TRIAGE: This patient should be triaged as an immediate casualty. ACTION AFTER TRIAGE: The patient should be taken immediately to the emergency treatment area and given three (3) nerve agent antidote kits followed by one (1) diazepam autoinjector. PROGNOSIS: This patients prognosis is good with immediate treatment.
PATIENT 6 This patient is found stumbling along a forest path with vomitus on the front of his BDU, which is partly unbuttoned (patient feels hot). His mask carrier is open, but his mask is nowhere in sight. He says in a quiet and softly slurred voice that he was running from a large tank and that he got sick from running too fast.
MOULAGE: MOPP 0 except that mask and injectors are missing from mask carrier; BDU partly unbuttoned; vomitus on front of BDU and T-shirt. FIELD MEDICALCARD: Heat casualty? T 100 ACTING: This patient speaks softly and with some slurring, as if he were very tired, even half-asleep. He says that he is weak and tired. If asked about the tank, he says that the last time he checked, he had outwitted the tank but now is trying to get away from a HummVee. He says that he is hot, and he keeps starting to take the rest of the BDU shirt off and then stops as if he had forgotten what he was going to do. Once in a while (but not too obviously), he picks some real or imaginary lint from his shirt and trousersand occasionally from the air, too. If asked what he is picking from the air, he reports something (dandelion seeds drifting by, big fluffy snowflakes, etc.) that he obviously thinks he sees. If asked specifically about the sizes of the things in the air, he reports that theyre smaller now than they were a little while ago. If asked about his mask and autoinjectors, he says that he had to give them to a man who looked just like the Jolly Green Giant. If asked about his sight, he says that he is wearing rose-colored glasses. COMPLAINTS: No real complaints, although if asked he admits that he feels hot. He is unable to say whether he is feeling better or worse. AGENT SIMULATED: Anticholinergic incapacitating agent such as BZ or Agent (DDx: atropine overdose, heat injury, anxiety) TRIAGE: This casualty should probably be considered to be delayed. ACTION AFTER TRIAGE: Ambulatory decontamination if patient is cooperative; otherwise, litter decontamination. Observation. He should be evacuated if he does not continue to improve or if his condition deteriorates. PROGNOSIS: Good as long as attention is paid to protecting him from himself and from hyperthermia and as long as it is realized that the patient may become paranoid as his other symptoms begin to resolve. P 120 BP 96/60. Skin and mouth dry. Red face. Rash on hands.
PATIENT 7 Approximately 2 hours ago, artillery shells started falling near your unit. Shortly after the attack began, the Individual Chemical Agent Detector (ICAD) detected agent, the GAS alarm was given, and your unit went to MOPP IV. While crawling for cover, your BDO jacket became hung up on barbed wire so you removed it. You continued to crawl through the brush, then removed your t-shirt in order to wipe off all the oily liquid you suddenly noticed on your chest and arms. MOULAGE: Upper body bare except mask and gloves Trunk and upper extremities very red M9 detector paper on right ankle. M9 paper has red spots FIELD MEDICAL CARD: Block 3: Place X on trunk (front and back) and both upper extremities (front and back) and an X in the block burn Block 4: Place an X in the box for alert/alerte Block 5: Write 94 in this block Block 9: SBP- 130, red trunk and upper extremities ACTING: Severe burning and itching. Feels like skin is on fire. Requesting something for pain. AGENT SIMULATED: Mustard. Severe exposure TRIAGE: This patient should be triaged as expectant ACTION AFTER TRIAGE: The patient should be sent to ambulatory decontamination and evacuated to the next echelon if evacuation assets are or become available PROGNOSIS Guarded to poor secondary to severity of exposure.
PATIENT 8 This patient was policing around the latrine about 3 days ago. The M8A1 chemical alarm went off. While running to get his MOPP gear he tripped and injured his right arm. Because of the injury, the patient managed to don his MOPP about 10 minutes after the alarm sounded. No agent was detected and the all-clear was given 30 minutes later. He is alert and oriented with some difficulty answering questions. He appears to be working to breathe and complains of difficulty swallowing. His pupils appear dilated and react sluggishly to light; he states he has blurry vision and has been nauseated since breakfast (8 hours ago). Two other soldiers from his unit have similar problems and were taken to another hospital today. An hour ago on his way to the aid station he tripped and hurt his ankle. MOULAGE: Splint on ankle. Complete MOPP IV M9 detector paper on upper right arm, left wrist and right ankle. FIELD MEDICAL CARD: Block 3: Place an X on right ankle Block 5: Place 90 in this block Block 9: Write the following in this block: BP 100/RR 24 Slight drooping of the eyelids Pupils are dilated Difficulty swallowing and breathing Nasal secretions Complains of nausea Blurred vision (The above nave progressed over the past 24 hours) Block 13: Write the following in this block: Possible F/X ankle. ??? Pain in ankle1 hour Block 14: Write the following in this block: No treatment given ACTING: He is anxious with garbled speech Slight secretions from nose Rapid, shallow respiration AGENT SIMULATED: Botulism TRIAGE: This patient should be classified as immediate. ACTION AFTER TRIAGE: This patient should be taken to the emergency treatment area. If he stops breathing, he will need intubation and ventilation. This patient will need the botulism antitoxin. Needs an IV. Notify command of bio attack. This patient should be sent through litter decon.
PATIENT 9 This patient was caught in a chemical attack 30 minutes ago. The patient left his protective mask about 25 yards away. After donning his mask, the soldier tripped, tore his left glove and twisted his left ankle. Approximately 15 minutes ago the patient began to experience rhinorrhea, mild SOB, left hand twitching, and nausea. He gave himself one nerve agent antidote kit and now his secretions and breathing are about normal, his left hand has stopped twitching, but he continues to have nausea.
MOULAGE: Field bandage on left wrist Complete MOPP IV M9 detector paper on upper right arm and right ankle (NO COLOR CHANGE ON M9 PAPER) FIELD MEDICAL CARD: Block 3: Place an X on the left wrist and left ankle Block 9: Write the following in this block: Mild difficulty breathing Upset stomach and nausea Rhinorrhea Left hand twitching subsided Block 14: Write the following in this block: Sling 1 NAAK, MK I ACTING: He is to indicate that his nose was running like crazy, but his breathing and secretions are now about normal if he is specifically asked whether they have changed. He should breathe normally with an occasional deep breath. If asked, he should also indicate that his left hand twitching has ceased but he continues to be nauseated. He complains of pain in his wrist and ankle, which is why he came to the aid station. AGENT SIMULATED: Nerve (V or G series)/liquid TRIAGE: Can triage immediate initially for additional antidote therapy, then delayed for conventional injury if condition continues to improve. ACTION AFTER TRIAGE: Spot decon left wrist now, the litter decon when stable PROGNOSIS: This patients prognosis is excellent.
PATIENT 10 This patient received a small wound (gunshot) to the upper left arm about 4 hours ago which ripped his left MOPP jacket arm. His squad was at MOPP I with jackets unzipped. As he tried to bandage his wound, he noted his chest, abdomen, and upper back (on the wound side) were covered with an oily liquid. The patient removed his BDO jacket and T-shirt. He tried to wipe the liquid off using the T-shirt. After applying a crude bandage to his wound he wiped his chest and back with his M291 skin decontamination kit (SDK) 10-15 minutes later. He then put on his extra BDO jacket. He now presents with the bandaged wound, slightly reddened chest, belly, arm, and back, and complaints of burning and itching in these areas. MOULAGE: Bloody bandage on upper left arm. Complete MOPP IV with jacket open. No BDU or T-shirt M9 detector paper on upper right arm, left wrist and right ankle. The M9 paper has red spots. Reddened skin in areas noted above. FIELD MEDICAL CARD: Block 3: Place an X on the chest, abdomen, upper back, and upper left arm Block 9: Write the following in this block: Pain in left arm Itching , burning of chest, arm, abdomen, back (20-30 minutes) Block 13: Write the following this block: Arm wound Block 14: Write the following in this block: Field dressing ACTING: NOTE: Patient should be a male so makeup can be applied to chest, abdomen, back, and arm. AGENT SIMULATED: Mustard TRIAGE: This patient should be triaged as delayed/expectant. ACTION AFTER TRIAGE: Should be sent to ambulatory decon. PROGNOSIS: This patients prognosis is poor. Due to the extensive body surface area (BSA) covered by the mustard agent this casualty will die in several weeks due to sepsis, secondary infections, and other complications associated with gradual total destruction of his bodys ability to fight off infections.
PATIENT 11 About 20 minutes ago this soldier, a combat lifesaver, was at MOPP 1 with his unit when one of the riflemen in his platoon was shot. The combat lifesaver, with a field rucksack and a medical kit bag, shouted encouragement to the injured soldier, ran to him, applied a dressing to the wound, and then started dragging him to a patient collection point 75 meters away across a field covered with dew. In the center of the field was a small creek, and as the combat lifesaver carried the rifleman across the creek he had to pass through what appeared at the time to be low-lying fog on both sides of the creek. An ambulance had been prepositioned at the collection point and immediately transported both soldiers to your facility. The rifleman is awaiting triage nearby. The combat lifesaver is still gulping air. He is coughing and sneezing and says (hoarsely) that he cant breathe properly. He is shaking all over and has marked rhinorrhea and tearing. He is starting to panic. He also appears to have been incontinent of urine. MOULAGE: MOPP 1 (mask in carrier) with M9 paper on arm; M9 paper has small red spots on it. FIELD MEDICALCARD: Short of breath; coughing and sneezing; secretions; twitching; feels warm; P 100; SBP 140. ACTING: What did I get into back there? Why cant I breathe? This patient shakes all over (partly from fright, partly from exhaustion) but without any violent movements (more like shivering). He also has nasal secretions and has to keep sniffing. His eyes also burn and itch. In the heat of the moment he has forgotten, but if asked specifically about any pre-existing medical conditions or about any recent illnesses he realizes that he coughs and wheezes when he exercises, that he gets really bad hay fever, and that he has had a headache and a cold for the last two days. COMPLAINTS: Shortness of breath; cant seem to stop coughing. AGENT SIMULATED: Reactive airway disease complicated by URI, environmental allergies, and fear (DDx: pulmonary agent, nerve agent, vesicant); possible unknown nerve-agent or vesicant exposure vs. false-positive reaction of M9. TRIAGE: Most likely delayed. ACTION AFTER TRIAGE: Ambulatory decontamination if patient is able; otherwise, litter decontamination. PROGNOSIS: Good if no agent exposure occurred (use PIE); but observation and rest necessary before excluding agent exposure.
PATIENT 12 This patient has a wound (gunshot) in his abdomen and apparently got splashed with liquid nerve agent on the skin or into the wound through a torn garment when he fell. This happened 15 20 minutes ago. A dressing was applied to the abdominal wound, and the patient presents with moderate (but progressing to severe) nerve-agent intoxication. MOULAGE: Large bloody dressing on abdomen Complete MOPP IV. M9 detector paper on upper right arm, left wrist and right ankle. The M9 paper has red spots. FIELD MEDICAL CARD: Block 3: Place an X on the abdomen. Block 5: Nothing Block 9: Write the following in this block: Retching Twitching (5-10 min) Difficulty breathing Secretions (5-10 min) HR is 120-130 BP is now 90 Block 13: Write the following in this block: Pain in abdomen (20 min) Abdominal wound (20 min) Block 14: Write the following in this block: Pressure dressing ACTING: Breathing with difficulty Retching/vomiting Twitching, generalized Secretions, mouth and nose Semi-conscious AGENT SIMULATED: Nerve agent (V or G) TRIAGE: This casualty is probably expectant; but could be classified as immediate. ACTION AFTER TRIAGE: This patient should go to the emergency treatment area and receive three (3) nerve agent antidote kits and one (1) diazepam autoinjector. An IV should also be started. PROGNOSIS: The patients prognosis is poor. Due in great part to the type of wound and the indications that nerve agent was injected into the wound and onto surrounding skin. The delay in receiving treatment may hasten this patients death but in all likelihood the casualty would die due to the amount of agent in the wound and the amount which has absorbed through the skin.
APPENDIX H CASUALTY ASSESSMENT EXERCISE NOTE-TAKING OUTLINE
PATIENT NO. 1. DIAGNOSIS(ES): 2. TRIAGE CATEGORY : MINIMAL (M) DELAYED (D) IMMEDIATE (I) EXPECTANT (E)
3. TREATMENT: 4. DECON:
NO
YES LITTER URGENT URGENT
WHAT? AMBULATORY NON-URGENT PRIORITY ROUTINE
5. DECON PRIORITY: 6. EVAC PRIORITY: 7. PROGNOSIS: PATIENT NO. 1. DIAGNOSIS(ES): 2. TRIAGE CATEGORY :
MINIMAL (M)
DELAYED (D)
IMMEDIATE (I)
EXPECTANT (E)
NO
MINIMAL (M)
DELAYED (D)
IMMEDIATE (I)
EXPECTANT (E)
NO
5. DECON PRIORITY: 6. EVAC PRIORITY: 7. PROGNOSIS:
PATIENT NO. 1. DIAGNOSIS(ES): 2. TRIAGE CATEGORY : MINIMAL (M) DELAYED (D) IMMEDIATE (I) EXPECTANT (E)
NO
MINIMAL (M)
DELAYED (D)
IMMEDIATE (I)
EXPECTANT (E)
NO
MINIMAL (M)
DELAYED (D)
IMMEDIATE (I)
EXPECTANT (E)
NO
5. DECON PRIORITY: 6. EVAC PRIORITY: 7. PROGNOSIS:
Facilitator Course Application

Medical Management of Chemical and Biological Casualties Video Course
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FACILITATOR COURSE APPLICATION MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE
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SAMPLE AGENDA FOR MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE
Course Location: (Your Location) (DATE)
DAY 1
0800
Introduction/Overview of Chemical Agents
LTC James Madsen, MC
0900
History of the Medical Aspects of Chemical Warfare
Fredrick R. Sidell, M.D.
0940
Break
0950
Nerve Agents and Pretreatment
Fredrick R. Sidell, M.D.
LTC Jonathan Newmark, MC 1130 Break
1140
Vesicants
COL Charles G. Hurst, MC
1240
Lunch
1340
Cyanide
1440
Pulmonary Agents
LTC Roger D. Baxter, AN
1440
Break
1450
Incapacitating Agents
1540
Riot-Control Agents LTC Jonathan Newmark, MC
1610
Fill Out Critique
Encl 2 DAY 2 0800 Triage and Field Management of Baxter, AN Chemical-Agent Casualties LTC Roger D.
0900 NBC Counterterrorism and Scenarios Newmark, MC
LTC Jonathan
1000
Break
1015
Overview of Biological Agents LTC Theodore J. Cieslak, MC
1130 MC
Bacterial Threat- Anthrax
LTC Theodore J. Cieslak,
1200 MC
Bacterial Threat- Plague
LTC Theodore J. Cieslak,
1240
Lunch
1340
Viral Threat- Smallpox
LTC Theodore J. Cieslak, MC
1420
Toxin Threat - Botulinum Toxins Ricin, Staphylococcal Enterotoxin B, Mycotoxin
LTC Theodore J. Cieslak, MC
1700
Fill Out Critique
DAY 3
0800
Examination
0830
Decontamination (Optional)
0930
Introduction to the Field Exercise (Optional)
1030 1230
Field Training Exercise (Optional) Fill Out Critique
SAMPLE AGENDA FOR MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES (MCBC) VIDEOTAPE COURSE
Course Location: (Your Location) (DATE) DAY 1 0800 0900 0940 0950 1130 1140 1240 1340 1440 1440 1450 1540 1610 Introduction/Overview of Chemical Agents History of the Medical Aspects of Chemical Warfare Break Nerve Agents and Pretreatment Break Vesicants Lunch Cyanide Pulmonary Agents Break Incapacitating Agents Riot-Control Agents Fill Out Critique LTC James Madsen, MC LTC Jonathan Newmark, MC LTC James Madsen, MC LTC Roger D. Baxter, AN COL Charles G. Hurst, MC Fredrick R. Sidell, M.D. LTC Jonathan Newmark, MC LTC James Madsen, MC Fredrick R. Sidell, M.D.
Encl 2
DAY 2 0800 0900 1000 1015 1130 1200 1240 1340 1420 Triage and Field Management of Chemical-Agent Casualties NBC Counterterrorism and Scenarios Break Overview of Biological Agents Bacterial Threat- Anthrax Bacterial Threat- Plague Lunch Viral Threat- Smallpox Toxin Threat - Botulinum Toxins Ricin, Staphylococcal Enterotoxin B, Mycotoxin Fill Out Critique DAY 3 0800 0830 0930 1030 1230 Examination Decontamination (Optional) Introduction to the Field Exercise (Optional) Field Training Exercise (Optional) Fill Out Critique LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Theodore J. Cieslak, MC LTC Roger D. Baxter, AN LTC Jonathan Newmark, MC
1700
STUDENT REGISTRATION FORM Medical Management of Chemical and Biological Casualties (MCBC) Videotape Course
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CRITIQUE MEDICAL MANAGEMENT OF CHEMICAL AND BIOLOGICAL CASUALTIES COURSE Course Site: Course Date:
Please rate the sections as follows: 1. 2. 3. 4. 5. Outstanding Excellent Good Fair Poor
Day 1
LECTURE/SPEAKER Introduction/Overview of Chemical Agents
CONTENT
PRESENTATION SUITABILITY
OVERALL
_________ ______________ ___________
________
History of the Medical Aspects of Chemical Warfare _________ ______________ ___________ Nerve Agents/Pretreatment Vesicants Cyanide Pulmonary Agents Incapacitating Agents Riot Control Agents _________ ______________ ___________ _________ ______________ ___________ _________ ______________ ___________ _________ ______________ ___________ _________ ______________ ___________ _________ ______________ ___________
________ ________ ________ ________ ________ ________ ________
Day 2 LECTURE/SPEAKER CONTENT PRESENTATION SUITABILITY OVERALL ________
Triage and Field Management _________ ______________ ___________ Of Chemical -Agent Casualties NBC Counterterrorism and Scenarios _________ ______________ ___________
________
Overview of Biological Agents _________ ______________ ___________ Bacterial Threat- Anthrax Bacterial Threat- Plague Viral Threat - Smallpox _________ ______________ ___________ _________ ______________ ___________ _________ ______________ ___________
________ ________ ________ ________
Toxin Threat- Botulinum Toxins, Ricin, Staphylococcal Enterotoxin B, Myotoxin _________ ______________ ___________
________
Day 3 LECTURE/SPEAKER Examination Introduction to the FTX Field Training Exercise CONTENT _________ _________ _________ PRESENTATION SUITABILITY ______________ ___________ ______________ ___________ ______________ ___________ OVERALL ________ ________ ________
************************************************************************************************************* 1. Did this course satisfy your requirements? How - or why not?
2. If you were Course Director, what changes would you make?
3. Do you have any other criticisms/comments?
4. Do you feel that this program was fair, balanced and free of commercial bias?
Following are 40 questions regarding the medical management of biological and chemical casualties. Please read each question thoroughly and mark the answer on your answer sheet only that is the MOST appropriate choice. 1. The clinical manifestations of Venezuelan Equine Encephalitis can consist of the following: a. b. A benign influenza-like illness A severe febrile encephalitis with a 20% fatality rate c. A febrile illness consisting of headaches, myalgias, vomiting, diarrhea, and lethargy which lasts 3-5 days and has an overall case fatality rate of less than 1% All of the above
d.
3. The following measures were instituted to protect our troops in the Persian Gulf against weaponized Bacillus anthracis during the Gulf War: a. Ciprofloxacin in a 5-day blister pack was issued to each soldier to begin taking immediately after exposure and was to be continued for 30 days if a true exposure occurred b. Soldiers deemed to be at highest risk of exposure were given two doses of the licensed vaccine two weeks apart early in January 1991 c. All soldiers in the theater would have eventually received three doses of the licensed vaccine, as more was made, if the conflict had continued for several months All of the above
d.
4. The biological threat agent with the potential for producing the greatest number of deaths in a battlefield field environment is: a. b. c. Q Fever Tularemia Anthrax
d.
Staphylococcal Enterotoxin B
10. Which of the following is false regarding treatment of plague: a. Chloramphenicol is the first drug of choice used to treat plague meningitis b. Face-to-face contacts of pneumonic plague victims should be given prophylaxis with a tetracycline c. Emergence of antibiotic-resistant Yersinia pestis is a common problem in the treatment of plague d. Streptomycin is the drug of choice for treating both bubonic and pneumonic plague e. Both A and C 11. Plague Vaccine, USP: a. Is a live-attenuated whole-cell preparation yielding life-long protection via a single inoculation b. Is proven to be effective in immunizing and protecting troops for rapid deployment (within one month) c. Is virtually unchanged since its development 50 years ago d. Is a component vaccine made with recombinant DNA technology 12. The most effective particle size range of an infectious aerosol is: a. b. c. d. Less than one micron One to five microns Seven to twelve microns Greater than 20 microns
13. The best time for disseminating an effective aerosol is: a. Just before sunrise, dusk, or at night b. During daylight in order to maximize the number of people outside of their homes and buildings c. When the wind is blowing 20-30 mph in order to quickly and effectively distribute the infectious aerosol None of the above
d.
14. All of the following statements regarding Q fever are true, except: a. Infection may be initiated by as few as 10 organisms b. The incubation period is constant, regardless of whether the infecting inoculum is large or small c. The signs and symptoms of Q fever are non-specific, so the diagnosis requires a high index of suspicion and/or compatible epidemiological history Administration of the vaccine should be preceded by a skin test
d.
17. How may Investigational New Drugs (Vaccines) be administered according to FDA regulation: a. b. c. They may be given as any other drug is given They must be given under protocol with informed consent They may be given under a protocol but informed consent is not required d. They may be given by the military as any other drug is given but must be given to the general public under protocol and informed consent
21. Which of the following is true concerning LD50, the Ct product, and LCt50? a. They estimate the amount of agent with a 50% chance of killing an individual b. Effects from a given Ct product are essentially unaffected by rate and depth of breathing c. Both LD50 and LCt50 estimate how much agent would kill 50% of an exposed group d. As the LD50 and LCt50 get smaller, the agent potency (toxicity) decreases as well e. The LCt50 of mustard is greater than the average LCt50 of cyanide 22. Of the following, the earliest indicator of pulmonary edema in a casualty exposed to a respiratory agent is: a. an abnormal arterial-blood-gas (ABG) test b. dyspnea (shortness of breath) c. a pattern of scattered infiltrates with Kerley B lines on PA and lateral chest radiographs d. dullness to percussion on physical examination. e. wheezing 23. Which of the following is true concerning cyanide? a. A dependable warning of the presence of AC is its characteristic odor of bitter almonds b. As a blood agent, cyanide binds avidly to the oxyhemoglobin in blood c. Cyanide reacts strongly with certain transitional metals and with sulfur donors d. Because cyanide prevents cellular utilization of oxygen, supplemental oxygen is not indicated e. Once breathing has stopped, a cyanide casualty should be triaged as expectant 24. In a person severely intoxicated by nerve agent, atropine administration should be titrated to which of the following? a. b. c. d. e. Clinical reduction of bronchospasm and secretions Clinical restoration of normal heart rate and blood pressure Clinical reduction of skeletal-muscle fasciculations and twitching Clinical reduction of gastrointestinal distress and spasm Clinical resolution of miosis and eye pain
25. Differences between sulfur mustard and Lewisite include which of the following? a. Mustard patients usually need more vigorous fluid resuscitation than do Lewisite
patients b. Lewisite is approximately 5 to 8 times more toxic than is sulfur mustard c. The latent period of Lewisite is longer than that of sulfur mustard d. Pulmonary edema is more likely with Lewisite than with sulfur mustard e. Lewisite has a higher boiling point than does sulfur mustard 26. It is important to decide whether agent exposure is to vapor or to liquid because: a. only vapors produce eye effects b. the strength of bleach chosen depends upon whether the agent is a vapor or a liquid c. clinical effects from liquid exposure may be delayed d. wearing the mask may not be necessary if the agent is liquid e. diazepam is not indicated for exposure to nerve-agent vapor 27. Which of the following is true concerning peripherally acting pulmonary agents? a. b. Symptoms never precede signs They cause clinical effects that mimic adult respiratory distress syndrome (ARDS)
c. Irritation of the nose and mouth with coughing and bronchospasm effectively excludes these agents d. Their peripheral effects are probably caused by hydrochloric acid e. In most cases, prophylactic administration of antibiotics is a reasonable medical option 28. The M256 detector ticket will detect vapors of which of the following? a. b. c. d. e. Nerve agents and cyanide only Nerve, cyanide, and vesicant agents Cyanide, mustard, and only the G nerve agents Vesicants and nerve agents only None of the above
29. For a casualty exposed on the skin to liquid mustard two hours ago, skin decontamination: a. should be omitted, since the damage occurred during the first two to five minutes b. should be done using 5% instead of 0.5% hypochlorite c. should be done only to protect health-care workers d. should be done to inactivate mustard in blisters, since mustard in fluid is very persistent e. should be done to protect the patient from continuing exposure and to protect
health-care workers 30. Which of the following is true about incapacitating agents? a. b. signs c. The agent once weaponized by the U.S. was a highly persistent liquid Bradycardia (heart rate "slow as a snail") is one of the characteristic presenting
Classic central-nervous-system effects include abstract geometric hallucinations
d. Administration of a specific antidote is almost always indicated in confused or combative casualties e. Iraq is suspected of having stockpiled large amounts of one of these agents in the 1980s. 31. Which of the following is the standard U.S. military treatment for cyanide poisoning on the battlefield? a. b. c. d. e. Sodium nitrate followed by sodium thiosulfite Amyl nitrite followed by sodium nitrate and then sodium thiosulfite 100% oxygen administered concomitantly with sodium thiosulfate Sodium nitrite, sodium thiosulfite, and diazepam Sodium nitrite and sodium thiosulfate
33. Which of the following statements concerning sulfur mustard is true? a. b. c. d. War I e. cells Mustard is a recognized carcinogen Body surface area involved with skin burns is highly correlated with mortality Mustard dissolves quickly in aqueous solutions such as sweat Hands were among the body sites most frequently burned by mustard in World Mustard penetrates skin rapidly but typically takes several hours to damage skin
34. The M40 protective mask with its C2A1 canister:
a. Depends upon a HEPA particulate filter as a barrier to cyanide, G agents, and phosgene b. Will protect the wearer against carbon monoxide and low concentrations of oxygen c. Is to be donned, cleared, and checked in up to 15 seconds d. Uses zinc-impregnated charcoal to adsorb molecules of chemical-agent vapor and gas e. Is only rarely associated with increased work of breathing and shortness of breath 35. Central effects differ from peripheral effects in that central effects: a. b. c. d. e. Seldom exhibit a latent period Do not usually result from exposure to phosgene or PFIB Should be suspected when a casualty reports being short of breath Cause gurgling from pulmonary-edema fluid rising in the airways Usually produce noise from turbulent airflow
37. Pre-exposure administration of pyridostigmine bromide: a. is given when ordered by the senior medical officer in the division b. is given to create a reserve force of protected AChE c. is most appropriate when the threat agent is known to be GF d. is associated with a high incidence of debilitating side effects e. increases survival even when antidotes are not given after nerve-agent exposure 38. Effects after cyanide inhalation typically include which of the following? a. b. c. d. e. Miosis, bronchial hypersecretion, and nausea Brief hyperventilation and initial increases in heart rate and blood pressure Convulsions, vomiting, and flaccid paralysis Muscle weakness, cyanosis, and secretions Sudden loss of consciousness after a latent period of up to 60 minutes
40. The clean treatment area should be: a. upwind from the area of contamination b. downwind from contamination in order to take advantage of detector systems in place c. uncovered whenever possible to prevent dripping of agent from overhead cover d. downwind from the PDS e. as close as possible to the hot line
I certify that I have completed this educational activity and post-test.
___________________________ Physicians Name
Following are 40 questions regarding the medical management of biological and chemical casualties. Please read each question thoroughly and mark the answer on your answer sheet only that is the MOST appropriate choice. 1. The clinical manifestations of Venezuelan Equine Encephalitis can consist of the following: a. b. c. d. A benign influenza-like illness A severe febrile encephalitis with a 20% fatality rate A febrile illness consisting of headaches, myalgias, vomiting, diarrhea, and lethargy which lasts 35 days and has an overall case fatality rate of less than 1% All of the above
3. The following measures were instituted to protect our troops in the Persian Gulf against weaponized Bacillus anthracis during the Gulf War: a. b. c. d. Ciprofloxacin in a 5-day blister pack was issued to each soldier to begin taking immediately after exposure and was to be continued for 30 days if a true exposure occurred Soldiers deemed to be at highest risk of exposure were given two doses of the licensed vaccine two weeks apart early in January 1991 All soldiers in the theater would have eventually received three doses of the licensed vaccine, as more was made, if the conflict had continued for several months All of the above
4. The biological threat agent with the potential for producing the greatest number of deaths in a battlefield field environment is: a. b. c. d. Q Fever Tularemia Anthrax Staphylococcal Enterotoxin B
U:\courses\video\MCBCVideo_Exam.doc
rev: 07/22/2003
10. Which of the following is false regarding treatment of plague: a. b. c. d. e. Chloramphenicol is the first drug of choice used to treat plague meningitis Face-to-face contacts of pneumonic plague victims should be given prophylaxis with a tetracycline Emergence of antibiotic-resistant Yersinia pestis is a common problem in the treatment of plague Streptomycin is the drug of choice for treating both bubonic and pneumonic plague Both A and C
11. Plague Vaccine, USP: a. b. c. d. Is a live-attenuated whole-cell preparation yielding life-long protection via a single inoculation Is proven to be effective in immunizing and protecting troops for rapid deployment (within one month) Is virtually unchanged since its development 50 years ago Is a component vaccine made with recombinant DNA technology
rev: 07/22/2003
12. The most effective particle size range of an infectious aerosol is: a. b. c. d. Less than one micron One to five microns Seven to twelve microns Greater than 20 microns
13. The best time for disseminating an effective aerosol is: a. b. c. d. Just before sunrise, dusk, or at night During daylight in order to maximize the number of people outside of their homes and buildings When the wind is blowing 20-30 mph in order to quickly and effectively distribute the infectious aerosol None of the above
14. All of the following statements regarding Q fever are true, except: a. b. c. d. Infection may be initiated by as few as 10 organisms The incubation period is constant, regardless of whether the infecting inoculum is large or small The signs and symptoms of Q fever are non-specific, so the diagnosis requires a high index of suspicion and/or compatible epidemiological history Administration of the vaccine should be preceded by a skin test
17. How may Investigational New Drugs (Vaccines) be administered according to FDA regulation: a. b. c. d. They may be given as any other drug is given They must be given under protocol with informed consent They may be given under a protocol but informed consent is not required They may be given by the military as any other drug is given but must be given to the general public under protocol and informed consent
rev: 07/22/2003
21. Which of the following is true concerning LD50, the Ct product, and LCt50? a. b. c. d. e. They estimate the amount of agent with a 50% chance of killing an individual Effects from a given Ct product are essentially unaffected by rate and depth of breathing Both LD50 and LCt50 estimate how much agent would kill 50% of an exposed group As the LD50 and LCt50 get smaller, the agent potency (toxicity) decreases as well The LCt50 of mustard is greater than the average LCt50 of cyanide
22. Of the following, the earliest indicator of pulmonary edema in a casualty exposed to a respiratory agent is: a. b. c. d. e. an abnormal arterial-blood-gas (ABG) test dyspnea (shortness of breath) a pattern of scattered infiltrates with Kerley B lines on PA and lateral chest radiographs dullness to percussion on physical examination. wheezing
23. Which of the following is true concerning cyanide? a. b. c. d. e. A dependable warning of the presence of AC is its characteristic odor of bitter almonds As a blood agent, cyanide binds avidly to the oxyhemoglobin in blood Cyanide reacts strongly with certain transitional metals and with sulfur donors Because cyanide prevents cellular utilization of oxygen, supplemental oxygen is not indicated Once breathing has stopped, a cyanide casualty should be triaged as expectant
24. In a person severely intoxicated by nerve agent, atropine administration should be titrated to which of the following? a. b. c. d. e. Clinical reduction of bronchospasm and secretions Clinical restoration of normal heart rate and blood pressure Clinical reduction of skeletal-muscle fasciculations and twitching Clinical reduction of gastrointestinal distress and spasm Clinical resolution of miosis and eye pain
rev: 07/22/2003
25. Differences between sulfur mustard and Lewisite include which of the following? a. b. c. d. e. Mustard patients usually need more vigorous fluid resuscitation than do Lewisite patients Lewisite is approximately 5 to 8 times more toxic than is sulfur mustard The latent period of Lewisite is longer than that of sulfur mustard Pulmonary edema is more likely with Lewisite than with sulfur mustard Lewisite has a higher boiling point than does sulfur mustard
26. It is important to decide whether agent exposure is to vapor or to liquid because: a. b. c. d. e. only vapors produce eye effects the strength of bleach chosen depends upon whether the agent is a vapor or a liquid clinical effects from liquid exposure may be delayed wearing the mask may not be necessary if the agent is liquid diazepam is not indicated for exposure to nerve-agent vapor
27. Which of the following is true concerning peripherally acting pulmonary agents? a. b. c. d. e. Symptoms never precede signs They cause clinical effects that mimic adult respiratory distress syndrome (ARDS) Irritation of the nose and mouth with coughing and bronchospasm effectively excludes these agents Their peripheral effects are probably caused by hydrochloric acid In most cases, prophylactic administration of antibiotics is a reasonable medical option
28. The M256 detector ticket will detect vapors of which of the following? a. b. c. d. e. Nerve agents and cyanide only Nerve, cyanide, and vesicant agents Cyanide, mustard, and only the G nerve agents Vesicants and nerve agents only None of the above
29. For a casualty exposed on the skin to liquid mustard two hours ago, skin decontamination: a. b. c. d. e. should be omitted, since the damage occurred during the first two to five minutes should be done using 5% instead of 0.5% hypochlorite should be done only to protect health-care workers should be done to inactivate mustard in blisters, since mustard in fluid is very persistent should be done to protect the patient from continuing exposure and to protect health-care workers
30. Which of the following is true about incapacitating agents? a. b. c. d. e. The agent once weaponized by the U.S. was a highly persistent liquid Bradycardia (heart rate "slow as a snail") is one of the characteristic presenting signs Classic central-nervous-system effects include abstract geometric hallucinations Administration of a specific antidote is almost always indicated in confused or combative casualties Iraq is suspected of having stockpiled large amounts of one of these agents in the 1980s.
rev: 07/22/2003
31. Which of the following is the standard U.S. military treatment for cyanide poisoning on the battlefield? a. b. c. d. e. Sodium nitrate followed by sodium thiosulfite Amyl nitrite followed by sodium nitrate and then sodium thiosulfite 100% oxygen administered concomitantly with sodium thiosulfate Sodium nitrite, sodium thiosulfite, and diazepam Sodium nitrite and sodium thiosulfate
33. Which of the following statements concerning sulfur mustard is true? a. b. c. d. e. Mustard is a recognized carcinogen Body surface area involved with skin burns is highly correlated with mortality Mustard dissolves quickly in aqueous solutions such as sweat Hands were among the body sites most frequently burned by mustard in World War I Mustard penetrates skin rapidly but typically takes several hours to damage skin cells
34. The M40 protective mask with its C2A1 canister: a. b. c. d. e. Depends upon a HEPA particulate filter as a barrier to cyanide, G agents, and phosgene Will protect the wearer against carbon monoxide and low concentrations of oxygen Is to be donned, cleared, and checked in up to 15 seconds Uses zinc-impregnated charcoal to adsorb molecules of chemical-agent vapor and gas Is only rarely associated with increased work of breathing and shortness of breath
35. Central effects differ from peripheral effects in that central effects: a. b. c. d. e. Seldom exhibit a latent period Do not usually result from exposure to phosgene or PFIB Should be suspected when a casualty reports being short of breath Cause gurgling from pulmonary-edema fluid rising in the airways Usually produce noise from turbulent airflow
rev: 07/22/2003
37. Pre-exposure administration of pyridostigmine bromide: a. b. c. d. e. is given when ordered by the senior medical officer in the division is given to create a reserve force of protected AChE is most appropriate when the threat agent is known to be GF is associated with a high incidence of debilitating side effects increases survival even when antidotes are not given after nerve-agent exposure
38. Effects after cyanide inhalation typically include which of the following? a. b. c. d. e. Miosis, bronchial hypersecretion, and nausea Brief hyperventilation and initial increases in heart rate and blood pressure Convulsions, vomiting, and flaccid paralysis Muscle weakness, cyanosis, and secretions Sudden loss of consciousness after a latent period of up to 60 minutes
40. The clean treatment area should be: a. b. c. d. e. upwind from the area of contamination downwind from contamination in order to take advantage of detector systems in place uncovered whenever possible to prevent dripping of agent from overhead cover downwind from the PDS as close as possible to the hot line
I certify that I have completed this educational activity and post-test.
___________________________ Physicians Name
rev: 07/22/2003
Student Materials Packet

Medical Response to Chemical Warfare and Terrorism 2000 5, 6 & 7 December 2000
Introduction On behalf of the United States Army Medical Research Institute of Chemical Defense, we would like to welcome you to this live three-day program. Whether you're watching this broadcast live via satellite, through a video teleconferencing link, at our special Internet simulcast sites, or via videotape, you will be pleased to know that you are part of a large viewing audience that is scattered throughout all fifty states in the U.S. The course will be presented over three afternoons. Sessions will focus on topics such as chemical agents and the proper medical responses in the event of intentional or accidental chemical agent exposure, battlefield management, decontamination of casualties, and personal protective equipment. Discussions on antiterrorism will be integrated throughout the program. We will feature discussions with world-renowned scientists, researchers, clinicians and counterterrorism experts. Objectives At the end of the program you should be able to: list the 4 major chemical agent classes and discuss the key effects of each on the human organism. identify the key elements of pre-hospital medical management for each of the 4 major chemical agent classes. identify cutting edge diagnostics and therapeutics for vesicants and nerve agents. identify and describe each of the three tiers of response to a disaster. About This Packet The guide is designed to assist participants in successfully completing the course. It provides information on the daily activities of the course as well as how to take the examination. The section on Making the Most of the Broadcast will assist those individuals new to distance learning in achieving course objectives. The Resources for Learning section will inform you of the variety of on-line materials available for reference. In addition, the resources include a series of quick reference guides on chemical agents and chemical defense equipment.
TABLE OF CONTENTS
Understanding Your Continuing Medical Education ......................................... 3 Agenda.................................................................................................................. 5 Making the Most of the Satellite Broadcast........................................................ 8 Resources for Learning ....................................................................................... 9 Textbook, Handbooks, Additional Publications ........................................... 9 Sample Exam Questions ...........................................................................10 Agent Scenarios ........................................................................................12 Least You Need to Know About Chemical Warfare Agents........................13 Quick Reference Table for Chemical Agents .............................................21 Physical Properties of Chemical Agents ....................................................23 Chemical Defense Equipment ...................................................................25 Personal Protective Equipment..................................................................27 Completing the Evaluation and Taking the Examination .................................29
UNDERSTANDING YOUR CONTINUING MEDICAL EDUCATION Sponsored by the U.S. Army Medical Command
The following information is provided to help you understand the number of credits that are being offered as well as the specific accreditation statement that will appear on your course certificate. Accreditation Statement The U.S. Army Medical Command is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The U.S. Army Medical Command takes responsibility for the content, quality, and scientific integrity of this CME activity. Credit Designation The U.S. Army Medical Command designates this educational activity for a maximum of 12 hours in category 1 credit towards the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Statement of Need The planning committee for this activity has determined that an important need exists to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with the information that they can use to manage chemical agent casualties, both in the field and in a fixed facility. The course is also required for medical personnel at depots where chemical agents are stored. Learning Objectives At the conclusion of this activity, participants should be able to: list the 4 major chemical agent classes and discuss the key effects of each on the human organism. identify the key elements of pre-hospital medical management for each of the 4 major chemical agent classes. identify cutting edge diagnostics and therapeutics for vesicants and nerve agents. identify and describe each of the three tiers of response to a disaster.
Intended Audience This educational activity is designed to provide military medical personnel (physicians, nurses, physicians' assistants, and certain corpsmen) with information that they can use to manage chemical agent casualties, both in the field and in a fixed facility.
Disclosure of Faculty Relationships As a sponsor accredited by the ACCME, it is the policy of the U.S. Army Medical Command to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. For this educational activity, no faculty reported any information to disclose.) Disclosure of Unlabeled/Unapproved Uses of Drugs or Devices (NA) Acknowledgment of Commercial Support There is no commercial support associated with this educational activity.
COURSE AGENDA MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000

Presented by U.S. Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground, Maryland Course Director: COL Charles G. Hurst, MC
The agent segments listed below will include discussion of: the history of the agent development and use, its physical properties, mechanism of action, and clinical effects and treatment. Interviews with clinicians who have treated exposures as well as interviews with scientists researching medical countermeasures and case studies or scenarios will be presented. Each day will conclude with a LIVE call-in session to a panel of respected experts who will discuss audience questions and concerns.
5 DECEMBER 2000
Presents an overview of Pulmonary Agents and Vesicants Pulmonary Agents History About the Agents Clinical and Scientific Scenario Summary Counterterrorism
Vesicants (Particularly Sulfur Mustard) History About the Agents Clinical and Scientific Scenario Summary Counterterrorism
Live Panel Question and Answer Period
COURSE AGENDA MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 6 DECEMBER 2000
The agent segments listed below will include discussion of: the history of the agent development and use, its physical properties, mechanism of action, and clinical effects and treatment. Interviews with clinicians who have treated exposures as well as interviews with scientists researching medical countermeasures and case studies or scenarios will be presented. Each day will conclude with a LIVE call-in session to a panel of respected experts who will discuss audience questions and concerns. Presents an overview of Nerve Agents and Cyanide Nerve Agents History About the Agents Clinical and Scientific Scenario Summary Counterterrorism
Cyanide History About the Agents Clinical and Scientific Scenario Summary Counterterrorism
Live Panel Question and Answer Period
COURSE AGENDA MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 7 DECEMBER 2000
The agent segments listed below will include discussion of: the history of the agent development and use, its physical properties, mechanism of action, and clinical effects and treatment. Interviews with clinicians who have treated exposures as well as interviews with scientists researching medical countermeasures and case studies or scenarios will be presented. Each day will conclude with a LIVE call-in session to a panel of respected experts who will discuss audience questions and concerns. Presents discussions on Field Management and Antiterrorism Field Management Decontamination Protection, Individual and Collective Triage Evacuation Summary Scenario Counterterrorism
Antiterrorism The antiterrorism segment will include discussion of the structure, operations, and capabilities of crisis and consequence management organizations with reference to both military and domestic preparedness perspectives. Live Panel Question and Answer Period Final Examination
MAKING THE MOST OF THE SATELLITE BROADCAST

Attend All Three Days of the Broadcast It is important to attend and participate in all three days of the broadcast. Your attendance at all three days is required for certification. Ask Questions At the end of each day, you will be able to interact with our experts. Fax in your questions throughout each day or call in your questions during the live call in session. Ask your site facilitator for Call-In and Fax-In Sheets. You might also want to make use of the on-line discussion board. Visit http://ccc.apgea.army.mil and click on the banner at the bottom of the page. Then click on the link for the discussion board. Utilize the On-Line Discussion Board Posting your question on the discussion board will allow for interaction between you and other participants in the class. Our instructors will be monitoring and contributing to the discussion area throughout the live broadcast. Sample Examination Questions Contained in this guide on page 8, you will find 5 sample examination questions. Completing the sample test questions will allow you to test your knowledge of the course material prior to taking the examination. See the Sample Exam Questions on page 8 in the Resources for Learning Section of this packet. Complete the Course Evaluation and Examination Your comments about the broadcast are collected in the course evaluation. The course evaluation feedback will assist us in planning for future broadcasts as well as to develop future distance learning products. We value your opinion and look forward to your review of the broadcast. Once you have completed the course evaluation, please complete the course examination. Remember, you are required to complete the examination in order to receive credit for the course.
RESOURCES FOR LEARNING

Textbook, Handbooks, Additional Publications There are several on-line resources for learning available at http://ccc.apgea.army.mil. Once at the site, click on the link for 2000 Satellite Broadcast. Next, click on the link for Course Materials. The on-line Resources for Learning include: Textbook of Military Medicine Medical Aspects of Chemical and Biological Warfare - This volume of the textbook was prepared for military medical educational use. The purpose of the textbook is to make the reader aware of the threats of chemical and biological weapons and how to respond to them. The main focus of the textbook is the medical management of chemical and biological casualties. Note: This version of the textbook is best viewed on the web. If you are interested in a hard copy of the text, please see the Educational Products sheet under the Course Materials link. Medical Management of Chemical Casualties Handbook - The handbook provides medical personnel in the field with a concise, pocket-sized reference source for the medical management of chemical casualties. Note: This version of the handbook is best viewed on the web. If you are interested in a hard copy of the text, please see the Educational Products sheet under the Course Materials link. Field Management of Chemical Casualties Handbook - The handbook provides military and civilian emergency response personnel in the field with a concise, pocket-sized reference source for the medical management of chemical casualties. Note: This version of the handbook is best viewed on the web. If you are interested in a hard copy of the text, please see the Educational Products sheet under the Course Materials link. Publications on Pyridostigmine - The following publications are available for download and print at http://ccc.apgea.army.mil. Click on the Reference Materials Link. Defense Against Toxin Weapons USAMRICD Special Publication 98-01: Pyridostigmine (LTC James M. Madsen) USAMRICD Technical Memorandum 90-4: Pyridostigmine (Frederick R. Sidell, M.D.) Interactions Between Nerve Agent Pretreatment and Drugs Commonly Used in Combat Anesthesia Pyridostigmine Used as a Nerve Agent Pretreatment Under Wartime Conditions
SAMPLE EXAM QUESTIONS

1. Of the following, the earliest indicator of pulmonary edema in a casualty exposed to a respiratory agent is: An abnormal arterial-blood-gas (ABG) test Dyspnea (shortness of breath) A pattern of scattered infiltrates with Kerley B lines on PA and lateral chest radiographs Dullness to percussion on physical examination Wheezing In a person severely intoxicated by nerve agent, atropine administration should be titrated to which of the following? Clinical reduction of bronchospasm and secretions Clinical restoration of normal heart rate and blood pressure Clinical reduction of skeletal muscle fasciculations and twitching Clinical reduction of gastrointestinal distress and spasm Clinical resolution of miosis and eye pain Someone with severe systemic effects from a nerve agent should initially receive: Three MARK I kits One Diazepam Three MARK I kits and diazepam One MARK I kit Three Mark I kits and an additional 2 mg of atropine Decontamination should be performed Inside the receiving medical facility (e.g., ER) Downwind from the receiving medical facility Before any medical care is rendered By fully qualified medical personnel A cyanide casualty who is not breathing but still has a pulse just entered your Battalion Aid Station. He/she: Should be given the three separate antidotes in the military cyanide antidote kit. Should receive sodium thiosulfate followed by sodium nitrite. Should be considered expectant. Should immediately have blood drawn to determine the level of cyanide in the blood. Should be given sodium nitrite followed by sodium thiosulfate.
a. b. c. d. e. 2.
a. b. c. d. e. 3.
a. b. c. d. e. 4. a. b. c. d. 5.
a. b. c. d. e.
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SAMPLE EXAM QUESTION ANSWERS

1. The answer is B. Swelling in the tissues between the airspaces (alveoli) and capillaries causes stiffness and impaired gas exchange. It is perceived by the affected individual as shortness of breath but is not usually heard or seen by the clinician on clinical exam or x-ray. 2. The answer is A. Atropine reverses nerve agent induced stimulation of the muscarinic receptors but not the nicotinic receptors. The most critical muscarinic systems are in the airways and excess stimulation of them is marked by bronchospasm (asthma-like) and excess secretions. Reduction of the spasm and secretions are readily appreciated as improved ventilation. 3. The answer is C. This is standard military doctrine. The logic is that a severe nerve agent casualty has enough agent on board to need at least 6 mg atropine and full dose oxime immediately. The diazepam is given even if the casualty is not seizing because that casualty is likely to seize. In reality, the severely intoxicated casualty will probably need more than 6 mg atropine, and if he/she does seize, will need more than 10 mg diazepam. Medics expecting to treat these casualties carry additional atropine and diazepam injectors. 4. The answer is B. It is most important to avoid cross contamination (spreading the agent to non-contaminated personnel) and to avoid contaminating the health care facility. It is best if decontamination is done outside the facility and downwind, meaning the wind blows contaminants away from the health care facility toward the decontamination point. 5. The answer is E. Respiration is lost nearly immediately after high dose cyanide intoxication occurs, but the casualty is fully recoverable as long as the heart continues to beat. The military antidote kit does not contain amyl nitrite as does the civilian kit. Both contain sodium nitrite (methemoglobin former) and sodium thiosulfate (sulfur donor). In pure cyanide intoxication, both are given in the order listed. If amyl nitrite is available, it is given earliest, as the others are prepared for infusion. It can be administered to a non-breathing casualty through bag and mask.
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AGENT SCENARIOS
Pulmonary Agents A pulmonary agent casualty presents to the Battalion Aid Station (BAS) for care and manifests early symptoms. The first scene shows incorrect management of the casualty. The discussion includes a demonstration of correct casualty management. Issues discussed focus on medical care. In the non-battlefield setting, other issues might include identification/selection of potential injured from a population of worried residents, source of agent, criminal investigation, evacuation, and others. Nerve Agents A liquid nerve agent casualty presents to the BAS for care and manifests severe symptoms. Issues discussed focus on medical care, but others include appropriate self-protection by health care personnel and decontamination of the casualty. Field Management A field treatment site receives casualties of several different exposures, including conventional wounds and psychogenic. The camera focuses on the medic triaging 6 of the casualties to demonstrate the triage categories and different agents/routes of exposure. The discussion asks the viewer to triage the 6 and to justify the resultant order. Cyanide Firefighters respond to a building fire and notice casualties in a stairwell remote from the fire. The disconnect triggers a consideration of a HAZMAT incident. At onset, the culprit is seen releasing the chemical and setting the fire. Issues discussed focus on medical care, but others raised include appropriate method of agent deployment, threat to first responders (secondary device), and decisions required by incident commander. Sulfur Mustard Soldiers on dismounted reconnaissance encounter liquid and vapor sulfur mustard. Two are casualties, although the injuries of only one are visible within the time frame of the movie. Issues discussed focus on medical care, but others include appropriate tactical use of a persistent agent and the hard choices a squad leader faces in balancing mobility against protection.
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LEAST YOU NEED TO KNOW ABOUT CHEMICAL AGENTS

THE LEAST YOU NEED TO KNOW ABOUT PULMONARY AGENTS
PULMONARY AGENTS: Chlorine Phosgene (CG) HC smoke HC smoke is the standard, white obscurant smoke fielded by the military in smoke grenades and artillery rounds. The nitrate-based explosives used by the military generate oxides of nitrogen. Oxides of Nitrogen PFIB Perfluoroisobutylene (PFIB) is a toxic pyrolysis product of Teflon. The electrical wiring found in military vehicles and aircraft is insulated with Teflon polymers. STATE: Gas ROUTE OF EXPOSURE: Inhalation EFFECTS: Local TIME COURSE OF EFFECTS: There is a latent period between exposure and onset of symptoms. The onset of pulmonary symptoms within four hours after exposure to any pulmonary agent indicates a severe and potentially fatal exposure. Late complications include: secondary pneumonia, fibrotic changes (HC, NOx). Complications: pneumonia, fibrotic changes (HC, NOx). MANAGEMENT: rest, observation, evacuation, PPV with PEEP and fluid resuscitation. KEY POINTS ABOUT PULMONARY AGENTS: The lung is the most important route of exposure for chemical warfare agent (CWA) because: CWA are most often dispersed as gases, vapors or aerosols that are easily inhaled. The surface area available for exposure to CWA is 50-100 times greater in the lung than on the skin. Penetration of CWA into the systemic circulation is more rapid via the lung than the skin. Pulmonary-agent effects are local, not systemic. They produce tissue damage at the site of contact in the lung. Pulmonary agents that act on the Central airways, like sulfur mustard: Are highly reactive or highly water soluble compounds. Produce inflammation, necrosis and acute obstructive problems like laryngospasm, bronchospasm, pseudomembranes. Usually produce early clinical signs and symptoms, such as coughing, pain, hoarseness, stridor, wheezing.
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Pulmonary agents that act on the Peripheral airways, like phosgene: Are only weakly reactive or soluble. Produce non-cardiogenic pulmonary edema. Are associated with a latent period, of sometimes many hours, between exposure and onset of symptoms. Produce no early clinical signs of exposure. Chlorine is intermediate in its solubility and reactivity and, therefore, produces effects in both lung compartments. High-dose exposure to any of the pulmonary agents can produce effects in both lung compartments. Chlorine and phosgene are true gases at standard temperature and pressure, and are heavier than air. Phosgene has an odor of fresh-cut grass or hay, or green corn. The combustion of halogenated hydrocarbon compounds releases toxic precursors like phosgene. Of all the CW and BW agents, phosgene and chlorine have the greatest potential for terrorist use because: They are used extensively in industry and are, therefore, readily available and accessible in lethal quantities. They are easily dispersed without the use of a weapon system.
TREATMENT FOR PULMONARY AGENT EXPOSURE: Treatment for exposure to a peripheral pulmonary agent includes: Bedrest, supplemental oxygen, observation for at least 6 hours. Positive airway pressure in the form of positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) to keep alveoli expanded, limit or reverse transudation of fluid, and thereby improve diffusion of gases across the alveolar-capillary membrane. The potential requirement for intubation and positive pressure ventilation to maintain adequate oxygenation. Transudation of fluid across the alveolar-capillary membrane following phosgene exposure creates intravascular volume depletion. Casualties will require volume resuscitation. Diuretics should be avoided. Fifteen per cent of the population possesses hyperreactive airways. Following exposure to pulmonary agent, casualties with preexisting, overt or latent reactive airways disease will: Likely present first for care (ie. shorter latent period). Have symptoms of bronchospasm in addition to agent effects. Require the addition of bronchodilators and, possibly, steroids to the treatment regimen. ANSWER THESE QUESTIONS ABOUT PULMONARY AGENTS: What are the main pillars of management for pulmonary agents? What are we going to do medically at a higher echelon of care? Differentiate pulmonary agents from mustard and Lewisite. What agents are considered pulmonary agents?
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THE LEAST YOU NEED TO KNOW ABOUT CYANIDE

CYANIDE AGENTS: Hydrogen cyanide (AC) Cyanogen chloride (CK) STATE: Below 780 F: liquid and vapor Above 780 F: gas ROUTE OF EXPOSURE: Inhalation (battlefield and terrorist) Percutaneous Ingestion EFFECTS: Systemic TIME COURSE OF EFFECTS: Very rapid for large inhaled doses OTHER DIAGNOSES: nerve agents, heart attack, epilepsy KEY POINTS ABOUT CYANIDE AGENTS: Even though it's called a "blood" agent, cyanide actually does most of its dirty work inside cells rather than in the blood and that it shuts down cellular respiration and produces histotoxic anoxia. Cyanide likes to react with metals (such as the iron in methemoglobin) and sulfur. This explains how the antidotes work! Some antidotes provide metals to react with cyanide, and one supplies sulfur. What antidotes provide a metal to cyanide? Metal providers: Amyl nitrite Sodium nitrite 4-DMAP, dicobalt edetate, hydroxycobalamin Sulfur donor: Sodium thiosulfate The two major antidotes for cyanide are sodium nitrite and sodium thiosulfate. If you had only one of these to choose from, which would you choose? (thiosulfate) Like the pulmonary agents, cyanide is more of a terrorist threat than a battlefield threat. ANSWER THESE QUESTIONS ABOUT CYANIDE: What makes cyanide different from the preceding pulmonary agents? What else can drop you as quickly as cyanide does, and how would you tell the difference? At what temperatures will cyanide change state? Name the agents that fall within the cyanide category. What are the clinical effects of cyanide? What antidotes are used to stop the effects of cyanide and how do they work?
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THE LEAST YOU NEED TO KNOW ABOUT VESICANTS

VESICATING AGENTS: Sulfur mustard (H, HD) Lewisite (L) Phosgene oxime (CX) STATE: solid (below 580 F), liquid, and vapor ROUTE OF EXPOSURE: All (especially inhalation, skin, and eye) EFFECTS: Local (respiratory tract, eyes, and skin) Systemic TIME COURSE OF EFFECTS: Latent period for mustard; inversely correlated with dose OTHER DIAGNOSES: No latent period for Lewisite or phosgene oxime. MANAGEMENT: Dimercaprol (BAL) only for Lewisite Early decontamination Symptomatic treatment for sulfur mustard and phosgene oxime KEY POINTS ABOUT VESICANTS: Even though soldiers realized that mustard was a liquid as well as a vapor, the old term poison gas was so firmly entrenched that people called this agent mustard gasand still do, incorrectly. It is important to know that mustard is a very powerful alkylating agent; that is, it binds strongly to various molecules in the body. Its binding to DNA and related molecules leads to its radiomimetic effectsthe effects that are like those from radiation. Systemic absorption occurs even from a small dose of mustard, but acute systemic effects are seen only when the dose is high. The mechanism of mustard deaths is usually respiratory and occurs in three basic peaks: one from laryngospasm or from airway obstruction in the first 24 hours, another in the next couple of days from secondary bacterial pneumonia, and a third several days later from septic pneumonia. LD50 for sulfur mustard: 7 g (about 1 teaspoon) ANSWER THESE QUESTIONS ABOUT VESICANTS: What makes sulfur mustard different from the earlier agents? In what PHYSICAL STATES will we encounter mustard? About how much liquid mustard does it take to kill? And how much liquid mustard would it take to kill if the entire dose was absorbed? What are possible routes of entry of vesicants into the body? Are mustard effects local or systemic? Is there a latent period for mustard, and if so what clinical information does that give you? Do we have any antidotes for the vesicating agents?
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THE LEAST YOU NEED TO KNOW ABOUT NERVE AGENTS

NERVE AGENTS: G agents: GA (tabun), GB (sarin), GD (soman) VX STATE: G agents: liquid and vapor VX: liquid ROUTE OF EXPOSURE: Respiratory tract Skin Eye EFFECTS: Brain: seizures Skeletal muscle: twitching, fasciculations paralysis Smooth muscle: pinpoint pupils, chest tightness, nausea/vomiting/cramping Exocrine glands: "wet all over" TIME COURSE OF EFFECTS: Vapor: short onset Liquid: delay OTHER DIAGNOSES: Cyanide MANAGEMENT: Atropine 2-PAM chloride Diazepam DOSAGE: Severe exposure = 3 Mark I kits (atropine + 2-PAM chloride) + diazepam; additional atropine as needed. ANTIDOTAL ENHANCEMENT: Pyridostigmine bromide KEY POINTS ABOUT NERVE AGENTS: The G agents are typically liquids that produce vapor, whereas VX is a persistent liquid about the consistency of motor oil. Body sites, or routes of entry, include skin contact for both kinds of agents and inhalation of G-agent vapor. The time from exposure to clinical effects varies depending upon the state of the agent and the route of exposure. But exposure by any route to a massive dose of either liquid or vapor can present initially with sudden collapse, cessation of breathing, and convulsions. Does this sound familiar? Is there another agent that can present like this? [cyanide] Atropine is a competitive inhibitor of acetylcholine at muscarinic sites Imagine atropine coating the smooth muscle or the gland so that even though there are still too many green dots in the space, not many can get through.
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As a carbamate anticholinesterase, pyridostigmine binds reversibly with Pacmen. The principle here is that by filling beforehand the mouths of a quarter or so of the Pacmen we create a reserve force that will then spit out the pyridostigmine later and be available to gobble up more green dots again. Because pyridostigmine is a charged molecule, it normally doesn't cross the blood-brain barrier. That's a real plus when you give pyridostigmine to, for example, pilots. Atropine doesn't work at nicotinic sites because it can't fit at those sites. The second antidote is 2 PAM CHLORIDE, also known as the 2-PAM crowbar, because it pries the nerve agent out of the mouth of the Pacman, as long as you use the crowbar before the glue sets. Diazepam, isn't really a specific antidote for nerve-agent poisoning at all, but just raises the seizure threshold. The dosage regimen for SEVERE EXPOSURE to nerve agent is 3 MARK Is (atropine + 2 PAM) and a diazepam initially, then atropine every 5-10 minutes. The endpoint is drying secretions or improved ventilation. Pyridostigmine is a charged molecule, it doesnt cross the BBB. LD50 (VX): 10 mg (a pinhead)
NERVE AGENT ACTION: Remember that normal cholinergic neurotransmission involves release of the neurotransmitter acetylcholinethe little green dots of our graphicsand that the green dots cross a space to get to the end organ, which can be another nerve cell, a skeletal muscle, a smooth muscle, or an exocrine gland. Normally, the enzyme acetylcholinesterasethe orange Pacmen of our animationinactivates or gobbles up the green dots. Nerve agents irreversibly bind to acetylcholinesterase; that is, they stick in the mouths of the Pacmen. At this point, the Pacman won't be able to spit out the nerve agent by itself, but at least one of our antidotes (the oxime) can pry the nerve agent out of the Pacman's mouth. However, after a time, the glue, so to speak, sets, a process that we call aging. Then, not even our the oxime can pry the nerve agent out of the mouth of the Pacman. Now when the mouths of the Pacmen are full, green dots accumulate and overstimulate the end organs. Hyperstimulation, though, is eventually followed by fatigue and organ failure. Reviewing this is important because understanding how nerve agents work helps us understand both their clinical effects and our antidotal treatment. ANSWER THESE QUESTIONS ABOUT NERVE AGENTS: What are the two major types of nerve agents? How much liquid, say, VX, does it take to kill? Knowing what you know about the mechanism of action of nerve agents, what will be their effects when the end organs are other neurons, say in the brain? Effects on skeletal muscle? What about smooth muscle? And exocrine glands? Looking at the time course of effects, is there a latent period associated with nerve agent exposure? For a massive exposure, what's the dosage regimen?
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QUICK REFERENCE TABLES
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QUICK REFERENCE GUIDE TO CHEMICAL AGENTS

Type of Agent Pulmonary: CG (PFIB) HC Effects
Dyspnea, coughing
Onset
Hours
Signs and Symptoms

Eye and airway irritation, dyspnea, chest tightness, and delayed pulmonary edema.
Immediate Management
Termination of exposure, ABCs of resuscitation, enforced rest and observation, oxygen with or without positive airway pressure for signs of respiratory distress, other supportive therapy as needed. Antidote: intravenous (IV) sodium nitrite and sodium thiosulfate. Supportive: oxygen, correct acidosis
Skin Decontamination
Vapor - fresh air Liquid - copious water irrigation.
Detection
The MINICAMS, Monitox Plus, Draeger tubes, Individual Chemical Agent Detector (ICAD), M18A2, M90, and M93A1 Fox will detect small concentrations of phosgene. The M256A1 detector kit, chemical-agent detector paper (M8 paper, M9 paper) and ICAM will not detect phosgene. The M256A1 detector ticket detects hydrogen cyanide (AC) as vapor or gas in the air, and the M272 kit detects cyanide in water. The ICAD, M18A2, and M90 detectors also detect AC. The ICAM, M22, M8A1 automatic chemical agent alarm (ACAA), and M8 and M9 paper do not detect cyanide. M256A1, M272 water testing kit, MINICAMS, M18A2, M21 remote sensing alarm, M90, M93A1 Fox, Bubbler, ICAM, and DAAMS, M8 paper, or M9 paper. M22 ACADA detect vesicants. (NOT the M8A1 automatic chemical agent alarm)
Cyanide: AC, CK
Loss of consciousness, convulsions, apnea
Seconds
After exposure to high dose: seizures, respiratory and cardiac arrest.
None usually needed
Vesicants: H, HD
Erythema, blisters, irritation of eyes; cough, dyspnea
Hours
Asymptomatic latent period (hours). Erythema and blisters on the skin; irritation, conjunctivitis, corneal opacity, and damage In the eyes; mild upper respiratory signs to marked airway damage; also gastrointestinal (GI) effects and bone marrow stem cell suppression.
Decontamination immediately after exposure is the only way to prevent damage. Supportive care of patients. There is no specific therapy.
0.5% hypochlorite, M291 kit, and water in large amounts
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QUICK REFERENCE GUIDE TO CHEMICAL AGENTS

Type of Agent Lewisite: L Effects
Erythema, blisters, irritation of eyes; cough, dyspnea
Onset
Immediate
Signs and Symptoms

Lewisite causes immediate pain or irritation of skin and mucous membranes. Erythema and blisters on the skin and eye and airway are similar to those seen after mustard exposures. Vapor: miosis, rhinorrhea, dyspnea Liquid: Sweating, vomiting Both: convulsions, apnea
Immediate Management
Immediate decontamination; symptomatic management of lesions the same as for mustard lesions; a specific antidote (BAL) will decrease systemic effects. Administration of MARK I Kits (atropine and pralidoxime chloride); diazepam. If casualty is severe; ventilation and suction of airways for respiratory distress.
Skin Decontamination
M291, 0.5% hypochlorite, water in large amounts.
Detection
M22, M9, M256A1 kit, M272 water testing kit, MINICAMS, M18A2, M21 remote sensing alarm, M90, M93A1 Fox, Bubbler, ICAM, and DAAMS (but NOT the M8A1 automatic chemical agent alarm).
Nerve Agents: GA, GB, GD, GF, VX
Vapor: miosis, rhinorrhea, dyspnea Liquid: sweating, vomiting Both: convulsions, apnea
Vapor: Seconds Liquid: Minutes to Hours
M291, M258A1, 0.5% hypochlorite, large amounts of water.
M256A1kit, CAM, M9 paper, M8A1, M22 ACADA alarm systems, M90, Draeger, M272 Water Test Kit, M18A2, and the M93A1 FOX.
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PHYSICAL PROPERTIES OF CHEMICAL AGENTS

Symbol
GA GB GD GF VX Vx H and HD HT HN-1 HN-2 HN-3 L HL CX CG DP AC CK DM DA DC CN CA
Appearance and Notes

Clear, colorless, and tasteless liquid, chemically similar to organophospate pesticides such as Malathion or Parathion. Has a slightly fruity odor. Solubility: miscible with water (H2O) Clear, colorless, and tasteless liquid. Has a faintly sweet smell. Odorless in vapor and pure form. Solubility: miscible in water Clear, colorless, and tasteless liquid. Has slight camphor odor and gives off a colorless vapor. Liquid with sweet or musty odor of peaches. Oily liquid that is clear, odorless, and tasteless. It is amber colored similar in appearance to motor oil. Moderate solubility in water. Liquid with faint fishy odor Liquid is colorless when pure, but it is normally a yellow to brown oily substance. Vapor is colorless with a slight garlic or mustard like odor. Sparingly soluble in H2O; freely soluble in organic solvents. A mixture of 60% HD and 40% T. T is a sulfur; oxygen and chlorine compound similar to HD and is a clear yellowish liquid with a slight garlic or mustard like odor. Insoluble in water. Oily, colorless to pale yellow with a faint, fishy, or musty odor. Soluble in organic solvents. Pale amber to yellow oily liquid; fruity odor in high concentrations; smells like soft soap with a fishy smell in low concentrations. Soluble in organic solvents. Colorless to pale yellow liquid with a butter almond odor; most stable in storage of the three nitrogen mustards. Insoluble in water; soluble in organic solvents. In a pure form Lewisite is a colorless and odorless liquid, but usually contains small amounts of impurities that give it a brownish color and an odor resembling geranium oil. It is heavier than mustard, poorly soluble in water but soluble in organic solvents. Dark oily liquid giving off a colorless vapor. Has garlic-like odor from its HD content. Insoluble in H2O May appear as a colorless, low-melting point (crystalline) solid or as a liquid. It has a high vapor pressure, slowly decomposes at normal temperatures; it has a disagreeable, penetrating odor. Fog-like in its initial concentration, but it becomes colorless as it spreads; it has both a newly mown hay or green corn odor and a highly toxic suffocating odor. Extremely volatile and nonpersistent agent. Colorless liquid. It has a newly mown hay or green corn odor. Nonpersistent, colorless liquid that is highly volatile. It has a faint odor similar to bitter almonds that sometimes cannot be detected even at lethal concentrations. Colorless gas with a sharp, pepperish odor similar to that of most tear gasses. The odor of CK often goes unnoticed because it is so irritating to the mucous membranes. Slightly soluble in H2O Light green to yellow crystals at room temperature; irritates nasal passages similar to pepper; no odor, but irritating. Insoluble in H2O; Slightly soluble in common organic solvents. Colorless, crystalline, vapor odor is shoe polish, vapor color is white or gray Colorless, solid, vapor odor is garlic, vapor color is white 3 Colorless to gray crystalline solid with a sharp, irritating floral odor. Odor threshold for CN is 0.1 mg/m . Insoluble in water. In pure form, colorless crystalline solid with sour or rotten fruit odor. Insoluble in water. White smoke. Clear liquid smelling like flypaper; it has an immediately strong irritating effect on the eyes and respiratory tract. May cause severe nausea.
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CNS PS CS CR BZ LSD
Colorless, oily liquid with a stinging pungent odor. Insoluble in water; soluble in organic solvents.
White crystalline solid; burnt to create a colorless gas with an acrid pepper-like smell. Pale yellow crystalline solid; has a pepper-like odor. An odorless white crystalline solid. Slightly soluble in H2O; soluble in dilute acids. Solid which is soluble in water.
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CHEMICAL DEFENSE EQUIPMENT EQUIPMENT

M40 Mask
WHAT IT IS
Full-face respirator fitted with an external mounted filter canister. The filter canister has a pleated HEPA filter and ASZ charcoal impregnated. A two-layer, two piece chemical protective garment consisting of coat and trousers. Outer layer is water repellent treated nylon. Inner liner is polyurethane foam/nylon tricot laminate impregnated with active charcoal. A two-layer, two piece chemical protective garment consisting of coat and trousers. Lighter and less bulkier than previous generations of chemical overgarments. Outer shell is a 50/50 nylon/cotton poplin ripstop with durable water repellent finish. Liner layer is no-woven front laminated. Total encapsulating protective ensemble. It is the military level A suit. It has a self-contained breathing apparatus, a battery power cooling system and a hands-free communication system.
WHAT IT DOES
Protect face and respiratory tracts of the wearer against volatile agents and aerosols by removing biological and toxin agents from the ambient air. Provide dermal protection from all chemical agents vapors, liquids, droplets, and biological toxins up to 24 hours after exposure.
WHO USES IT
U.S. Army, U.S. Marine Corps, and U.S. Navy
LIMITATIONS
Does not filter out ammonia, carbon monoxide, nitric oxide, or carbon dioxide. Does not protect in close space when oxygen in atmosphere is below 19.5%. Not effective when wet, restricts mobility, increases wearers body temperature. Must be removed and discarded before 24- hour time limit. POL products will decrease suit effectiveness. Not effective when wet, restricts mobility, increases wearers body temperature. Must be removed and discarded before 24- hour time limit.
Battledress Overgarment (BDO)
All U.S. Armed Forces, with the exception of specialized units.
Joint Service Lightweight Integrated Suit Technology (JSLIST)
Can be worn in all environments. Can be laundered up to six times before agent exposure. Provides dermal protection from all chemical agents vapors, liquids, droplets, and biological toxins up to 24 hours after exposure.
All U.S. Armed Forces
Self-Contained Toxic Environment Protective Outfit (STEPO)
Improved Chemical Agent Monitor (ICAM)
Hand-held, point source post-attack device, used for monitoring chemical agent contamination on people and equipment.
Provide protection against chemical/biological agents, missile/rocket fuels, petroleum, oils and lubricants (POL), and industrial chemicals. Provide 4 hours of selfcontained breathing and cooling in highly toxic and oxygen deficient environments. Can be decontaminated for reuse after 5 vapor exposures. Identify mustard and nerve agents on personnel and equipment.
Explosive Ordnance Disposal (EOD), Technical Escort Units (TEU), Ammunition handlers, and Chemical Surety Activity personnel. U.S. Army, U.S. Marine Corps, and U.S. Navy
Must be discarded after liquid chemical agent contamination.
Point source device, can give false reading due to interference; take long time to purge if probe becomes contaminated; detects only vapor.
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EQUIPMENT
M256A1 - Chemical Detector Kit
WHAT IT IS
Portable and disposable chemical agent detector kit; has 12 samplerdetectors and instruction cards, and M8 detector paper. Hand-held chemical sampling test kit made of detector tubes, tickets, paper substrates, and instruction booklet.
WHAT IT DOES
Test for chemical agents in the air; usually used to determine when it is safe to unmask. M8 paper is used to detect liquid chemical agents on exposed surfaces. Detect and classify dangerous concentrations of toxic chemical agents in the air and liquid chemical agents on exposed surfaces. Kit is also used to collect and forward samples of unidentified toxic chemical agents to a technical intelligence team or laboratory for identification. Produce red spots upon contact with liquid nerve agents (G and V) and blister agents (H and L).
WHO USES IT
LIMITATIONS
Does not detect Phosgene (CG); battlefield contaminants can interfere giving false readings. Five-year shelf life Time consuming
M18A2 - Chemical Agent Detector Kit
Technical Escort Units (TEU)
M9 - Chemical Agent Detection Paper (Includes M8 Paper)
Chemical treated, dye impregnated, adhesive backed paper, issued in 30foot roll.
Only detects vapor, does not identify agent, battlefield contaminants can interfere with readings.
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Personal Protection Equipment

EPA/OSHA PPE LEVEL
LEVEL A
WHAT IT IS
It should be worn when the highest level of respiratory, skin, eye and mucous membrane protection is needed. Positive pressure (pressure demand), self contained breathing apparatus (NIOSH approved), or positivepressure supplied air respirator with escape SCBA. Fully encapsulating chemical protective suit. Gloves, inner, chemical resistant. Gloves, outer, chemical resistant. Boots, chemical resistant, steel toe and shank. Two-way radio communications (intrinsically safe/non-sparking).
WHAT IT DOES
Provides full body coverage and positive pressure, selfcontained breathing apparatus or airline respirator with escape SCBA. Protects against substances that have a high degree of hazard to the skin and/or in poorly ventilated areas. Provides maximum respiratory and mucous membrane protection and less skin protection than Level A.
WHO USES IT
Personnel working in area where the highest level of protection for the skin, eyes, and respiratory system is required.
LIMITATIONS
High stress level due to limited visibility and mobility, and being in a highly toxic environment. Poor dexterity due to multiple layers of gloves; no thermal protection and limited radiation protection. Limited work time due to SCBA and/or total encapsulation. No thermal protection, increase weight, breathing air time, and limited communications and mobility in confined area.
LEVEL B
LEVEL C
The minimum level recommended on initial site entries until the hazards have been further identified and defined by monitoring, sampling, and other reliable methods of analysis, and equipment corresponding with those findings utilized. Positive-pressure (pressure-demand), self-contained breathing apparatus(SCBA) (NIOSH approved), or positive-pressure supplied air respirator with escape SCBA. Chemical resistant clothing (overalls and longsleeved jacket, coveralls, hooded two-piece chemical splash suit, disposable chemical resistant coveralls.) Coveralls (under splash suit). Gloves, outer, chemical resistant. Gloves, inner, chemical resistant. Boots, outer, chemical resistant, steel toe and shank. Two-way radio communications (intrinsically safe). Full-face or half-mask, air-purifying respirator (NIOSH approved). Chemical resistant clothing (one piece coverall, hooded two piece chemical splash suit, chemical resistant hood and apron, disposable chemical resistant coveralls.) Gloves, outer, chemical resistant. Gloves, inner, chemical resistant. Boots, steel toe and shank, chemical resistant. Two-way radio communications (intrinsically safe). Primarily work uniform and is used for nuisance contamination only. It requires only coveralls and safety shoes/boots. Other PPE is based upon the situation (types of gloves, etc.).
First responders and initial site entry personnel.
Provides full body coverage and an air purifying respirator. Provides limited respiratory, mucous membrane, and skin protection.
Personnel working in area where the airborne substance is known, and concentration measured.
Only provides minimal skin and respiratory system protection.
LEVEL D
Only a safety work clothes.
Almost anyone not directly working in hazardous chemical environments.
Cannot be worn on any site where respiratory or skin hazards exist.
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Instructions for completing Participant Registration and Evaluation Optical Scantron Form
Read the Privacy Act Statement, on page 32, before filling out the form. Please use a No. 2 pencil only. Erase completely to change a mark. Since an optical scanner reads the forms, we cannot accept photocopied forms. If you need additional Scantron forms, please contact the CCCD at 410-436-2230. Failure to complete this form will result in no course credit being given. Do not fold or staple anything to the scantron form.
Section 1: Name, SSN, Telephone Number, etc. It is important you correctly enter your first name, last name and middle initial to ensure an accurate certificate. The SSN is used for identity purposes and prevents the assignment of more than one identification number to the same individual. If you do not wish to use your SSN, you must provide a unique identification number that you will easily remember. You may create the number by using a combination of other numbers familiar to you, for example, your telephone area code (3 digits), followed by the month of your birth (2 digits), and ending with the last 4 digits of your phone number or SSN. Fill in your response to the following two questions: How did you find out about our broadcast? (select one) Are you a Physician, Registered Nurse or Other (PA, LPN, medic, first responder) (select one).
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Section 2: Military Personnel Only This section should be filled out by military personnel only. Shade the appropriate bubbles for your service (select one), career branch (select one), and rank (select one). If your service, branch or rank are not listed, shade in the bubble for Other. Fill in your response for the following question: Are you PROFIS? (A PROFIS officer is one who does something else in his/her "real" assignment, but carries vest-pocket orders assigning him/her to a go-to-war unit on a part-time deployment basis.)
Section 3: Civilian Personnel Only This section should be filled out by civilian personnel only. Shade in your professional title (select one). If your professional title is not listed, shade in the Other bubble.
Section 4: Evaluation/Critique Use this section to fill in your responses to the 8 Evaluation questions and the 32 examination questions regarding the medical management of chemical agent casualties.
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MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 FINAL EVALUATION AND EXAMINATION The following are 8 course critique questions. Please read each of the statements and select the response that best reflects your feelings about the course. Following the critique, are 32 questions regarding the medical management of chemical agent casualties. Please read each question thoroughly and select the answer that is the MOST appropriate choice. MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 SATELLITE BROADCAST COURSE EVALUATION 1. a. b. c. d. 2. a. b. c. d. e. 3. a. b. c. d. e. 4. a. b. c. d. e. This course was a valuable educational activity. Agree No Opinion Disagree Not applicable Which of the following topics would you like covered more extensively in the future? Pulmonary Agents Nerve Agents Cyanide Vesicants Field Management (Equipment/Decontamination/Triage/Evacuation/Protection) Which part of the course was the most interesting to you? Pulmonary Agents Cyanide Vesicants Nerve Agents Field Management and Antiterrorism What was your overall impression of the course? Superior Excellent Good Satisfactory Poor
5. a. b. c. d. e. 6. a. b. c. d. e. 7. a. b. c. d. 8. a. b. c. d.
I prefer to attend satellite broadcast training as opposed to regular classroom training because: It fits into my work schedule I prefer the format and structure It allows me to avoid extensive travel There is a significant cost savings for me I do not prefer satellite broadcast training What was the most important factor in your decision to participate in this satellite broadcast? Content Continuing Education Required to take the course Supervisor recommended Other The promotional material for the broadcast adequately described the training and its content. Agree No Opinion Disagree Not applicable The pre-registration process for participation in the broadcast was user friendly. Agree No Opinion Disagree Not applicable
MEDICAL RESPONSE TO CHEMICAL WARFARE AND TERRORISM 2000 SATELLITE BROADCAST COURSE EXAMINATION 9. a. b. c. d. e. 10. a. b. c. d. e. 11. a. b. c. d. e. 12. a. b. c. d. Protective equipment is assigned an OSHA ranking (A through D) based on the following Level of dermal protection afforded Level of respiratory protection afforded How uncomfortable it is to wear A and B All of the above Of the following, the earliest indicator of pulmonary edema in a casualty exposed to a respiratory agent is: An abnormal arterial-blood-gas (ABG) test Dyspnea (shortness of breath) A pattern of scattered infiltrates with Kerley B lines on PA and lateral chest radiographs Dullness to percussion on physical examination Wheezing In a person severely intoxicated by nerve agent, atropine administration should be titrated to which of the following? Clinical reduction of bronchospasm and secretions Clinical restoration of normal heart rate and blood pressure Clinical reduction of skeletal muscle fasciculations and twitching Clinical reduction of gastrointestinal distress and spasm Clinical resolution of miosis and eye pain All of the following are true regarding the radiomimetic effect of sulfur mustard on bone marrow EXCEPT: Assessment of the cellular components of the blood can be used to identify the severity of sulfur mustard exposure. Early decline in numbers of lymphocytes predict subsequent decline in the platelet count. Very early (1-2 hrs.) simple measurement of the total white blood cell count can be used to predict severity of exposure and need for early evacuation. Following a severe exposure to sulfur mustard, lymphocyte count rapidly decreases, while the number of granulocytes increases.
13. a. b. c. d. 14. a. b. c. d. e. 15.
It is important to decide whether a patient is exposed to nerve agent vapor or to nerve agent liquid agent because: The strength of bleach chosen depends upon whether the agent is a vapor or a liquid. Clinical effects from liquid exposure may be delayed. Wearing the mask may not be necessary if the agent is liquid. Diazepam is never given for exposure to nerve-agent vapor. Which of the following is true concerning peripherally acting pulmonary agents? Symptoms never precede signs. They cause clinical effects that mimic adult respiratory distress syndrome (ARDS). Irritation of the nose and mouth with coughing and bronchospasm generally excludes these agents. Their peripheral airway effects are probably caused by hydrochloric acid. In most cases, prophylactic administration of antibiotics is a reasonable medical option. An individual who is vomiting and fasciculating reports nerve agent exposure. He does not have miosis (pinpoint pupils). An appropriate response includes which of the following: Discharge from care Administer nerve agent antidotes Observe for pinpoint pupils before administering antidote A and C above None of the above A cyanide casualty who is not breathing but still has a pulse just entered your Battalion Aid Station. He/she: Should be given the three separate antidotes in the military cyanide antidote kit. Should receive sodium thiosulfate followed by sodium nitrite. Should be considered expectant. Should immediately have blood drawn to determine the level of cyanide in the blood. Should be given sodium nitrite followed by sodium thiosulfate. Someone with severe systemic effects from a nerve agent should initially receive: Three MARK I kits One Diazepam Three MARK I kits and diazepam One MARK I kit Three Mark I kits and an additional 2 mg of atropine
a. b. c. d. e. 16. a. b. c. d. e. 17. a. b. c. d. e.
18. a. b. c. d. e. 19. a. b. c. d. 20. a. b. c. d. e. 21. a. b. c. d. e. 22. a. b. c. d. e.
Which of the following is a necessary part of management for a casualty who has inhaled sulfur mustard? Enforced rest and observation for signs and symptoms of pulmonary edema Immediate intubation Close monitoring of arterial blood gases Close observation for the development of partial or complete airway obstruction Prophylactic administration of antibiotics Decontamination should be performed Inside the receiving medical facility (e.g., ER) Downwind from the receiving medical facility Before any medical care is rendered By fully qualified medical personnel Of the following, what is the first indication of inhalation of very high concentrations of phosgene? Abnormal arterial blood gases Chest tightness Coughing, hoarseness, and eye irritation Cyanosis Convulsions The two categories of agents that pose the greatest threat on a modern battlefield are: Nerve agents and cyanide Vesicants and riot agents Riot agents and nerve agents Vesicants and nerve agents Pulmonary agents and vesicants Effects after severe cyanide inhalation typically include which of the following? Miosis, bronchial hypersecretion, and nausea. Brief hyperventilation, loss of consciousness, convulsions, followed by respiratory and subsequent cardiac failure. Convulsions, vomiting, and flaccid paralysis. Muscle weakness, cyanosis, and secretions. Sudden loss of consciousness after a latent period of up to 60 minutes.
23. a. b. c. d. e. 24.
Cyanide is considered an important terrorist threat, but not an effective battlefield agent because: Cyanide is more effective in enclosed spaces. Cyanide is slightly less dense than air. Cyanide is widely used in the chemical industry. Cyanide is very volatile. All of the above In a mass casualty scenario, a casualty exposed 2 hours ago to sulfur mustard vapor now has facial erythema, red eyes, marked difficulty breathing, and a productive cough. This casualty should most appropriately be triaged as: Urgent Immediate Delayed Minimal Expectant The most important purpose of the emergency medical treatment station on the dirty side of the hotline (U.S. Army decontamination model) is: To provide full definitive medical treatment for immediate casualties. To stabilize patients well enough to survive the decontamination process. To remove gross chemical agent contamination from small areas prior to full decontamination. To provide a definitive diagnosis of serious poisoning and other conditions in order to expedite later medical care on the clean side of the hot line. To allow observation of delayed casualties while they are waiting to proceed through litter decontamination. A casualty who collapsed 2 minutes ago and is convulsing: Should be restrained until convulsions cease. Could be a nerve-agent casualty or a cyanide casualty. Should be ventilated before antidotes are given if the diagnosis is nerve agent poisoning. Should be triaged as expectant. Is not a nerve agent casualty if miosis is not present (i.e., if the pupils are not pinpoint). Which of the following is true about centrally and peripherally acting pulmonary acting agents? They may be reliably distinguished by their various odors. Their site(s) of action in the respiratory tract are determined primarily by their water solubility and their chemical reactivity. Even in high concentrations, a centrally acting agent such as mustard is unlikely to produce pulmonary edema. Their clinical effects are usually seen within 2 hours of exposure.
a. b. c. d. e. 25. a. b. c. d. e. 26. a. b. c. d. e. 27. a. b. c. d.
28.
A casualty was exposed to both nerve agent vapor and liquid 2 hours ago. The casualty immediately developed pinpoint pupils, shortness of breath, tearing, and nasal secretions. The casualty quickly donned a mask, was removed from the area of exposure, and underwent ambulatory decontamination. The casualty now has miosis. How would you manage this patient? Tell him/her that the miosis will resolve within 2 to 4 days. Triage as minimal. Would not expect him/her to get worse, since he/she is no longer being exposed to agent. Observe him/her for 12 to 24 hours. Administer one or two Mark Is to counter the miosis. The most important reason(s) for setting up a casualty decontamination site is to: Remove the sources of chemical vapor and liquid hazard Protect the receiving medical facility and staff from chemical contamination Medically stabilize casualties A. and B. All of the above Which of the following is TRUE concerning cyanide? A dependable warning of the presence of AC is its characteristic odor of bitter almonds. As a blood agent, cyanide binds avidly to the oxyhemoglobin in blood. Cyanosis is diagnostic of the presence of cyanide. Cyanide prevents cellular utilization of oxygen. Once breathing has stopped, a cyanide casualty should be triaged as expectant. Why should all levels of care be prepared to conduct casualty decontamination? Potentially contaminated patients may present themselves directly to the nearest facility. Casualties may skip echelons of care. Lower echelons may not have the resources necessary to decontaminate the casualties requiring evacuation. A. and B. All of the above
a. b. c. d. e. 29. a. b. c. d. e. 30. a. b. c. d. e. 31. a. b. c. d. e.
32 a. b. c. d. e. 33. a. b. c. d. e. 34. a. b. c. d. e. 35. a. b. c. d. 36.
What is/are the essential component(s) of initial chemical casualty decontamination? Decontamination with bleach Remove the patient from the contaminated environment Remove the contaminant from the patient A and B B and C Personnel operating in protective gear, OSHA level C and higher, are at significant increased risk for Heart attack Contamination Heat stress Dehydration C and D above What are important questions to ask when deciding what type of protective gear to use? What is the nature of the threat (respiratory or dermal, hi or lo concentration)? Is supplemental air or oxygen required? How long will it be worn? Is there a legal requirement to be met? All of the above The Armys M256 detector ticket samples for chemical agent vapors. It detects all of the following EXCEPT: Nerve agents Pulmonary agents Vesicants Cyanides The medical response to chemical terrorism against a US city or military installation differs from the medical response to chemical agents on the battlefield in which of the following ways? Different antidotes are used There is less need to protect medical facilities against contamination on the battlefield Civilian responders may not be able to provide emergency medical treatment on the dirty side of the hot line (warm zone), whereas military responders probably can do this None of these are true All of these are true
a. b. c. d. e.
37. a. b. c. d. e. 38. a. b. c. d. e. 39.
Which statement is true concerning responsibility for a chemical terrorist incident in the United States? Once the Federal authorities are on the scene, they are in charge. Local authorities remain in charge unless the military arrives, at which time the military will be in charge. Once State authorities arrive, they will accept responsibility from local authority. Local authorities remain in charge throughout the incident. Each incident is a unique event and responsibility will be different depending upon circumstances. The medical services of which agencies of the US Federal Government have specified roles to play in responding to a chemical terrorist incident? Active duty military Military reservists The National Guard Department of Veterans Affairs (VA) All of these Under the Federal Response Plan, the Department of Justice is the lead Federal agency during crisis management. What is true concerning the consequence management phase? The Department of Justice remains in charge of Federal response. The Federal Emergency Management Agency (FEMA) is the lead Federal Agency for consequence management. Since the incident started as crisis management it will remain a crisis management incident throughout. During consequence management, the Federal authorities will supersede local ones. None of these. What is true regarding the threat of chemical terrorism in the United States? The FBI receives more chem./bio terrorism threats every year than conventional bomb threats. Most alleged perpetrators of chemical terrorism in the United States are foreigners. All potential chemicals of terrorist interest in the United States are illegal to buy on the open market. The amount of money dedicated to fighting chemical terrorism in the United States has plateaued or declined. Dual-use technology is a good way to conceal a chemical terrorist program.
a. b. c. d. e. 40. a. b. c. d. e.
Courses Courses
Articles
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Pyridostigmine:
s s
Pyridostigmine Used as a Nerve Agent Pretreatment Under Wartime Conditions USAMRICD Special Publication 03-01: Pyridostigmine (Frequently Asked Question) USAMRICD Technical Memorandum 90-4: Pyridostigmine
Chemical Agent Simulant Training Instructions

s s s s
Instructions For Using Chemical Agent Simulant in Decontamination Training TINOP CBS-X - Distyrl Biphenyl Derivative CanolaGold 110 Polyethylene Glycol
Miscellaneous:
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Defense Against Toxin Weapons How to Handle Anthrax and Other Biological Agent Threats Interactions Between Nerve Agent Pretreatment and Drugs Commonly Used in Combat Anesthesia Nerve Agents In Children: Dosing Card Nerve Agents In Children: Guidelines Personal Protective Equipment Guide for Military Medical Treatment Facility Personnel Handling Casualties from Weapons of Mass Destruction and Terrorism Events
Chemical Casualty Care Division Educational Courses

Product Medical Management of Chemical and Biological Casualties (MCBC) Course (In-House) Description Credit Available How to Register
Active Army: Fill out a Training Form (DA3838) and send it through the chain of command to PERSCOM. Active Navy: Request a seat in the course by contacting Naval Operational Medicine Institute (NOMI), ATTN: N2 Operational Medicine Training Directorate, 220 Hovey Road, Pensacola, FL 32508-1047, telephone 850-4528266, DSN 922-8266. Upon approval, your name will then be entered into the ATRRS, based on available slots. Air Force: Request a seat in the course by contacting the training office at Randolph Air Force Base. Phone: (210) 565-2638 DSN 665-2638 Army Reserve: Request a seat in the course through your reserve unit. National Guard: Applicants should apply through their State Plans, Operations and Training Office, their unit or contact the National Guard in Arlington, VA. DoD Civilian Personnel must fill out a DD1556. This form should be submitted through the chain of command for approval and sent to the respective CPO Training Office. Non-DoD Civilian Requestors: Submit a written request to our office which includes your name, social security number, address, phone number, email address, job description, job title, and point of contact. Fax: (410) 436-3086 Submit a written request to our office which includes name, rank, social security number (DoD Military Only), address, phone number, email address, job description, job title, and point of contact. Fax: (410) 436-3086 Active Navy: Request a seat in the course by contacting Naval Operational Medicine Institute (NOMI), ATTN: N2 Operational Medicine Training Directorate, 220 Hovey Road, Pensacola, FL 32508-1047, telephone 850-4528266, DSN 922-8266 DoD Personnel: obtain tapes through Defense Audio Visual Information System (DAVIS) at http://dodimagery.afis.osd.mil Fax: (570) 895-6106 DSN 795-6106 Non-DoD Requestors: Obtain tapes through National Technical Information Service (NTIS) at http://www.ntis.gov Phone: 1-800-553-6847 Fax: (703) 605-6900 Order Number: AVA20830VOXO Cost: $350 Obtain Facilitator Registration Form and submit via fax to 410-436-3086; DSN 584-3086 The Medical Management of Chemical and Physicians (Medical Corps officers, Biological Casualties Course (MCBC) is MD, DO) - 46.75 CME designed for physicians, nurses and other Nurses (Military (AN/NC) Civilian medical professionals. Classroom, labora(RN) - 54.6 CEU contact hours. tory and field instruction focuses on patho All Other Attendees (DC, VC, SP/ physiology, diagnosis and treatment of PA, MS, Senior Medical NCOs, EMT, casualties. LPN) - Certificate of attendance for 46.75 credit hours Course Number: 6H - F26 3 Upper Level College Credit Hours
Field Management of Chemical and Biological Casualties (FCBC) Course (In-House)
The Field Management of Chemical and Biological Casualties Course (FCBC) is designed for medical and chemical NCOs, Chemical and Medical Service Corps officers and civilian first responders. Instruction focuses on emergency treatment, triage, decontamination and evacuation of casualties. This series of 17 videotapes is NOT intended to replace the in house MCBC course. Rather, the series is designed for refresher training of medical personnel and as an alternate way of obtaining the core didactic MCBC material when attendance at the in house course is not feasible.
All Participants obtain 40 credit

hours for attending the course
Medical Management of Chemical and Biological Casualties (MCBC) Videotape Course
CME/CEU are available for the videotape course until 30 JUN 2003
Physicians 15.50 CME Nurses 18.6 CEU All Others 15.50 credit hours
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Chemical Casualty Care Division Educational Courses (contd)

Product Medical Response to Chemical Warfare and Terrorism 2000 Satellite Videotape Course (5-7 DEC 2000) Description
The program combines the best of the 1999 program with new and updated information. Program topics include: review of the history, physical properties, clinical effects and treatment of chemical warfare agents, case studies of actual exposures, interviews with scientists discussing their cutting edge research in medical countermeasure development, updates on treatment and field management and a recorded question and answer session.
Credit Available
CMEs/CEUs available for the videotape course until 30 JUN 2003
How to Register
DoD Personnel: Contact the CCCD via email at ccc@apg.amedd.army.mil for information on how to obtain the videotapes Non-DoD: Requestors: Obtain the tapes through National Technical Information Service (NTIS) at http://www.ntis.gov Phone: 1-800-553-6847 Fax: (703) 605-6900 Order Number: AVA20893VNB6 Cost: $135.00 Register: Individuals should register online at http://www.registeramerica.net/cccd2000/
Physicians - 10.75 CME Nurses - 12.9 CEU All Others - 10.75 credit hours
Biological & Chemical Warfare and Terrorism: Medical Issues and Response Satellite Videotape Course (28-30 NOV 2001)
The program is a 12 hour course including didactic material, interviews and scenario discussions. The course presents an overview of biological agents, chemical agents, and discusses the management of a biological or chemical warfare or terrorist event with experts.
CMEs/CEUs available for the videotape course until 9 DEC 2003
Physicians - 12 CME Nurses - 14.4 CEU All Others - 12 credit hours
DoD Personnel: Available through Defense Audio Visiual Information System at http://dodimagery.afis.osd.mil Non-DoD: Available through Swank Healthcare Services on videotapes or CDROM at http://www.swankhealth.com/chemorder.htm
Phone: 1-800-553-6847 Cost: $98.50

Register: Individuals should register online at http://www.biomedtraining.org
Medical Management of Nerve Agent Casualties Course
This interactive multimedia learning course is targeted towards reaching the following objective: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of nerve agent casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to nerve agent exposure.
CMEs/CEUs available for the course until 30 JUN 2003
Individuals can take the course online at the CCCD website at http://ccc.apgea.army.mil Register: Individuals should register online at http://ccc.apgea.army.mil Note: Individuals can also take the course on the Medical Management of Chemical Casualties Supplemental Training Materials V.3.00 CDROM
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Chemical Casualty Care Division Educational Courses (contd)

Product Medical Management of Vesicant Agent Casualties Course Description
This interactive multimedia learning course is targeted towards reaching the following objective: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of vesicant agent casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to vesicant agent exposure.
Credit Available
How to Register
Individuals can take the course online at the CCCD website at http://ccc. apgea.army.mil Register: Individuals should register online at http://ccc.apgea.army.mil
Medical Management of Pulmonary Agent Casualties Course
This interactive multimedia learning course is targeted towards reaching the following objective: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of pulmonary agent casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to pulmonary agent exposure.
Medical Management of Cyanide Agent Casualties Course
This interactive multimedia learning course is targeted towards reaching the following objective: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of cyanide agent casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to cyanide agent exposure.
Medical Management of Incapacitating and Riot Control Agent Casualties Course
This interactive multimedia learning course is targeted towards reaching the following objective: Given a chemical casualty scenario, apply the fundamentals of chemical agent terminology, mechanism of action, pathophysiology, and consideration of patient circumstances to the diagnosis and treatment of incapacitating and riot control agent casualties and recommend appropriate treatment, decontamination and detection to reduce illness and injury due to incapacitating and riot control agent exposure.
Virtual Field Training Exercise Course
This interactive multimedia learning course is targeted towards reaching the following objective: Given a situation where chemical agents have been employed, students will demonstrate the basic tactical and technical skills necessary to establish and operate a Patient Decontamination Site (PDS) IAW FM 8-10-7, FM 8285, FM 3-5, and Field Management of Chemical Casualties Handbook (July 2000).
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Chemical Casualty Care Division Educational Products

Product Medical Management of Chemical Casualties Supplemental Training Materials V. 3.00 CDROM Description Credit Available Obtaining Material (DoD)
Obtaining Materials (Non-DoD)

Contact the CCCD via email at ccc@apg.amedd.army.mil for information on how to obtain the CDROM
This product is designed primarily for sustainNA ment training in the medical management of chemical casualties. By listening to didactic instruction while viewing PowerPoint slides (MMCC Fundamentals), students obtain core content on the medical management of chemical casualties. The additional materials contained on the CD support the instructional material (textbook, handbooks to include the Medical NBC Battlebook, video segments, casualty assessment scenarios, related published work). The Medical Management of Nerve Agent Casualties Module I is also on the CDROM. This volume of the textbook was prepared for NA military medical educational use. The purpose of the textbook is to make the reader aware of the threats of chemical and biological weapons and how to respond to them. The main focus of the textbook is the medical management of chemical and biological casualties.
Textbook of Military Medicine, Medical Aspects of Chemical and Biological Warfare
Contact Joyce Gross at the AMEDD Center and School Fax request to (210) 221-4012 Cost: Complimentary Non-Military: See Non-DoD
Contact Government Printing Office Phone: (202) 512-1800 Web: www.access.gpo.gov/su_docs Cost: $66 Domestic/$82.50 Foreign
See an illustrated version of the handbook at http://ccc.apgea.army.mil NA Medical Management of Chemi- The handbook provides medical personnel in cal Casualties Handbook, Third the field with a concise, pocket-sized reference source for the medical management of chemiEdition, July 2000 cal casualties. Read the textbook on-line at http://ccc.apgea.army.mil See an illustrated version of the handbook at http://ccc.apgea.army.mil NA Field Management of Chemical The handbook provides military and civilian Casualties Handbook, Second emergency response personnel in the field with a concise, pocket-sized reference source for Edition, July 2000 the medical management of chemical casualties. Contact the CCCD via email at ccc@apg.amedd.army.mil Contact Linda Harris, EAI Corp. Phone: (410) 676-1449 Contact the CCCD via email at ccc@apg.amedd.army.mil Contact Linda Harris, EAI Corp. Phone: (410) 676-1449
See an illustrated version of the handbook at http://ccc.apgea.army.mil
Website: http://ccc.apgea.army.mil Email: ccc@apg.amedd.army.mil
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Updated: 16 April 2003
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Satellite Broadcasts
Biological & Chemical Warfare and Terrorism: Advanced Topics on Medical Defense Against Biological and Chemical Agents
Through the use of satellite broadcasts, the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD) are able to reach large audiences during a single course. USAMRIID and USAMRICD offered a six (6) part series of live, interactive, 2-hour broadcasts during the period of 6 November 2002 through 27 August 2003 covering a variety of topics in medical defense against biological and chemical agents. These programs, hosted by the U.S. Army Medical Research and Materiel Command was presented at no charge to the viewer. Topics covered: Part Part Part Part Part Part 1 2 3 4 5 6 Smallpox: Recognition & Response (6 November 2002) Advanced Management of Nerve Agent and Sulfur Mustard Casualties (8 January 2003) Vaccines Against Biological Warfare Agents (5 March 2003) Chemical Threat Agents: The Community Provider's Perspective (21 May 2003) Toxins as Biological Warfare and Terrorism Agents (9 July 2003) Chemical Threat Agents: What Has History Taught Us? (27 August 2003)
These topics, selected from current research as well as student surveys, are most appropriate for continuing education within the area of chemical and biological warfare. Subsequent to the live broadcast, each segment has been made available on VHS tape and DVD and can be viewed for Continuing Medical Education (CME) credits. Registration for CME credits available at RegisterAmerica. For information on how to obtain these products, go to Obtain Products.
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The Toxic Chemical Training Course

(TCTC)
""The Emergency Medical Training and Preparedness Division of SAIC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians."" ""The Emergency Medical Training and Preparedness Division of SAIC designates this educational activity for a maximum of 26.75 category 1 credits towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity."" It is the policy of the Emergency Medical Training and Preparedness Division of SAIC that the sponsor and faculty disclose real or apparent conflict of interest relating to the topics of this educational activity. The sponsor and the faculty have disclosed no real or apparent conflict of interest. The book contains images of numerous types of equipment available to emergency responders. These items are referred to as examples only. In accordance with the ACCME Standards for Commercial Support, the audience is advised that no presentations in this continuing medical education activity contain references to unlabeled nor unapproved uses of drugs or devices. There is no commercial support for this activity. A need was identified by the army for personnel to be prepared for responding to and recovering from a chemical accident incident involving surety or nonsurety materiel. The Toxic Chemical Training Course for Medical Support Personnel is an occupational health course designed for physicians, physician assistants, nurses, paramedics, other emergency response personnel that assist in medical response, and CSEPP planners who provide support (both on the installation and in the community) to the chemical weapons storage and disposal programs. The course encompasses the toxicity of nerve agents and vesicants, diagnosis and treatment of chemical agent casualties, and emergency response operations from the installation, EMS and hospital perspectives. An overview of storage and disposal operations is provided, particularly in the context of the potential exposure risks to workers and the general public if an accident were to occur. Exposure control strategies are discussed, to include the use of monitoring and detection equipment, decontamination, personal protective equipment, and occupational health and safety standards. Both field and tabletop exercises are conducted to provide students some hands-on opportunities to use the knowledge they have acquired from lectures, demonstrations and case study presentations. The course has been accredited for a maximum of 26.75 hours of Category I CME for physicians, 27.9 hours of CEU credit for nurses and 31.25 hours of CEU credit for emergency medical technicians. At the conclusion of this training the participants will be able to do the following:
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identify the clinical signs and symptoms of the respective chemical agents identify the decontaminants used in the depot and demilitarization environment list the different levels of dermal protective ensembles and state the indications for their use identify the toxicologic bases for the chemical agent occupational health exposure limits
explain the approach taken for triaging conventional and chemical agent casualties in the setting of a chemical accident
For more information on this course, contact SAIC at (410) 538-2964. (FY) 2004 Course Schedule 29 March-2 April 2004
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Presentations
Please note: These files are intended to be used as reference materials. The Chemical Casualty Care Division is not responsible for any instruction provided with this files. The files are available in PowerPoint, Zip, Acrobat and Word documents. To download any of these presentations, you must login first. Casualty Decon Layout Chemical Warfare Agents: Overview Cyanide Field Training Exercise (FTX) Guide Incapacitating Agents Nerve Agents Personnel Decon Layout Pulmonary Agents Triage Case Studies Triage and Field Management Vesicants
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Video Teleconferencing
We have a fully functioning Video Teleconferencing (VTC) system on MEDNET. If you are interested in participating in a VTC of our Medical Management of Chemical and Biological Casualties Course (MCBC) via a Video Teleconference you will need to contact us no later than six weeks prior to the start of the course. The MCBC VTC offers students the lectures from the chemical portion of the course only (2 days). You may also elect to conduct a field training exercise at your site (1 day). CME credit is available and is based on the sections of the course in which you participate.
You may also wish to participate in a VTC of our Field Management of Chemical and Biological Casualties (FCBC) Course. Please contact the Chemical Casualty Care Division at 410-436-2230 DSN 584-2230 for more information.
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Course and Product Feedback

Quotes and Comments
"Thanks to all of you for allowing us to attend the FCBC class last week - your operation there at Edgewood is, without question, first class. Your course is the most comprehensive, well planned, well-equipped, and obviously well thoughtout class of its kind that we have ever attended. The inter-agency/inter-service interaction was excellent as well. Thanks again for everything." 18 June 2002 "I would like to thank you for allowing me to participate in your training course and field exercise at Aberdeen this March. It is the best educational experience in this area that I have ever had. I was one of a handful of civilian participants. There is nothing like it available for civilians. I would encourage you to provide more courses for civilian physicians, especially those in larger metropolitan areas, who may have a need to deal with mass casualties.." 8 April 2002 "I want to express my appreciation for the hard work and skills you all demonstrated in presenting this wonderful course. You do a fantastic job. I am strongly recommending that many of my colleagues register for your course. Also, thanks for the many resources you provided as part of course attendance." 21 March 2002 "I really enjoyed the on-site training last month. You people do an outstanding job - great quality, great teaching, and real time value. I felt empowered when I left for home. I get about 140 CME every year and this was one of the most outstanding learning experience I have ever had." 27 November 2001 "I really enjoyed the course and learned a tremendous amount. All of your soldiers/teachers were great! The course was well organized and ran smoothly from the time I arrived at BWI until I left. I would like to take the course again perhaps spring or fall of next year. Thank you and everyone else involved. I know it was a lot of work at a time when the country was requiring much from you also." 28 October 2001 "Without a doubt, this course is the most interesting I've ever attended, and before too much time elapses, I wanted to be sure to thank you for directing me to it. I find it difficult to believe that more people from the Baltimore area (especially physicians) are not attending. That may be because it has not been publicized by my state (MedChi) and county medical societies, and had I not subscribed to [neurolist], I would have missed out on a very excellent educational opportunity. If the MedChi people do not know about it, they should, so I relayed the information about the ccc.apgea website and a bit of a description of the course so they can get the word out for the next time." 24 October
2001 "I wanted to say a thank you again for the FCBC course. The skills/knowledge have proven helpful in my work at Booz Allen Hamilton, and I hope to continue to be able to improve our Homeland Security through the knowledge gained and questions raised." 24 September 2001 "I can't tell you how helpful your CD has been to the improvement of my soldiers' knowledge. This is a great SGT's time tool. Please keep these educational tools flowing. Medics need all the help they can get on the battlefield." 22 June 2000 "Truly enjoyed this course. It sure brings home the true threat of BW. I feel much more confident in how to protect myself and my troops." 15 March 2000
Letters of Appreciation
4 April 2002 (PDF Format) 12 June 2001 (PDF Format) 26 February 2001 (PDF Format)
April 4, ibO2
Dear Mr. President: As a civilian physician in Houston, I have just returned from an awesome, six day course presented by the U.S. Army Medical Research Institute of Chemical Defense at.Aberdeen Proving Ground, MD and the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick in Frederick, MD. The course titled Medical Management of Chemical and Biological Casualties was truly one of the finest continuing medical education courses in my thirty years of medical practice. With the world events over the past twelve or so years and a life long interest in emergency health care, I felt totally qrqq@ ShdkJ 0~ ify&d~. g$q ,a ,$ppk@. oi- biqlogic.al ,teprist h+lent. ,Becaus~ .$thg : Armys course I no,w f+elmoreconfident and,isu;cl? !bet$er prepared:.:toYass$-in the Care for those casualties: should .they.O$3uJ.. :: , j ! ,:.,.. ;i:: 1.:L.s _!, ;.,;ir, :i :~,.:.t,: I. / .:., ,r. , r. I. .. ,,: ,.>,,, I.. I .: The staff that ta~~~,~~,c,~~~~~~~~:fr;;m:bothfadiiitiesdeserve ourcountys highest praise and gratitude. Gese rnen.$nd women are,~well~educated and totally involved in their area of expertise. Our Armed Services and Our Country are certainly in the best of hands. That a few civilian medical providers were invited to participate in this enlightening experience along with medical folk from all of the military and Coast Guard services is an absolute credit to the US. Army, The Department of Defense and to the Presidency. Please extend my gratitude to COLJames A. Romano, Jr., MS, Commander of USAMRICD and his great staff of instructors. Also a BIG Huuu Raaa to COL Edward M. Eitzen, Jr., MC, Commander of USAMRIID and his outstanding staff
Yours Truly,
R. Craig Bales, M.D. RCB:mj cc: : ;. Hon. Hon. Hon. COL COL Hon. . Tom Ridge, As,sist,ant to the President for Homeland Se&rity Donald II.. Rumsfeld, Secretary .ofDefense Thomas E: White, Secretary of the Army I James.A. Romano, Jr., MS, USA, Commander of USAMRICD Edward M. Eitzen, Jr., MC, USA? Co.mqnder of USAMRIID David Dewhurst, Chairman of the Texas, Governors Task Force on Homeland Security
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Chemical Agent Quizzes

The quiz below is designed to help you assess your knowledge of chemical agents and how to care for those exposed to them. This will give you an idea of how much you already know. Once you complete the quiz you will be provided with a score. Enjoy the learning experience!
Quiz # 1
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Chemical Agent Quiz

Test Your Knowledge of Chemical Agents
Directions: Read each question and select the correct answer from the drop down list. When you are finished answering all of the questions click the submit button at the bottom of the page. Incorrect answers will be indicated with a check mark.
1. This agent is a dense, acrid, pungent, greenish-yellow gas that is easily recognized by both color and odor 2. Carbonyl chloride, D-Stoff, green cross 3. When organofluoride polymers are burned, this is one combustion by-product 4. Sodium nitrite and sodium thiosulfate are used to treat exposure to this agent 5. These agents inhibit ChE, which then cannot hydrolize ACht 6. An oily liquid that is generally regarded as persistent because of its low volatility 7. Similar to mustard but its clinical effects appear within minutes of exposure 8. Of the following biological threats, the one with the potential for producing the greatest number of death is: 9. Vaccines that could be useful in protecting military personnel exist for all of the following hemorrhagic fever viruses EXCEPT: 10. The lethal effects of inhalational anthrax occur PRIMARILY in which of the following anatomic sites:
-- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --- Choose an answer --
11. Which of the following is a specific antidote for an anticholinergic incapacitating agent? 12. Soldiers wearing the Battle Dress Overgarment (BDO), overboots, protective mask and hood, would be at what MOPP level? 13. A casualty was exposed 30 minutes ago to both nerve-agent vapor and liquid. The casualty is now reporting mild shortness of breath that is improving. The casualty should be triaged as: 14. The greatest vapor hazard within a casualty decontamination site would be found at the: 15. A casualty complains of shortness of breath 3 hours after rescuing another soldier from M1 Tank fire. Which of the following agents should you suspect?
-- Choose an answer --- Choose an answer --
-- Choose an answer --
-- Choose an answer --- Choose an answer --
Submit
You got Your Score:
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out of
15
%
correct.
Evaluate your performance: If you scored 90 - 100, EXCELLENT! You can advance your knowledge by participating in our Satellite Broadcast 2000. If you scored 80 - 90, GOOD. Continue to learn about the management of chemical casualties by reading the Textbook of Military Medicine If you scored 70 - 80, OK. You might want to brush up on your knowledge. Try reading The Medical Management of Chemical Casualties Handbook. or The Field Management of Chemical Casualties Handbook If you scored <70 It's time to hit the books! Visit our courses and products links on the top menu for information about in house and distance learning training products.
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Textbooks and Handbooks

We have a variety of textbooks and handbooks available online. This hard cover volume of the Textbook of Military Medicine series is a comprehensive reference dealing with the history, development, use, and medical management of chemical and biological warfare agents. Our Field Management of Chemical Casualties Handbook and the Medical Management of Chemical Casualties Handbook are a soft cover handbook that provide military and civilian emergency response personnel with a consice, pocket-sized reference source for the medical managment of chemical casualties in a field environment. In addition to providing information on the various chemical agents and their emergency treatment, it also covers the set up of a medical decontamination line and detection/decontamination equipment and supplies used by the military for field medical decontamination. They also include history, triage, diagnosis, and treatment.
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Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare Field Management of Chemical Casualties Medical Management of Chemical Casualties Clinical Management of Mustard Gas Casualties Medical Management of Biological Casualties Medical Management of Radiological Casualties NATO Handbook on the Medical Aspects of NBC Defensive Operations (AFJMAN 44-151) The Medical NBC Battle Book - USACHPPM Tech Guide 244 Treatment of Biological Warfare Agent Casualties - Field Manual (AFMAN(I) 44156)
To view any of the textbooks or handbooks, you must login first.
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Database
Medical Supplies Database
This database is a list of everything that the military medical system thinks it will need to care for chemical and biological casualties. It was produced by the Joint Readiness Clinical Advisory Board (JRCAB), based upon the recommendations of the chemical and biological panels of 1999 and 2001. The chemical panels included members of the US Army Medical Research Institute of Chemical Defense staff. The biological panels included members of the staff at the US Army Medical Research Institute of Infectious Diseases. This list of items derives from JRCAB patient conditions, hypothetical patients with syndromes caused by chemical and biological warfare agents. The supplies are listed alphabetically, not by patient, since there is enormous overlap between patients. You may contact JRCAB directly, if you would like, for example, the specific list of items required to care for a severe nerve agent casualty. In the database, as presented here, all of the items are listed together, along with National Stock Numbers (NSNs) and associated costs. You may use this list as a reference for supplies you wish to order, or to identify or print out selected items with their costs. Products listed in the database may be purchased through the approved military purchasing system. If you are outside of the military, you may purchase them through commercial vendors.
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View Database: Medical Supply Database
This list is supplied to us, for distribution in this format, freely by JRCAB, who maintains it and updates it every two years. JRCAB may be
contacted directly at Fort Detrick, Maryland, at 301-619-2001 or DSN 343-2001.
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Medical Supplies
Directions: Select items you are interested in from the "All Items" combo box (you can select multiple items by holding the "Ctrl" key while making selections) and then click on the "-->" button. Chosen items will appear in the "Selected Items" box. You can remove an item by choosing it in the "Selected Items" combo box and clicking the "<--" button. If you would like to remove everything, click on "<<--". To see prices and to perform calculations on chosen items, click the "Go To Calculation Page" button. If you want to see the entire list, just click the "Go To Calculation Page" button without making prior selections. All Items:
Selected Items:
Acetaminophen suppositories 650mg adult rectal i.s. 100/package -->> Acetaminophen tablets usp 0.325gm 1000s Acetazolamide tablets usp 250mg 100 tablets per bottle --> Acetic acid glacial usp 1 lb Acetone acs liquid 1 pt (473 ml) Acyclovir capsules 200mg 100 capsules per bottle <-Adapter injection-aspiration site male luer reusable sterile200s Adapter medicinal 22mm id odorless plastic disposable 50s Adapter oxygen flow meter to tubing 1.50"lg non-ster green 50s <<-Adenosine injection usp 2ml single dose vial 10 per package Adhesive moleskin 4 yds long 9" wide soft 12 per package Adhesive tape surgical porous woven 1"x 10yd 12s Adhesive tape surgical porous woven 3 inches by 10 yards 4s Adhesive ties surgical 11.125 by 7.250 inches 24s Adhesive tissue octlycanoacrylate adh use to close surg wound12s Administration set Airway nasopharyngeal 6mm id 8mm od smooth rd edges plas disp10s Airway nasopharyngeal argyle design 28fr 6.9x9.3mm crvd plas 10s Airway pharyngeal 4" airway/cut away flange kink res 30fr 30s Airway pharyngeal berman dsgn medium 90mm lg open side disp 12s Airway pharyngeal guedel dsgn sz 4 med/lge adl 90mm lg plas 30s Albumin human usp 25% 100ml can Albuterol inhalation aerosol 17gm container 200 metered sprays Albuterol sulfate inhalation solution 20ml bottle with dropper Amiodarone hydrochloride injection 50mg/ml 3ml ampul 10/package Amoxicillin and potassium clavulanate tablets 30 tablets/bottle Ampicillin sodium sterile usp powder form 1gm bottle Anesthesia breathing circuit Anesthesia set epidural 10s 2 components Antimicrobial inoculation & preparation kit 60 procedures Applicator disp pov-iod 7.2ml impreg tip .125dia 3.75 to 4.5"l Go To Calculation Page
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Educational Videos
Welcome to the video segments portion of our website. Here you will find a variety of educational video clips, extracted from footage of our many satellite broadcasts. These video segments cover a wide range of information from toxicologic fundamentals to current science to cutting edge clinical management of chemical casualties. They are ideal for initial awareness and sustainment training and can be used in developing your own continuing education modules. We will be adding videos in the future, so check here periodically for new additions. Note: These videos may react differently depending on the viewer and the speed of your connection to the internet.
Click on the icon to download the player. To view these videos, you must login.
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Site Guide
About this site
This site offers the latest information on the management of chemical agent casualties. It provides training materials to include self assessments, short courses for educational credit, comprehensive listings of reference materials, video materials, teaching presentations, and access to courses available for physicians, nurses and first responders that are offered by the United States Army Research Institute of Chemical Defense (USAMRICD), Chemical Casualty Care Division.
Browser Compatibility
This site is best viewed in Internet Explorer 4.x or Netscape Navigator 4.x. Problems may occur in IE 3.x and Netscape Navigator 3.x. The video segments require Real Media player which can be downloaded from the Internet. If you have any technical issues or questions please e-mail our web support department.
Click on the icon to download the player.
Site Map
This link takes you to an index of our site. Every page is listed and hyper linked. Click Here
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Frequently Asked Questions

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How do I sign up for the course if I am from another branch of service? Can I drive my own car? What are my chances of getting in? I sent in my request, can you send me information so I can make my necessary selections? How do I register or get a seat in the course? I'm enrolled for the course, but I'm not sure where I'm supposed to report... where do I go? What do I wear? What should I bring? What are the dates for future courses? How much does the course cost (including lodging and food)? Do you need my Registration Sheet and/ or Protective Mask Form sent in now, or can I give it to you on my first day of class? How many credits, CME's, or CEU's do I get for taking the course? When will I get my fund cite/ funding information?
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Do you do off-site courses/ can you come to our site and teach? Am I enrolled for the upcoming course? The amount you gave me on my fund cite does not cover the airfare from my site to yours. I would like to sign up for the MCBC, but do not know my course number and which school code to use.
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How do I sign up for the course if I am from another branch of service? This procedure varies from course to course for each branch of the military. Detailed instructions are provided on our registration page.
Can I drive my own car? Yes. You will need two forms of identification to get onto the installation where the course is being held. Our suggestion is that you take the bus.
What are my chances of getting in? I sent in my request, can you send me information so I can make my necessary arrangements? Civilians must understand that military have first priority. Civilians will be placed on a waiting list. Approximately 3 weeks prior to the beginning of the course, civilians will be notified by email of their acceptance in the course and at that time receive an information packet.
How do I register or get a seat in the course?
This information is found at http://ccc.apgea.army.mil/courses/registration/registration.htm.
I'm enrolled for the course, but I'm not sure where I'm supposed to report... where do I go? What do I wear? What should I bring? If you have received your Welcome Packet, the answers to all of these questions can be found in the Course Information document. If you have not received the Welcome Packet, please send an email to ccc@apg.amedd.army. mil.
What are the dates for future courses? Future courses are listed on our Calendar of Events.
How much does the course cost (including lodging and food)? See the updated registration fees. All students are responsible for costs associated with travel, lodging and food. The rate for the hotel is approximately $60.00 per night. We have a catered lunch brought in, which costs $6.00 a day. We provide round trip bus transportation between the hotel and course sight. We also provide round trip bus transportation between the Airport and hotel upon arrival and departure.
Do you need my Registration Sheet and or Protective Mask Form sent in now, or can I give it to you on my first day of class? We need it now. Please fax it to 410-436-3086.
How many credits, CME's, or CEU's do I get for taking the course?
This information can be found by clicking here.
When will I get my fund cite/ funding information? Fund cites are emailed, along with Welcome Packets, approximately 30 days prior to the course start. If you have received your Welcome Packet and have not received your fund cite, email us at ccc@apg.amedd.army.mil. However, if you were enrolled after "30 days prior" to the course start date, you will NOT receive your fund cite with your Welcome Packet. The fund cite process takes at least 5 business days. If you do not receive it within the 5 day time frame, please contact us at the above email address.
Do you do off-site courses/ can you come to our site and teach? A formal, written request is needed for all off-site courses. Please email all requests and inquiries to ccc@apg. amedd.army.mil.
Am I enrolled for the upcoming course? Please send an email to ccc@apg.amedd.army.mil so we can check to see if you are currently enrolled.
The amount you gave me on my fund cite does not cover the airfare from my site to yours. Please send an email containing your name and a number where you can be reached to ccc@apg.amedd.army.mil.
I would like to sign up for the MCBC, but do not know my course number and which school code to use. Could you please provide this information?
The course number for the MCBC is 6H-F26. You MUST sign up under both school codes (877 and 879).
Course Content-Related
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I am pregnant; will this present a problem during the Field Training Exercise (FTX)? Am I going to be exposed to a live chemical agent? I wear glasses... What do I do about the mask for the FTX? I would like to host a VTC and need more information. What is a VTC? How does it work? What equipment do I need? Back to Top
I am pregnant; will this present a problem during the Field Training Exercise(FTX)? It could possibly cause a problem depending on how far along you are and the time of the year. During the FTX, students will be running and lifting litters - this could be too much for someone who is over 3 months pregnant. If you will be further than 3 months into the pregnancy, we recommend you cancel this course and reschedule for a later date.
Am I going to be exposed to a live chemical agent? No, there will be no chemical agents present during the course.
I wear glasses... What do I do about the mask for the FTX?
You will need to call your eye doctor and get inserts for your mask. During the FTX, you will need to keep the mask on while running through a field and while reading the Field Medical Cards. If you feel that your vision is sufficient enough to complete these assignments without inserts, that will be fine; but if you are severely vision impaired, you must get the inserts.
I would like to host a VTC and need more information. What is a VTC? How does it work? What equipment do I need? VTC stands for "Video Teleconferencing". VTC offers students the lectures for the chemical portion of the course only (2 days). You may also elect to conduct a field training exercise at your site (1 day). Credits are available for VTC's. They are based on the section of the course in which the organization participates. Please send an email to ccc@apg.amedd.army.mil <mailto:ccc@apg.amedd.army.mil> with the following information in the body of the message: your name, the requesting unit and location, your phone number, your email address, the number of participants, the audience demographic (i.e. # of doctors, # of nurses), and an approximate time frame.
Products
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How can I get a copy of the handbook, videos, CD, or textbook? What products to you have available? I'm a civilian and would like to request copies of all of your satellite and MCBC in-house videos. Will you send them to me? How much will EAI charge for the Medical Management of Chemical Casualties (Red) Handbook or the Field Management of Chemical Casualties (Gold) Handbook?
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How can I get a copy of the handbook, videos, CD, or textbook? Please send an email to ccc@apg.amedd.army.mil. In this email, you must state your name, job title, who you work for, what you will be using the product for, how many copies of the product you would like, a shipping address, and a phone number.
What products do you have available? All of the products we offer are listed on our website. Go to our homepage and select "Products/How To Obtain Products" from the menu.
I am a civilian and would like to request copies of all of your satellite and MCBC in-house videos. Will you send them to me? All civilians must request videos from the suppliers listed on the Obtain Products page under the Non-DOD column.
How much will EAI charge for the Medical Management of Chemical Casualties (Red) Handbook or the Field Management of Chemical Casualties (Gold) Handbook? The Red Handbook costs $24.00 each and the Gold Handbook costs $12.00 each. This price includes shipping and handling.
Technical
I can't figure out how to work the CD. How do I use the CD?
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I can't figure out how to work the CD. How do I use the CD? Please send an email to ccc@apg.amedd.army.mil with your name and a phone number where you can be reached.
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Security and Privacy Notice
1. Information presented on U.S. Army Medical Research Institute of Chemical Defense is considered public information and may be distributed or copied for non-commercial purposes. Use of appropriate byline/photo/image credits is requested. 2. For site management purposes, information is collected. This government computer system uses software programs to create summary statistics, which are used for web site planning and maintenance, determining technical design specifications, and analyzing system performance. 3. For security purposes and to ensure that this service remains available to all users, this government computer system employs software programs to monitor network traffic and to identify unauthorized attempts to upload or change information, to cause damage, or to deny service to users. 4. Except for authorized law enforcement investigations, no other attempts are made to identify individual users or their usage habits. Server logs are scheduled for regular destruction in accordance with National Archives and Records Administration General Schedule 20. 5. Unauthorized attempts to upload information or change information on this service are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act of 1987 and the National Information Infrastructure Protection Act. The appearance of hyperlinks does not constitute an endorsement by USAMRICD of the web site or the information, products, or services contained therein. USAMRICD does not exercise any editorial control over the information you may find at these locations. Links provided are consistent with the purpose of this DoD web site.
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This CD-ROM is a comprehensive look at all of our products and training materials. It contains the Medical Management of Chemical Casualties Fundamentals mini course, consisting of PowerPoint presentations, speaker notes and speaker voice-overs for each slide. Lectures cover: history, nerve agents, vesicants, pulmonary agents, cyanide, field management, triage, and decontamination. The mini course is an excellent overview in the medical management of chemical casualties. This CD-ROM also contains interactive multimedia assessment scenarios, the Medical Management of Nerve Agent Casualties interactive module, a Field Training Exercise (FTX) guide, over 100 minutes of scenarios and educational video segments, information about our courses and how to obtain our products, a medical supplies database, a variety of handbooks, textbooks, field manuals, reference articles, and over 100 minutes of video segments. If you have any questions about our CD please e-mail us here
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157 documents match your query. The libraries queried on were . To preview the posting in another browser click the document icon. 1. (100) AFDD2-1.8 (PUBS Catalog) 2. (100) AFPAM10-219V10 (PUBS Catalog) 3. (100) AFMAN32-4017 (PUBS Catalog) 4. (94) AFI10-201 (PUBS Catalog) 5. (93) AFPD10-26 (PUBS Catalog) 6. (93) AFTTP(I)3-2.33 (PUBS Catalog) 7. (90) AFI32-4001_AFSPCSUP1_I (PUBS Catalog) 8. (90) AFI32-4001_30SWSUP1_I (PUBS Catalog) 9. (90) AFI32-4001 (PUBS Catalog) 10. (89) AFMAN32-4006 (PUBS Catalog) 11. (88) AFI41-106 (PUBS Catalog) 12. (88) AFPAM10-219V1 (PUBS Catalog) 13. (87) AFPAM10-219V3 (PUBS Catalog)
14. (87) AFI10-404 (PUBS Catalog) 15. (86) AFMAN32-4005 (PUBS Catalog) 16. (86) AFMAN10-401V2 (PUBS Catalog) 17. (85) AFMAN44-156(I) (PUBS Catalog) 18. (84) AMCPAM36-4 (PUBS Catalog) 19. (84) AMCMAN34-501 (PUBS Catalog) 20. (84) AFPAM10-219V5 (PUBS Catalog) 21. (84) AFPAM10-219V2 (PUBS Catalog) 22. (84) AMCPAM90-202 (PUBS Catalog) 23. (83) AFTTP(I)3-2.24 (PUBS Catalog) 24. (83) AFH32-4014V4 (PUBS Catalog) 25. (83) AFTTP(I)3-2.22 (PUBS Catalog)
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[Go To Best Hit] SHORT TITLE: AFDD2-1.8 EFFECTIVE: Aug 16 2000 12:00AM FAS: HQ AFDC/DR
NUMBER OF PAGES: 46
AVAILABLE FROM: AFPUBS
PURPOSE: AFDD 2-1.8 establishes operational doctrine for the United States Air Force to conduct operations to counter NBC weapons. It articulates fundamental Air Force principles for the application of combat force and provides commanders operational-level guidance on the employment and integration of Air Force resources to achieve desired objectives. CHANGE SUMMARY: RELEASEABILITY CONSIDERATIONS: DOCUMENT CLASSIFICATION: U SPECIAL HANDLING: None SPECIALTY CODE(S): None APPLIES TO: AIR NATIONAL GUARD: AIR FORCE RESERVE: MEDIUM: E
DISTRIBUTION CODE(S): F
SHORT TITLE: AFPAM10-219V10 EFFECTIVE: Sep 1 1998 12:00AM FAS: HQ AFCESA/CEX
NUMBER OF PAGES: 553 AVAILABLE FROM: AFPUBS
PURPOSE: This volume in this pamphlet series addresses the typical major contingency and wartime tasks Air Force engineers could face and identifies the training programs associated with these tasks. It primarily focuses upon functions and jobs not normally perfo CHANGE SUMMARY: Not Available RELEASEABILITY CONSIDERATIONS: DOCUMENT CLASSIFICATION: U SPECIAL HANDLING: None SPECIALTY CODE(S): None APPLIES TO: AIR NATIONAL GUARD: AIR FORCE RESERVE: MEDIUM: E
DISTRIBUTION CODE(S): F
Chemical Page
home | nuc | bio | chem | missiles | conventional | rivals | terror | treaties | organizations | reference | index Use Ctrl-F to Find word/phrase on this or other browser pages. Also, try AWC Quick Portal
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Organizations/Resources C-CW CONOPS Chemical Effects Chemical Weapon Treaties Threat Risk Technologies Involved Historical Notes
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See also: Military Medicine Proliferants Terrorism Page Labs & Research Battle Labs GAO: WMD GAO: Proliferation Main CPC Menu
Commanders' chemical-biological resource website, USAF

Contact us. Please read this disclaimer regarding links. Page updated 12 May 03.
Organizations and Resources

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See also Organizations page, especially DoD and other government resources. United Nations U.N. Disarmament Home Page NBC and/or multi-threat The Nonproliferation Review, by the Center for Nonproliferation Studies (CNS) Applied Science and Analysis, Inc., "established in 1983 to specialize in nuclear, biological and chemical defense and protection issues worldwide" Bonn International Center for Conversion (BICC), "conversion of military resources for civilian purposes"
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CW destruction in Russia, project by BICC Joint Bradford - SIPRI Chemical and Biological Warfare Project Chemical and Biological Arms Control Institute (CBACI) Federation of American Scientists (FAS) home page Center for Nonproliferation Studies (CNS), Monterey Institute of International Studies
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Chemical U.S. Army Chemical School U.S. Navy Chemical-Biological Defense U.S. Army Medical Research Institute of Chemical Defense (USAMRICD) U.S. Army Soldier and Biological Chemical Command (SBCCOM) Organisation for the Prohibition of Chemical Weapons (OPCW) Home Page, the Chemical Weapons Convention Website Chemical Weapons Convention (CWC) Homepage, joint site sponsored by Dept of State, Bureau of Arms Control; and Dept of Commerce, Bureau of Export Administration (BXA) Technology Study Group for the Destruction of Abandoned Chemical Weapons re: buried Japanese chem weapons abandoned in China Joint Bradford - SIPRI Chemical and Biological Warfare Project Chemical and Biological Arms Control Institute (CBACI) Henry L. Stimson Center r Chemical and Biological Weapons Nonproliferation Project s Ataxia: The Chemical and Biological Terrorism Threat and the US Response s Toxic Archipelago: Preventing Proliferation from the Former Sovie Chemical and Biological Weapons Complexes Defence Research Establishment Suffield (DRES) "to protect the Canadian Forces against chemical and biological warfare, and to enhance their capabilities to manoeuvre and deny mobility to an adversary through timely expert scientific advice and associated technology development." Counter-Terrorism The International Policy Institute for Counter-Terrorism Security Studies Resources INCORE Regional Internet Guides, by the Initiative on Conflict Resolution & Ethnicity (INCORE) The Brookings Institution, public policy issues The Canadian Insititute of Strategic Studies (CISS) Center for International Security and Cooperation (CISAC), Stanford Univ.
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Counter-Chemical Warfare CONOPS guidance/support
Counter-NBC Operations Readiness Initiative, posted by AF/XONP Counter-NBC Operations Roadmap, posted by AF/XONP AF/XO Counter-Chemical Warfare (C-CW) CONOPS resource website AF/XO Commanders' Chem-Bio resource website r Library Counter-Chemical Warfare Concept of Operations, Air Force Qualification Training Package 3E9X1 -- 2 CD-ROM set of training materials, from the Air Force Civil Engineer Support Agency (AFCESA)/CEXR Briefings r Introduction, 230 kb r Senior Leader's C-CW CONOPS Orientation, 2,100 kb r Frequently Asked Questions, 137 kb r Revising CONOPS for a CW Environment, 2,300 kb r C-CW CONOPS Background Info, 1,000 kb r C-CW CONOPS Implications for Services, 770 kb r C-CW CONOPS Implications for Sortie Generation, 1,000 kb r C-CW CONOPS Implications for Aircrew and Aircraft Operations, 600 kb r C-CW CONOPS Implications for Aircrew Life Support (ALS), 760 kb r C-CW CONOPS Implications for Communications, 230 kb r C-CW CONOPS Impact on Munitions, 1,200 kb r C-CW CONOPS Vehicles, 690 kb
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Chemical Effects
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Chemical/Biological/Radiological Incident Handbook, from the Interagency Intelligence Committee on Terrorism - shows differences between the different types of attack Chemical Weapons Convention (CWC) Homepage, joint site sponsored by Dept of State, Bureau of Arms Control; and Dept of Commerce, Bureau of Export Administration (BXA) Medical NBC Information Server, from U.S. Army Surgeon General r Medical NBC Glossary r Medical Aspects of Chemical and Biological Warfare, published by the Office of the Surgeon General, U.S. Army (Local Copy) Medical Management of Chemical Casualties Handbook - you now have to register for site access Nuclear Biological Chemical, bibliographies, Air University Library Delayed toxic effects of chemical weapons, SIPRI monograph
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Chemical Weapons
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Chemical Weapons Convention (CWC) Homepage, joint site sponsored by Dept of State, Bureau of Arms Control; and Dept of Commerce, Bureau of Export Administration (BXA) Organisation for the Prohibition of Chemical Weapons (OPCW) Home Page, the Chemical Weapons Convention Website Chemical Weapons Convention ---(local copy) Chemical Weapons Convention texts posted by Federation of American Scientists
Threat Risk
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Democratization's Influence on CW Demilitarization: The Case of Russia, by French, June 1999, hosted by SIPRI Weapons Proliferation and Organized Crime: The Russian Military and Security Force, by Turbiville, USAFA INSS Occasional Paper Issues of Russian Compliance with the Chemical Weapons Convention, by Kalyadin, July 1999, hosted by SIPRI Proliferation of Weapons of Mass Destruction: Assessing the Risks, 1993 OTA publication --(local copy) Delayed toxic effects of chemical weapons, SIPRI monograph
Technologies Involved
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Militarily Critical Technologies (MCT) home page r MCT Part I: Weapons Systems Technologies (WST) r MCT Part III: Developing Critical Technologies (DCT) Technologies Underlying Weapons of Mass Destruction, 1993 OTA publication ---(local copy)
Historical Notes
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Historical documents on CBW disarmament, from SIPRI, going back to 100 B.C. The Other Holocaust: Nanjing Massacre, Unit 731 and Unit 100, independent site with multiple links to other sources Chemical Warfare in the Iraq-Iran War, SIPRI Fact Sheet

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Medical Management of Chemical and Biological Casualties (MCBC) Military Personnel:

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Release Date 24 JUN 2001 Expiration Date - 23 JUN 2004

Release Date 24 JAN 2003 Expiration Date - 23 JAN 2005

13 category 1 credits toward the AMA Physicians Recognition Award

15.6 CEU contact hours

Certificate of attendance for 12 credit hours of AMA PRA category 1 credit

Release Date 24 JAN 2003 Expiration Date - 23 JAN 2005

Release Date 28 OCT 2002 Expiration Date - 27 OCT 2004

Release Date 8 NOV 2002 Expiration Date - 7 NOV 2004

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Release Date 31 JAN 2003 Expiration Date - 30 JAN 2005

Release Date 31 MAR 2003 Expiration Date - 30 MAR 2005

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